ISMN

DRUG ORDER MECHANISM OFACTION

ISOSORBIDE MONONITRATE (ISMN)
ANTI-ANGINAL DRUGS
DOSAGE: tab ROUTE: POFREQUENCY: OD
Nitrates are drugs that act directly on the smooth muscleto cause relaxation and todepress muscle
tone.

Prevention and treatment of Angina Pectoris in Adults

The presence of any allergiesto nitrates. These drugs arealso contraindicated in the following
conditions: Severeanemia, head trauma orhemorrhage, pregnancy andlactation.

(CNS) Headache, dizziness,and myasthenia. (GI) N & Vand incontinence. ( CV) Hypotension. (SKIN)
Flushintg pallor sweating and increasedperspiration

Instruct patient to takemedication asdirected, even if feeling better. Takemissed doses as soonas
remembered; dosesof isosorbide dinitrateshould be taken at least 2 hr apart (6 hrwith extended-
releasepreparations); dailydoses of isosorbidemononitrate should betaken 7 hr apart. Donot double
doses. Donot discontinueabruptlyCaution patient tomake positionchanges slowly tominimize
orthostatichypotension

Isosorbide mononitrate is a drug used principally in the treatment of angina pectoris and acts by dilating the
blood vessels so as to reduce the blood pressure. It is sold by AstraZeneca under the trade name Imdur.

Isosorbide mononitrate is used to for the the prophylactic treatment of angina pectoris; that is, it is taken in
order to prevent or at least reduce the occurrence of angina. Research on Isosorbide mononitrate as a cervical
ripener to reduce time at hospital to birth is supportive.

Isosorbide mononitrate is an active metabolite of isosorbide dinitrate and exerts qualitatively similar effects.
Isosorbide mononitrate reduces the workload of the heart by producing venous and arterial dilation. By
reducing the end diastolic pressure and volume, isosorbide mononitrate lowers intramural pressure, hence
leading to an improvement in the subendocardial blood flow. The net effect when administering isosorbide
mononitrate is therefore a reduced workload for the heart and an improvement in the oxygen supply/demand
balance of the myocardium.

The adverse reactions which follow have been reported in studies with isosorbide mononitrate: Very common.
Headache predominates (up to 30%) necessitating withdrawal of 2 to 3 % of patients, but the incidence
reduces rapidly as treatment continues . Common. Tiredness, sleep disturbances (6%) and gastrointestinal
disturbances (6%) have been reported during clinical trials with isosorbide mononitrate modified release
tablets, but at a frequency no greater than for placebo. Hypotension (4 to 5%), poor appetite (2.5%), nausea
(1%). Adverse effects associated with the clinical use of the drug are as expected with all nitrate preparations.
They occur mainly in the early stages of treatment. Hypotension (4%) with symptoms such as dizziness and
nausea (1%) have been reported. These symptoms generally disappear during long-term treatment. Other
reactions that have been reported with isosorbide mononitrate modified release tablets include tachycardia,
vomiting, diarrhoea, vertigo and heartburn
Calcium Carbonate
(1 tab tid)
Classification: Electrolyte replacement or
supplements. Antacid
Desired Dosage: 500 mg (200 mg Ca), 600
mg
(240 mgCa), 650 mg (260 mg Ca), 667 mg (266.8 mg Ca), 1 g (400 mg Ca), 1.25 mg (500 mg
Ca), 1.5 mg (600 mg Ca)
Mode of Action: Essential for nervous, muscular, and skeletal systems. Maintain cell membrane
and capillary permeability. Act as an activator in the transmission of nerve impulses and
contraction of cardiac,
skeletal and smooth muscles. It is essential for bone formation
and blood coagulation. It is also used a replacement of calcium in deficiency states. It controls
of hyperphosphatemia in end-stage renal disease without promoting aluminum absorption.
Interactions: Hypercalcemia increases the risk of digoxin toxicity. Chronic use with antacids in
renal insufficiency may lead to milk-alkali syndrome. Ingestion by mouth may decrease the
absorption of orally administered tetracyclines, fluoroquinolones, phenytoin, and iron salts.
Excessive amounts may decrease the effects of calcium channel blockers, atenolol. Concurrent
use with diuretics may result in hypercalcemia.
Side Effects:
y
CNS: syncope, tingling
y
CV: cardiac arrest, arrythmias, bradycardia
y
GI: constipation, nausea, vomting
y
GU: calculi, hypercalciuruia
y
Local: phlebitis (IV only)
Nursing Responsibilities:
1. Monitor VS especially BP and PR.
2. Obtain ECG result.
3. Asses for heartburn, indigestion, abdominal pain.
4. Monitor serum calcium before treatment.
5. Assess for nausea and vomiting, anorexia, thirst, severe constipation
Gastric-peptic disease occurs as a result of an imbalance between protective factors, such as mucus, bicarbonate, and
prostaglandin secretion, and aggressive factors, such as hydrochloric acid, pepsin, and Helicobacter pylori (H. pylori).
Antacids work by restoring acid-base balance, attenuating the pepsin activity and increasing bicarbonate and
prostaglandin secretion. The acid-neutralizing capacity of calcium carbonate is 58 mEq/15 ml. When used as a nutritional
supplement, calcium carbonate acts by directly increasing calcium stores within the body.

Mechanism of action

Calcium carbonate is a basic inorganic salt that acts by neutralizing hydrochloric acid in gastric secretions. It also inhibits
the action of pepsin by increasing the pH and via adsorption. Cytoprotective effects may occur through increases in
bicarbonate ion (HCO3-) and prostaglandins. Neutralization of hydrochloric acid results in the formation of calcium
chloride, carbon dioxide and water. Approximately 90% of calcium chloride is converted to insoluble calcium salts (e.g.
calcium carbonate and calcium phosphate).

Calcium carbonate is an inorganic salt used as an antacid. It is a basic compound that acts by neutralizing
hydrochloric acid in gastric secretions. Subsequent increases in pH may inhibit the action of pepsin. An
increase in bicarbonate ions and prostaglandins may also confer cytoprotective effects. Calcium carbonate
may also be used as a nutritional supplement or to treat hypocalcemia.
Generic Name: Amlodopine
Brand Name: Norvasc
Classifications: cardiovascular agent; calcium channel blocker
Pregnancy Category:C
Availability 2.5 mg, 5 mg, 10 mg tablets
Actions
Amlodipine is a calcium channel blocking agent that selectively blocks calcium ion reflux across cell membranes of
cardiac and vascular smooth musclewithout changing serum calcium concentrations. It predominantly acts on the
peripheral circulation, decreasing peripheral vascular resistance, and increases cardiac output.
Therapeutic effects
Amlodipine reduces systolic, diastolic, and mean arterial blood pressure.
Uses
Treatment of mild to moderate hypertension and angina.
Contraindicatons
Hypersensitivity to amlodipine.
Route & Dosage
Hypertension
adult:PO 510 mg once daily
geriatric:start with 2.5 mg, adjust dose at intervals of not less than 2 wk
Renal Impairment
Start with 2.5 mg, adjust dose at intervals of not less than 2 wk
Administration
Oral
Give drug without regard to meals.
Prescribed initial dosages of 2.5 mg daily are common if added to a regimen including other antihypertensive
drugs.Note: Doses are usually titrated over a period of 14 d or more rapidly if warranted.
Store at 1530 C (5986 F).
Adverse effects
CV:Palpitations, flushing tachycardia, peripheral or facial edema, bradycardia, chest pain, syncope, postural hypotension.
CNS:Light-headedness, fatigue, headache.
GI:Abdominal pain, nausea, anorexia, constipation, dyspepsia, dysphagia, diarrhea, flatulence, vomiting.
Urogenital:Sexual dysfunction, frequency, nocturia.
Respiratory:Dyspnea.
Skin:Flushing, rash.
other:Arthralgia, cramps, myalgia.
Nursing Implications
Assessment & Drug Effects
Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are achieved
69 h following oral doses.Monitor for S&S of dose-related peripheral or facial edema that may not be accompanied by
weight gain; rarely, severe edema may cause discontinuation of drug.
Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when additional
antihypertensives or diuretics are added.
Monitor heart rate; dose-related palpitations (more common in women) may occur.
Patient & Family Education
Report significant swelling of face or extremities.
Take care to have support when standing & walking due to possible dose-related light-headedness/dizziness.
Report shortness of breath, palpitations, irregular heartbeat, nausea, or constipation to physician.
Do not breast feed while taking this drug without consulting physician.
Generic
Dosag
Name/
e
Brand Mechanism of Contraindicat
Frequ Indication Adverse Reaction Nursing Consideration
Name Action ion
ency
Classific
Route
ation
Ferrous Sulfate The Patie Adverse Reactions Store all forms at
Generic: is an essential prevention nts receiving of Ferrous Sulfate room temperature.
Ferrous Dose: component in or repeated Give between meals
sulfate 2-3 the formation of treatment blood * Large doses with water but may
mg/kg hemoglobin, of iron transfusions; may aggravate give with meals if
gastrointestinal
Brand myoglobin and deficiency anaemia not peptic ulcer,
discomfort occurs.
Name: Frequ enzymes. It is anemia due to iron regional enteritis,
Transient staining of
Ferrous ency: necessary for due to deficiency. and ulcerative mucous membranes
sulfate Once effective inadequate colitis. and teeth will occur
a day erythropoiesis diet, * Severe Iron with liquid iron
and transport or malabsorpt Poisoning: preparation. To
Route: utilization of ion o Vomiting avoid, place liquid
Classific PO oxygen. pregnancy, o Severe on the back of the
ation: and blood abdominal pain tongue with dropper
loss. o Diarrhea or use straw.
Enzymati o Avoid simultaneous
c mineral Dehydration administration of
antacids or
and Iron o tetracycline.
preparati Hyperventilation Do not crush
on. o Pallor or sustained-release
cyanosis preparations.
o Eggs and milk
Cardiovascular inhibit absorption.
collapse Monitor serum iron,
total iron-binding
capacity,
reticulocyte count,
hemoglobin, and
ferritin.
Monitor daily
pattern of bowel
activity and stool
consistency.
Assess for clinical
improvement, record
of relief of
symptoms (fatigue,
irritability, pallor,
paresthesia, and
headache).
Generic
Name Brand
Name Classification Action Route/
Dosage Indication Contra-indication Adverse
Reactions Nursing Responsibilities

Fluids, Electrolyte,
Blood Products,
And
Hematological
Drugs

Increases plasma bicarbonate, neutralizes gastric acid which forms water, sodium chloride, carbon dioxide, and raises
blood pH.

Oral route/ TID

Treatment of metabolic acidosis, promotion of gastric, systemic and urine alkalinization in the case of intoxication with
weak organic acids.

Hypoventilation, hypocalcemia, increase serum osmolarity, further in all situations where sodium intake must be
restricted like cardiac insufficiency, edema hypertension, eclampsia, severe kidney insufficiency.

Hypernatremia and serum osmolarity, paravenous administrations may lead to tissue necrosis.
Obtain patient history including drug history and any hypersensitivity.
Assess respiratory and pulse rate, rhythm, depth, lung sounds and notify the physician.
Assess for carbon dioxide in GI tract, may lead to perforation if ulcer is severe.
Test and monitor urine pH, urinary output, during beginning treatment.
If patient has edematous tendency, notify physician.
If patient is vomiting withhold medication and immediately inform the physician.
If the patient exhibits shortness of breath and hyperpnea, immediately inform the physician.
Inform physician if relief is not obtained or if the patient demonstrate any symptoms suggest bleeding, such as
black tarry stools or coffee ground emesis.
Caution patient to immediately report to physician if symptoms such as nausea, vomiting and anorexia occurs.
Advise the patient to notify the physician if indigestion is accompanied by chest pain, dyspnea, diarrhea.
Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration,
raises blood pH and reverses the clinical manifestations of acidosis.
Mechanism of action
Sodium bicarbonate is a systemic alkalizer, which increases plasma bicarbonate, buffers excess hydrogen ion
concentration, and raises blood pH, thereby reversing the clinical manifestations of acidosis. It is also a urinary alkalizer,
increasing the excretion of free bicarbonate ions in the urine, thus effectively raising the urinary pH. By maintaining an
alkaline urine, the actual dissolution of uric acid stones may be accomplished. Sodium bicarbonate acts as an antacid and
reacts chemically to neutralize or buffer existing quantities of stomach acid but has no direct effect on its output. This
action results in increased pH value of stomach contents, thus providing relief of hyperacidity symptoms. [PharmGKB]