DRUG STUDY

Name Generic Name: Carvedilol Action -blocks stimulation of beta1 (myocardial) & beta2 (pulmonary, vascular & uterine) adregenic receptor sites -also has alpha1 blocking activity, w/c may result in orthostatic hypotension Indications -management of HPN & angina pectoris also as an adjunct to standard therapy in symptomatic heart failure Contraindications -2nd 3rd degree heart block -severe bradycardia, shock, uncontrolled heart failure, asthma, hx of chronic obstructive airway disease, hepatic impairment Adverse Effects -postural hypotension, dizziness, headache, fatigue, GI upset, bradycardia -occasionally: diminished peripheral circulation, dry eyes & flu-like symptoms Nursing Responsibilities -monitor BP & PR assess pt routinely for s/sx of fluid overload -assess for orthostatic hypotension -pt. may experience worsening of sx during initiation of therapy for CHF -check frequency of refills to determine adherence

Name Generic Name: Diltiazem Brand Name: Cordazem

Action Inhibits calcium ion influx across cell membrane during cardiac depolarization, produces relaxation of coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries. Action Decreases pain by inhibiting the uptake of norepinephrine & serotonin in the CNS. May produce opioid-like effects, but causes less respiratory depression than morphine.

Indications -angina pectoris

Contraindications -sick sinus syndrome -2nd & 3rd AV block -severe hypotension -pregnancy

Adverse Effects -dizziness, lightheadedness, headache, asthenia,fatigue -peripheral edema, hypotension, arrhythmias, bradycardia, AV block,asystole -flushing,rash -nausea, hepatic injury, reflux Adverse Effects -CNS & GI disturbances. -Nausea, dizziness, somnolence. -Asthenia, fatigue, hot flushes, constipation, diarrhea, flatulence, dry mouth, pruritis, diaphoresis, tinnitus.

Nursing Responsibilities -monitor BP carefully if patient is on concurrent doses of nitrates. -ensure pt. swallows ER & SR preparations whole; do not cut, crush, or chew -should be administered w/ food or after eating Nursing Responsibilities -assess for level of pain relief -assess BP & RR -assess bladder & bowel function -monitor for respiratory depression & seizures -to be taken w/ meals to avoid GI upset. -encourage coughing & deep breathing q 2 hrs to prevent atelactasis & pneumonia

Name Generic Name: Tramadol Brand Name: Dolcet

Indications moderate to acute or chronic pain and in painful diagnostic or therapeutic measures

Contraindications - Acute intoxication w/ alcohol, hypnotics, narcotics, centrally-acting analgesics, opioids or psychototropic drugs. -Hypersensitivity

Name Generic Name: Co amoxiclav Brand Name: Augmentin

Action amino penicillin that inhibits cellwall synthesis during bacterial multiplication. Bacteriaresist amoxicillin by producing penicillinases (enzymes that hydrolyze amoxicillin)

Indications -systemic infections

Contraindications -pts w/ a hx of hypersensitivity to -lactams, eg, penicillins & cephalosporins. -pts w/ a previous hx of co-moxiclavassociated jaundice/hepatic dysfunction

Adverse Effects -hepatitis, cholestatic jaundice -erythema multiforme -toxic epidermal necrolysis; exfoliative dermatitis -Diarrhea, vomiting -neutropenia, anemia Adverse Effects -constipation, flatulence, diarrhea, renal dysfunction, acid rebound

Nursing Responsibilities -ask about allergic reactions to penicillin -administer w/ food or after eating to prevent GI upset -monitor pt. for adverse effects

Name Generic Name: Calcium Carbonate Brand Name: Calci-Aid

Action -decreases total acid load of GI tract. -increases esophageal sphincter tone

Indications -antacid, -calcium supplement -osteoporosis

Contraindications -Hypercalcemia, -bone tremors -severe renal failure -hypersensitivity

Nursing Responsibilities -ask client for allergic reactions to calcium -administer 1-3 hrs after meals & at bedtime (as ordered) -have pt. chew antacid tablets thoroughly before swallowing; follow w/ glass of milk/water Nursing Responsibilities -provide small frequent meals if GI upset occurs -provide comfort measure & arrange for analgesics if headache occurs

Name Generic Name: Clopidogrel Bisulfate Brand Name: Plavix

Action -inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.

Indications -treatment of pt. at risk for ischemic eventsrecent MI, recent ischemic CVA, peripheral artery disease. -treatment of pt w/ acute coronary syndrome

Contraindications -allergy to clopidogrel -active pathological bleeding such as peptic ulcer/intracranial hemorrhage -lactation

Adverse Effects -headache, dizziness, weakness, syncope, flushing -HPN, edema -rash, pruritis -nausea, GI distress, constipation, diarrhea, GI bleeding -increased bleeding risk Adverse Effects -Hypercalcemia

Name Ketosteril

Action Normalizes metabolic process, promotes recycling product exchange. Reduces ion concentration of potassium, magnesium and phosphate.

Indications -protein energy malnutrition -prevention and treatment of conditions caused by modified or insufficient protein metabolism in chronic renal failure

Contraindications -allergy & hypersensitivity to any content of this drug -Hypercalcemia -disturbed amino acid metabolism

Nursing Responsibilities -assess for Hypercalcemia -administer w/ food or after eating to prevent GI upset

Name Generic Name: Lactulose Brand Name: Duphalac

Action Drug passes unchanged into colon where bacteria breaks it down into organic acids that increase the osmotic pressure & slightly acidify colonic contents w/c increase stool softening action

Indications -constipation -prevention & treatment of portal-systemic encephalopathy

Contraindications -low galactose diet -intestinal obstruction

Adverse Effects -abdominal discomfort associated w/ flatulence/cramps -prolonged use/large doses may result in diarrhea w/ excessive loss of water & electrolytes

Nursing Responsibilities -do not administer if pt. has already pass out stool -give laxative syrup w/ water, juice or milk to increase palatability -do not give other laxatives -replace fluid loss -monitor serum ammonia levels & blood glucose levels Nursing Responsibilities -arrange for culture & sensitivity tests before beginning of therapy -administer oral drug 4 hrs before or at least 8 hrs after antacids or other anioncontaining drugs -discontinue & report to physician if s/sx of hypersensitivity or w/ severe diarrhea Nursing Responsibilities -assess for edema, w/c may indicate inability to utilize NaHCO3 -observe for dry skin & mucous membranes, polydipsia, polyuria, & air hunger may indicate a reversal of metabolic acidosis. -monitor electrolytes & ABGs. -WOF: s/sx of milk-alkali syndrome (polyuria)

Name Generic Name: Moxifloxacin Brand Name: Avelox

Action -bactericidal -interferes w/ DNA replication, repair, transcription & recombination in gram pos. & gram neg. bacteria, preventing cell reproduction & leading to cell death

Indications Treatment for URTI & LRTI eg. acute sinusitis, acute exacerbations of chronic bronchitis, CAP, treatment of skin & soft tissue infections

Contraindications -allergy w/ fluoroquinolones, prolonged QT interval, hypokalemia, pregnancy & lactation

Adverse Effects -GI disturbance, headache, dizziness, taste perversion, musculoskeletal effects, CVS effects, hematological changes, CNS disturbances, skin reactions, visual disturbances.

Name Generic Name: Sodium Bicarbonate Brand Name: Sodium Bicarbonate

Action -increases plasma Bicarbonate -neutralizes gastric acid -raises blood pH, urine pH & gastric pH -inhibits pepsin activity

Indications -treatment of metabolic acidosis -symptomatic relief of upset stomach from hyperacidity associated w/ peptic ulcer, gastritis, peptic esophagitis, hiatal hernia -Prophylaxis of GI bleeding, stress ulcers, aspiration pneumonia

Contraindications -allergy to components -low serum chloride -metabolic & respiratory alkalosis -Hypocalcemia

Adverse Effects -gastric rupture following ingestion -systemic alkalosis, Hypokalemia secondary to shifting of potassium, Hypernatremia -chemical cellulitis, tissue necrosis, ulceration

Name Generic Name: Celecoxib Brand Name: Celebrex

Action -Decreased pain and inflammation caused by arthiritis -Prevention of M Inhibits the enzyme COX-2. -Has analgesic, anti inflammatory & antipyretic properties.

Indications -s/sx of osteoarthritis & rheumatoid arthritis in adults

Contraindications -asthma, urticaria, allergic-type reaction to sulfonamides, aspirin or other NSAIDs. -treatment of perioperative pain in the setting of coronary artery bypass graft surgery -severe hepatic impairment

Adverse Effects -anaphylatic reactions, renal toxicity. -hallucination, aguesia, anosmia, aseptic menlugitis, vasculitis, GI hemorrhage, interstitial nephritis, photosensitivity reaction, exfoliative dermatitis, erthema, StevensJohnson syndrome, toxic epidermal necrolysis & menstrual disorder. -cerebral hemorrhage, fulminant hepatitis, liver necrosis, hyponatremia, conjunctivitis Adverse Effects -rarely, urticaria, bronchospasm, nausea, vomiting Aerosol treatment: rhinitis, stomatitis

Nursing Responsibilities -assess patients ROM, degree of swelling, and pain in affected joints -assess patient for allergy to sulfonamides, aspirin, or NSAIDS. -may be administered without regard to meals. -advise to report if s/sxof GI toxicity (abdominal pain, black stools), skin rash, unexplained weight gain, edema occurs

Name Generic Name: Acetylcysteine Brand Name: Fluimucil

Action Exerts mucolytic action through its free sulfhydryl group which opens up the disulfide bonds in the mucoproteins thus lowering mucous viscosity.

Indications -Acute & chronic respiratory tract infections w/ abundant mucus secretions

Contraindications -Effervescent tab/ Sachet -Phenylketonurics

Nursing Responsibilities -monitor effectiveness of therapy & adverse effects -instruct pt. in appropriate use -report if adverse effects occurs

Name Generic Name: Isosorbide Mononitrate (ISMN) Brand Name: Imdur

Action Thought to reduce cardiac oxygen demand by decreasing preload & afterload. Drug may also increase blood flow through the collateral coronary vessels.

Indications -acute angina attacks; to prevent situations that may cause anginal attacks

Contraindications - Hypersensitivity -Severe cerebral sclerosis -Hypotension -relief of acute attacks

Adverse Effects -headache, dizziness, weakness -orthostatic hypotension, tachycardia, palpitations, ankle edema, fainting, flushing -SL burning - nausea, vomiting - cutaneous vasodilation, rash

Nursing Responsibilities -monitor BP & intensity & duration of drug response -WOF: s/sx of Methemoglobine mia (impaired O2 delivery despite adequate cardiac output and adequate arterial partial pressure of O2) -advice pt. to move slowly to prevent dizziness & orthostatic hypotension

Name Generic Name: Atorvastatin Brand Name: Lipitor

Action -selectively HMGCoA reductase which converts HMG-CoA to mevalonate, a precursor of sterols. -lowers cholesterol and lipoprotein levels

Indications -reduction of elevated total cholesterol & LDL cholesterol

Contraindications -active liver disease -pregnancy & lactation

Adverse Effects -headache, asthenia, insomnia -peripheral edema -rhinitis, sinusitis pharyngitis, -abdominal pain, dyspepsia, flatulence, nausea, diarrhea constipation, -UTI -arthritis, myalgia arthralgia, -bronchitis -rash - infection, flulike syndrome, allergic reaction Adverse Effects -Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities -Rash, inflammation, urticaria, pruritus, alopecia, dry skin - Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy -URI symptoms, cough, epistaxis -Cancer in preclinical studies, back pain, fever

Nursing Responsibilities -hx of liver disease -avoid intake of alcohol -monitor creatinine phosphokinase & transaminase elevation -monitor VS especially the BP -should be administered w/ food or after eating

Name Generic Name: Omeprazole Brand Name: Prilosec

Action Gastric acidpump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production

Indications Short-term treatment of: -active duodenal ulcer -heartburn or symptoms of gastroesophageal reflux disease (GERD) -active benign gastric ulcer, GERD, severe erosive esophagitis, poorly responsive symptomatic GERD Long-term therapy Treatment of pathologic -hypersecretory conditions - Eradication of H. pylori with amoxicillin or metronidazole & clarithromycin

Contraindications Contraindicated w/ hypersensitivity to omeprazole or its components; Use cautiously with pregnancy, lactation.

Nursing Responsibilities -administer before meals. Caution patient to swallow capsules whole not to open, chew, or crush them. -arrange for further evaluation of patient after 8 wk of therapy for gastroreflux disorders; not intended for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies. -administer antacids with omeprazole, if needed