NAME: Jance, Giosyl May E.

YEAR & SECTION: BSN2-D

Scenario:

Susan Perez is a 48-year-old office staff who sought consult at a barangay health center in her community. Upon consultation, she verbalized she has been having on and off headache, dizziness
and sometimes, blurred vision.

Physician conducted physical examination as well.  Upon consultation, the physician ascertained the medical history of the client and asked for family history of diabetes, hypertension,
pulmonary related condition or other hereditary disease condition. Susan, told the doctor that her mother has diabetes and father has hypertension and asthma. She verbalized she is not taking
any maintenance medication.

The doctor ordered for routine tests like urinalysis, complete blood count (CBC), lipid profile, fasting blood sugar (FBS) and electrocardiogram (ECG). Results came out and Susan was found to be
Hypertensive and Diabetic with high FBS results.

She was prescribed:

1. Amlodipine 5 mg. 1 tablet  BID

2. Metformin 500 mg. 1 tablet BID

DRUG STUDY
Name of Drug Dosage, Frequency, Mechanism of Action Indication Contraindication Adverse Effect Nursing Responsibilities
Timing/ Route

1.  Generic Name:  Dosage: 5mg/1tab  Inhibits the transport of  Alone or with other  Contraindicated in:  CNS: dizziness,  Assessment:
Amlodipine  calcium into myocardial agents in the Hypersensitivity; fatigue.  Monitor BP and pulse before therapy,
Frequency: Twice a during dose titration, and periodically
and vascular smooth management of Systolic BP 90 mm Hg.
Brand Name: day or B.I.D. CV: peripheral during therapy. Monitor ECG
muscle cells, resulting in hypertension,
Norvasc Use Cautiously in: edema, angina, periodically during prolonged therapy.
inhibition of excitation- angina pectoris, and
Timing: 8AM-8PM Severe hepatic bradycardia,  Monitor intake and output ratios and
Classification: contraction coupling and vasospastic daily weight. Assess for signs of HF
Route: P.O. impairment (dosage hypotension,
Therapeutic: subsequent contraction. (Prinzmetal’s) (peripheral edema, rales/crackles,
angina reduction palpitations.
antihypertensives dyspnea, weight gain, jugular venous
Therapeutic Effects: recommended); Aortic distention).
Pharmacologic: GI:gingival
Systemic vasodilation stenosis; History of  Angina: Assess location, duration,
calcium channel resulting in decreased BP. HF; hyperplasia, nausea. intensity, and precipitating factors of
blockers patient’s anginal pain.
Coronary vasodilation Derm: flushing.
resulting in decreased Geri: Dose reduction  Lab Test Considerations: Total serum
 frequency and severity of recommended; ↑risk calcium concentrations are not affected
attacks of angina. of hypotension. by calcium channel blockers.

Implementation:
 Do not confuse amlodipine with
amiloride.
 Do not confuse Norvasc with
 Navane.
 PO:May be administered without
regard to meals.
2.  Generic Name:  Dosage: Decreases hepatic glucose Management of Contraindicated in: GI: abdominal  Assessment:
Metformin 500mg/1tab production. Decreases type 2 diabetes Hypersensitivity; bloating, diarrhea,  When combined with oral
intestinal glucose mellitus; may be Metabolic acidosis; nausea, vomiting, sulfonylureas, observe for signs and
Brand Name: Frequency: Twice a symptoms of hypoglycemic reactions
absorption. Increases used with diet, Dehydration, sepsis, unpleasant metallic
Riomet day or B.I.D. (abdominal pain, sweating, hunger,
sensitivity to insulin. insulin, or hypoxemia, hepatic taste.
weakness, dizziness, headache, tremor,
Classification: Timing: 8AM-8PM sulfonylurea oral impairment, excessive tachycardia, anxiety).
Therapeutic Effects: Endo:
Therapeutic: hypoglycemics. alcohol use (acute or  Patients who have been well controlled
Route: P.O. Maintenance of blood hypoglycemia.
antidiabetics chronic); Renal on metformin who develop illness or
glucose. dysfunction (SCr 1.5 laboratory abnormalities should be
Pharmacologic: F and E: LACTIC
mg/dL in men or 1.4 assessed for ketoacidosis or lactic
biguanides ACIDOSIS. acidosis. Assess serum electrolytes,
mg/dL in women);
ketones, glucose, and, if indicated,
Radiographic studies Misc: decreased
blood pH, lactate, pyruvate, and
requiring IV iodinated vitamin B12 levels. metformin levels. If either form of
contrast media acidosis is present, discontinue
(withhold metformin); metformin immediately and treat
HF. acidosis.
 Lab Test Considerations: Monitor
Use Cautiously in: serum glucose and glycosylated
Concurrent renal hemoglobin periodically during therapy
disease; to evaluate effectiveness of therapy.
May cause false-positive results for
Geri: urine ketones.
Geriatric/debilitated  Assess renal function before initiating
and at least annually during therapy.
patients (pdoses may
Discontinue metformin if renal
be required; avoid in impairment occurs.
patients 80 yr unless  Monitor serum folic acid and vitamin
 renal function is B12 every 1– 2 yr in long-term therapy.
normal); Chronic Metformin may interfere with
alcohol use/abuse; absorption.
Serious medical
Implementation:
conditions (MI,
 Do not confuse metformin with
stroke); Patients metronidazole.
undergoing stress  Patients stabilized on a diabetic
(infection, surgical regimen who are exposed to stress,
procedures); Hypoxia; fever, trauma, infection, or surgery may
Pituitary deficiency or require administration of insulin.
Withhold metformin and reinstitute
hyperthyroidism;
after resolution of acute episode.
 Metformin should be temporarily
discontinued in patients requiring
surgery involving restricted intake of
food and fluids. Resume metformin
when oral intake has resumed and
renal function is normal.
 Withhold metformin before or at the
time of studies requiring IV
administration of iodinated contrast
media and for 48 hr after study.
 PO: Administer metformin with meals
to minimize GI effects.
 XR tablets must be swallowed whole;
do not crush, dissolve, or chew.