Generic name: Metformin and Sitagliptin Brand name: Janumet Classification: Anti diabetic Dosage: 50mg 1 tab OD Action: Decreases hepatic glucose production. Decreases intestinal glucose absorption. Increases sensitivity to insulin. Indications: Management of type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea hypoglycemia. Contraindications: hypersensitivity, metabolic acidosis, dehydration, sepsis, renal dysfunction, hepatic impairment. Side effects: diarrhea, nausea, unpleasant metallic taste. Nursing considerations: • Assess for patient's history of diabetes • Monitor for patient's blood glucose before and after giving medications • Assess for hypersensitivity to Metformin • Assess for patient's renal function • Monitor for signs and symptoms of hypoglycemic reactions (e.g. cold and clammy skin) • Discontinue if renal impairment occurs • Instruct patient to do proper foot care • instruct patient for unpleasant metallic taste of the drug 2. Generic Name: Losartan Brand Name: Cozaar Classification: antihypertensive Dosage: 50/500 mg 1 tab BID Action: blocks vasoconstrictor and aldosterone producing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands Indications: Hypertension, DM type 2, CHF, and patients who can not tolerate ACE inhibitors Contraindications: hypotension, pregnancy and lactation Side Effects: fatigue, weakness, drug induced hepatitis, bradycardia, hypotension Nursing Considerations: • Monitor for blood pressure, ECG, pulse frequently during dose adjustments • Monitor for intake and output ratios and daily weight. • Assess for signs and symptoms of CHF • Assess for signs and symptoms of Hypotension • Instruct patient to have a low fat low sodium diet regimen • Assess for signs of angioedema • Monitor BUN and serum creatinine levels • Monitor for signs of hyperkalemia 3. Generic name: CLopidogrel Brand name: Norplat Classification: Anti platelet Action: Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets. Indications: treatment of patients at risk for ischemic events and peripheral artery disease, acute coronary syndrome, as a loading dose with aspirin to prevent adverse cardiac events in coronary stent implantation

Contraindications: hypersensitivity, active pathological bleeding, lactation, use cautiously with bleeding disorders, recent surgery, hepatic impairment, pregnancy Side effects: Headache, dizziness, weakness, hypertension, edema, nausea, GI distress, constipation, diarrhea. Increased bleeding risk Nursing considerations: • Assess for hypersensitivity to clopidogrel • Assess for bleeding disorders • Provide small frequent meals if GI upset occurs • Provide comfort measures and arrange for analgesics if headache occurs • Give client awareness to the side effects of the drug • Provide a safety environment 4. Generic name: Rosuvastatin calcium Brand name: Crestor Classification: Anti-hyperlipidemic HMG-CoA reductase inhibitor Dosage: 20 mg 1 tab OD Action: 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 cholesterol, serum LDLs (associated with increased risk of coronary artery disease) and either an increase or no change in serum HDLs (associated with decreased) Indications: an adjunct to diet in the treatment of elevated total cholesterol, mixed dyslipidemia, atherosclerosis, Contraindications: hypersensitivity, impaired hepatic function, alcoholism, renal impairment, advanced age, hypothyroidism Side effects: Nausea, dyspepsia, diarrhea, constipation, vomiting, rhinitis, sinusitis, cough, dyspnea, pneumonia Nursing considerations: • 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. 5. Generic Name: Vitamin B complex Classification: Vitamins -Includes Vitamin B1, B2, B6 and B12 Dosage: 1 tab OD PO PC breakfast

Action: B1: Thiamin: Required for the metabolism of carbohydrates and for normal nerve function B2: Riboflavin: Required for the metabolism of carbohydrates and amino acids and for healthy mucous membranes, such as those lining the mouth B6: Pyridoxine: Required for the metabolism of amino acids and fatty acids, for nerve function, for formation of red blood cells and for healthy skin B12: Cobalamin: Required for maturation of red blood cells, for nerve function, and DNA synthesis Indication: Indicated to the following diseases, manifesting with a vitamin B deficiency: neuritis; alcohol, toxic, and post infectious polyneuritis; diabetic polio neuropathy; neuralgia; sciatica central spastic conditions; myasthenia; paresthesia; atherosclerosis; Wernicke’s encephalopathy; vegetative neurosis; dermatitis; neurodermatitis; psoriasis; lupus erythematodes; furunculosis; stomatitis; Contraindication: Vitamin B complex should not be used in hypersensitivity to any of the vitamins, containing in the preparation, as well as in patients with 2nd and 3rd degree arterial hypertension Side effects: Although the preparation is very well tolerated, in rare cases in predisposed patients itching, urticaria, and Quincke’s edema may appear. Nursing considerations: • Make sure patient gets the right dose • The vitamin should be taken once a day 6. Generic name: Cilostazol Brand name: Pletal Classification: Antiplatelet Dosage: 50mg/tab 1 tab BID PC Action: Reversibly inhibits platelet aggregation induced by a variety of stimuli including ADP, thrombin, collagen, shear stress, epinephrine, arachidonic acid by inhibiting cAMP phosphodiesterase III; produces vascular dilation in vascular beds with a specificity for femoral beds; seems to have no effect on renal arteries. Indication: Reduction of symptoms of intermittent claudication allowing increased walking distance. Contraindication: Contraindicated with allergy to cilostazol, heart failure of any severity (decreased survival rates have occurred), active bleeding, hemostatic disorders. Side effects: dizziness, headache, heart failure, tachycardia, palpitations, diarrhea, cough, dyspepsia, peripheral edema, infection, back pain Nursing considerations: • Assess for heart failure • Administer drug on an empty stomach, at least 30 min before or 2 hr after breakfast and dinner • Encourage patient to avoid use of grape fruit juice • Establish walking distance to monitor drug effectiveness • Establish safety precautions to avoid injury and bleeding

Encourage patient to continue therapy, results may not be seen for 2-4 wks Give patient awareness to the side effects of the drug

7. Generic name: Sulodexide Brand name: Vessel due F Classification: Anticoagulant, antithrombotics and fibrinolytics Dosage: 1 tab BID PC Action: Inhibits coagulation by attacking several sites of the coagulation system. Its effect is dependent on the presence of antithrombin III, an alpha 2- globulin whose activity is augmented by heparin. The heparin- antithrombin complex inactive factors IXa, Xa, XIa, and XIIa, and prevents thrombin formation. Furthermore, the complex reverses the effect of already formed thrombin. In high concentrations, heparin also inhibits thrombocyte aggregation.

Indication: Vascular pathologies with thrombotic risk, transient ischemic attacks and cerebrovascular disease, peripheral vascular insufficiency, diabetic retinopathy, MI, retinal vasal thrombosis. Contraindication: Hypersensitivity to sulodexide, heparin and heparin like products. Diathesis and hemorrhagic diseases. Side effects: nausea, vomiting, epigastralgia. Pain, burn, hematoma at the site of injection Nursing considerations: • Assess patients for signs of bleeding and hemorrhage (bleeding gums;nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac- positive stools). Notify physician if these occur. • Monitor patient for hypersensitivity reactions (chills, fever, urticaria). Report signs to physician • Subcutaneous: observe injection sites for hematomas, ecchymosis, or inflammation

Monitor platelet count every 2-3 days throughout therapy. May cause mild thrombocytopenia, which appears on the 4th day and resolves despite continued heparin therapy.

8. Generic name: Insulin lispro and Insulin lispro protamine Brand name: Humalog mix Classification: Antidiabetic hormone Dosage: 25 12 ‘u’ SQ ac breakfast Action: Insulin is a hormone secreted by beta cells of the pancreas that, by receptormediated effects, promotes the storage of the body’s fuels, facilitating the transport of metabolites ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose of fats from lipids, and proteins from amino acids. Indication: Diabetes mellitus type1 and Diabetes mellitus type 2 that cannot be controlled by diet or oral drugs, sever ketoacidosis, hyperkaletomia Contraindication: Contraindicated with allergy to pork products, history of smoking or lung disease Side effects: Hypersensitivity, hypoglycemia, decline in pulmonary Nursing considerations: • Assess if allergic to pork products • Do not give insulin injection concentrated IV; severe anaphylactic reactions can occur • Store insulin in a cool place away from direct sunlight. Refrigeration is preferred. Do not freeze insulin. • Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage. Patients can learn to adjust insulin dosage on sliding scale based on test results. • Monitor insulin needs during times of trauma or severe stress; dosage adjustment may be needed • Tell client to avoid alcohol; serious reactions can occur • Tell client to report if fever, sore throat, vomiting, hypoglycemic reactions and rash occur. 9. Generic name: Aspirin Brand name: Classification: Analgesic, Anti-inflammatory, Antiplatelet, Antipyretic, Antirheumatic, NSAID, Salicylate

Dosage: Action: Analgesic and antirheumatic effects attributable to aspirin’s ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of prostaglandin intermediary. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs at low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation. Indication: mild to moderate pain, fever, inflammatory conditions- rheumatic fever, rheumatoid arthritis, osteoarthritis, prophylaxis against cataract formation with longterm use Contraindication: Contraindicated with allergy to salicylates os NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency. Use cautiously with impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation. Side effects: Acute aspirin toxicity, aspirin intolerance, nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, occult blood loss, hemostatic defects, dizziness, vomiting, diarrhea, mental confusion Nursing considerations: • Assess for hypersensitivity to salicylates or NSAIDs and to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk • Give drug with food after meals if GI upset occurs • Give drug with a full glass of water to reduce risk of tablet or capsule lodging in the esophagus • Do not crush, and ensure that patient does not chew SR preparations • Do not use aspirin that has a strong vinegar like odor • Give patient awareness of the side effects of the drug • Tell client to report possible occurrence of the following: -ringing of the ears -dizziness -confusion -abdominal pain -rapid or difficult breathing -nausea and vomiting -bloody stools

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