Domperidone Vometa 3 mL TID = 5:30 pm (before dinner)

Antiemetic
Uses: This medication increases movement through the digestive system. It is used to treat symptoms of
stomach disorders. It may also be used to prevent nausea and vomiting caused by certain medications.
SIDE EFFECTS: Headache, dizziness, dry mouth, nervousness, flushing, or irritability may occur the first
several days as your body adjusts to the medication. Trouble sleeping, stomach cramps, hot flashes and
leg cramps have also been reported. If any of these effects continue or become bothersome, inform your
doctor. Notify your doctor immediately if you develop: chest pain, slow/fast/irregular heartbeat, swelling
of the feet or ankles, difficulty urinating, swelling of the breasts or discharge from the nipple in men or
women, menstrual changes, sexual difficulties. If you notice other effects not listed above, contact your
doctor or pharmacist.
NEBIVOLOL 5mg half tab OD
Class: Selective Beta-Blockers
Action: Nebivolol is a beta-1 adrenergic receptor antagonist with antihypertensive and vasodilatory
activity. Nebivolol binds to and blocks the beta-1 adrenergic receptors in the heart, thereby
decreasing cardiac contractility and rate. This leads to a reduction in cardiac output and lowers
blood pressure. In addition, nebivolol potentiates nitric oxide (NO), thereby relaxing vascular
smooth muscle and exerting a vasodilatory effect.
Indication: It is used to manage HYPERTENSION and chronic HEART FAILURE in elderly
patients. For migraine prophylaxis
Contraindication: Hepatic disease
Nebivolol is contraindicated in patients with severe hepatic disease (Child-Pugh Class > B).
Nebivolol is extensively metabolized by the liver, and dosage adjustments are required in patients
with moderate hepatic impairment.
Acute heart failure, AV block, bradycardia, cardiogenic shock, sick sinus syndrome
Because beta-blockers depress conduction through the AV node, nebivolol is contraindicated in
patients with severe bradycardia, sick sinus syndrome, or advanced AV block (second or third-
degree AV block) unless a functioning pacemaker is present. In general, beta-blockers are
contraindicated in patients with cardiogenic shock or acute heart failure, particularly in those with
severely compromised left ventricular dysfunction, because the negative inotropic effect of these
drugs can further depress cardiac output. In patients with stable, chronic heart failure, however,
some beta-blockers given in low doses have been documented to be beneficial. No worsening of
heart failure was reported in a placebo-controlled trial of 1067 patients > 70 years with chronic
heart failure receiving a maximum of nebivolol 10 mg/day PO. If heart failure worsens,
discontinuation of nebivolol therapy should be considered. Beta-blockers have also been used for
the treatment of hypertrophic cardiomyopathy. In the treatment of myocardial infarction, beta-
blockers are contraindicated in patients with hypotension (SBP < 100 mmHg).
Diabetes mellitus
Beta-blockers have been shown to increase the risk of developing diabetes mellitus in hypertensive
patients; however this risk should be evaluated relative to the proven benefits of beta-blockers in
reducing cardiovascular events. Nonselective beta-blockers can potentiate insulin-induced
hypoglycemia and delay the recovery of serum glucose levels. It is not known if nebivolol has these
effects. Beta-blockers also can mask signs of hypoglycemia, especially tachycardia, palpitations,
and tremors; in contrast, diaphoresis and the hypertensive response to hypoglycemia are not
suppressed with beta-blockade. Beta-blockers can occasionally cause hyperglycemia. This is
thought to be due to blockade of beta-2-receptors on pancreatic islet cells, which would inhibit
insulin secretion. However, clinical trial data indicate that vasodilating beta-blockers (e.g.,
carvedilol, nebivolol) may actually improve insulin sensitivity and glycemic control. Thus, blood
glucose levels should be monitored closely if a beta-blocker is used in a patient with diabetes
mellitus. Nebivolol should be used cautiously in poorly controlled diabetic patients, in diabetic
 patients receiving insulin or oral hypoglycemic agents and in patients subject so spontaneous
hypoglycemia.
Adverse reactions
Severe
bradycardia / Rapid / 0-1.0
angioedema / Rapid / 0-1.0
pulmonary edema / Early / Incidence not known
AV block / Early / Incidence not known
myocardial infarction / Delayed / Incidence not known
bronchospasm / Rapid / Incidence not known
vasculitis / Delayed / Incidence not known
renal failure (unspecified) / Delayed / Incidence not known
1. LOZARTAN
CARDIOVASCULAR AGENT; ANGIOTENSIN II RECEPTOR ANTAGONIST;
ANTIHYPERTENSIVE
Actions
Angiotensin II receptor (type AT1) antagonist acts as a potent vasoconstrictor and primary vasoactive
hormone of the renin–angiotensin–aldosterone system.

Therapeutic Effects
Selectively blocks the binding of angiotensin II to the AT1 receptors found in many tissues (e.g., vascular
smooth muscle, adrenal glands). Antihypertensive effect results from blocking the vasoconstricting and
aldosterone-secreting effects of angiotensin II.

Uses
Hypertension.

Contraindications
Hypersensitivity to losartan, pregnancy [category C (first trimester), category D (second and third
trimesters)], lactation.

Adverse Effects (1%)

CNS: Dizziness, insomnia, headache. GI: Diarrhea, dyspepsia. Musculoskeletal: Muscle cramps, myalgia,
back or leg pain. Respiratory: Nasal congestion, cough, upper respiratory infection, sinusitis.

Nursing Implications
Assessment & Drug EffectS
Monitor BP at drug trough (prior to a scheduled dose).
Monitor drug effectiveness, especially in African-Americans when losartan is used as monotherapy.
Inadequate response may be improved by splitting the daily dose into twice-daily dose.
Lab tests: Monitor CBC, electrolytes, liver & kidney function with long-term therapy.

ISOSORBIDE MONONITRATE
Classifications: CARDIOVASCULAR AGENT; NITRATE VASODILATOR
Actions
Isosorbide mononitrate is a long-acting metabolite of the coronary vasodilator isosorbide dinitrate. It
decreases preload as measured by pulmonary capillary wedge pressure (PCWP), and left ventricular end
volume and diastolic pressure (LVEDV), with a consequent reduction in myocardial oxygen
consumption.
Therapeutic Effects
It is equally or more effective than isosorbide dinitrate in the treatment of chronic, stable angina. It is a
potent vasodilator with antianginal and antiischemic effects.
Uses
Prevention of angina. Not indicated for acute attacks.
Contraindications
Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma, postural hypotension, head trauma,
cerebral hemorrhage (increases intracranial pressure). Safe use during pregnancy [(category C) and
(category B) for sustained form] or lactation is not established.
Adverse Effects (1%)
CNS: Headache, agitation, anxiety, confusion, loss of coordination, hypoesthesia, hypokinesia, insomnia
or somnolence, nervousness, migraine headache, paresthesia, vertigo, ptosis, tremor. CV: Aggravation of
angina, abnormal heart sounds, murmurs, MI, transient hypotension, palpitations. Hematologic:
Hypochromic anemia, purpura, thrombocytopenia, methemoglobinemia (high doses). GI: Nausea,
vomiting, dry mouth, abdominal pain, constipation, diarrhea, dyspepsia, flatulence, tenesmus, gastric
ulcer, hemorrhoids, gastritis, glossitis. Metabolic: Hyperuricemia, hypokalemia. GU: Renal calculus, UTI,
atrophic vaginitis, dysuria, polyuria, urinary frequency, decreased libido, impotence. Respiratory:
Bronchitis, pneumonia, upper respiratory tract infection, nasal congestion, bronchospasm, coughing,
dyspnea, rales, rhinitis. Skin: Rash, pruritus, hot flashes, acne, abnormal texture. Special Senses:
Diplopia, blurred vision, photophobia, conjunctivitis.
Nursing Implications
Monitor cardiac status, frequency and severity of angina, and BP.
Assess for and report possible S&S of toxicity, including orthostatic hypotension, syncope, dizziness,
palpitations, light-headedness, severe headache, blurred vision, and difficulty breathing.
Lab tests: Monitor serum electrolytes periodically.

NYSTATIN
Classifications: ANTIINFECTIVE; ANTIFUNGAL ANTIBIOTIC
Actions
Nontoxic, nonsensitizing antifungal antibiotic produced by Streptomyces noursei. Binds to sterols in
fungal cell membrane, thereby changing membrane potential and allowing leakage of intracellular
components.
Therapeutic Effects
Fungistatic and fungicidal activity against a variety of yeasts and fungi; not appreciably active against
bacteria, viruses, or protozoa.
Uses
Local infections of skin and mucous membranes caused by Candida sp. including Candida albicans (e.g.,
paronychia; cutaneous, oropharyngeal, vulvovaginal, and intestinal candidiasis).
Contraindications
Use of vaginal tablets during pregnancy (category C); vaginal infections caused by Gardnerella vaginalis
or Trichomonas sp.
Adverse Effects (1%)
GI: Nausea, vomiting, epigastric distress, diarrhea (especially with high oral doses).
Nursing Implications
Monitor oral cavity, especially the tongue, for signs of improvement.
Avoid occlusive dressings or applications of ointment preparation to moist, dark areas of body because
they favor growth of yeast.
TRAMADOL

Indications Moderate to severe pain.

Contraindications Acute intoxication w/ alcohol, hypnotics, centrally-acting analgesics, opioids, or psychotropic
drugs; uncontrolled epilepsy. Severe hepatic impairment. Concurrent use or w/in 2 wk of
discontinuation from MAOIs.
Adverse Drug Postural hypotension, resp depression, hepatotoxicity, Stevens-Johnson syndrome, toxic
Reactions epidermal necrolysis, bradycardia, collapse, allergic reactions w/ resp symptoms (e.g.
dyspnoea, bronchospasm, wheezing, angioneurotic oedema), changes in appetite, motor
weakness, changes in mood, activity, cognitive and sensorial capacity; exacerbation of
asthma, withdrawal symptoms (e.g. agitation, anxiety), skin rash, blood dyscrasias,
hypoprothrombinemia.
Monitoring Monitor pain relief, resp rate, BP, and pulse rate; signs of tolerance, abuse, or suicidal
Parameters ideation.
Mechanism of Action
Description: Tramadol is a centrally acting opioid analgesic which binds to mu-opioid
receptors and weakly inhibits the reuptake of norepinephrine and serotonin. Paracetamol, a
para-aminophenol derivative, has analgesic, antipyretic and weak anti-inflammatory activity.
Together, tramadol and paracetamol has faster onset of action compared to tramadol alone
and longer duration of action compared to paracetamol alone.

ACETYLCYSTEINE
Classifications: SKIN AND MUCOUS MEMBRANE AGENT; MUCOLYTIC; ANTIDOTE
Actions
Acetylcysteine probably acts by disrupting disulfide linkages of mucoproteins in purulent and
nonpurulent secretions.
Therapeutic Effects
Acetylcysteine lowers viscosity and facilitates the removal of secretions.
Uses
Adjuvant therapy in patients with abnormal, viscid, or inspissated mucous secretions in acute and chronic
bronchopulmonary diseases, and in pulmonary complications of cystic fibrosis and surgery,
tracheostomy, and atelectasis. Also used in diagnostic bronchial studies and as an antidote for acute
acetaminophen poisoning.
Contraindications
Hypersensitivity to acetylcysteine; patients at risk of gastric hemorrhage
Adverse Effects (1%)
CNS: Dizziness, drowsiness. GI: Nausea, vomiting, stomatitis, hepatotoxicity (urticaria). Respiratory:
Bronchospasm, rhinorrhea, burning sensation in upper respiratory passages, epistaxis.
Nursing Implications
During IV infusion, carefully monitor for fluid overload and signs of hyponatremia (i.e., changes in
mental status).
Monitor for S&S of aspiration of excess secretions, and for bronchospasm (unpredictable); withhold drug
and notify physician immediately if either occurs.
Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry as indicated.
Have suction apparatus immediately available. Increased volume of respiratory tract fluid may be
liberated; suction or endotracheal aspiration may be necessary to establish and maintain an open airway.
Older adults and debilitated patients are particularly at risk.
Nausea and vomiting may occur, particularly when face mask is used, due to unpleasant odor of drug and
excess volume of liquefied bronchial secretions.

TRIMETAZIDINE
ANTI-ANGINA

CLOPIDOGREL BISULFATE
Classifications: BLOOD FORMERS, COAGULATORS, AND ANTICOAGULANTS;
ANTIPLATELET AGENT
Actions
Inhibits platelet aggregation by selectively preventing the binding of adenosine diphosphate to its platelet
receptor. It is an analog of ticlopidine. The drug's effect on the adenosine diphosphate receptor of a
platelet is irreversible.
Therapeutic Effects
Consequently, clopidrogrel prolongs bleeding time.
Uses
Secondary prevention of MI, stroke, and vascular death in patients with recent MI, stroke, unstable angina
or established peripheral arterial disease.
Contraindications
Hypersensitivity to clopidogrel; intracranial hemorrhage, peptic ulcer, or any other active pathologic
bleeding; pregnancy (category B). Discontinue clopidogrel 7 d before surgery and during lactation. Safety
and efficacy not established in children.
Adverse Effects (1%)
Body as a Whole: Flu-like syndrome, fatigue, pain, arthralgia, back pain. CV: Chest pain, edema,
hypertension, thrombocytic purpura. GI: Abdominal pain, dyspepsia, diarrhea, nausea,
hypercholesterolemia. Hematologic: Thrombotic thrombocytopenic purpura, epistaxis. CNS: Headache,
dizziness, depression. Respiratory: URI, dyspnea, rhinitis, bronchitis, cough. Skin: Rash, pruritus.
Nursing Implications
Carefully monitor for and immediately report S&S of GI bleeding, especially when coadministered with
NSAIDs, aspirin, heparin, or warfarin.
Lab tests: Periodic platelet count and lipid profile.
Evaluate patients with unexplained fever or infection for myelotoxicity.

CILOSTAZOL
Pletal
Classifications: CARDIOVASCULAR AGENT; COAGULATOR; VASODILATOR; ANTIPLATELET
AGENT; PHOSPHODIESTERASE INHIBITOR
Actions
Inhibition of an isoenzyme which results in vasodilatation and inhibition of platelet aggregation induced
by collagen or arachidonic acid.
Therapeutic Effects
Increases the skin temperature of the extremities and improves claudication. Effectiveness is indicated by
increased ability to walk further without claudication.
Uses
Intermittent claudication.
Contraindications
Congestive heart failure of any severity; hypersensitivity to cilostazol; pregnancy (category C), lactation.
Adverse Effects (1%)
Body as a Whole: Back pain, headache, infection, myalgia. CNS: Dizziness, vertigo. CV: Palpitations,
tachycardia. GI: Abdominal pain, abnormal stools, diarrhea, dyspepsia, flatulence, nausea. Respiratory:
Cough, pharyngitis, rhinitis.
Nursing Implications
Monitor therapeutic effectiveness indicated by ability to walk farther without leg pain.
Monitor for S&S of CHF. Do not give cilostazol to patients with preexisting CHF.

FERROUS SULFATE
Actions
Ferrous sulfate: Standard iron preparation against which other oral iron preparations are usually
measured. Corrects erythropoietic abnormalities induced by iron deficiency but does not stimulate
erythropoiesis. May reverse gastric, esophageal, and other tissue changes caused by lack of iron. Ferrous
gluconate: Claimed to cause less gastric irritation and be better tolerated than ferrous sulfate.

Therapeutic Effects
Experienced within 48 h as a sense of well-being, increased vigor, improved appetite, and decreased
irritability (in children). Reticulocyte response begins in about 4 d; it usually peaks in 7–10 d
(reticulocytosis) and returns to normal after 2 or 3 wk. Hemoglobin generally increases by 2 g/dL and
hematocrit by 6% in 3 wk. Iron supplements correct erythropoietic abnormalities induced by iron
deficiency but do not stimulate erythropoiesis.

Uses
To correct simple iron deficiency and to treat iron deficiency (microcytic, hypochromic) anemias. Also
may be used prophylactically during periods of increased iron needs, as in infancy, childhood, and
pregnancy.

Contraindications
Peptic ulcer, regional enteritis, ulcerative colitis; hemolytic anemias (in absence of iron deficiency),
hemochromatosis, hemosiderosis, patients receiving repeated transfusions, pyridoxine-responsive anemia;
cirrhosis of liver
Adverse Effects (1%)
GI: Nausea, heartburn, anorexia, constipation, diarrhea, epigastric pain, abdominal distress, black stools.
Special Senses: Yellow-brown discoloration of eyes and teeth (liquid forms.) Large Chronic Doses in
Infants Rickets (due to interference with phosphorus absorption). Massive Overdosage Lethargy,
drowsiness, nausea, vomiting, abdominal pain, diarrhea, local corrosion of stomach and small intestines,
pallor or cyanosis, metabolic acidosis, shock, cardiovascular collapse, convulsions, liver necrosis, coma,
renal failure, death.
Nursing Implications
Lab tests: Monitor Hgb and reticulocyte values during therapy. Investigate the absence of satisfactory
response after 3 wk of drug treatment.
Continue iron therapy for 2–3 mo after the hemoglobin level has returned to normal (roughly twice the
period required to normalize hemoglobin concentration).
Monitor bowel movements as constipation is a common adverse effect.

MEDROXYPROGESTERONE ACETATE
Classifications: HORMONES AND SYNTHETIC SUBSTITUTES; PROGESTIN
Actions
Synthetic derivative of progesterone with prolonged, variable duration of action and androgenic and
antiestrogenic activity. No deleterious effects on lipid metabolism.
Therapeutic Effects
Induces and maintains endometrium, preventing uterine bleeding; inhibits production of pituitary
gonadotropin, preventing ovulation; and produces thick cervical mucus resistant to passage of sperm.
Uses
Dysfunctional uterine bleeding; secondary amenorrhea; parenteral form (Depo-Provera) used in
adjunctive, palliative treatment of inoperable, recurrent, and metastatic endometrial or renal carcinoma;
contraception; endometriosis-associated pain.
Contraindications
History of thromboembolic disorders; pregnancy (category X), lactation.
Adverse Effects (1%)
CNS: Cerebral thrombosis or hemorrhage, depression. CV: Hypertension, pulmonary embolism, edema.
GI: Vomiting, nausea, cholestatic jaundice, abdominal cramps. Urogenital: Breakthrough bleeding,
changes in menstrual flow, dysmenorrhea, vaginal candidiasis. Skin: Angioneurotic edema. Body as a
Whole: Weight changes; breast tenderness, enlargement or secretion. Musculoskeletal: Loss of bone
mineral density.
Nursing Implications
See progesterone for numerous additional nursing implications.
Be aware that IM injection may be painful. Monitor sites for evidence of sterile abscess. A residual lump
and discoloration of tissue may develop.
Monitor for S&S of thrombophlebitis (see Appendix F).
Note: Planned menstrual cycling with medroxyprogesterone may benefit the patient with a history of
recurrent episodes of abnormal uterine bleeding.