DRUG NAME Brand Name: LANOXIN Generic Name: Digoxin Drug Cla : An!iarr"#!"mic $ ino!

ro%ic

MODE OF ACTION Increa e !"e &orce o& m#ocardial con!rac!ion' (rolong re&rac!or# %eriod o& !"e AV node' Decrea e conduc!ion !"roug" !"e SA and AV node ' Increa ed cardiac ou!%u! )%o i!i*e ino!ro%ic e&&ec!+ and lo,ing o& !"e "ear! ra!e )nega!i*e c"rono!ro%ic e&&ec!+'

INDICATION Cardiac &ailure accom%anied -# a!rial &i-rilla!ion. managemen! o& c"ronic cardiac &ailure ,"ere # !olic d# &unc!ion or *en!ricular dila!a!ion i dominan!. managemen! o& cer!ain u%ra*en!ricular arr"#!"mia $ %ar!icularl# c"ronic a!rial &lu!!er / &i-rilla!ion'

ADVERSE DRUG REACTION CNS di !ur-ance $ di00ine . *i ual di !ur-ance )-lurred or #ello,i " *i ion+. arr"#!"mia$ conduc!ion di !ur-ance $ -igemin#$ !rigemin#$ (R %rolonga!ion$ inu -rad#cardia. nau ea$ *omi!ing$ diarr"ea. ur!icarial or carla!ini&orm ,1 eo ino%"ilia'

NURSING CONSIDERATION Moni!or a%ical %ul e -e&ore admini !ering' Moni!or -lood %re ure %eriodicall# in %a!ien! recei*ing IV dogoxin' Moni!or in!a2e and ou!%u! ra!io and dail# ,eig"! ' O- er*e %a!ien! &or ign and #m%!om o& !oxici!#' Oral %re%ara!ion can -e admini !ered ,i!"ou! regard !o meal ' Be&ore admini !ering ini!ial loading do e$ de!ermine ,"e!"er %a!ien! "a !a2en an# digi!ali %re%ara!ion in !"e %receding 34 5 ,2'

CONTRAINDICATIO N

In!ermi!!en! com%le!e "ear! -loc2 or 3nd degree AV -loc2 e % i& !"ere i a "i !or# o& S!o2e 4Adam a!!ac2 . arr"#!"mia cau ed -# cardiac gl#co ide in!oxica!ion$ u%ra*en!ricular arr"#!"mia cau ed -# 6ol&&4(ar2in on4 6"i!e #ndrome. *en!ricular !ac"#cardia or &i-rilla!ion. "#%er!ro%"ic o- !ruc!i*e cardiom#o%a!"#' 7#%er en i!i*i!# !o o!"er digi!ali gl#co ide '

Generic Name: TELMISARTAN Brand Name: Micardi Drug Cla : Angiotensin II Antagonists 1 Diuretics

Telmi ar!an )Teli mar2e!ed -# cadila %"arma+ i an Angio!en in Rece%!or Bloc2er )ARB+ !"a! "o, "ig" a&&ini!# &or !"e angio!en in II !#%e 8 )AT8+ rece%!or $ "a a long dura!ion o& ac!ion$ and "a !"e longe ! "al&4li&e o& an# ARB' In addi!ion !o -loc2ing !"e Renin4Angio!en in S# !em )RAS+$ !elmi ar!an ac! a a elec!i*e modula!or o& (eroxi ome %roli&era!or4ac!i*a!ed rece%!or gamma )((AR49+$ a cen!ral regula!or o& in ulin and gluco e me!a-oli m' I! i -elie*ed !"a! !elmi ar!an: dual mode o& ac!ion ma# %ro*ide %ro!ec!i*e -ene&i! again ! !"e *a cular and renal damage cau ed -# dia-e!e and cardio*a cular di ea e )CVD+' Telmi ar!an "a -inding a&&ini!# 5;;; !ime grea!er &or AT8 !"an AT3 rece%!or ' Telmi ar!an al o "a !"e longe ! "al& li&e )3<

Trea!men! &or e en!ial "#%er!en ion' Bloc2 *a ocon !ric!ing'

Telmi ar!an: 7eadac"e$ u%%er re %ira!or# !rac! in&ec!ion$ di00ine ' 7#droc"loro!"ia0ide: Anorexia$ ga !ric irri!a!ion$ mu cle %a m$ lee% di !ur-ance '

Moni!or clien! &or "#%o!en ion a&!er !ar!ing drug' (lace clien! u%ine i& "#%o!en ion occur $ and gi*e IV normal aline$ i& needed' For %a!ien! ,"o e renal &unc!ion ma# de%end on !"e ac!i*i!# o& !"e rennin angio!en in aldo !erone # !em ) uc" a !"o e ,i!" e*ere "ear! &ailure+ !rea!men! ,i!" ACE in"i-i!or and angio!en in rece%!or an!agoni ! "a cau ed oliguria or %rogre i*e a0o!emia and acu!e renal &ailure or dea!"'

(regnanc# / lac!a!ion' C"ole !a i / -iliar# o- !ruc!i*e di order ' Se*ere "e%a!ic / renal im%airmen! )CrCl =5; m>1min+' Re&rac!or# "#%o2alemia$ "#%ercalcemia'

Generic Name: E ome%ra0ole Brand Name: Nexium Dug Cla : An!acid $ An!ire&lux Agen! / An!iulceran!

"r + o& all angio!en in II !#%e 8 rece%!or an!agoni ! ' Nexium)e ome%ra0ole+ i a %ro!on %um% in"i-i!or !"a! u%%re e ga !ric acid ecre!ion -# %eci&ic in"i-i!ion o& 7?1@?4 AT(a e in !"e ga !ric %arie!al cell' B# ac!ing %eci&icall# on !"e %ro!on %um%$ Nexium -loc2 !"e &inal !e% in acid %roduc!ion$ !"u reducing ga !ric acidi!#' T"i e&&ec! i do e4rela!ed u% !o a dail# do e o& 3;A<; mg and lead !o in"i-i!ion o& ga !ric acid ecre!ion'

Trea!men! o& GERD a an al!erna!i*e !o oral !"era%# in %a!ien! ,"en oral !"era%# i no! a%%ro%ria!e' S"or! 4 !erm main!enace o& "emo !a i / %re*en!ion o& re-leeding in %a!ien! &ollo,ing !"era%eu!ic endo co%# &or acu!e -leeding o& ga !ric or duodenal ulcer '

7eadac"e$ a-dominal %ain$ con !i%a!ion$ diarr"ea$ &la!ulence$ nau ea$ *omi!ing' InBec!ion i!e reac!ion'

In !ruc! %a!ien! !o !a2e drug exac!l# a %re cri-ed' Tell !"e %a!ien! !o !a2e drug a! lea ! 8 "our -e&ore a meal' Ad*i e %a!ien! !"a! an!acid can -e u ed ,"ile !a2ing drug unle o!"er,i e direc!ed -# %re cri-er'

7#%er en i!i*i!# !o u- !i!u!ed -en0imida0ole ' C"ildren'

Generic Name: 6ar&arin Brand Name : Coumadin, anto!en Drug Cla : An!icoagulan! $ An!i%la!ele! / Fi-rinol#!ic )T"rom-ol#!ic +

An!icoagulan!' "#armaco$og%: Coumadin and o!"er coumarin an!icoagulan! ac! -# in"i-i!ing !"e #n!"e i o& *i!amin @4 de%enden! coagula!ion &ac!or ' T"e re ul!an! in vivo e&&ec! i a eCuen!ial de%re ion o& Fac!or VII$ ID$ D and II ac!i*i!ie ' T"e degree o& de%re ion i de%enden! u%on !"e do age admini !ered' An!icoagulan! "a*e no direc! e&&ec! on an e !a-li "ed !"rom-u $ nor do !"e# re*er e i c"emic !i ue damage' 7o,e*er$ once a !"rom-u "a occurred$ !"e goal o& an!icoagulan! !rea!men! i !o %re*en! &ur!"er ex!en ion o& !"e &ormed clo! and %re*en! econdar# !"rom-oem-olic com%lica!ion ,"ic" ma# re ul! in eriou and %o i-le &a!al eCuelae' "#armaco&inetics: A&!er oral admini !ra!ion o& Coumadin$ a- or%!ion i e en!iall# com%le!e$

(ro%"#laxi / !rea!men! o& *enou !"rom-o i $ a!rial &i-rilla!ion ,1 em-oli0a!ion$ %ulmonar# em-oli m$ adBunc! in %ro%"#laxi o& # !emic em-oli m a&!er MI'

(o!en!ial ad*er e reac!ion !o Coumadin ma# include: 7emorr"age &rom an# !i ue or organ' T"i i a con eCuence o& !"e an!icoagulan! e&&ec!' T"e ign and #m%!om ,ill *ar# according !o !"e loca!ion and degree or ex!en! o& !"e -leeding' 7emorr"agic com%lica!ion ma# %re en! a %aral# i . "eadac"e$ c"e !$ a-domen$ Boin! or o!"er %ain. "or!ne o& -rea!"$ di&&icul! -rea!"ing or ,allo,ing. unex%lained ,elling. or unex%lained "oc2' T"ere&ore$ !"e %o i-ili!# o& "emorr"age "ould -e con idered in e*alua!ing !"e condi!ion o& an# an!icoagula!ed %a!ien! ,i!" com%lain! ,"ic" do no! indica!e an o-*iou diagno i ' Bleeding during an!icoagulan! !"era%# doe no! al,a# correla!e ,i!" %ro!"rom-in ac!i*i!# ) ee Trea!men! under O*erdo age+' Bleeding ,"ic" occur ,"en !"e (T i ,i!"in !"e !"era%eu!ic range ,arran! diagno !ic

U e cau!iou l# ,i!" di*er!i!iculi!i $ coli!i $and mild or modera!e "#%er!en ion$ or mild or modera!e "e%a!ic or renal di ea e. ,i!" drainage !u-e in an# ori&ice. ,i!" regional or lum-ar -oc2 ane !"e ia. or in condi!ion !"a! increa e ri 2 o& "emorr"age. al o u e cau!iou l# in -rea !&eeding ,omen' I'M admini !ra!ion i n:! recommended' Tell %a!ien! !o re%or! ad*er e reac!ion %rom%!l#' Tell !"e %a!ien! !o ea! a dail#$ con i !en! amoun! o& lea&# green *ege!a-le con!aining *i!amin @'

An!icoagula!ion i con!raindica!ed in an# locali0ed or general %"# ical condi!ion or %er onal circum !ance in ,"ic" !"e "a0ard o& "emorr"age mig"! -e grea!er !"an i! %o!en!ial clinical -ene&i! eg: (regnanc#: 6omen ,"o are or ma# -ecome %regnan! -ecau e !"e drug %a e !"roug" !"e %lacen!al -arrier and ma# cau e &a!al "emorr"age !o !"e &e!u in utero' Fur!"ermore$ !"ere "a*e -een re%or! o& -ir!" mal&orma!ion in c"ildren -orn !o mo!"er ,"o "a*e -een !rea!ed ,i!" ,ar&arin during %regnanc#' Em-r#o%a!"# c"arac!eri0ed -# na al "#%o%la ia ,i!" or ,i!"ou! !i%%led e%i%"# e )c"ondrod# %la ia %unc!a!a+ "a -een re%or!ed in %regnan! ,omen ex%o ed !o ,ar&arin during !"e 8 ! !rime !er' Cen!ral ner*ou # !em a-normali!ie al o

and maximal %la ma concen!ra!ion are reac"ed in 84E "r ' A%%roxima!el# EFG i -ound !o al-umin ,i!"in !"e %la ma' An an!icoagulan! e&&ec! generall# occur ,i!"in 3< "r ' 7o,e*er$ %ea2 an!icoagulan! e&&ec! ma# -e dela#ed F34EH "r and i! dura!ion o& ac!ion ma# %er i ! &or <4I da# $ !"u %roducing a moo!"$ long4la !ing re %on e cur*e' Coumadin i me!a-oli0ed -# "e%a!ic micro omal en0#me !o inac!i*e me!a-oli!e !"a! are excre!ed in!o !"e -ile$ rea- or-ed and excre!ed in!o !"e urine' Coumadin i a %o!en! drug ,i!" a "al&4li&e o& 3J da# . !"ere&ore i! e&&ec! ma# -ecome more %ronounced a dail# main!enance do e o*erla%'

in*e !iga!ion ince i! ma# unma 2 a %re*iou l# un u %ec!ed le ion eg$ !umor$ ulcer$ e!c' Necro i o& 2in and o!"er !i ue ) ee 6arning +' O!"er ad*er e reac!ion are in&reCuen! and con i ! o& alo%ecia$ ur!icaria$ derma!i!i $ &e*er$ nau ea$ diarr"ea$ a-dominal cram%ing$ # !emic c"ole !erol microem-oli0a!ion$ %ur%le !oe #ndrome$ c"ole !a!ic "e%a!ic inBur# and "#%er en i!i*i!# reac!ion ' (ria%i m "a -een a ocia!ed ,i!" an!icoagulan! admini !ra!ion. "o,e*er$ a cau al rela!ion "i% "a no! -een e !a-li "ed'

"a*e -een re%or!ed$ including dor al midline d# %la ia c"arac!eri0ed -# agene i o& !"e cor%u callo um$ Dand#4 6al2er mal&orma!ion$ and midline cere-ellar a!ro%"#' Ven!ral midline d# %la ia$ c"arac!eri0ed -# o%!ic a!ro%"#$ and e#e a-normali!ie "a*e -een o- er*ed' Men!al re!arda!ion$ -lindne $ and o!"er cen!ral ner*ou # !em a-normali!ie "a*e -een re%or!ed in a ocia!ion ,i!" 3nd and 5rd !rime !er ex%o ure' Al!"oug" rare$ !era!ogenic re%or! &ollo,ing in utero ex%o ure !o ,ar&arin include urinar# !rac! anomalie eg$ ingle 2idne#$ a %lenia$ anence%"al#$ %ina -i&ida$ cranial ner*e %al #$ "#droce%"alu $ cardiac de&ec! and congeni!al "ear! di ea e$ %ol#dac!#l#$ de&ormi!ie o& !oe $ dia%"ragma!ic "ernia$ and corneal leu2oma' S%on!aneou a-or!ion and !ill-ir!" are

2no,n !o occur and a "ig"er ri 2 o& &e!al mor!ali!# i a ocia!ed ,i!" !"e u e o& ,ar&arin' 6omen o& c"ild-earing %o!en!ial ,"o are candida!e &or an!icoagulan! !"era%# "ould -e care&ull# e*alua!ed and !"e indica!ion cri!icall# re*ie,ed ,i!" !"e %a!ien!' I& !"e %a!ien! -ecome %regnan! ,"ile !a2ing !"i drug$ "e "ould -e a%%ri ed o& !"e %o!en!ial ri 2 !o !"e &e!u $ and !"e %o i-ili!# o& !ermina!ion o& !"e %regnanc# "ould -e di cu ed in lig"! o& !"o e ri 2 ' 7emorr"agic !endencie or -lood d# cra ia ' Recen! or con!em%la!ed urger# o& !"e cen!ral ner*ou # !em$ e#e$ or !rauma!ic urger# re ul!ing in large o%en ur&ace ' Bleeding !endencie a ocia!ed ,i!" ac!i*e ulcera!ion or o*er! -leeding o& !"e ga !roin!e !inal$ geni!ourinar# or

Generic name: (o!a ium C"loride Brand Name: 'a$ium Duru$e Drug Cla : Elec!rol#!e and mineral

Su%%lemen!al %o!a ium in !"e &orm o& "ig" %o!a ium &ood or %o!a ium c"loride ma# -e a-le !o re !ore normal %o!a ium le*el '

For "#%o2alemia A %ro%"#laxi during !rea!men! ,i!" diure!ic To %re*en! and !rea! %o!a ium$ de&ici! econdar# !o diure!ic or cor!ico !eroid !"era%#' Al o indica!ed ,"en %o!a ium$

renal in u&&icienc# "#%er2alemia nau ea *omi!ing irri!a-ili!# mu cle ,ea2ne di&&icul!# in ,allo,ing

Some %a!ien! &ind i! di&&icul! !o ,allo, !"e large i0ed @Cl !a-le!' Admini !er ,"ile %a!ien! i i!!ing u% or !anding )ne*er in recum-en! %o i!ion+ !o %re*en! drug4

re %ira!or# !rac! . cere-ro*a cular "emorr"age. aneur# m 4cere-ral$ di ec!ing aor!a. %ericardi!i $ %ericardial e&&u ion and -ac!erial endocardi!i ' T"rea!ened a-or!ion$ eclam% ia and %reeclam% ia' InadeCua!e la-ora!or# &acili!ie or un u%er*i ed enili!#$ alco"oli m$ % #c"o i or lac2 o& %a!ien! coo%era!ion' S%inal %unc!ure and o!"er diagno !ic or !"era%eu!ic %rocedure ,i!" %o!en!ial &or uncon!rolla-le -leeding' Mi cellaneou : MaBor regional$ lum-ar -loc2 ane !"e ia and malignan! "#%er!en ion' (Se*ere renal im%airmen! ( e*ere "emol#!ic reac!ion ( acu!e de"#dra!ion ("ea! cram% ("#%er2alemia Cau!iou u e in: (cardiac or renal di ea e. # !ema!ic acido i

i de%le!ed -# e*ere *omi!ing$ %rolonged diure i and dia-e!ic acido i '

Generic Name: S%ironolac!one Brand Name: A$da)ide Drug Cla : Diure!ic $ O!"er An!i"#%er!en i*e

S%ironolac!one %romo!e diure i in %a!ien! ,i!" oedema or a ci!e ' S%ironolac!one ac! in !"e di !al %or!ion o& !"e renal !u-e -# com%e!i!i*e in"i-i!ion o& aldo !erone$ a odium4re!aining$ %o!a ium4excre!ing "ormone' I o-u!#l"#droc"loro!"i a0ide %romo!e odium and ,a!er excre!ion -# in"i-i!ing odium and c"loride rea- or%!ion in !"e 2idne# !u-ule' T"e com-ina!ion o& %ironolac!one and i o-u!#l"#droc"loro!"i a0ide %ro*ide an e&&ec!i*e !rea!men! &or man# %a!ien! ,"o ,ould no! re %ond !o ei!"er drug alone' T"e

E en!ial "#%er!en ion$ oedema and a ci!e o& conge !i*e "ear! &ailure$ cirr"o i o& !"e li*er$ !"e ne%"ro!ic #ndrome$ idio%a!"ic oedema'

Gastro-intestinal disorders: a-dominal %ain$ *omi!ing$ nau ea$ diarr"oea$ ga !ro4 in!e !inal di !ur-ance' Body as a whole: a !"enia$ &e*er$ ana%"#lac!oid reac!ion$ malai e' Skin and appendages: ra "$ %ruri!i $ derma!i!i $ %"o!o en i!i*i!#' Nervous system disorders: di00ine $ "eadac"e$ %arae !"e ia' Psychiatric disorders: im%o!ence' Neoplasm: -rea ! neo%la m$ including malignanc#' Metabolic and nutritional disorders: elec!rol#!e di !ur-ance ' Reproductive disorders: -rea ! di order $ men !rual di order '

induced e o%"agu ' Follo, in !ruc!ion regarding dilu!ion' Color in ome commercial oral olu!ion &ade ,i!" ex%o ure !o lig"! -u! drug e&&ec!i*ene i re%or!edl# no! al!ered' Educa!e !o a*oid "a0ardou ac!i*i!# uc" dri*ing un!l re %on e !o drug i 2no,n' Ta2e ,i!" meal . a*oid exce i*e inge !ion o& &ood "ig" in %o!a ium or u e o& al! u- !i!u!e ' Diure!ic e&&ec! ma# -e dela#ed 345 da# and maximum "#%er!en i*e ma# -e dela#ed 345,ee2 . moni!or I and O ra!io and dail# ,eig"!$ B($ erum

Acu!e renal in u&&icienc#$ igni&ican! im%airmen! o& renal &unc!ion$ anuria$ "#%er2alemia or en i!i*i!# !o %ironolac!one$ !"ia0ide diure!ic or !o o!"er ul&onamide4 deri*ed drug ' ul&onamide4 deri*ed medicine '

com-ina!ion re ul! in an addi!i*e diure!ic e&&ec! ince -o!" drug ,ill increa e odium and ,a!er excre!ion -# ac!ing in di&&eren! %ar! o& !"e renal !u-ule'

aematological disorders: !"rom-oc#!o%enia

elec!rol#!e )@$ Na+ and renal &unc!ion'

Generic name: Ci!icoline Brand name: *%na+se Drug Cla : Neuro%ro!ec!i*e$ CNS Drug / Agen! &or AD7D

Neuro*a cular en"ancer' "#armaco$og%: (irace!am ac! elec!i*el# u%on !"e !elence%"alon -# im%ro*ing i! a ocia!i*e &unc!ion' I! increa e !"e energ# ou!%u! o& !"e -rain cell and ac!i*a!e i! neuro%"# iological %o!en!iali!ie $ e %eciall# in de&ici! condi!ion ' Noo!ro%il i *ir!uall# non!oxic and "a no !imula!ing$ eda!i*e or neuro*ege!a!i*e ac!i*i!ie ' "#armaco$og%: (irace!am ac! elec!i*el# u%on !"e !elence%"alon -# im%ro*ing i! a ocia!i*e &unc!ion' I! increa e !"e energ# ou!%u! o& !"e -rain cell and ac!i*a!e i!

Trea!men! o& cere-ro*a cular acciden! in acu!e and reco*er# %"a e$ #m%!om and ign o& cere-ral in u&&icienc# eg$ di00ine $ memor# lo $ %oor concen!ra!ion$ di orien!a!ion$ recen! cranial !rauma and !"eir eCuelae'

Ga !roin!e !inal di order ' Allergic reac!ion: I!c"ing or "i*e $ ,elling in #our &ace or "and $ ,elling or !ingling in #our mou!" or !"roa!$ c"e ! !ig"!ne $ !rou-le -rea!"ing$ or ra "$ >o, -lood %re ure )&ain!ne $ di00ine +$ Slo, or &a ! "ear! -ea!$ 7eadac"e$ Nau ea$ *omi!ing$ or diarr"ea )loo e BM +

Veri&# !"e doc!or: order' A e allerg# !o ,ar&arin' Do no! u e rug i& !"e %!ien! i %regnan! )u e con!race%!i*e +' Moni!or clo el# (T ra!io and INR' Admini !er !"e drug in IV &orm i& !"e clien! can no! !a2e i! orall#' Documen! !"e %rocedure'

(a!ien! ,i!" %ara #m%a!"e!ic "#%er!onia'

Generic Name: (irace!am Brand Names: Nootro+i$ Drug Cla Noo!ro%ic / Neuro!onic

Trea!men! o& %o ! !ro2e eCuelae ie a%"a ia$ cor!ical m#oclonu $ alone or in com-ina!ion$ *er!igo / a ocia!ed di order o& -alance$ ,1 !"e exce%!ion o& di00ine o&

7#%er2ine ia$ ,! gain$ a !"enia$ ner*ou ne $ omnolence$ de%re ion$ *er!igo$u%%er a-dominal %ain$diarr"ea$nau ea$ *omi!ing$ ana%"#lac!oid reac!ion$ a!axia$ im%aired -alance$ aggra*a!ed e%ile% #$ "eadac"e$

"rior to: 6a " "and !"oroug"l#' A 2 !"e %a!ien! name Al,a# o- er*e a e%!ic !ec"niCue During:

Cerebral hemorrhage, end stage renal disease, Huntington's chorea. Pregnancy & lactation.

neuro%"# iological %o!en!iali!ie $ e %eciall# in de&ici! condi!ion ' Noo!ro%il i *ir!uall# non!oxic and "a no !imula!ing$ eda!i*e or neuro*ege!a!i*e ac!i*i!ie '

*a omo!or or % #c"ic origin' S#m%!oma!ic !rea!men! o& !"e % #c"o4organic #ndrome ,"o e &ea!ure are memor# lo $ a!!en!ion di order / lac2 o& dri*e' (ed !rea!men! &or d# lexia in com-ina!ion ,1 a%%ro%ria!e mea ure eg %eec" !"era%#'

in omnia$ u-cu!aneou di order '

2in

/ !i ue

Ex%lain !"e %rocedure !o !"e %a!ien!1SO' Ex%lain ,"a! i !"e general ac!ion o& !"e drug !o !"e -od#' A,ter: Record !"e drug a&!er i! admini !ra!ion )c"ar!ing+' O- er*e !"e %a!ien! &or %o i-le un!o,ard reac!ion' In !ruc! !o !a2e !"e medica!ion exac!l# a direc!ed' A e %a!ien! &or ign o& -leeding and "emorr"age )-leeding gum . no e-leed. unu ual -rui ing. -lac2$ !arr# !ool . "ema!uria. &all in "ema!ocri! or -lood %re ure. guaiac4%o i!i*e !ool +' No!i&# %"# ician i& !"e e occur'

Generic Name: Su$odexide Brand Name: Ve el Due F Drug Cla : An!icoagulan! $ An!i%la!ele! / Fi-rinol#!ic )T"rom-ol#!ic + See a*aila-le -rand o& ulodexide

Sulodexide i a "e%arinoid con i !ing o& K;G &a ! mo*ing "e%arin and 3;G derma!an ul&a!e' I! i "#%oli%idaemic and an!i!"rom-o!ic and "a -een admini !ered -# mou!" and %aren!erall# &or %eri%"eral *a cular di ea e and cere-ro*a cular di ea e' I! i al o included in !o%ical %re%ara!ion &or local *a cular in&lamma!ion and o&! !i ue

An!i!"romo!ic'

Oral: Nau ea$ *omi!ing$ e%iga !ric %ain' (aren!eral: (ain$ -urning and "aema!oma a! inBec!ion i!e'

Hypersensitivity to sulodexide, heparin, and heparin-like products. Diathesis, haemorrhagic conditions. Pregnancy.

di order ' Sulodexide di&&er &rom "e%arin -# "a*ing a longer "al&4 li&e and a decrea ed e&&ec! on # !emic clo!!ing and -leeding' A admin o& "e%arin and lo, molecular ,! "e%arin re ul! in a relea e o& li%o%ro!ein li%a e$ !"e ac!i*i!# o& ulodexide i ex%re ed a >i%o%ro!ein li%a e Relea ing Uni! )>SU+' 8 mg o& ulodexide i eCui*alen! !o 8; >SU'

Generic Name: Mannito$ Brand name: O mi!rol$ Re c!i ol Drug C$ass : Diuretics, Misce$$aneous

Manni!ol increa e urinar# ou!%u! -# in"i-i!ing !u-ular rea- or%!ion o& ,a!er and elec!rol#!e ' I! rai e !"e o mo!ic %re ure o& !"e %la ma allo,ing ,a!er !o -e dra,n ou! o& -od# !i ue ' Onset: Diure i : 845 "r' Reduc!ion in in!racere-ral %re ure: around 8I min' Duration: Reduc!ion in in!racere-ral %re ure: 8'I4H "r' A-sor+tion: Small amoun! are a- or-ed &rom !"e GI !rac!'

(romo!ion o& diure i in !"e %re*en!ion or !rea!men! o& !"e oliguric %"a e o& acu!e renal &ailure -e&ore irre*er i-le renal &ailure -ecome e !a-li "ed' Reduc!ion o& in!racranial %re ure and -rain ma ' Reduc!ion o& "ig" in!raocular %re ure ,"en !"e %re ure canno! -e lo,ered -# o!"er mean ' (romo!ion o& urinar# excre!ion o& !oxic

Fluid and elec!rol#!e im-alance. acido i ),i!" "ig" do e +' Nau ea$ *omi!ing$ !"ir !. "eadac"e$ di00ine $ con*ul ion $ c"ill $ &e*er. !ac"#cardia$ c"e ! %ain. -lurred *i ion. ur!icaria and "#%o!en ion or "#%er!en ion. acu!e renal &ailure. 2in necro i . !"rom-o%"loe-i!i '

Moni!or %a!ien! &or "#%er en i!i*i!# reac!ion )c"ill $ &e*er$ ur!icaria+' Re%or! ign !o %"# ician' Moni!or %la!ele! coun! e*er# 345 da# !"roug"ou! !"era%#' Ma# cau e mild !"rom-oc#!o%e nia$ ,"ic" a%%ear on !"e <!" da# and re ol*e de %i!e con!inued "e%arin !"era%#' T"e cardio*a cular !a!u o& !"e %a!ien! "ould -e care&ull# e*alua!ed -e&ore ra%idl# admini !ering manni!ol ince udden ex%an ion o& !"e ex!racellular &luid ma# lead !o &ulmina!ing conge !i*e "ear! &ailure' S"i&! o& odium4&ree in!racellular &luid in!o !"e

(ulmonar# conge !ion or oedema. in!racranial -leeding. C7F. me!a-olic oedema ,i!" a-normal ca%illar# &ragili!#. anuria due !o e*ere renal di ea e. e*ere de"#dra!ion'

Distri-ution: Concen!ra!ed in ex!racellular com%ar!men! ' I! doe no! %ene!ra!e !"e -lood4-rain -arrier nor !"e e#e' Meta-o$ism: Minimal "e%a!ic me!a-oli m$ con*er!ed !o gl#cogen' Excretion: Urine *ia !"e 2idne# )unc"anged drug+'

ma!erial ' Edema

ex!racellular com%ar!men! &ollo,ing manni!ol in&u ion ma# lo,er erum odium concen!ra!ion and aggra*a!e %re4exi !ing "#%ona!remia' B# u !aining diure i $ manni!ol admini !ra!ion ma# o- cure and in!en i&# inadeCua!e "#dra!ion or "#%o*olemia' Elec!rol#!e4&ree manni!ol olu!ion "ould no! -e gi*en conBoin!l# ,i!" -lood' I& i! i e en!ial !"a! -lood -e gi*en imul!aneou l#$ a! lea ! 3; mEC o& odium c"loride "ould -e added !o eac" li!er o& manni!ol olu!ion !o a*oid % eudoagglu!in a!ion' 6"en ex%o ed

!o lo, !em%era!ure $ olu!ion o& manni!ol ma# cr# !ali0e' I& cr# !al are o- er*ed$ !"e con!ainer "ould -e ,armed !o redi ol*e$ !"en cooled !o -od# !em%era!ure -e&ore admini !ering' See NOTE under #o. su++$ied' 6"en in&u ing 3;G or 3IG manni!ol concen!ra!ion $ !"e admini !ra!ion e! "ould include a &il!er' Do no! in&u e manni!ol olu!ion i& cr# !al are %re en!' Do no! admini !er unle olu!ion i clear and con!ainer i undamaged' Di card unu ed %or!ion' Do no! admini !er Manni!ol 3IG

i& !"e Fli%!o% *ial eal i no! in!ac!' Generic Name: Car*edilol Brand Name: Di$atrend Drug Cla : An!i"#%er!en i*e Decrea ed "ear! ra!e and %ul e %re ure' Fa!igue Di00ine Brad#cardia C7F (ulmonar# edema 7#%o!en ion Con !i%a!ion Im%o!ence Moni!or B( and %ul e %rior and !"roug"ou! !"era%#' Ta2e a%ical %ul e$ i& le !"an I; -%m$ ,i!""old medica!ion and no!i&# %"# ician' Ad*i e %a!ien! &or %ro%er die!$ regular exerci e$ and li&e !#le modi&ica!ion' Dia-e!ic "ould clo el# moni!or -lood ugar' A e men! / Drug E&&ec! A e %a!ien! ,"o de*elo% e*ere diarr"ea and *omi!ing &or de"#dra!ion and elec!rol#!e im-alance' >a- !e ! : 6i!" long4!erm !"era%# )no! recommended+ Di ea e !"a! con !ric! !"e re %ira!or# !rac! )-ronc"ial a !"ma$ c"ronic -ronc"i!i $ %ulmonar# em%"# ema+$ allergic r"ini!i $ ,elling o& !"e lar#ngeal muco a$ inu node #ndrome$ SA -loc2$ 3nd / 5rd degree AV -loc2$ !oo lo, "ear! ra!e$ "oc2$ MI ,1 com%lica!ion $ e*ere li*er d# &unc!ion$ me!a-olic acido i $ or imul!aneou MAOI !"era%#'

E en!ial "#%er!en ion. C7F'

Generic name: Me&enamic acid Brand Name: "onstan Drug Cla : An!i4%#re!ic or an!i4 %#re!ic and an!i4in&lamma!or# analge ic

(on !an "a analge ic$ an!i4in&lamma!or# and an!i4%#re!ic %ro%er!ie ' T"e %"armacological ac!i*i!# o& (on !an ma# -e due in %ar! !o i! a-ili!# !o in"i-i! !"e #n!"e i o& %ro !aglandin ' (on !an al o in"i-i! !"e ac!ion o& exogenou %ro !aglandin on u!erine mu cle$ u!erine

Relie& o& %ain including mu cular$ r"euma!ic$ !rauma!ic$ den!al$ %o !4o% / %o !%ar!um %ain$ "eadac"e / in c"ildn ,1 &e*er / Bu*enile RA' Al o &or !"e relie& o& %rimar# d# menorr"ea'

Di !ur-ance o& !"e gu! uc" a indige !ion$ diarr"oea$ con !i%a!ion$ nau ea$ *omi!ing or a-dominal %ain 7eadac"e Di00ine Dro, ine S2in ra "e Vi ual di !ur-ance Re!en!ion o& ,a!er

lceration in the upper or lo!er intestinal tract. Children "#$ yr. Pregnancy.

!u-e con!rac!ion and o*arian c#clic AM( and %roge !erone &orma!ion in animal model ' ("armaco2ine!ic and Me!a-oli m: Me&enamic acid i ,ell a- or-ed &rom !"e ga !ro4in!e !inal !rac!' (ea2 %la ma concen!ra!ion occur in a-ou! 3 !o < "our $ ,i!" a "al&4li&e o& 3 !o < "our ' (la ma le*el are %ro%or!ional !o do e$ &ollo,ing mul!i%le do e $ ,i!" no drug accumula!ion' Me&enamic acid i ex!en i*el# -ound !o %la ma %ro!ein ' O*er I;G o& !"e do e ma# -e reco*ered in !"e urine a unc"anged drug or conBuga!ed me!a-oli!e '

in !"e -od# !i ue )&luid re!en!ion+$ re ul!ing in ,elling )oedema+ A,arene o& #our "ear!-ea! )%al%i!a!ion + Ulcera!ion o& !"e !omac" or in!e !ine Bleeding &rom !"e !omac" or in!e !ine In&lamma!ion o& !"e %ancrea )%ancrea!i!i + Allergic reac!ion uc" a e*ere 2in ra "e $ ,elling o& !"e li% $ !ongue and !"roa! )angioedema+ or narro,ing o& !"e air,a# )-ronc"o %a m+ @idne#$ li*er or -lood di order

o-!ain %eriodic com%le!e -lood coun! $ 7c! and 7g-$ and 2idne# &unc!ion !e ! ' (a!ien! / Famil# Educa!ion Di con!inue drug %rom%!l# i& diarr"ea$ dar2 !ool $ "ema!eme i $ ecc"#mo e $ e%i !axi $ or ra " occur and do no! u e again' Con!ac! %"# ician' No!i&# %"# ician i& %er i !en! GI di com&or!$ ore !"roa!$ &e*er$ or malai e occur' Do no! dri*e or engage in %o!en!iall# "a0ardou ac!i*i!ie un!il re %on e !o drug i 2no,n' I! ma# cau e di00ine and dro, ine ' Moni!or -lood gluco e &or lo o& gl#cemic con!rol i& dia-e!ic'

 Do no! -rea ! &eed ,"ile !a2ing !"i drug ,i!"ou! con ul!ing %"# ician' Generic Name: /urosemide Brand Name: >a ix Drug C$ass : Diuretics See a!ai$a-$e -rands o, ,urosemide Furo emide in"i-i! rea- or%!ion o& Na and c"loride mainl# in !"e medullar# %or!ion o& !"e a cending >oo% o& 7enle' Excre!ion o& %o!a ium and ammonia i al o increa ed ,"ile uric acid excre!ion i reduced' I! increa e %la ma4renin le*el and econdar# "#%eraldo !eroni m ma# re ul!' Furo emide reduce B( in "#%er!en i*e a ,ell a in normo!en i*e ' I! al o reduce %ulmonar# oedema -e&ore diure i "a e! in' A-sor+tion: Fairl# ra%idl# a- or-ed &rom !"e GI !rac! )oral+' Distri-ution: Cro e !"e %lacen!a and en!er -rea ! mil2' (ro!ein4 -inding: EEG' Excretion: Via urine )a unc"anged+. 3 "r )elimina!ion "al&4li&e+$ ma# -e %rolonged in Oral$ IV: Edema a ocia!ed ,i!" C7F$ cirr"o i $ renal di ea e IV: Acu!e %ulmonar# edema Oral: 7#%er!en ion Fluid and elec!rol#!e im-alance' Ra "e $ %"o!o en i!i*i!#$ nau ea$ diarr"oea$ -lurred *i ion$ di00ine $ "eadac"e$ "#%o!en ion' Bone marro, de%re ion )rare+$ "e%a!ic d# &unc!ion' 7#%ergl#caemia$ gl#co uria$ o!o!oxici!#' "otentia$$% /ata$: Rarel#$ udden dea!" and cardiac arre !' 7#%o2alaemia and magne ium de%le!ion can cau e cardiac arr"#!"mia ' Admini !er ,i!" &ood or mil2 !o %re*en! GI u% e!' Reduce do age i& gi*en ,i!" o!"er an!i"#%er!en i* e . readBu ! do age graduall# a B( re %ond ' Gi*e earl# in !"e da# o !"a! increa ed urina!ion ,ill no! di !urlee%' A*oid IV u e i& oral u e i a! all %o i-le' Se*ere odium and ,a!er de%le!ion$ "#%er en i!i*i!# !o ul%"onamide and &uro emide$ "#%o2alaemia$ "#%ona!raemia$ %recoma!o e !a!e a ocia!ed ,i!" li*er cirr"o i $ anuria or renal &ailure' Addi onL di ea e'

Generic Name: (arace!amol 0rand Name: Ae&ni$ Drug Cla : Analge ic )Non4 O%ioid+ / An!i%#re!ic

neona!e and renal and "e%a!ic im%airmen!' An!i%#re!ic$ analge ic' "#armaco$og%: (arace!amol %roduce analge ia -# rai ing !"e !"re "old o& !"e %ain cen!er in !"e -rain and -# o- !ruc!ing im%ul e a! !"e %ain4 media!ing c"emorece%!or ' T"e drug %roduce an!i%#re i -# an ac!ion on !"e "#%o!"alamu . "ea! di i%a!ion i increa ed a a re ul! o& *a odila!ion and increa ed %eri%"eral -lood &lo,' "#armaco&inetics: (arace!amol i ra%idl# and almo ! com%le!el# a- or-ed &rom !"e ga !roin!e !inal !rac!' Follo,ing oral admini !ra!ion$ %ea2 %la ma le*el are a!!ained in 8; min !o 8 "r and !"e "al&4li&e i FI min !o 5 "r ' Di !ri-u!ion o& %arace!amol !o mo ! -od# !i ue and &luid i -o!" ra%id and uni&orm' (arace!amol i excre!ed in !"e urine %rimaril# a !"e

(#rexia o& un2no,n origin' Fe*er / %ain a ocia!ed ,1 common c"ild"ood di order $ !on illi!i $ u%%er re % !rac! in&ec!ion %o !4 immuni0a!ion reac!ion $ a&!er !on illec!om# / o!"er condi!ion ' (re*en!ion o& &e-rile con*ul ion' 7eadac"e$ cold$ inu i!i $ mu cle %ain$ ar!"ri!i / !oo!"ac"e'

(arace!amol "a rarel# -een &ound !o %roduce an# ad*er e e&&ec! in !"era%eu!ic do e and i u uall# ,ell !olera!ed -# a %irin4 en i!i*e %a!ien! ' Toxici!# ma# re ul! &rom a ingle !oxic do e o& !"e drug or &rom c"ronic inge !ion' T"e &ollo,ing ad*er e reac!ion "a*e -een re%or!ed: S2in eru%!ion$ "ema!ological !oxici!# eg$ !"rom-oc#!o%enia and leuco%enia$ me!"emoglo-inaemia ,"ic" can re ul! in c#ano i $ and on long4 !erm u e$ renal damage can re ul!'

In !ruc! !"e %a!ien! !o !a2e ,i!" meal ' 7a*e %len!# o& ,a!er ,"en !a2ing !"i drug'

Ne%"ro%a!"#'

glucuronide and maller amoun! a !"e ul&a!e$ merca%!ura!e and unc"anged drug' A%%roxima!el# KIG o& a do e o& %arace!amol i excre!ed in !"e urine ,i!"in 3< "r a&!er admini !ra!ion' Generic Name: NA>BU(7INE 7MDROC7>ORIDE 0rand Name: Nu-ain C$ass : Anaest#etics 1 Loca$ 2 Genera$, Ana$gesics 3O+ioid4 "#armaco$og%: Nal-u%"ine 7Cl i a %o!en! analge ic$ 8; mg o& ,"ic" i com%ara-le in analge ic %o!enc# !o K4 8; mg o& mor%"ine ul&a!e$ ,"e!"er admini !ered IV$ SC or IM' T"e on e! o& ac!ion occur ,i!"in 345 min a&!er IV admini !ra!ion o& nal-u%"ine 7Cl and in =8; min &ollo,ing SC or IM inBec!ion' Clinical ex%erience ugge ! !"a! in ome %a!ien! $ analge ia ma# -e longer la !ing !"an &rom com%ara-le do e o& mor%"ine$ e&&ec! "a*ing -een o- er*ed in acu!e and c"ronic %ain &or 54K "r ' T"e !J o& nal-u%"ine i I "r ' Nal-u%"ine 7Cl "a !"e e&&ec! o& lo,ering !"e cardiac ,or2 load Seda!ion' In&reCuen!l# ,ea!ing$ GI u% e! $ *er!igo$ di00ine . dr# mou!". "eadac"e$ allergic reac!ion ' No!e general clien! condi!ion' Documen! indica!ion &or !"era%#$ !#%e1 on e! o& #m%!om / an!ici%a!ed' Moni!or V1S / I/O'

Relie& o& modera!e !o e*ere %ain' (re4o% analge ia$ a a u%%lemen! !o -alanced ane !"$ urgical ane !"$ &or o- !e! analge ia during la-or / relie& o& %ain &ollo,ing MI' (o !4o% oma!ic / *i ceral %ain'

Patients !ho are hypersensitive to nalbuphine HCl.

and can -e u ed immedia!el# in m#ocardial in&arc!ion )u e ,i!" cau!ion ,"ere eme i i in*ol*ed+' 7emod#namic !udie in %a!ien! ,i!" e*ere ar!erio clero!ic "ear! c"ange re*eal !"a! nal-u%"ine 7Cl "a circula!or# e&&ec! imilar !o !"o e o& mor%"ine ie$ a minimal decrea e in ox#gen con um%!ion$ cardiac index$ le&! *en!ricular end dia !olic %re ure and cardiac ,or2' Nal-u%"ine 7Cl an!agoni ! ac!i*i!# i N a %o!en! a nalor%"ine and a%%roxima!el# 81<; !"a! o& naloxone' Generic Name: Ci$osta)o$ Brand Name: (le!al Drug C$ass : Anticoagu$ants, Anti+$ate$ets 2 /i-rino$%tics 3T#rom-o$%tics4 Cilo !a0ol i a re*er i-le$ elec!i*e in"i-i!or o& %"o %"odie !era e4III )(DE4III+$ !"ere-# u%%re ing c#clic adeno ine mono%"o %"a!e )cAM(+ degrada!ion' Increa e in cAM( in %la!ele! and -lood *e el lead !o in"i-i!ion o& %la!ele! aggrega!ion and *a odila!ion' (eri%"eral *a cular di ea e 7eadac"e$ di00ine $ %al%i!a!ion $ diarr"oea$ a-normal !ool . %ain$ in&ec!ion. %eri%"eral oedema$ nau ea$ *omi!ing$ o!"er cardiac arr"#!"mia $ c"e ! %ain$ r"ini!i $ %"ar#ngi!i $ ecc"#mo i and 2in ra "' Be&ore: Do no! ex%o e %remixed ingle4do e %roduc! !o exce i*e "ea!. !ore a! 8I45; C' >i ! drug %re cri-ed !o en ure none in!erac! un&a*ora-l#' A e loca!ion$ c"arac!eri !ic $

Heart %ailure& kno!n predisposition to bleeding& history o% ventricular arrhythmias& '( interval prolongation& severe renal impairment& moderate to severe hepatic impairment.

Cilo !a0ol al o in"i-i! adeno ine u%!a2e in!o cell $ ,"ic" augmen! !"e cAM(4ele*a!ing e&&ec! o& (DE4III in"i-i!ion' A-sor+tion: A- or-ed &rom !"e GI !rac! a&!er oral admin' Distri-ution: EI4EKG -ound !o %la ma %ro!ein ' Meta-o$ism: Ex!en i*el# me!a-oli ed "e%a!icall# -# CM(<I; i oen0#me $ mainl# CM(5A<' Excretion: Mainl# excre!ed in !"e urine$ remainder excre!ed in !"e &aece

Generic Name: "otassium C#$oride Brand Name: @4Dur$ @4>or$ @4Ta-$ @aon C>$ @lor*e $ Slo,4@$ Ten4@$ @lo!rix$ @4 >#!e C> Drug C$ass : E$ectro$%tes

(o!a ium c"loride i a maBor ca!ion o& !"e in!racellular &luid' I! %la# an ac!i*e role in !"e conduc!ion o& ner*e im%ul e in !"e "ear!$ -rain and 2ele!al mu cle. con!rac!ion o& cardiac

(re*en!ion o& "#%o2alaemia

GI ulcera!ion ) ome!ime ,i!" "aemorr"age and %er&ora!ion or ,i!" la!e &orma!ion o& !ric!ure + &ollo,ing !"e u e o& en!eric4coa!ed @ c"loride %re%ara!ion. "#%er2alaemia' Oral: Nau ea$ *omi!ing$

ex!en! o& a-dominal %ain. no!e -lood in eme i $ !ool1 ga !ric a %ira!e' During: Admini !er (O medica!ion ,i!" meal / ,i!" a nac2 a! -ed!ime' In renal d# &unc!ion$ a do e o& 5;; mg (O1 IV g 83 "r' ma# -e nece ar#' For IM u e$ gi*e undilu!ed' A&!er: No!e general clien! condi!ion' Documen! indica!ion &or !"era%#$ !#%e1 on e! o& #m%!om / an!ici%a!ed' Moni!or V1S / I/O' Moni!or %la ma %o!a ium le*el Moni!oring o& acid4-a e -alance$ %o!a ium le*el $ and ECG

7#%erc"loraemia$ e*ere renal or adrenal in u&&icienc#'

2ele!al and moo!" mu cle . main!enance o& normal renal &unc!ion$ acid4-a e -alance$ car-o"#dra!e me!a-oli m and ga !ric ecre!ion' A-sor+tion: 6ell a- or-ed &rom !"e u%%er GI !rac!' Distri-ution: Ac!i*e !ran %or! mec"ani m allo, @ c"loride !o en!er cell &rom !"e ex!racellular &luid' Excretion: Mainl# *ia !"e urine ,i!" mall amoun! *ia !"e ,ea! and &ece '

diarr"oea and a-dominal cram% ' IV: (ain or %"loe-i!i . cardiac !oxici!#'

i recommended'