Indication Mechanism Of Action Dosage And Frequency
Adverse Reactions
Nursing Consideration A T O R V A S T A T I N Lipitor Anti- hyperlipi demic HMG- CoA reductase inhibitor An adjunct to diet in the treatment of elevated total cholester ol, mixed dyslipide mia, atheroscl erosis A fungal metabolite that inhibits the enzyme (HGM-CoA) that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum 10 mg OD
Nausea, dyspepsia, diarrhea, constipation, vomiting, rhinitis, sinusitis, cough, dyspnea, pneumonia Arrange for proper consultation about need for diet and exercise changes Administer drug at bed time Monitor patient closely for signs of muscle injury, especially higher doses Provide comfort measures to deal with headache, muscle cramps, or nausea Offer support and encouragement to deal with disease, diet, drug therapy, and follow-up care. 75
cholesterol, serum LDLs (associated with increased risk of coronary artery disease) and either an increase or no change in serum HDLs (associated with decreased). 76
Generic Name Brand Name
Classification
Indication Mechanism Of Action Dosage And Frequency
Adverse Reactions
Nursing Consideration
C L O P I D O G R E L
N O R P L A T
Anti platelet
Treatme nt of patients at risk for ischemic events and peripher al arterydis ease, acute coronary
Inhibits platelet aggregati on by blocking ADP receptors on platelets, preventing clumping of platelets.
syndrom e, as a loading dose with aspirin to prevent adverse cardiac events in coronary stent implanta tion
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Generic Name Brand Name
Classification
Indication Mechanism Of Action Dosage And Frequency
Adverse Reactions
Nursing Consideration M E T O P R O L O L Betaloc Beta1- selective adrenergic blocker, Anti- hypertensive Hyper tension, alone or with other drugs, especially diuretics Preve ntion of reinfarction in MI patients who are hemodynam ically stable Competitively blocks beta- adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of 100 mg Once daily Pharyngitis, erythematous rash, fever, sore throat, laryngospasm Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, Do not discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring. Ensure that patient swallows the ER tablets whole; do not cut, crush, or chew. Consult physician about withdrawing drug if patient is 79
or within 3 10 days of the acute MI (immediate- release tablets and injection) Treat ment of angina pectoris Treat ment of stable, symptomati c CHF of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone. memory loss, slurred speech CHF, cardiac arrhythmias, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Rash, pruritus, sweating, dry skin Eye irritation, dry eyes, to undergo surgery (controversial). Give oral drug with food to facilitate absorption. Provide continual cardiac monitoring for patients receiving IV metoprolol. 80
ischemic, hypertensiv e, or cardiomyop athic origin (Toprol-XL only) conjunctivitis, blurred vision Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, 81
Indication Mechanism Of Action Dosage And Frequency
Adverse Reactions
Nursing Consideration N I C A R D I P I N E Perdipine Therapeutic: antianginals, antihypertensi ve Pharmacolog ic: calcium channel blockers. Manageme nt of: Hypertensio n, Angina pectoris, Va sospastic (Prinzmetal s) angina. Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation- contraction coupling and subsequent contraction. Therapeutic Effects: PO (Adults): 2 0mg 3 times daily,may increase q3 days (range 20 40mg 3 times daily); or 30 mg twice daily as sustained- CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, jitteriness, nervousness, psychiatric disturbances, weakness. EENT : blurred vision, disturbed equilibrium, epist axis, 1. Advise patient to take medication exactly as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually. 2. Instruct patient on technique for monitoring pulse. Instruct patient to contact health care professional if heart rate is <50 bpm. 3. Advise patient to avoid grapefruit and grapefruit juice 83
Systemic vasodilation resulting in decreased blood pressure. Coronary vasodilation res ulting in decreased frequency and severity of attacks of angina. release form (up to 60mg twice daily). IV (Adults): T o replace PO use 0.5 2.2mg/hr continuous infusion. For acute hypertensi ve episode s5mg/hr tinnitus. Resp: c ough, dyspnea, shortne ss of breath. CV:ARR HYTHMIAS, CHF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia. GI: abnormal results in liver function during therapy. 4. Caution patient to change positions slowly to minimize orthostatic hypotension. 5. May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known. 6. Instruct patient to avoid concurrent use of alcohol or OTC medications, especially cold preparations, without consulting health care professional. 84
titrated as needed (up to 15 mg/hr). studies, anorexia , constipation, diarrhea, dry mouth, dysgeusi a, dyspepsia, nausea, vomiting. GU: dy suria, nocturia, polyuria, sexual dysfunction, urin ary frequency. Derm : dermatitis, erythemamultifor me, flushing, increased 7. Advise patient to notify health care professional if irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness nausea, constipation, or hypotension occurs or if headache is severe or persistent. 8. Caution patient to wear protective clothing and to use sunscreen to prevent photosensitivity reactions. 9. Angina: Instruct patient on concurrent nitrate or beta- blocker therapy to continue taking both medications as 85
sweating, photosensitivity, pruritus/urticaria, rash.Endo: gyne comastia, hyperg lycemia. Hemat: anemia, leukope nia, thrombocytopeni a. Metab: weight gain. MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc:ST directed and to use SL nitroglycerin as needed for anginal attacks. 10. Advise patient to contact health care professional if chest pain does not improve, worsens after therapy, or occurs with diaphoresis; if shortness of breath; or if persistent head ache occurs. 86
EVENS- JOHNSON SYN DROME, gingival hyperplasia.
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Generic Name Brand Name
Classification
Indication Mechanism Of Action Dosage And Frequency
Adverse Reactions
Nursing Consideration O M E P R A Z O L E Losec Gastrointestinal Agent; Proton Pump Inhibitor Duodenal and gastric ulcer. Gastroeso phageal reflux disease including severe erosive esophagiti s (4 to 8 wk treatment) An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+- ATPase enzyme system [the acid (proton H+) pump] in the Gastroeso phageal Reflux, Erosive Esophagit is, Duodenal Ulcer adult: PO 20 mg once/d for 48 wk Gastric Ulcer adult: PO CNS:Headache, dizziness, fatigue. GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests. Urogenital:Hem aturia, proteinuria. Skin:Rash. Assessment & Drug Effects
Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use. Patient & Family Education Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood in urine. Report severe diarrhea; drug may need to be discontinued. Do not breast feed while taking this drug. 88
. Long- term treatment of pathologic hypersecr etory conditions such as Zollinger- Ellison syndrome, multiple endocrine adenomas , and parietal cells.
20 mg b.i.d. for 4 8 wk Hypersecr etory Disease adult:PO 60 mg once/d up to 120 mg t.i.d. Duodenal Ulcer Associate d with H. pylori 89
systemic mastocyto sis. In combinati on with clarithrom ycin to treat duodenal ulcers associate d with Helicobact er pylori. adult:PO 40 mg once/d for 14 d, then 20 mg/d for 14 days, in combinatio n with clarithromy cin 500 mg t.i.d. for 14 days
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Generic Name Brand Name
Classification
Indication Mechanism Of Action Dosage And Frequency
Adverse Reactions
Nursing Consideration Sodium Bicarbon ate Sodium Bicarbon ate Gastrointestinal agent; antacid; fluid and electrolyte balance agent. Systemic alkalinizer to correct metabolic acidosis (as occurs in diabetes mellitus, shock, cardiac arrest, or vascular collapse), to minimize uric acid Short-acting, potent systemic antacid. Rapidly neutralizes gastric acid to form sodium chloride, carbon dioxide, and water. After absorption of sodium bicarbonate, Adult:PO 0.32 g 1 4 times/d or 1/2 tsp of powder in glass of water Urinary Alkalinizer Adult:PO 4 g initially, then 12 g q4h Child:PO 84840 mg/kg/d in divided doses Cardiac Arrest Adult:IV 1 mEq/kg of a 7.5% or 8.4% solution GI: Belching, gastric distention, flatulence. Metabolic: Metabolic alkalosis; electrolyte imbalance: sodium overload (pulmonary edema), hypocalcemia (tetany), hypokalemia, Assessment & Drug Effects - Be aware that long-term use of oral preparation with milk or calcium can cause milk-alkali syndrome: Anorexia, nausea, vomiting, headache, mental confusion, hypercalcemia, hypophosphatemia, soft tissue calcification, renal and ureteral calculi, renal insufficiency, metabolic alkalosis. - Lab tests: Urinary alkalinization: Monitor urinary 91
crystallizatio n associated with uricosuric agents, to increase the solubility of sulfonamide s, and to enhance renal excretion of barbiturate and salicylate plasma alkali reserve is increased and excess sodium and bicarbonate ions are excreted in urine, thus rendering urine less acid. Not suitable for treatment of peptic ulcer because it is initially, then 0.5 mEq/kg q10min depending on arterial blood gas determinati ons (8.4% solutions contain 50 mEq/50 mL), give over 12 min Child:IV 0.51 mEq/kg of a 4.2% solution q10min depending on arterial blood gas determinati ons, give over 12 min milk-alkali syndrome, dehydration. Others: Rapid IV in neonates (Hypernatremia, reduction in CSF pressure, intracranial hemorrhage). Skin: Severe tissue damage following extravasation of IV solution. Urogenital: pH as a guide to dosage (pH testing with nitrazine paper may be done at intervals throughout the day and dosage adjustments made accordingly). - Lab tests: Metabolic acidosis: Monitor patient closely by observations of clinical condition; measurements of acid-base status (blood pH, Po2, Pco2, Hco3-, and other electrolytes, are usually made several times daily during acute period). 92
overdosage . Commonly used as home remedy for relief of occasional heartburn, indigestion, or sour stomach. Used topically as paste, bath, or soak to relieve short-acting, high in sodium, and may cause, gastric, distention, systemic, alkalosis, and possibly acid- rebound. Metabolic Acidosis Adult:IV 25 mEq/kg by IV infusion over 48 h Infant:IV 23 mEq/kg/d of a 4.2% solution over 48 h Renal calculi or crystals, impaired kidney function. - Observe for signs of alkalosis (over treatment) - Observe for and report S&S of improvement or reversal of metabolic acidosis. Patient & Family Education - Do not use sodium bicarbonate as antacid. A nonabsorbable OTC alternative for repeated use is safer. - Do not take antacids longer than 2 wk except under advice and supervision of a physician. Self-medication with routine 93
itching and minor skin irritations such as sunburn, insect bites, prickly heat, poison ivy, sumac, or oak. Sterile solutions are used to buffer acidic parenteral solutions to prevent doses of sodium bicarbonate or soda mints may cause sodium retention and alkalosis, especially when kidney function is impaired. - Be aware that commonly used OTC antacid products contain sodium bicarbonate: Alka-Seltzer, Bromo-Seltzer, Gaviscon. - Do not breast feed while taking this drug without consulting physician.
94
acidosis. Also as a buffering agent in many commercial products (e.g., mouthwash es, douches, enemas, ophthalmic solutions).