Cardiovascular Drugs and Medications Q 78
Before giving milrinone (Primacor) by an IV infusion to a client with symptoms of CHF, which of the following nursing actions is necessary?
A. Record sodium level.
B. Administer loading dose over 15 minutes.
C. Assess CV status.
D. Review medication regimen to identify if the client is on IV furosemide (Lasix).
Correct Answer: D. Review medication regimen to identify if the client is on IV furosemide (Lasix).
Milrinone (Primacor) is incompatible with IV furosemide (Lasix), and many clients with CHF are taking furosemide. Use of milrinone is generally contraindicated in patients with acute renal failure and end-stage renal disease, as it primarily undergoes renal excretion, although studies demonstrate that the dose-dependent relationship of adverse events is scarce and there is no clear guidance for milrinone use or dosing in chronic renal disease.
Option A: Assessing potassium, not sodium, is essential. Cardiovascular toxicity is primarily seen in patients receiving milrinone chronically and manifests as tachyarrhythmias and sudden cardiac death. At high dosing, patients may also experience hypotension and syncope.
Option B: Administering a loading dose over 15 min is not done before administration but during administration. Milrinone is primarily for use in the ICU and perioperative setting. Before initiation of this medication, a right heart catheterization may be a consideration for obtaining hemodynamic measurements to establish the patient’s baseline parameters and to gauge the patient response to continuous infusion.
Option C: Assessment of CV status is not specific for milrinone and is indicated for any drug that affects the circulatory system. Repeat or dosing monitoring is not routine due to the risks associated with repeat vascular access or risks related to continuous indwelling catheters. Pulmonary artery catheterization for monitoring of pulmonary pressures should be done with discretion and only after considering a risk-benefit analysis on a case-by-case basis.