Drug Mechanism of Action
Generic Name: Produce vasodilation (venous
Isosorbide Mononitrate greater than arterial). Decrease left
(ISMH) ventricular end-diastolic pressure
and left ventricular end-diastolic
volume (preload). Net effect is
Brand Name: reduced myocardial oxygen
Monoket consumption. Increase coronary
blood flow by dilating coronary
Classification: arteries and improving collateral
Antianginals flow to ischemic regions.
Route, Frequency & Therapeutic Effects: Relief and
Dosage: prevention of anginal attacks.
30 mg OD PO
Indications Side Effects
Acute treatment of anginal
attacks (SL only). Prophylactic
management of angina pectoris
Nursing Implications
 Dizziness  Assess location, duration,
 Headache intensity, and precipitating
 Nausea factors of anginal pain.
 Vomiting
 Hypotension  Monitor BP and pulse
 Tachycardia routinely during period of
dosage adjustment.
 Instruct patient to take
medication as directed,
even if feeling better. Take
missed doses as soon as
remembered; doses of
isosorbide dinitrate should
be taken at least 2 hr apart
(6 hr with extended-release
preparations); daily doses
of isosorbide mononitrate
should be taken 7 hr apart.
 Extended-release tablets
should be swallowed
whole. Do not break, crush,
or chew.
 Caution patient to make
 position changes slowly to
minimize orthostatic
hypotension.

 May cause dizziness.

Caution patient to avoid
driving or other activities
requiring alertness until
response to medication is
known.

 Instruct patient to take last

dose of day (when taking
2–4 doses/day) no later
than 7 pm to prevent the
development of tolerance.

 Advise patient to avoid

concurrent use of alcohol
with this medication.
Instruct patient to notify
health care professional of
all Rx or OTC medications,
vitamins, or herbal
products being taken and
to consult health care
professional before taking
other Rx, OTC, or herbal
products.

 Inform patient that

headache is a common
 side effect that should
decrease with continuing
therapy. Aspirin or
acetaminophen may be
ordered to treat headache.
Notify health care
professional if headache is
persistent or severe. Do
not alter dose to avoid
headache.

 Advise patient to notify

health care professional if
dry mouth or blurred vision
occurs

Contraindications Adverse Effects

Hypersensitivity; Concurrent use  Paradoxic bradycardia

of sildenafil, vardenafil, or  Syncope
tadalafil.

Source: APRIL HAZARD VALLERAND, PhD, RN, FAAN; CYNTHIA A. SANOSKI, BS, Pharm D, FCCP, BCPS; JUDITH HOPFER DEGLIN, Pharm D; (2015) Davis’s DRUG GUIDE
FOR NURSES, 14th Edition; Retrieved from https://www.mims.com/philippines/drug/info
 Drug Mechanism of Action Indications Side Effects Nursing Implications

Generic Name: Inhibits platelet aggregation by Reduction of atherosclerotic  Dizziness  Assess patient for
Clopidogrel irreversibly inhibiting the binding of events (MI, stroke, vascular  Fatigue symptoms of stroke,
ATP to platelet receptors. death) in patients at risk for  Headache peripheral vascular
Brand Name: such events including recent MI,  Depression disease, or MI periodically
Flavix Therapeutic Effects: Decreased acute coronary syndrome  Dyspnea during therapy.
occurrence of atherosclerotic (unstable angina/ non–Q-wave  Cough
Classification: events in patients at risk MI), stroke, or peripheral  Chest pain  Monitor patient for signs of
Antiplatelet vascular disease  Edema thrombotic thrombocytic
 Hypertension purpura
Route, Frequency &  Abdominal pain (thrombocytopenia,
Dosage:  Diarrhea microangiopathic hemolytic
75 mg OD PO  Dyspepsia anemia, neurologic
 Gastritis findings, renal dysfunction,
fever). May rarely occur,
even after short exposure
(2 wk). Requires prompt
treatment.

 Monitor bleeding time

during therapy. Prolonged
bleeding time, which is
time- and dose-dependent,
is expected.

 Monitor CBC with

differential and platelet
count periodically during
therapy. Neutropenia and
thrombocytopenia may
 rarely occur

 Instruct patient to take

medication exactly as
directed. Take missed
doses as soon as possible
unless almost time for next
dose; do not double doses.
Do not discontinue
clopidogrel without
consulting health care
professional; may increase
risk of cardiovascular
events. Advise patient to
read the Medication Guide
before starting clopidogrel
and with each Rx refill in
case of changes.

 Advise patient to notify

health care professional
promptly if fever, chills,
sore throat, rash, or
unusual bleeding or
bruising occurs.

 Advise patient to notify

health care professional of
medication regimen prior to
treatment or surgery.

 Instruct patient to notify

health care professional of
 all Rx or OTC medications,
vitamins, or herbal
products being taken and
to consult health care
professional before taking
any other Rx, OTC, or
herbal products, especially
those containing aspirin or
NSAIDs or proton pump
inhibitors.

 Advise female patient to

notify health care
professional if pregnancy is
planned or suspected, or if
breast feeding.

Contraindications Adverse Effects

 Hypersensitivity  Gi bleeding
 Pathologic bleeding  Drug rash with
(peptic ulcer, eosinophilia and systemic
intracranial symptoms
hemorrhage)  Neutropenia
 Concurrent use of  Thrombotic
omeprazole or thrombocytopenic purpura
esomeprazole  Hypercholesterolemia
 Impaired CYP2C19  Arthralgia
function due to genetic
variation
Source: APRIL HAZARD VALLERAND, PhD, RN, FAAN; CYNTHIA A. SANOSKI, BS, Pharm D, FCCP, BCPS; JUDITH HOPFER DEGLIN, Pharm D; (2015) Davis’s DRUG GUIDE
FOR NURSES, 14th Edition; Retrieved from https://www.mims.com/philippines/drug/info
 Drug Mechanism of Action
Generic Name: Inhibit an enzyme, 3-hydroxy-3-
Atorvastatin methylglutaryl-coenzyme A
(HMG-CoA) reductase, which is
Brand Name: responsible for catalyzing an early
Lipitor step in the synthesis of
cholesterol.
Classification:
Lipid-lowering agents or Therapeutic Effects: Lowers total
HMG-CoA reductase and LDL cholesterol and
inhibitors triglycerides. Slightly increase
HDL. Slows of the progression of
Route, Frequency & coronary atherosclerosis with
Dosage: resultant decrease in CHD-related
80 mg OD PO events (all agents except
rosuvastatin have indication
forpevents).
Indications
Primary prevention of
cardiovascular disease (decrease
the risk of MI or stroke) in patients
with multiple risk factors for
coronary heart disease CHD or
type 2 diabetes mellitus (also
decrease therisk of angina or
revascsularization procedures in
patients with multiple risk factors
for CHD)
Side Effects Nursing Implications
 Amnesia  Obtain a dietary history,
 Confusion especially with regard to
 Dizziness fat consumption.
 Headache
 Insomnia  Lab Test Considerations:
 Memory loss Evaluate serum
 Weakness cholesterol and triglyceride
 Chest pain levels before initiating,
 Peripheral edema after 4–6 wk of therapy,
 Abdominal cramps and periodically thereafter.
 Constipation
 Diarrhea  Monitor liver function tests,
 Flatus including AST and ALT,
 Heartburn before initiating therapy
 Altered taste and if signs of liver injury
 Drug-induced hepatitis (fatigue, anorexia, right
 Dyspepsia upper abdominal
 Elevated liver enzymes discomfort, dark urine or
 Nausea jaundice) occur. May also
 Pancreatitis cause qalkaline
phosphatase and bilirubin
levels.
 If patient develops muscle
tenderness during therapy,
monitor CK levels. If CK
levels are 10 times the
upper limit of normal or
myopathy occurs, therapy
should be discontinued.
 Monitor for signs and
symptoms of immune-
mediated necrotizing
myopathy (IMNM)
(proximal muscle
weakness andqserum
creatine kinase), persisting
despite discontinuation of
statin therapy. Perform
muscle biopsy to
diagnose; shows
necrotizing myopathy
without significant
inflammation. Treat with
immunosuppressive
agents.

Contraindications Adverse Effects

 Hypersensitivity  Rhabdomyolysis
 Active liver disease or  Arthralgia
unexplained persistent  Immune-mediated
increase in AST or ALT necrotizing myopathy
 Myalgia
 Concurrent use of  Myopathy
gemfibrozil, azole
antifungals, erythromycin,
clarithromycin, protease
inhibitors, niacin, or
cyclosporine (higher risk
 of
myopathy/rhabdomyolysis
)

Source: APRIL HAZARD VALLERAND, PhD, RN, FAAN; CYNTHIA A. SANOSKI, BS, Pharm D, FCCP, BCPS; JUDITH HOPFER DEGLIN, Pharm D; (2015) Davis’s DRUG GUIDE
FOR NURSES, 14th Edition; Retrieved from https://www.mims.com/philippines/drug/info
 Drug Mechanism of Action Indications Side Effects Nursing Implications

Generic Name: Decreases hepatic glucose Management of type 2 diabetes  Abdominal bloating  When combined with oral
Metformin production. Decreases intestinal mellitus; may be used with diet,  Diarrhea sulfonylureas, observe for
glucose absorption. Increases insulin, or sulfonylurea oral  Nausea signs and symptoms of
Brand Name: sensitivity to insulin. hypoglycemics.  Vomiting hypoglycemic reactions
Glycon  Unpleasant metallic taste (abdominal pain, sweating,
Therapeutic Effects: Maintenance hunger, weakness,
Classification: of blood glucose. dizziness, headache,
Antidiabetics tremor, tachycardia,
anxiety).
Route, Frequency &
Dosage:  Patients who have been
500 mg 1 tab BID pre meals well controlled on
metformin who develop
illness or laboratory
abnormalities should be
assessed for ketoacidosis
or lactic acidosis. Assess
serum electrolytes,
ketones, glucose, and, if
indicated, blood pH,
lactate, pyruvate, and
metformin levels. If either
form of acidosis is present,
discontinue metformin
immediately and treat
acidosis.

 Lab Test Considerations:

 Monitor serum glucose and
glycosylated hemoglobin
periodically during therapy
to evaluate effectiveness of
therapy. May cause false-
positive results for urine
ketones.

 Assess renal function

before initiating and at
least annually during
therapy. Discontinue
metformin if renal
impairment occurs.

 Monitor serum folic acid

and vitamin B12 every 1– 2
yr in long-term therapy.
Metformin may interfere
with absorption.

 Instruct patient to take

metformin at the same time
each day, as directed.
Take missed doses as
soon as possible unless
almost time for next dose.
Do not double doses.
Instruct parent/caregiver to
read the Medication Guide
prior to use and with each
Rx refill; new information
 may be available.

 Explain to patient that

metformin helps control
hyperglycemia but does
not cure diabetes. Therapy
is usually long term.

 Encourage patient to follow

prescribed diet,
medication, and exercise
regimen to prevent
hyperglycemic or
hypoglycemic episodes.

 Explain to patient the risk

of lactic acidosis and the
potential need for
discontinuation of
metformin therapy if a
severe infection,
dehydration, or severe or
continuing diarrhea occurs
or if medical tests or
surgery is required.
Symptoms of lactic
acidosis (chills, diarrhea,
dizziness, low BP, muscle
pain, sleepiness, slow
heartbeat or pulse,
dyspnea, or weakness)
should be reported to
health care professional
 immediately

Contraindications Adverse Effects

Hypersensitivity; Metabolic  Lactic acidosis

acidosis; Dehydration, sepsis,  Decreased vitamin b12
hypoxemia, hepatic impairment, levels
excessive alcohol use (acute
orchronic); Renal dysfunction
(SCr 1.5 mg/dL in men or 1.4
mg/dL in women); Radiographic
studies requiring IV iodinated
contrast media (withhold
metformin); HF

Source: APRIL HAZARD VALLERAND, PhD, RN, FAAN; CYNTHIA A. SANOSKI, BS, Pharm D, FCCP, BCPS; JUDITH HOPFER DEGLIN, Pharm D; (2015) Davis’s DRUG GUIDE
FOR NURSES, 14th Edition; Retrieved from https://www.mims.com/philippines/drug/info
 Drug Mechanism of Action Indications Side Effects Nursing Implications

Generic Name: Produce analgesia and reduce Prophylaxis of transient  Tinnitus  Patients who have asthma,
Acetylsalicylic acid inflammation and fever by inhibiting ischemic attacks and MI.  Dyspepsia allergies, and nasal polyps
(ASA); Aspirin the production of prostaglandins.  Epigastric distress or who are allergic to
 Nausea tartrazine are at an
Brand Name: Aspirin Only: Decreases platelet  Abdominal pain increased risk for
Arthrisin aggregation.  Anorexia developing hypersensitivity
 Hepatotoxicity reactions.
Classification: Therapeutic Effects: Analgesia.  Vomiting
Antipyretics, Non-opioid Reduction of inflammation.  Assess for rash periodically
analgesics Reduction of fever. during therapy. May cause
Stevens-Johnson
Route, Frequency & Aspirin: Decreased incidence of syndrome or toxic
Dosage: transient ischemic attacks and MI. epidermal necrolysis.
80 mg OD PO Discontinue therapy if
severe or if accompanied
with fever, general malaise,
fatigue, muscle or joint
aches, blisters, oral
lesions, conjunctivitis,
hepatitis, and/or
eosinophilia.

 Assess pain and limitation

of movement; note type,
location, and intensity
before and at the peak
(see Time/Action Profile)
after administration.
 Assess fever and note
associated signs
(diaphoresis, tachycardia,
malaise, chills).

 Instruct patient to take

salicylates with a full glass
of water and to remain in
an upright position for 15–
30 min after administration.

 Advise patient to report

tinnitus; unusual bleeding
of gums; bruising; black,
tarry stools; or fever lasting
longer than 3 days.

 Caution patient to avoid

concurrent use of alcohol
with this medication to
minimize possible gastric
irritation; 3 or more glasses
of alcohol per day may
increase the risk of GI
bleeding. Caution patient to
avoid taking concurrently
with acetaminophen or
NSAIDs for more than a
few days, unless directed
by health care professional
to prevent analgesic
nephropathy
 Contraindications Adverse Effects

Hypersensitivity to aspirin,  GI bleeding

tartrazine (FDC yellow dye #5),  Exfoliative dermatitis
or other salicylates;  Stevens-johnson
Crosssensitivity with other syndrome
NSAIDs may exist (less with  Toxic epidermal
nonaspirin salicylates); Bleeding necrolysis
disorders or thrombocytopenia  Anaphylaxis
(more important with aspirin);  Laryngeal edema
Children or adolescents with
viral infections (may increase
the risk of Reye’s syndrome);
Peri-operative pain from
coronary artery bypass graft
(CABG) surgery.

Source: APRIL HAZARD VALLERAND, PhD, RN, FAAN; CYNTHIA A. SANOSKI, BS, Pharm D, FCCP, BCPS; JUDITH HOPFER DEGLIN, Pharm D; (2015) Davis’s DRUG GUIDE
FOR NURSES, 14th Edition; Retrieved from https://www.mims.com/philippines/drug/info