Drug Name

Classification

Mechanism of Action Required for nucleoprotein synthesis and maintenance of normal erythropoiesis.

Indication

Contraindication

Side/Adverse effects Hypersensitivity: Allergic reactions LOCAL: Pain and discomfort at injection site

Nursing Considerations

Generic: Folic acid (folate) Brand : Folvite

Folic acid Vitamin supplement

Treatment of megaloblastic anemias due to sprue, nutritional deficiency, pregnancy, infancy, and childhood

-Contraindicated with allergy to folic acid preparations; pernicious, aplastic, normolytic anemias

- Administer orally if at all possible. With severe GI malabsorption or very sever disease, give IM, or subcuetaneously

Drug Name

Classification

Mechanism of Action Elevates the serum iron concentration, and is then converted to Hgb or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of iron.

Indication

Contraindication

Side/Adverse effects -CNS: CNS toxicity, acidosis, coma and death with overdose -GI: GI upset, anorexia, nausea and vomiting, constipation, diarrhea, dark stools, temporary staining of teeth (liquid preparations)

Nursing Considerations

Generic: ferrous sulfate Brand : Apo-Ferrous Sulfate (CAN) Feosol Fer-gen-sol Fer-in-sol

Iron preparation

-Prevention and treatment of iron deficiency anemias -Dietary supplement for iron -Unlabeled use: Supplemental use during epoetin therapy to ensure proper hematologic response to epoetin

-Contarindicated with allergy to any ingredient; sulfite allergy; hemochromatosis, hemosiderosis, hemolytic anemias. -Use cautiously with normal iron balance; peptic ulcer, regional enteritis, ulcerative colitis

-Confirm that patient does have iron deficiency anemia before treatment. -Give drug with meals (avoiding milk, eggs, coffee ,and tea) if GI discomfort is severe; slowly increase to build up tolerance. -Administer liquid preparations in water or juice to mask the taste and prevent staining -Warn patient that stool may be dark or green

Drug Name

Classification

Mechanism of Action Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the reninangiotensin system as well as the release of aldosterone leading to decreased BP.

Indication

Contraindication

Side/Adverse effects -CNS: Headache, dizziness, syncope, insomnia -CV: Hypertension

Nursing Considerations

Generic: Losartan potassium Brand : Cozaar

Antihypertensive

-Treatment of hypertension, alone or in combination with other antihypertensives -Treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria in patients with type 2 (non-insulin dependent) diabetes and a history of hypertension

-Contraindicated with hypersensitivity to losartan -Use cautiously with hepatic or renal impairment, hypovolemia, history of angioedema.

- Administer without regard to meals -Report fever, chills

-Dermatologic: Rash, urticaria, pruritus, alopecia, dry skin -GI: Diarrhea, abdominal pain, dry mouth

Drug Name

Classification

Mechanism of Action Renin, synthesized by the kidneys, is released into the circulation where it acts on a plasma precursor to produce angiotensin I, which is converted by ACE to angiotensin II, a potent vasoconstrictor that also causes release of aldosterone from the adrenals; both of these actions increase BP. Enalapril blocks the conversion of angiotensin II, decreasing BP, decreasing aldosterone secretion, slightly increasing serum K+ levels, and causing Na+ and fluid loss; increased prostaglandin synthesis also may involved in the antihypertensive action.

Indication

Contraindication

Side/Adverse effects CNS: Headache, dizziness, fatigue CV: Syncope, chest pain, palpitations, hypotension in salts-or in volumedepleted patients

Nursing Considerations

Generic: enalapril maleate Brand : Vasotec

ACE inhibitor Antihypertensive

Oral -Treatment of hypertension alone or in combination with other antihypertensives, especially thiazidetype diuretics Parenteral -Treatment of hypertension when oral therapy is not possible

-Contraindicated with allergy to enalapril

- Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril. -Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur. -Arranged for reduce dosage in patients with impaired renal function.

-Use cautiously with impaired renal function; salt or volume depletion(hypoten sion may occur) GI: Gastric irritation, nausea, vomiting, diarrhea, abdominal pain GU: Renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Hematologic: Decreased Hct and Hgb

Drug Name

Classification

Mechanism of Action Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

Indication

Contraindication

Side/Adverse effects CNS: Headache, sleep disturbances GI: Flatulence, diarrhea, abdominal pain, cramps, nausea, heartburn, liver failure

Nursing Considerations

Generic: simvastatin Brand : Apo-Simvastatin (CAN) CO Simvastatin (CAN) Gen-Simvastatin (CAN) Novo-Simvastatin (CAN)

Antihyperlipidemic HMG-CoA reductase inhibitor

-Adjunct to diet in the treatment of elevated total cholesterol and LDL cholesterol with primary hypercholesterolemi a (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures -Treatment of patients with isolated hypertriglyceridemi a.

-Contraindicated with allergy to simvastatin, active liver disease or unexplained, persistent elevations of serum transaminases -Use cautiously with impaired hepatic and renal functions, cataracts

- Ensure that patient has tried a cholesterol-lowering diet regimen for 3-6mos before beginning therapy. -Give in the evening; highest rates of cholesterol synthesis are between midnight and 5am. -Arrange for regular followup during long-term therapy. Consider reducing dose if cholesterol falls below target.

Drug Name

Classification

Mechanism of Action A natural glycoprotein produced in the kidneys, which stimulates red blood cell production in the bone marrow.

Indication

Contraindication

Side/Adverse effects CNS: Headache, seizure, CVA, TIA CV: Hypertension, edema, chest pain GI: Nausea, vomiting

Nursing Considerations

Generic: epoetin alfa Brand : Epogen Eprex (CAN) Procrit

Recombinant human erythropoietin

-Treatment of anemia associated with chronic renal failure, including patients older than 1 mo on dialysis -Treatment of anemia related to therapy with azidothymidine (AZT) in HIVinfected patients -Reduction of allogenic blood transfusions in surgical patients

-Contraindicated with uncontrolled hypertension

-Confirm chronic, renal nature of anemia; not intended as a treatment of severe anemia or substitute for emergency transfusion. -Patients with chronic renal failure on hemodialysis should receive the drug IV, not by subcutaneous injection, to decrease the risk of developing antierythropoietin antibodies - Gently mix; do not shake, shaking may denature the glycoprotein. Use only one dose per vial; do not reenter the vial. Discard unused portions. -Do not give with any other drug solution. -Administer dose three times per week. If administered independent of dialysis, administer into venous access line. If patients on dialysis, administer IV or subcutaneously. -Monitor access line of clotting. -Institute seizure precautions.