DRUG MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION

ACTION
HYDRALAZINE Direct vasodilating Hydralazine is used Occasional: Headache, BASELINE ASSESSMENT
effects on arterioles. with or without other anorexia, nausea, - Obtain B/P, pulse immediately
Brand name: medications to treat vomiting, diarrhea, before each dose, in addition to
-Apo-Hydralazine, Apresoline, Therapeutic Effect: high blood pressure. palpitations, regular monitoring (be alert to
Novo-Hylazin Decreases B/P, Lowering high blood Tachycardia, angina fluctuations).
systemic vascular pressure helps prevent pectoris. INTERVENTION/EVALUATION
PO: ADULTS: Initially, 10 mg 4 resistance. strokes, heart attacks, - Monitor B/P, pulse, ANA titer.
times a and kidney problems. Rare: Constipation, Monitor for headache,
Day for first 2–4 days. May ileus, edema, peripheral palpitations, and tachycardia.
increase to 25 neuritis (paresthesia), - Assess for peripheral edema of
mg 4 times/day balance of first dizziness, muscle hands, feet.
wk. May cramps, anxiety, - Monitor daily pattern of bowel
increase by 10–25 mg/dose hypersensitivity activity, stool consistency.
gradually to reactions (rash, PATIENT/FAMILY TEACHING
50 mg 4 times/day. Usual range: urticaria, pruritus, - To reduce hypotensive effect, go
25–100 fever, from lying to standing slowly.
Mg in 2–3 divided doses. chills, arthralgia), nasal - Report muscle/joint aches, fever
Maximum: congestion, (lupus-like reaction), flu-like
300 mg/day. Flushing, symptoms.
conjunctivitis. - Limit alcohol use.
IV, IM: ADULTS, ELDERLY:
Initially, 25–50
mg/dose q4–6h. C

Classsification:
PHARMACOTHERAPEUTIC
: Vasodilator. CLINICAL:
Antihypertensive.
DRUG
HYDROCHLOROTHIAZIDE
Brand Name:
-Apo-Hydro, Microzide, Novo-
Hydrazide, Exforge HCT,
Hyzaar, Inderide, Lopresor HCT,
Lotensin HCT, Micardis HCT,
Moduretic, Prinzide/Zestoretic,
Tekturna HCT, Teveten HCT,
Timolide, Tribenzor, Uniretic,
Vaseretic, Ziac
Edema
PO: ADULTS: 25–100 mg/day in
1–2 divided doses. May give on
alternate days
Or on 3–5 days/wk.
Hypertension
PO: ADULTS: 12.5–50 mg/day.
Usual Elderly Dosage
PO: 12.5–25 mg once daily.
Classification:
PHARMACOTHERAPEUTIC
: Sulfonamide derivative.
CLINICAL: Thiazide
Diuretic, antihypertensive.
MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION
Inhibits sodium Treatment of mild to Expected: Increased BASELINE ASSESSMENT
- Check vital signs, esp. B/P for
reabsorption in distal moderate hypertension, urinary frequency, hypotension before administration.
Renal tubules, causing edema in HF, hepatic Urine volume. Assess baseline electrolytes, esp. for
excretion of sodium, cirrhosis, renal hypokalemia.
- Evaluate skin turgor, mucous membranes
potassium, hydrogen Dysfunction (e.g., Frequent: Potassium for hydration status.
ions, water. nephrotic syndrome). depletion. - Evaluate for peripheral edema. Assess
muscle strength, mental status.
- Note skin temperature, moisture.
Therapeutic Effect: OFF-LABEL: Occasional: Orthostatic - Obtain baseline weight.
Promotes diuresis; Treatment of lithium- hypotension, headache, - Monitor I&O.
reduces B/P. induced GI disturbances,
INTERVENTION/EVALUATION
diabetes insipidus photosensitivity - Continue to monitor B/P, vital signs,
electrolytes, I&O, daily weight.
- Note extent of diuresis. Watch for
changes from initial assessment
(hypokalemia may result in weakness,
tremor, muscle cramps, nausea, vomiting,
altered mental status, tachycardia;
hyponatremia may result in confusion,
thirst, cold/clammy skin).
- Be esp. alert for potassium depletion in
pts taking digoxin (cardiac arrhythmias).
- Potassium supplements are frequently
ordered.
- Check for constipation (may occur with
exercise diuresis).
PATIENT/FAMILY TEACHING
- Expect increased frequency, volume of
urination.
- To reduce hypotensive effect, go from
lying to standing slowly.
- Eat foods high in potassium, such as
whole grains (cereals), legumes, meat,
bananas, apricots, orange juice, potatoes
(white, sweet), and raisins.
- Protect skin from sun, ultraviolet light

DRUG
LEVOTHYROXINE
Brand Name:
-Eltroxin, Synthyroid, Tirosint,
Unithroid
Note: IV dose is 50% of oral dose
Hypothyroidism
PO: ADULTS, GROWTH AND
PUBERTY
COMPLETE: 1.7 mcg/kg/day as
single Daily dose. Usual
maintenance: 100–125 mcg/day.
ELDERLY (OLDER THAN 50
YRS): Initially, 12.5–50 mcg/day.
Adjust dose by 12.5–25 mcg/day at
4–8 wk. intervals.
Pituitary Thyroid-Stimulating
Hormone
(TSH) Suppression
PO: ADULTS, ELDERLY: Doses
greater than 2 mcg/kg/day usually
required to suppress TSH below 0.1
milliunits/L.
Myxedema Coma
IV: ADULTS, ELDERLY: Initially,
200–500 mcg, then 100–300 mcg
next day if necessary.
Classification:
PHARMACOTHERAPEUTIC:
Synthetic isomer of thyroxine.
CLINICAL: Thyroid hormone (T4).
(photosensitivity may occur).
MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION
Converts to T3, then PO: Treatment of Occasional: Reversible BASELINE ASSESSMENT
binds to thyroid hypothyroidism, pituitary hair loss at start of - Obtain baseline TSH, T3, T4, weight,
vital signs.
receptor proteins thyroid-stimulating therapy in children. - Signs/symptoms of diabetes mellitus,
exerting metabolic hormone (TSH) diabetes insipidus, adrenal
effects through DNA suppression. Rare: Dry skin, GI insufficiency, and hypopituitarism may
and protein synthesis. intolerance, rash, become intensified.
IV: Myxedema coma. urticaria, pseudo tumor - Treat with adrenocortical steroids
before thyroid therapy in coexisting
Therapeutic Effect: cerebri, severe headache hypothyroidism and hypoadrenalism.
Involved in normal OFFLABEL: in children. -
metabolism, growth Management of INTERVENTION/EVALUATION
and development. hemodynamically unstable - Monitor pulse for rate, rhythm (report
Increases basal potential organ donors. pulse greater than 100 or marked
increase).
metabolic rate, - Observe for tremors, anxiety.
enhances - Assess appetite, sleep pattern.
gluconeogenesis, and - Monitor thyroid function tests.
stimulates protein -
PATIENT/ FAMILY TEACHING
synthesis.
- Do not discontinue drug therapy;
replacement for hypothyroidism is
lifelong. 
- Follow-up office visits, thyroid
function tests are essential. 
- Take medication at the same time each
day, preferably in the morning. 
- Monitor pulse for rate, rhythm; report
irregular rhythm or pulse rate over 100
beats/min. 
- Promptly report chest pain, weight loss,
anxiety, tremors, insomnia. 
- Full therapeutic effect may take 1–3
wks.
 DRUG
METFORMIN
Brand Name:
-Apo-Metformin, Fortamet,
Glucophage, Glucophage XR,
Glumetza, Glycon, Novo-
Metformin, Riomet
Diabetes Mellitus
PO (Immediate-Release Tablets,
Solution): ADULTS, ELDERLY:
Initially, 500 mg twice daily or 850
mg once daily.
Maintenance: 1,000–2,550 mg/day
in
2–3 divided doses. Maximum:
2,550 mg/day.
PO (Extended-Release Tablets
[Glucophage XR]): ADULTS,
ELDERLY: Initially, 500 mg once
daily. May increase by
500 mg at 1-wk intervals.
PO (Extended-Release Tablets
[Glumetza]): ADULTS,
ELDERLY: Initially,
1,000 mg once daily. May increase
by
500 mg at 1-wk intervals.
Maximum:
2,000 mg/day.
Classification:
PHARMACOTHERAPEUTIC:
Biguanide; Antihyperglycemic.
CLINICAL:
Antidiabetic agent.
MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION
Decreases hepatic Management of type 2 Occasional (greater BASELINE ASSESSMENT
production of glucose. diabetes mellitus as than 3%): GI - Assess baseline glucose, Hgb A1c,
CBC, renal function tests.
Decreases intestinal monotherapy or disturbances (diarrhea, -
absorption of glucose, concomitantly with oral nausea, vomiting,
INTERVENTION/EVALUATION
improves insulin sulfonylurea or insulin. abdominal bloating, - Monitor fasting serum glucose, Hgb
sensitivity. flatulence, anorexia) that A1c, renal function, CBC.
OFF-LABEL: Polycystic are transient and resolve - Monitor folic acid, renal function tests
for evidence of early lactic acidosis.
Therapeutic Effect: ovarian syndrome, spontaneously during - If pt is on concurrent oral sulfonylureas,
Improves glycemic gestational diabetes therapy. assess for hypoglycemia (cool/wet skin,
control, mellitus. Prevention of tremors, and dizziness anxiety,
stabilizes/decreases type 2 diabetes Rare (3%–1%): headache, and tachycardia, numbness in
body weight, and Unpleasant/metallic taste mouth, hunger, and diplopia).
- Be alert to conditions that alter glucose
improves lipid profile. that resolves requirements: fever, increased activity,
spontaneously during stress, surgical procedure.
therapy -
PATIENT/FAMILY TEACHING
- Discontinue metformin, report
immediately if evidence of lactic
acidosis appears (unexplained
hyperventilation, muscle aches, extreme
fatigue, and unusual drowsiness).
- Prescribed diet is principal part of
treatment; do not skip, delay meals.
- Diabetes mellitus requires lifelong
control.
- Avoid alcohol.
- Report persistent headache, nausea,
vomiting, and diarrhea or if skin rash,
unusual bruising/bleeding, change in
color of urine or stool occurs.
 DRUG
NEBIVOLOL
Hypertension
PO: ADULTS, ELDERLY:
Initially, 5 mg once daily alone or beta2 receptors.
in combination with other
antihypertensive. May increase at
2-wk intervals to maximum 40
mg once daily.
Severe Renal Impairment
(Creatinine
Clearance Less Than 30
ml/min)
PO: ADULTS, ELDERLY:
Initially, 2.5 mg once daily.
Increase dose cautiously.
Moderate Hepatic Impairment
PO: ADULTS, ELDERLY:
Initially, 2.5 mg once daily.
Increase cautiously.
Classification:
PHARMACOTHERAPEUTIC
: Betaadrenergic blocker.
CLINICAL: Antihypertensive.
MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION
Predominantly blocks Management of Generally well BASELINE ASSESSMENT
beta1-adrenergic hypertension. Used alone tolerated, with mild and - Assess baseline renal function,
receptors. Large doses or in combination with transient side effects. LFT.
block both beta1 and other antihypertensive. - Assess B/P, apical pulse
immediately before drug
Occasional (9%):
administration (if pulse is 60/min or
OFF-LABEL: HF Headache.
less, or systolic B/P is less than 90
Therapeutic Effect: mm Hg, withhold medication,
Lowers B/P. Rare (2%–1%): contact physician).
Fatigue, dizziness,
diarrhea, nausea, INTERVENTION/EVALUATION
insomnia, peripheral - Measure B/P near end of dosing
edema interval (Determines whether B/P is
controlled throughout day).
- Monitor B/P for hypotension.
- Assess pulse for quality, regularity,
and bradycardia.
- Question for evidence of headache
PATIENT/FAMILY TEACHING
- Compliance with therapy regimen
is essential to control hypertension.
- Do not use nasal decongestants,
OTC cold preparations (stimulants)
without physician’s approval.
- Monitor B/P, pulse before taking
medication.
- Restrict salt, alcohol intake.
- Do not chew, crush, dissolve, or
divide tablets. Swallow whole.
 DRUG
ASPIRIN
Brand Name:
-Asaphen E.C., Ascriptin Bayer,
Bufferin, Ecotrin, Entrophen,
Halfprin, Novasten, Aggrenox,
Fiorinal, Lortab/ASA, Percodan,
Pravigard
Analgesia, Fever
PO, Rectal: ADULTS,
ELDERLY: 325–650 mg q4–6h.
Anti-Inflammatory
PO: ADULTS, ELDERLY:
Initially, 2.4–3.6 g/
day in divided doses, then 3.6–
5.4 g/day
Revascularization
PO: ADULTS, ELDERLY: 80–
325 mg/day.
Classification:
PHARMACOTHERAPEUTIC
: Nonsteroidal salicylate.
CLINICAL: Antiinflammatory,
antipyretic, anticoagulant.
MECHANISM OF RATIONALE
ACTION
Inhibits cyclo- Treatment of mild to
oxygenase enzyme via moderate pain, fever.
Reduces inflammation
acetylation. Inhibits
formation of related to rheumatoid
arthritis (RA), juvenile
prostaglandin
arthritis, osteoarthritis,
derivative
rheumatic fever. Used as
thromboxane A. platelet aggregation inhibitor
in the prevention of transient
Therapeutic Effect: ischemic attacks
Reduces inflammatory (TIAs), cerebral
response, intensity of thromboembolism, MI or
pain; decreases fever; reinfarction.
inhibits platelet
aggregation. OFF-LABEL: Prevention
of
pre-eclampsia; alternative
therapy for
preventing
thromboembolism
associated
with atrial fibrillation when
warfarin cannot be used;
pericarditis associated with
MI; prosthetic valve
thromboprophylaxis.
Adjunctive treatment of
Kawasaki’s disease.
Complications associated
with autoimmune disorders;
colorectal cancer.
SIDE EFFECTS NURSING CONSIDERATION
Occasional: GI distress BASELINE ASSESSMENT
(including abdominal - Do not give to children or teenagers
who have or recently had viral
distention, cramping, infections (increases risk of Reye’s
heartburn mild nausea); syndrome).
allergic reaction - Do not use if vinegar-like odor is
(including noted (indicates chemical breakdown).
- Assess type, location, duration of pain,
bronchospasm, pruritus,
inflammation.
urticaria). - Inspect appearance of affected joints
for immobility, deformities, skin
condition.
- Therapeutic serum level for
antiarthritic effect: 20–30 mg/dL
(toxicity occurs if level is greater than
30 mg/dL)
INTERVENTION/EVALUATION
- Monitor urinary pH (sudden
acidification, pH from 6.5 to 5.5, may
result in toxicity).
- Assess skin for evidence of
ecchymosis.
- If given as antipyretic, assess
temperature directly before and 1 hr
after giving medication.
- Evaluate for therapeutic response:
relief of pain, stiffness, swelling;
increased joint mobility; reduced joint
tenderness; improved grip strength.
PATIENT/FAMILY TEACHING
- Do not, chew, crush, dissolve, or
divide enteric-coated tablets. 
- Avoid alcohol.
 DRUG
CLOPIDOGREL
Brand Name:
-Apo-Clopidogrel, Plavix
Reduction of Atherosclerotic
Events
(Pts with Recent MI, Stroke,
PAD)
PO: ADULTS, ELDERLY: 75 mg
once a day
Acute Coronary Syndrome
(ACS),
Unstable Angina/NSTEMI
PO: ADULTS, ELDERLY:
Initially, 300 mg loading dose,
then 75 mg once a day (in
combination with aspirin).
ACS (STEMI)
PO: ADULTS, ELDERLY 75
YRS OR YOUNGER:
Initially 300-mg loading dose, then
75 mg once a day. ELDERLY
OLDER THAN 75
YRS: 75 mg once daily
ACS (PCI)
PO: ADULTS, ELDERLY:
Initially, 600 mg, then 75 mg once
daily.
Classification:
PHARMACOTHERAPEUTIC:
Thienopyridine derivative.
CLINICAL: Antiplatelet.
MECHANISM OF RATIONALE
ACTION
Inhibits binding of Unstable angina/non–ST-
enzyme adenosine segment elevation
phosphate (ADP) to its MI. ST-segment elevation,
platelet receptor and acute MI. Recent
subsequent ADP- MI, stroke, or established
mediated activation of a peripheral arterial disease.
glycoprotein complex.
OFF-LABEL: Graft
Therapeutic patency (saphenous vein),
Effect: Inhibits platelet stable coronary artery
aggregation. disease (in combination
with aspirin). Initial
treatment of acute coronary
syndrome in pts allergic to
aspirin
SIDE EFFECTS
Frequent (15%): Skin
disorders.
Occasional (8%–6%):
Upper respiratory tract
infection, chest pain, flu-
like symptoms, headache,
dizziness, arthralgia.
Rare (5%–3%): Fatigue,
edema, hypertension,
abdominal pain,
dyspepsia, diarrhea,
nausea, epistaxis,
dyspnea, rhinitis.
NURSING CONSIDERATION
BASELINE ASSESSMENT
- Obtain baseline chemistries, platelet
count, PFA level.
- Perform platelet counts before drug
therapy, q2days during first week of
treatment, and weekly thereafter until
therapeutic maintenance dose is
reached.
- Abrupt discontinuation of drug therapy
produces elevated platelet count within
5 days.
INTERVENTION/EVALUATION
- Monitor platelet count for evidence of
thrombocytopenia.
- Assess Hgb, Hct, WBC; serum ALT,
AST, bilirubin, BUN, creatinine;
signs/symptoms of hepatic insufficiency
during therapy.
PATIENT/FAMILY TEACHING
- It may take longer to stop bleeding
during drug therapy.
- Report any unusual bleeding.
- Inform physicians, dentists if
clopidogrel is being taken, esp. before
surgery is scheduled or before taking
any new drug.
 DRUG
ISOSORBIDE
MONONITRATE
Brand Name:
-Apo- ISMO, Imdur, BiDil
Angina
PO (Isosorbide Dinitrate)
(Immediate-Release): ADULTS,
ELDERLY: Initially,
5–20 mg 2–3 times/day.
Maintenance:
10–40 mg 2–3 times/day.
Sustained-Release: ADULTS,
ELDERLY:
40 mg 1–2 times/day
PO (Isosorbide Mononitrate)
(Immediate-Release): ADULTS,
ELDERLY: 5–20 mg twice a day
given 7 hrs apart.
Classification:
PHARMACOTHERAPEUTIC
: Nitrate.
CLINICAL: Antianginal.
MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION
Stimulates Dinitrate: Prevention Frequent: Headache BASELINE ASSESSMENT
- Record onset, type (sharp, dull,
intracellular cyclic and treatmentof angina. (may be severe) occurs squeezing), radiation, location, intensity,
guanosine mostly in early therapy, duration of anginal pain; precipitating
monophosphate. Mononitrate: diminishes rapidly in factors (exertion, emotional stress).
- If headache occurs during management
Prevention of angina intensity, usually therapy, administer medication with
Therapeutic Effect: pectoris. disappears during meals.
Relaxes vascular continued treatment.
INTERVENTION/EVALUATION
smooth muscle of OFF-LABEL: - Assist with ambulation if light-
arterial, venous Esophageal Occasional: headedness, dizziness occurs.
vasculature. Decreases spastic disorders, HF. Transient flushing of - Assess for facial/neck flushing.
- Monitor number of anginal episodes,
preload, afterload, face/neck, dizziness, orthostatic B/P.
cardiac oxygen weakness, orthostatic
demand. hypotension, nausea, PATIENT/FAMILY TEACHING
- Do not chew, crush, dissolve, or divide
vomiting, restlessness. sublingual, extended-release, sustained-
GI upset, blurred release forms.
vision, dry mouth. - Take sublingual tablets while sitting
down.
- Go from lying to standing slowly
Sublingual: (prevents dizziness effect).
Frequent: Burning, - Take oral form on empty stomach
(however, if headache occurs during
tingling at oral point management therapy, take medication
of dissolution with meals).
- Dissolve sublingual tablet under tongue;
do not swallow.
- Avoid alcohol (intensifies hypotensive
effect).
- If alcohol is ingested soon after taking
nitrates, possible acute hypotensive
episode (marked drop in B/P, vertigo,
pallor) may occur. Report
signs/symptoms of hypotension, angina
 DRUG
ROSUVASTATIN
Brand Name:
-Apo-Rosuvastatin, Crestor
Hyperlipidemia, Dyslipidemia,
Atherosclerosis,
Dysbetalipoproteinemia,
Primary Prevention of
Cardiovascular
Disease
PO: ADULTS, ELDERLY:
Usual starting dosage is 10
mg/day, with adjustments based
on lipid levels; monitor q2–4wks
until desired level is achieved.
Lower starting dose of 5 mg is
recommended in pts of Asian
ancestry. Maximum: 40 mg/day.
Range: 5–40 mg/day.
Dosage in Renal Impairment
(Creatinine
Clearance Less Than 30
ml/min)
PO: ADULTS, ELDERLY: 5
mg/day; do not exceed 10
mg/day.
Classification:
PHARMACOTHERAPEUTIC
: HMG-CoA reductase inhibitor.
CLINICAL:
Antihyperlipidemic.
MECHANISM OF RATIONALE
ACTION
Interferes with Adjunct to diet therapy in pts
with primary hyperlipidemia
cholesterol biosynthesis
and mixed dyslipidemia; to
by inhibiting
conversion of the decrease elevated total, LDL
cholesterol, serum
enzyme HMG-CoA to
triglyceride levels; increases
mevalonate, a precursor
HDL. Adjunct to diet to slow
to cholesterol. progression of atherosclerosis
in pts with elevated
Therapeutic Effect: cholesterol. Treatment of
Decreases LDL, primary
VLDL, plasma dysbetalipoproteinemia,
triglyceride levels; homozygous familial
hypercholesterolemia (FH).
increases HDL
Treatment of pts ages 10–17
concentration.
years with heterozygous
familial hypercholesterolemia
(HeFH) to reduce elevated
total cholesterol, LDL
cholesterol, and
apolipoprotein B. Primary
prevention of cardiovascular
disease (risk reduction of
MI, stroke, arterial
revascularization)
without clinically evident
CAD, but with
multiple risk factors
SIDE EFFECTS
Generally well tolerated. BASELINE ASSESSMENT
Side effects are usually
mild, transient.
Occasional (9%–
3%): Pharyngitis,
headache, diarrhea,
INTERVENTION/EVALUATION
dyspepsia, nausea,
depression.
Rare (less
than 3%): Myalgia,
asthenia, back pain
PATIENT/FAMILY TEACHING
NURSING CONSIDERATION
- Obtain dietary history, esp. fat
consumption.
- Question for possibility of pregnancy
before initiating therapy (Pregnancy
Category X).
- Assess baseline lab results: serum
cholesterol, triglycerides, LFT
- Monitor serum cholesterol, triglycerides for
therapeutic response. Lipid levels should be
monitored within 2–4 wks of initiation of
therapy or change in dosage.
- Monitor LFT at 12 wks following initiation
of therapy, at any elevation of dose, and
periodically (e.g., semiannually) thereafter.
- Monitor CPK if myopathy is suspected.
- Monitor daily pattern of bowel activity,
stool consistency. Assess for headache, sore
throat. Be alert for myalgia, weakness.
- Use appropriate contraceptive measures
(Pregnancy Category X).
- Periodic lab tests are essential part of
therapy.
- Maintain appropriate diet (important part of
treatment).
- Report unexplained muscle pain,
tenderness, weakness, esp. if associated
with fever, malaise.
DRUG MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION
DRUG MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION
DRUG MECHANISM OF RATIONALE SIDE EFFECTS NURSING CONSIDERATION
ACTION