Name of Patient: E.F.F.JR. Physician: Dr. N. co-managed by Dr. B.

Age/Sex: 73/male Chief Complaint: chest pain

Name of Drug
(Dosage, Route, Frequency, Classification and Indication and Side Effects or Adverse Nursing Responsibilities
Timing) Mechanism of Action contraindication Reactions

Generic Name: Classification: Indication: Body as a whole: Back pain,  Observe the 14 rights in
Atorvastatin Calcium Therapeutic class: Adjunct to diet for the reduction asthenia, hypersensitivity medication administration.
Antilipidemics of LDL cholesterol and reaction, myalgia,
Brand Name: Pharmacologic class: triglycerides in patients with rhabdomyolysis.  Monitor for therapeutic
Lipitor HMG-CoA reductase inhibitors primary hypercholesterolemia effectiveness which is
and mixed dyslipidemia. CNS: headache indicated by reduction in the
level of LDL-C.
Dosage: GI: abdominal pain,
60mg/tab Mechanism of Action: constipation, diarrhea, dyspepsia,  Lab test: Monitor lipid levels
Atorvastatin competitively flatulence, increased liver within 2-4 weeks after
inhibits HMG-CoA reductase, function tests. initiation of therapy or upon
Route: the enzyme that catalyses the change in dosage; monitor
NGT conversion of HMG-CoA to Contraindication: Respiratory: sinusitis, liver functions at 6 and 12 wk
mevalonic acid. This results in Hypersensitivity to atorvastatin, pharyngitis after initiation or elevation of
the induction of the LDL myopathy, active liver disease, dose, and periodically
Frequency: receptors, leading to lowered unexplained persistent Skin: rash thereafter.
OD LDL-cholesterol concentration. transaminase elevations
 Assess for muscle pain,
tenderness; and, if present,
Timing: monitor CPK level.
8pm
 Monitor carefully for digoxin
toxicity with concurrent
digoxin use.
Name of Patient: E.F.F.JR. Physician: Dr. N. co-managed by Dr. B.
Age/Sex: 73/male Chief Complaint: chest pain

Name of Drug
(Dosage, Route, Frequency, Classification and Indication and Side Effects or Adverse Nursing Responsibilities
Timing) Mechanism of Action contraindication Reactions

Generic Name: Classification: Indication: CNS: vertigo, headache,  Observe the 14 rights in
Furosemide Therapeutic class: Acute pulmonary edema dizziness, paresthesia, weakness, medication administration.
Antihypertensives Edema restlessness, fever  Monitor weight, BP, and
Brand Name: Pharmacologic class:Loop Hypertension CV: orthostatic hypotension, pulse rate with long term use.
Lasix Diuretics thrombophlebitis with IV  Monitor for S&S of
Mechanism of Action: administration hypokalemia
Dosage: Inhibits sodium and chloride Contraindication: EENT: blurred or yellow vision,  Monitor I&O ratio and
20mg IVTT reabsorption at the proximal and Contraindicated in patients transient deafness, tinnitus pattern. Report decrease or
distal tubules and the ascending hypersensitive to drug and in GI: abdominal discomfort and unusual increase in output.
Route: loop of Henle those with anuria pain, diarrhea, anorexia, nausea, Excessive diuresis can result
IV vomiting, constipation, in dehydration and
pancreatitis hypovolemia, circulatory
GU: azotemia, nocturia, collapse, and hypotension.
Frequency: polyuria, frequent urination, Weigh patient daily under
Q8H oliguria standard conditions.
Hematologic: agranulocytosis,  Note: Excessive dehydration
aplastic anemia, leukopenia, is most likely to occur in
Timing: thrombocytopenia, anemia older adults, those with
8am, 4pm, 12am Hepatic: hepatic dysfunction, chronic cardiac disease on
jaundice prolonged salt restriction, or
Metabolic: volume depletion those receiving
and dehydration,asymptomatic sympatholytic agents.
hyperuricemia, impaired glucose
tolerance, hypokalemia,
hypochloremic alkalosis,
hyperglycemia, dilutional
hyponatremia, hypocalcemia,
hypomagnesemia
Musculoskeletal: muscle spasm
Skin: dermatitis, purpura,
photosensitivity reactions
Other: gout
Name of Patient: E.F.F.JR. Physician: Dr. N. co-managed by Dr. B.
Age/Sex: 73/male Chief Complaint: chest pain

Name of Drug
(Dosage, Route, Frequency, Classification and Indication and Side Effects or Adverse Nursing Responsibilities
Timing) Mechanism of Action contraindication Reactions

Generic Name: Classification: Indication: Body as a whole: allergy,  Observe the 14 rights in
Amlodipine besylate-telmisartan Angiotensin receptor blocker For the treatment of fever,leg pain, malaise medication administration.
(ARB) hypertension. Cardiovascular: palpitation,
Brand Name: –telmisartan dependent edema, angina  Assess for any signs of
Twynsta pectoris, tachycardia, leg edema, allergies
Calcium channel blocker abnormal ECG
Dosage: -Amlodipine CNS: insomnia, somnolence,
5/40mg 1tab Contraindication: migraine, vertigo, paresthesia,  Administer O2 inhalation if
Mechanism of Action: Hypersensitivity involuntary muscle contractions, there is shortness of breath
Route: Relax the blood vessels so that Do not coadminister with hypoesthesia
NGT blood can flow more easily. aliskiren in patient with diabetes GI:, constipation, flatulence,
mellitus gastritis, vomiting, fry mouth,  Monitor vital signs and note
haemorrhoids, gastroenteritis, if there is any abnormalities
Frequency: enteritis, gastroesophageal
OD reflux, toothache
Metabolic: gout,  Administer without any
hypercholesterolemia, diabetes regard to meals
Timing: mellitus
8am Musculoskeletal: arthritis,
arthralgia,, leg cramps  Assess for signs of
Psychiatric: anxiety, depression, CHF(peripheral edema,
nervousness rales/crackles, dyspnea,
Resistance mechanism: weight gain , jugular venous
infection,abcesses, otitis media distention).
Respiratory: asthma, bronchitis,
rhinitis, dyspnea, epistaxis
Skin: dermatitis, rash, eczema,
pruritus
Urinary: micturition frequency,
cystitis
Vascular: cerebrovascular
disorder
Special senses: abnormal vision,
conjunctivitis, tinnitus, earache
Name of Patient: E.F.F.JR. Physician: Dr. N. co-managed by Dr. B.
Age/Sex: 73/male Chief Complaint: chest pain

Name of Drug
(Dosage, Route, Frequency, Classification and Indication and Side Effects or Adverse Nursing Responsibilities
Timing) Mechanism of Action contraindication Reactions

Generic Name: Classification: Indication: Body as a whole: Back pain,  Observe the 14 rights in
Omeprazole Antisecretory drug Proton pump Omeprazole is used to treat asthenia, hypersensitivity medication administration.
Brand Name: inhibitor symptoms of gastroesophageal reaction, myalgia,
Losec reflux disease (GERD) and other rhabdomyolysis.  Check and verify with
Mechanism of Action: conditions caused by excess doctor’s order and Kardex.
Dosage: Gastric acid-pump inhibitor: stomach acid. It is also used to CNS: headache  Assess patient’s vital signs.
40mg Suppresses gastric acid secretion promote healing of erosive
by specific inhibition of the esophagitis (damage to your GI: abdominal pain,  Patient and family education.
Route: hydrogen-potassium ATPase esophagus caused by stomach constipation, diarrhea, dyspepsia, Notify the doctor if patient is
IV enzyme system at the secretory acid) flatulence, increased liver experiencing undesirable
surface of the gastric parietal Contraindication: function tests. effects.
cells; blocks the final step of acid Contraindicated with
Frequency: production hypersensitivity to omeprazole or Respiratory: sinusitis,
OD its components; pharyngitis

Skin: rash
Timing:
6am
Name of Patient: E.F.F.JR.
Age/Sex: 73/male
Name of Drug
(Dosage, Route, Frequency, Classification and
Timing) Mechanism of Action
Generic Name: Classification:
KETOANALOGUE Essential amino acids
Brand Name:
Mechanism of Action:
Dosage: Allows the intake of essential
2tabs amino acids while minimizing
the amino nitrogen intake.
Route: Following ingestion, the
NGT ketoanalogues are transmitted by
taking nitrogen from non-
essential amino acids, thereby
Frequency: decreasing the formation of urea
by reusing the amino group. The
levels of accumulating uremic
Timing: toxins are decreased. Keto and/or
8am pm, 12am hydroxyl-acids do not elicit
hyfiltration of residual ephrons.
Ketoacids containing
supplements have a positive
influence on the renal
hypoparathyroidism and can
improve renal osteodystrophy.
The use of ketobest in
association with a very low
protein intake of nitrogen while
avoiding the deleterious
consequence of inadequate
Indication and
contraindication
Indication:
Prevention and therapy of
damges due to faulty or deficient
protein metabolism in chronic
renal insufficiency in connection
with limited protein in food of
<40g/day(for adults). Generally
in patients with a glomerular
filtration rate (GFR) ,25mL/min.
Contraindication:
Hypercalcemia, disturbed amino
acid metabolism. In case of
heredity phenylketonuria, it has
to be taken into account that
ketobest contains phenylalanine.
Physician: Dr. N. co-managed by Dr. B.
Chief Complaint: chest pain
Side Effects or Adverse
Reactions
Body as a whole: Back pain,
asthenia, hypersensitivity
reaction, myalgia,
rhabdomyolysis.
CNS: headache
GI: abdominal pain,
constipation, diarrhea, dyspepsia,
flatulence, increased liver
function tests.
Respiratory: sinusitis,
pharyngitis
Skin: rash
Nursing Responsibilities
 Observe the 14 rights in
medication administration.
 Should be admininstered
during meals to allow proper
absorption and metabolism
into the corresponding amino
acids.
 Ensure sufficient supply with
calories.
 Pay attention to a reduction
of serum phosphate.
dietary protein intake and
malnourishment.
Name of Patient: E.F.F.JR. Physician: Dr. N. co-managed by Dr. B.
Age/Sex: 73/male Chief Complaint: chest pain

Name of Drug
(Dosage, Route, Frequency, Classification and Indication and Side Effects or Adverse Nursing Responsibilities
Timing) Mechanism of Action contraindication Reactions

Generic Name: Classification: Indication: Body as a whole: Back pain,  Observe the 14 rights in
Clopidogrel Antiplatelet agent  Used to prevent blood asthenia, hypersensitivity medication administration.
clots reaction, myalgia,
Brand Name:  Reduction of rhabdomyolysis, tiredness or  Assess skin for redness,
Mechanism of Action: atherosclerotic weakness itchiness, and if there are
Clopidogrel helps prevent events(MI, stroke, bruises present in the body.
Dosage: platelets from sticking together. vascular death) in patients CNS: headache, confusion,
75mg 1tab This stops them from forming at risk for such events stroke, vision loss
blood clots. including recent MI,  Check if there is yellowing of
Route: acute coronary GI: abdominal pain, the skin or sclera
NGT syndrome(unstable constipation, diarrhea, dyspepsia,
angina/non-Q-wave MI), flatulence, black tarry stools,
stroke or peripheral vomiting  check for BEFAST and any
Frequency: vascular disease. signs and symptoms of stroke
OD Respiratory: sinusitis,
Contraindication: pharyngitis, shortness of breath
Timing: Contraindicated in pathologic  Monitor vital signs
8am bleeding(peptic ulcer, Skin: rash, Itchy skin,
intracranial haemorrhage), unexplained bruises, jaundice
lactation, Hypersensitivity  Inspect eye if there is any
signs of blurriness or loss of
vision.

 Administer once daily

without regard to food.
 Monitor CBC with
differential and platelet
count.
Name of Patient: E.F.F.JR.
Age/Sex: 73/male
Name of Drug
(Dosage, Route, Frequency, Classification and
Timing) Mechanism of Action
Generic Name: Classification:
Gliclazide antidiabetics
Mechanism of Action:
Brand Name: Gliclazide is a sulphonylurea
Diamicron drug with an intermediate half-
life of around 11 hours. It is
Dosage: extensively metabolised, and
renal clearance accounts for only
Route: 4% of total drug clearance. The
NGT molecule contains an azabicyclo-
octyl group which confers
special properties on the basic
Frequency: sulphonylurea moiety. Gliclazide
OD stimulates insulin secretion
through the beta cell
Timing: sulhponylurea moiety. Gliclazide
30mins before breakfast stimulates insulin secretion
through the beta cell
sulphonylurea receptor, possibly
through a direct effect on
intracellular calcium transport. It
specifically improves the
abnormal first phase insulin
release in type 2 diabetes, and
also has an effect on the second
phase. This pattern of insulin
release is thought to explain the
lower incidence of
hypogycaemic episodes and
Indication and
contraindication
Indication:
Control of blood sugar in type 2
diabetes mellitus when control of
diet and exercise fails or when
insulin is not an option. Requires
some pancreatic function
Contraindication:
 Hypersensitivity; cross
sensitivity with other
sulfonylureas may occur
 Unstable diabetes, type 1
diabetes mellitus, diabetic
ketoacidosis, diabetic
coma or pre-coma
 Severe hepatic or renal
impairment
 Concurrent use of
oral/oromucosal
miconazole, alcohol or
alcohol-containing
medications, or systemic
phenyllbutazone
Physician: Dr. N. co-managed by Dr. B.
Chief Complaint: chest pain
Side Effects or Adverse
Reactions
Body as a whole: Back pain,
asthenia, hypersensitivity
reaction, myalgia,
rhabdomyolysis.
CNS: headache
GI: abdominal pain,
constipation, diarrhea, dyspepsia,
flatulence, increased liver
function tests.
Respiratory: sinusitis,
pharyngitis
Skin: rash
Nursing Responsibilities
 Observe the 14 rights in
medication administration.
 Observe for signs and
symptoms of hypoglycemia
(hunger, weaknesss,
sweating, dizziness,
tachycardia, anxiety).
 Assess patient for allergy to
sulfonylureas.
 Monitor renal function
periodically in patients with
mild to moderate renal
dysfunction. May cause
increased creatinine and
hyponatremia.
 Monitor liver function
periodically in patients with
mild to moderate liver
dysfunction. May cause
increased increased AST,
ALT, alkaline phosphatase
and LDH.
weight gain compared with some
other sulphonylureas.
Name of Patient: E.F.F.JR. Physician: Dr. N. co-managed by Dr. B.
Age/Sex: 73/male Chief Complaint: chest pain

Name of Drug
(Dosage, Route, Frequency, Classification and Indication and Side Effects or Adverse Nursing Responsibilities
Timing) Mechanism of Action contraindication Reactions

Generic Name: Classification: Indication:
Nitroglycerin Nitrates Drugs, Anti Anginals To prevent chronic angina
attacks;
Brand Name: Mechanism of Action: Acute angina pectoris; to prevent
(Nitrostat) A nitrate that reduces cardiac or minimize angina attacks
oxygen demand by decreasing before stressful events;
left ventricular end-diastolic Hypertension from surgery, heart
pressure (preload) and, to a lesser failure after MI, angina pectoris
Dosage: extent, systemic vascular in acute situations, to produce
resistance (afterload). Also controlled hypotension during
increases blood flow through the surgery.
Route: collateral coronary vessels.
Contraindication:
Frequency: Contraindicated in patients
hypersensitive to nitrates and in
those with early MI, severe
Timing: anemia, increased intracranial
pressure, angle-closure
glaucoma, orthostatic
hypotension, allergy to adhesives
(transdermal), or hypersensitivity
to nitrates. I.V. nitroglycerin is
contraindicated in patients
hypersensitive to I.V. form,
cardiac tamponade, restrictive
cardiomyopathy, or constrictive
pericarditis
CNS: headache, dizziness,
weakness.
CV: orthostatic hypotension,
Tachycardia, flushing,
palpitations, fainting.
EENT: burning
GI: nausea, vomiting
SKIN: cutaneous vasodilation,
contact dermatitis, rash
OTHER: hypersensitivity
 Observe the 14 rights in
medication administration.
 Use cautiously in patients
with hypotension or volume
depletion;
 Closely monitor vital signs
 Transdermal dosage forms
can be applied to any
nonhairy part of the skin
except distal parts of the arms
or legs (absorption won’t be
maximal at distal sites). Patch
may cause contact dermatitis;
 Remove transdermal patch
before defibrillation. Because
of the aluminum backing the
patch, the electric current
may cause arcing that can
damage the paddles and burn
the patient;
 When stopping transdermal
treatment of angina,
gradually reduce the dose and
frequency of application over
4 to 6 weeks;
 Monitor blood pressure and
intensity and duration of drug
 response;
 Drug may cause headaches,
especially at beginning of
therapy. Dosage may be
reduced temporarily, but
tolerance usually develops.
Treat headache with aspirin
or acetaminophen;
 Tolerance to drug can be
minimized with a 10 to 12
hour nitrate-free interval. To
achieve this, remove the
transdermal system in the
early evening and apply a
new system the next morning
or omit the last daily dose of
a buccal, sustained-release or
ointment form. Check with
the prescriber for alterations
in dosage regimen if
tolerance is suspected;
 Nitroglycerin may interfere
with cholesterol
determination tests using the
Zlatkis-Zak color reaction,
resulting in falsely decreased.