PHARMA CARD

Drug Brand Name: Capoten

Drug Generic Name: Captopril
Classification: A member of a class of drugs called angiotensin converting enzyme (ACE) inhibitors.
Mechanism of Action: There are two isoforms of ACE: the somatic isoform, which exists as a glycoprotein
comprised of a single polypeptide chain of 1277; and the testicular isoform, which has a lower molecular mass and
is thought to play a role in sperm maturation and binding of sperm to the oviduct epithelium. Somatic ACE has two
functionally active domains, N and C, which arise from tandem gene duplication. Although the two domains have
high sequence similarity, they play distinct physiological roles. The C-domain is predominantly involved in blood
pressure regulation while the N-domain plays a role in hematopoietic stem cell differentiation and proliferation.
ACE inhibitors bind to and inhibit the activity of both domains, but have much greater affinity for and inhibitory
activity against the C-domain. Captopril, one of the few ACE inhibitors that is not a prodrug, competes with ATI for
binding to ACE and inhibits and enzymatic proteolysis of ATI to ATII. Decreasing ATII levels in the body
decreases blood pressure by inhibiting the pressor effects of ATII as described in the Pharmacology section above.
Captopril also causes an increase in plasma renin activity likely due to a loss of feedback inhibition mediated by
ATII on the release of renin and/or stimulation of reflex mechanisms via baroreceptors. Captopril’s affinity for ACE
is approximately 30,000 times greater than that of ATI.
Indications: For the treatment of essential or renovascular hypertension (usually administered with other drugs,
particularly thiazide diuretics). May be used to treat congestive heart failure in combination with other drugs (e.g.
cardiac glycosides, diuretics, β-adrenergic blockers). May improve survival in patients with left ventricular
dysfunction following myocardial infarction. May be used to treat nephropathy, including diabetic nephropathy.

Contraindications:
Conditions:
high levels of potassium in the blood
inherited disorder of continuing episodes of swelling
a reduction in the body's resistance to infection
decreased function of bone marrow
low levels of a type of white blood cell called neutrophils
renal artery stenosis
low blood pressure
a type of allergic reaction called angioedema
recipient of organ transplant
hemodialysis with high-flux membrane
low amount of sodium in the blood
narrowing of the aortic heart valve
decreased kidney function
cough
pregnancy
brain blood flow problem
Allergies:
ACE Inhibitors

Side Effects: dry cough (should go away after you stop taking captopril)
dizziness
skin rash
a change in the way that foods taste

Adverse Effects:
CNS: dizziness, fatigue, headache, insomnia
Resp: cough
CV: hypotension, chest pain, palpitations, tachycardia
GI: taste disturbances, abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting
GU: proteinuria, impaired renal function
Derm: ANGIOEDEMA, rash, pruritis
F and E: hyperkalemia
Hemat: AGRANULOCYTOSIS, neutropenia
Misc: fever

Nursing Responsibility

o Caution patient to avoid salt substitutes containing potassium or foods containing high levels of
potassium or sodium unless directed by health care professional. See food sources for specific nutrients.
o Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, standing
for long periods, exercising, and hot weather may increase orthostatic hypotension.
o Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal
products being taken and consult health care professional before taking any new medications, especially
NSAIDs and cough, cold, or allergy remedies.
o May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until
response to medication is known.
o Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
o Advise patient that medication may cause impairment of taste that generally resolves within 8–12 wk,
even with continued therapy.
o Instruct patient to notify health care professional if immediately rash; mouth sores; sore throat; fever;
swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes,
lips, or tongue; difficulty swallowing or breathing occurs; or if taste impairment or skin rash
persists. Persistent dry cough may occur and may not subside until medication is discontinued. Consult
health care professional if cough becomes bothersome. Also notify health care professional if nausea,
vomiting, or diarrhea occurs and continues.
o Advise diabetic patients to monitor blood glucose closely, especially during first mo of therapy; may
cause hypoglycemia.
o Advise women of childbearing age to use contraception and notify health care professional immediately
if pregnancy is planned or suspected or if breastfeeding. If pregnancy is detected, discontinue
medication as soon as possible.
o Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.
Drug Brand Name: Aldactone, CaroSpir
Drug Generic Name: Spironolactone
Classification: belongs to a class of drugs called Aldosterone Antagonists, Selective, Diuretics, Potassium-Sparing.
Mechanism of Action: Spironolactone and its active metabolites are specific pharmacologic antagonists of
aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-
potassium exchange site in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium
and water to be excreted, while potassium is retained. Spironolactone acts both as a diuretic and as an
antihypertensive drug by this mechanism. It may be given alone or with other diuretic agents that act more
proximally in the renal tubule.
Indications: Diagnosis and maintenance of primary hyperaldosteronism
Adjunctive therapy in edema associated with CHF, nephrotic syndrome, hepatic cirrhosis when other therapies are
inadequate or inappropriate
Treatment of hypokalemia or prevention of hypokalemia in patients who would be at high risk if hypokalemia
occurred: Digitalized patients, patients with cardiac arrhythmias
Essential hypertension, usually in combination with other drugs
Unlabeled uses: Treatment of hirsutism due to its antiandrogenic properties, palliation of symptoms of PMS,
treatment of familial male precocious puberty, short-term treatment of acne vulgaris

Contraindications:
Conditions:
acid base problem with low chloride and basic pH blood
cessation of urine production
decreased kidney function
high levels of potassium in the blood
a condition where the adrenal glands produce less hormones called Addison's disease
hyperchloremic acidosis
decreased blood volume
acute kidney failure
low amount of sodium in the blood
Allergies:
Aldosterone Antagonists

Side Effects: Drowsiness, dizziness, lightheadedness, stomach upset, diarrhea, nausea, vomiting, or headache may
occur. To minimize lightheadedness, get up slowly when rising from a seated or lying position
Adverse Effects: Fluid or electrolyte imbalance, gynecomastia, GI upset, drowsiness, headache, hyponatremia;
tachycardia, hypotension, oliguria, hyperkalemia; confusion, weakness, paresthesia, hirsutism, mental disturbances,
menstrual irregularities, loss of libido and impotence.

Nursing Responsibility
Assessment
 History: Allergy to spironolactone; hyperkalemia; renal disease; pregnancy, lactation
 Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength; P, baseline ECG, BP; R,
pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns, menstrual cycle; CBC,
serum electrolytes, renal function tests, urinalysis
Interventions
 Mark calendars of edema outpatients as reminders of alternate day or 3- to 5-day/wk therapy.
 Give daily doses early so that increased urination does not interfere with sleep.
 Make suspension as follows: Tablets may be pulverized and given in cherry syrup for young children. This
suspension is stable for 1 mo if refrigerated.
 Measure and record regular weight to monitor mobilization of edema fluid.
 Avoid giving food rich in potassium.
 Arrange for regular evaluation of serum electrolytes and BUN
Digoxin

Drug classes:
● Cardiac glycoside
● Cardiotonic agent

Therapeutic actions: Increases intracellular calcium and allows more calcium to enter the myocardial cell during
depolarization via a sodium–potassium pump mechanism; this increases force of contraction (positive inotropic
effect), increases renal perfusion (seen as diuretic effect in patients with heart failure), decreases heart rate (negative
chronotropic effect), and decreases AV node conduction velocity.

Indications:
● Mild to moderate congestive heart failure and for treating an abnormal heart rhythm called atrial fibrillation,
arterial flutter, Paroxysimal atrial tachycardia

Contraindications and cautions:

● Contraindicated with allergy to cardiac glycosides, ventricular tachycardia, ventricular fibrillation, heart block,
sick sinus syndrome, IHSS, acute MI, renal insufficiency and electrolyte abnormalities (decreased K+, decreased
Mg2+, increased Ca2+).
● Use cautiously with pregnancy and lactation

Dosage:
Loading dose, 0.25 mg/day IV or PO for patients younger than 70 yr with good renal
function; 0.125 mg/day for patients older than 70 yr or with impaired renal function; or
0.0625 mg/day for patients with marked renal impairment. Maintenance dose, 0.125–0.5 mg/day PO.

Adverse effects:
● CNS: Headache, weakness, drowsiness, visual disturbances, mental status change
● CV: Arrhythmias
● GI: GI upset, anorexia

Nursing Management:
● Monitor apical pulse for 1 min before administering; hold dose if pulse lower
than 60 beats/min in adult or lower than 90 beats/min in infant; retake pulse in 1 hr. If adult
pulse remains lower than 60 beats/min or infant pulse remains lower than 90 beats/min, hold drug and notify
prescriber. Note any change from baseline rhythm or rate.
● Check dosage and preparation carefully.
● Avoid IM injections, which may be very painful.
● Follow diluting instructions carefully, and use diluted solution promptly.
● Avoid giving with meals; taking this drug with food will delay absorption and alter drug pharmacokinetics.
Dobutamine

Drug classes:
● Beta1-selective adrenergic agonist
● Sympathomimetic

Therapeutic actions:
Positive inotropic effects are mediated by beta1- adrenergic receptors in the heart; increases
the force of myocardial contraction with relatively minor effects on heart rate, arrhythmogenesis; has minor effects
on blood vessels.

Indications:
● For inotropic support in the short-term treatment of cardiac decompensation due to depressed contractility,
resulting from either organic heart disease or from cardiac surgical procedures
● Unlabeled uses: In children with congenital heart disease undergoing diagnostic cardiac catheterization, to
augment CV function

Contraindications and cautions:

● Contraindicated with IHSS; hypovolemia
(dobutamine is not a substitute for blood, plasma, fluids, electrolytes, which should be restored promptly when loss
has occurred and in any case before treatment with dobutamine); acute MI (may increase the size of an infarct by
intensifying ischemia); general anesthesia with halogenated hydrocarbons or cyclopropane, which sensitize the
myocardium to catecholamines; pregnancy.
● Use cautiously with diabetes mellitus, lactation; allergy to sulfites, more common in
asthmatic patients.

Available forms:
● Injection—12.5 mg/mL; injection in 5% dextrose injection—1 mg/mL, 2 mg/mL, 4 mg/mL

Dosages:
● Administer only by IV infusion using an infusion pump or other device to control the rate
of flow. Titrate on the basis of the patient’s hemodynamic and renal responses. Close monitoring is necessary.
● Adults:
2–20 mcg/kg/min IV is usual rate to increase cardiac output; rarely, rates up to 40 mcg/kg/min are needed.
● Pediatric patients:
Initially, 0.5–1 mcg/kg/min as continuous IV infusion. Maintenance dose, 2–20 mcg/kg/min;
on rare occasions up to 40 mcg/kg/min may be needed.

Adverse effects:
● CNS: Headache
● CV: Increase in HR, increase in systolic
BP, increase in ventricular ectopic beats
(PVCs), anginal pain, palpitations, shortness of breath
● GI: Nausea

Nursing Management:

Interventions:
● Arrange to digitalize patients who have atrial fibrillation with a rapid ventricular rate
before giving dobutamine—dobutamine facilitates AV conduction.
● Monitor urine flow, cardiac output, pulmonary wedge pressure, ECG, and BP closely during infusion; adjust dose
and rate accordingly.
Brand Name: ZINACEF
Generic Name: Cefuroxime
Classification: Anti-infective; Second-Generation Cephalosporin
Mechanism of Action: Binds to bacterial cell wall membrane, causing cell death
Indications: Treatment of respiratory tract infections, skin and skin structure infections, bone and joint
infections (IV), Urinary Tract Infections, Gynecological Infections, Septicemia (IV), Otitis media (PO),
Meningitis (IV), Lyme disease (PO).
Contraindications: Hypersensitivity to cephalosporins; serious hypersensitivity to penicillins.
Side effects & Adverse effects: (all systems involved)
 CNS: Seizures (high doses)
 Derm: Rash, urticaria, diaper dermatitis
 GI: (CDAD): Clostridioides Difficile-Associated Diarrhea, diarrhea, nausea, vomiting, cramps
 Hemat: bleeding, eosinophilia, hemolytic anemia, leukopenia
 Local: pain at IM site, phlebitis at IV site
 Misc: Hypersensitivity reactions (including anaphylaxis), superinfection
Nursing Responsibilities:
 Assess for infection (vital signs; appearance of wound, sputum, urine and stool; WBC) at beginning
of and throughout therapy
 Before initiating therapy, obtain a history to determine previous use of and reactions to penicillin or
cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic
response.
 Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before
receiving results
 Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing).
Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep
epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic
reaction.
 Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported
to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD).
May begin up to several week following cessation of therapy.
 Lab Test considerations: may cause positive results for Coombs’ Test
 May cause increase Serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and serum
creatinine.
 May rarely cause leukopenia, neutropenia, and eosinophilia.