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Ferrous sulfate

Generic Name: Ferrous sulfate


Brand Name: Feosol

Classification: Iron Preparation


Therapeutic Actions: elevates the serum iron concentration which then helps to
form Hgb or trapped in the reticuloendothelial cells for storage and eventual
conversion to a usable form of iron

Indications:
• Prevention and treatment of iron deficiency
• Dietary supplement of iron
• Unlabeled Use: supplemental use during epoetin therapy to ensure proper
hematologic response to epoetin

CONTRAINDICATIONS
• Hypersensitivity
• Severe hypotension

ADVERSE EFFECT
• CNS: CNS toxicity, acidosis, coma and death with overdose
• GI: GI upset, anorexia, nausea, vomiting, constipation, dark stools, temporary
staining of the teeth(liquid preparations)

DOSAGES:
Adults
• Daily requirements: Men, 8-11 mg/day PO; Women, 8-18 mg/day PO;
pregnant and lactating women, 9-27mg/day PO
• Replacement in deficiency states: 150-300 mg/day (6mg/kg/day) PO for
approximately 6-10 months may be required

AVAILABLE FORMS:
Ferrous sulfate: Capsule: 250 mg, 324 mg; Capsule, Extended Release: 250
mg; Elixir: 220 mg/5 mL; Enteric Coated Tablet: 325 mg; Liquid: 25 mg/mL, 75
mg/0.6 mL, 300 mg/5 mL; Solution: 300 mg/5 mL; Syrup: 90 mg/5 mL; Tablet: 195
mg, 300 mg, 324 mg, 325 mg; Tablet, Extended Release: 250 mg, 525 mgFerrous
sulfate, dried: Capsule, Extended Release: 150 mg, 159 mg; Enteric Coated
Tablet: 200 mg; Tablet:200 mg; Tablet, Extended Release: 152 mg, 159 mg, 160 mg

INTERACTIONS:
Antacids, oral / Iron absorption from GI tract Ascorbic acid / Ascorbic acid, 200 mg
or more, iron absorption Chloramphenicol / Serum iron
levels Cholestyramine / Iron absoprtion from GI tract Cimetidine / Iron
absorption from GI tract Fluoroquinolones / Fluoroquinolone absorption from GI
tract R/T formation of a ferric ion-quinolone complex Levodopa / Levodopa
absorption R/T formation of chelates with iron salts Levothyroxine / Levothyroxine
efficacy Methyldopa / Methyldopa absorption from GI tractPancreatic extracts /
Iron absorption from GI tract Penicillamine / Penicillamine absorption from GI tract
due to chelation St. John's wort / May absorption of iron Tetracyclines /
Absorption of both tetracyclines and iron from GI tract Vitamin E / Response to
iron therapy
NURSING RESPONSIBILITIES
• Assess patient’s and family’s knowledge of drug therapy; advise patient to take
medicine as prescribed.
• Caution patient to make position changes slowly to minimize orhtostatic
hypotension.
• Instruct patient to avoid concurrent use of alcohol or OTC medicine without
consulting the physician.
• Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of
hands and feet and hypotension occurs.
• Inform patient that angina attacks may occur 30 min. after administration due
reflex tachycardia.
• Encourage patient to comply with additional intervention for hypertension like
proper diet, regular exercise, lifestyle changes and stress management
• Give drug with meals if GI dioscomfort is severe
• Administer liquid preparations in water or juice to mask taste and prevent
staining of teeth
• Warn patient that stool may be dark or geen
• Use cautiously on long term basis, hematocrit, and reticulocyte count during
therapy.
• Be alert for adverse reactions and drug interactions.
• Cheese coffee, eggs,milk, tea, whole-grain breads, yogurt may impair oral iron
absorption. Advice against using together
Nifepidine
Generic name: Nifepidine
Brand name: Procardia
Drug classes: antiaginal, antihypertensive, calcium channel blocker
Therapeutic actions:
While all calcium channel blockers bind to this receptor, they have different binding
sites also blocking the L-channels or receptors inhibits inward calcium currents into
the cell -> reducing the concentration of calcium needed for muscle contraction,
leading to smooth muscle dilation, decreasing contractility of heart muscle, slowing
of the sinoatrial node firing rate and increasing AV nodal conductance time

Indications:
• Vasospastic (Prinzmetal's or variant) angina.
• Chronic stable angina without vasospasm, including angina due to increased
effort (especially in clients who cannot take beta blockers or nitrates or who
remain symptomatic following clinical doses of these drugs).
• Essential hypertension (sustained-release only).Investigational: PO, sublingually,
or chewed in hypertensive emergencies.
• Also prophylaxis of migraine headaches, primary pulmonary hypertension,
severe pregnancy-associated hypertension, esophageal diseases, Raynaud's
phenomenon, CHF, asthma, premature labor, biliary and renal colic, and
cardiomyopathy.
• To prevent strokes and to decrease the risk of CHF in geriatric hypertensives.
CONTRAINDICATIONS:
• Hypersensitivity
• Lactation, HF, aortic stenosis

AVAILABLE FORMS:
Capsule: 10 mg, 20 mg; Tablet, Extended Release: 30 mg, 60 mg, 90 mg

DOSAGES:
Capsules
Individualized. Initial: 10 mg t.i.d. (range: 10-20 mg t.i.d.); maintenance: 10-30 mg
t.i.d.-q.i.d. Clients with coronary artery spasm may respond better to 20-30 mg
t.i.d.-q.i.d. Doses greater than 120 mg/day are rarely needed while doses greater
than 180 mg/day are not recommended.
Sustained-Release Tablets
Initial: 30 or 60 mg once daily for Procardia XL and 30 mg once daily for Adalat CC.
Titrate over a 7- to 14-day period. Dosage can be increased as required and as
tolerated, to a maximum of 120 mg/day for Procardia XL and 90 mg/day for Adalat
CC.
Investigational, hypertensive emergencies.
10-20 mg given PO (capsule is punctured several times and then chewed).

SIDE EFFECTS:
• CV: Peripheral and pulmonary edema, MI, hypotension, palpitations, syncope,
CHF (especially if used with a beta blocker), decreased platelet aggregation,
arrhythmias, tachycardia. Increased frequency, length, and duration of angina
when beginning nifedipine therapy.
• GI: Nausea, diarrhea, constipation, flatulence, abdominal cramps, dysgeusia,
vomiting, dry mouth, eructation, gastroesophageal reflux, melena.
• CNS: Dizziness, lightheadedness, giddiness, nervousness, sleep disturbances,
headache, weakness, depression, migraine, psychoses, hallucinations,
disturbances in equilibrium, somnolence, insomnia, abnormal dreams, malaise,
anxiety.
• Dermatologic: Rash, dermatitis, urticaria, pruritus, photosensitivity, erythema
multiforme,Stevens-Johnson syndrome.
• Respiratory: Dyspnea, cough, wheezing, SOB, respiratory infection, throat, nasal,
or chest congestion.
• Musculoskeletal: Muscle cramps or inflammation, joint pain or stiffness, arthritis,
ataxia, myoclonic dystonia, hypertonia, asthenia.
• Hematologic: Thrombocytopenia, leukopenia, purpura, anemia.
• Other:Fever, chills, sweating, blurred vision, sexual difficulties, flushing, transient
blindness, hyperglycemia, hypokalemia, gingival hyperplasia, allergic hepatitis,
hepatitis, tinnitus, gynecomastia, polyuria, nocturia, erythromelalgia, weight
gain, epistaxis, facial and periorbital edema, hypoesthesia, gout, abnormal
lacrimation, breast pain, dysuria, hematuria.

INTERACTIONS:
Anticoagulants, oral / Possibility of PT Cimetidine / Bioavailability of
nifedipine Digoxin / Effect of digoxin by excretion by kidney Grapefruit juice /
Nifedipine plasma levels R/T metabolism Magnesium sulfate / Neuromuscular
blockade and hypotension Quinidine / Possible quinidine effect R/T plasma
levels; risk of hypotension, bradycardia, AV block, pulmonary edema, and
VTRanitidine / Nifedipine bioavailability Theophylline / Possible effect of
theophylline

NURSING CONSIDERATIONS
Assessment & Drug Effects
 Monitor BP carefully during titration period. Patient may become
severely hypotensive, especially if also taking other drugs known to
lower BP. Withhold drug and notify physician if systolic BP <90.
 Monitor blood sugar in diabetic patients. Nifedipine has diabetogenic
properties.
 Monitor for gingival hyperplasia and report promptly. This is a rare
but serious adverse effect (similar to phenytoin-induced hyperplasia).
Patient & Family Education
 Keep a record of nitroglycerin use and promptly report any changes
in previous pattern. Occasionally, people develop increased frequency,
duration, and severity of angina when they start treatment with this drug
or when dosage is increased.
 Be aware that withdrawal symptoms may occur with abrupt
discontinuation of the drug (chest pain, increase in anginal episodes, MI,
dysrhythmias).
 Inspect gums visually every day. Changes in gingivae may be
gradual, and bleeding may be exhibited only with probing.
 Seek prompt treatment for symptoms of gingival hyperplasia (easy
bleeding of gingivae and gradual enlarging of gingival mass, especially
on buccal side of lower anterior teeth). Drug will be discontinued if
gingival hyperplasia occurs.
 Research shows that smoking decreases the efficacy
of nifedipine and has direct and adverse effects on the heart in the
patient on nifedipine treatment.
 Do not breast feed while taking this drug without consulting
physician.