CHAPTER 7

APPENDIX

1. ANGIOTENSIN II RECEPTOR ANTAGONISTS

Prescribed Medication Prescribed Dosage: 50 mg OD
Brand Name: Cozaar Therapeutic Dosage: 50 mg PO qday initially; may increase up
Generic Name: Lozartan to 100 g/day

Drug Classification Mechanism of Action Patient Teachings Nursing Responsibilities

(General Action)

Therapeutic Class: Blocks the vasoconstrictor and -Teach patient that losartan Assess:
Angiotensin II Receptor aldosterone-secreting effects of may cause dizziness, 1. B/P with position
Blocker angiotensin II; selectively blocks lightheadedness, and fainting changes, pulse before
Pharmacologic Class: the binding of angiotensin II to the when you get up too quickly and periodically during
Angiotensin II receptor AT1 receptor found in tissues from a lying position. This is treatment; note rate,
antagonists more common when you first rhythm, quality; black
start taking losartan. To help patients should use
Laboratory Indications avoid this problem, get out of combination therapy for
Tests/Results Relevant to bed slowly, resting your feet on better control of B/P
the Medication the floor for a few minutes 2. Baselines of renal,
before standing up. hepatic, electrolyte
Hypertension and heart failure studies before therapy
Drug - Drug Interaction -Teach patient that diarrhea, begins and periodically
vomiting, not drinking enough thereafter
Potassium supplements, potassium-containing salt substitutes fluids, and sweating a lot can 3. Skin turgor, dryness of
(No Salt, Morton Salt Substitute, and others), and even high- cause a drop in blood pressure, mucous membranes for
potassium foods (including Noni juice) should be avoided by which may cause hydration status
those taking losartan, unless directed otherwise by their doctor. lightheadedness and fainting. 4. Angioedema: facial

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Side Effects swelling, dyspnea,
wheezing; may occur
Dizziness, insomnia, anxiety, confusion, migraine, tremor, rapidly; tongue
vertigo, headache, malaise, depression, fatigue, blurred vision, swelling (rare)
diarrhea, anorexia, constipation, dry mouth, gastritis, vomiting, 5. HF: jugular venous
nocturia, urinary frequency, UTI, renal failure, dry skin, distention; edema in
flushing, photosensitivity, rash, pruritus, sweating feet/legs, weight daily
6. Blood dyscrasias:
thrombocytopenia,
anemia (rare)

2. ANTIHYPERTENSIVE DRUGS
Prescribed Medication Prescribed Dosage: 200 mg tab TID
Brand Name: Aldomet Therapeutic Dosage: 250 mg PO q8-12hr for 2 days, increase
Generic Name: Methyldopa q2Days PRN

Drug Classification Mechanism of Action Patient Teachings Nursing Responsibilities

(General Action)

Therapeutic Class: Alpha-methyldopa is converted - Instruct patient not to stop 1. Check BP and pulse at
Antihypertensives to methyl norepinephrine abruptly or without prescribers least q30min until
Pharmacologic Class: centrally to decrease the consent stabilized during IV
Centrally acting adrenergic outflow by alpha-2 - Teach patient the sign and infusion and observe
sympatholytic agent agonistic action from the central symptoms of overdose it may for adequacy of urinary
nervous system, leading to include extreme drowsiness, output.
reduced total peripheral vomiting, or fainting 2. BP taken at regular
resistance and decreased - Instruct patient to avoid intervals in lying,
systemic blood pressure. getting up too fast from sitting sitting, and standing
or lying, or she may feel dizzy positions during the
Laboratory Tests/Results Indications

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Relevant to the Medication period of dosage
adjustment if physician
management of hypertension as requests.
monotherapy or in combination 3. Be aware that transient
with hydrochlorothiazide, sedation, drowsiness,
manage hypertensive crises mental depression,
weakness, and
Drug - Drug Interaction headache commonly
Certain depression drugs called monoamine oxidase inhibitors occur during the first
(MAOIs) shouldn't be used with methyldopa. Taking these drugs 24–72 h of therapy or
with methyldopa can cause your blood pressure to rise to whenever dosage is
dangerous levels. This is known as hypertensive crisis. increased. Symptoms
tend to disappear with
Side Effects continuation of therapy
or dosage reduction.
drowsiness, weakness, headache, pale or yellowed skin, dark
colored urine, fever, a light-headed feeling, like passing out

Prescribed Medication Prescribed Dosage: 75 mg/tab oral stat

Brand Name: Catapres Therapeutic Dosage: 75 mcg sublingual, 0.1 mg PO q12h
Generic Name: Clonidine

Drug Classification (General Mechanism of Action Patient Teachings Nursing Responsibilities

Action)

Therapeutic Class: Clonidine has an alpha- Instruct patient that: 1.) Monitor frequency of
Antihypertensives antagonist effect in the - Clonidine is usually taken in prescription refills to
Pharmacologic Class: posterior hypothalamus and the morning and at bedtime. If determine adherence.
Antiadrenergic agents, medulla. The final response is you take different doses of this 2.) Monitor CBC,

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centrally acting reduced sympathetic outflow medicine at each dosing time, electrolytes, LE cell
from the central nervous it may be best to take the larger prep, and ANA titer
system (CNS), which clinically dose at bedtime. prior to and
causes a decrease in arterial - Clonidine may be taken with periodically during
blood pressure. or without food. prolonged therapy.
- Swallow the extended-release 3.) Do not discontinue
Laboratory Tests/Results Indications tablet whole and do not crush, transdermal therapy
Relevant to the Medication chew, or break it. prior to surgery;
- You may have withdrawal monitor BP carefully
Antihypertensive medication symptoms if you stop using during surgery; have
that acts as an agonist on this medicine suddenly. Ask other BP-controlling
alphaadrenergic and your doctor before stopping the drugs readily available.
imidazoline receptors. medicine. 4.) Continue oral clonidine
Drug - Drug Interaction - Call your doctor if you are therapy within 4 hr of
sick with vomiting. This is surgery then resume as
Using clonidine with other drugs that make you drowsy can especially important for a child soon as possible
worsen this effect. Ask your doctor before using opioid taking clonidine. thereafter.
medication, a sleeping pill, a muscle relaxer, or medicine for - Alcohol drinking should be 5.) Store epidural injection
anxiety or seizures. avoided; and avoid overheating at room temperature;
- Store at room temperature discard any unused
Side Effects away from moisture, heat, and portions.
light.
Fatigue, fever, headache, pallor, weakness, SOB, chest pain, dry
mouth, dizziness, constipation, irritable

Prescribed Medication Prescribed Dosage: 5 mg IVTT stat

Brand Name: Dralzine Apresazide Therapeutic Dosage: 10 mg PO q6h for 2-4 days (severe
Generic Name: Hydralazine hypertension)

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Drug Classification (General Mechanism of Action Patient Teachings Nursing Responsibilities
Action)

Therapeutic Class: Vasodilates arteriolar smooth - Instruct patient to avoid 1.) Monitor BP and pulse
Vasodilators muscle by direct relaxation; getting up too fast from a frequently during initial
Pharmacologic Class: ACE reduction in blood pressure sitting or lying position, or you dose adjustment and
inhibitors with reflex increases in heart may feel dizzy. Get up slowly periodically during
rate, stroke volume, cardiac and steady yourself to prevent therapy.
output a fall. 2.) Monitor frequency of
- Hydralazine can pass into prescription refills to
Laboratory Tests/Results Indications breast milk, but effects on the determine adherence.
Relevant to the Medication nursing baby are not known. 3.) Monitor CBC,
Tell your doctor if you are electrolytes, LE cell
Hypertension breast-feeding. prep, and ANA titer
Drug - Drug Interaction - Keep using this medicine as prior to and
directed, even if you feel well. periodically during
Some products that may interact with this drug are: MAO High blood pressure often has prolonged therapy.
inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, no symptoms. You may need 4.) Crackles, dyspnea,
moclobemide, phenelzine, procarbazine, rasagiline, safinamide, to use blood pressure medicine orthopnea
selegiline, tranylcypromine) for the rest of your life.

Side Effects

Headache, dizziness, drowsiness, peripheral neuritis,

Palpitations, tachycardia, angina, orthostatic hypotension,
Nausea, vomiting, anorexia, diarrhea, Rash, pruritus, Lupuslike
symptoms
3. VASODILATORS
Prescribed Medication Prescribed Dosage: 50 mg/tab oral stat

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Brand Name: Apo-Metoprolol, Lopressor, Toprol XL Therapeutic Dosage: 50 - 100 mg per day
Generic Name: Metoprolol

Drug Classification (General Mechanism of Action Patient Teachings Nursing Responsibilies

Action)

Therapeutic Class: Lowers B/P by β-blocking - Instruct patient that: this 1.) Assess baseline renal
Vasodilators effects; reduces elevated renin medication should be taken function, LFT. Assess
Pharmacologic Class: Beta plasma levels; blocks β2- with a meal or just after a meal, B/P, apical pulse
blockers adrenergic receptors in take the medicine at the same immediately before
bronchial, vascular smooth time each day,swallow the drug administration (if
muscle only at high doses; capsule whole and do not pulse is 60/min or less
negative chronotropic effect crush, chew, break, or open it or systolic B/P is less
- Instruct patient to not mix than 90 mm Hg,
Laboratory Tests/Results Indications potassium-rich foods like meat, withhold medication,
Relevant to the Medication milk, bananas and sweet contact physician).
potatoes when taken with beta 2.) Hypertension/angina:
angina, heart failure, blockers can result in high ECG directly when
myocardial infarction, atrial blood potassium levels. giving IV during initial
fibrillation, atrial flutter and - A Toprol XL tablet can be treatment
hypertension divided in half if your doctor
Drug - Drug Interaction has told you to do so. Swallow
the half-tablet whole, without
Many drugs can interact with metoprolol, especially:any other chewing or crushing.
heart or blood pressure medications; epinephrine (Epi-Pen); an - You should not stop using
antidepressant; an ergot medicine--dihydroergotamine, this medicine suddenly.
ergonovine, ergotamine, methylergonovine; or an MAO Stopping suddenly may make
inhibitor--isocarboxazid, linezolid, phenelzine, rasagiline, your condition worse.
selegiline, tranylcypromine.

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Side Effects

Insomnia, dizziness, hallucinations, depression, anxiety,

headaches, nightmares, confusion, fatigue, weakness, diarhea
Mild itching or rash

Prescribed Medication Prescribed Dosage: n/a (unrecalled)

Brand Name: MgSO4 Therapeutic Dosage: 4 g intravenous loading dose, immediately
Generic Name: Magnesium Sulfate followed by 10 g intramuscularly and then 5 q 4h in alternating
buttocks

Drug Classification (General Mechanism of Action Patient Teachings Nursing Responsibilies

Action)

Class V antidysrhythmics
Laboratory Tests/Results Indications
Relevant to the Medication
Drug - Drug Interaction
Magnesium sulfate reduces - Instruct patient to drink 1.) An independent double
striated muscle contractions plenty of liquids while you are check of the drug,
and blocks peripheral
taking magnesium sulfate and concentration, infusion
neuromuscular transmission byreport to the nurse if she feels rate, pump settings, line
reducing acetylcholine release
any discomfort DOB. attachment, and patient
at the myoneural junction. - If you have rectal bleeding or should be required
if you do not have a bowel before IV magnesium
movement after using sulfate is administered.
magnesium sulfate as a 2.) Assess magnesium
laxative, stop using the level to determine
For preeclampsia, short-term medication and call your deficiency (the
treatment for constipation, doctor at once. These may be therapeutic range is
evacuation of the colon for signs of a more serious very narrow; toxic
rectal and bowel exams, condition. levels may develop
quickly).

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Taking magnesium with these medications might cause blood 3.) Monitor vital signs
pressure to go too low. Some of these medications include frequently throughout
nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin) intravenous infusion.
(magnesium sulfate
Side Effects depresses respirations,
pulse rate, and rhythm.)
Weakness, dizziness, fainting, sweating, palpitation, excessive
bowel activity

4. ANTIBIOTICS
Prescribed Medication Prescribed Dosage: 500 mg/tab bid x 7 days
Brand Name: Zegen Therapeutic Dosage: 250 to 500 mg BID for 10 days
Generic Name: Cefuroxime

Drug Classification (General Mechanism of Action Patient Teachings Nursing Responsibilies

Action)

Therapeutic Class: Inhibits bacterial cell wall Instruct patient that: 1.) Assess patient history
cephalosporin antibiotics synthesis, renders cell wall - Cefuroxime oral is taken by of allergies particularly
osmotically unstable, leads tomouth. cephalosporins and
cell death by binding to cell - Swallow the tablet whole and penicillins.
wall membrane. do not crush, chew, or break it. 2.) Assess mouth for white
Take with or without food. patches in mucous
Laboratory Tests/Results Indications - Shake the oral suspension membranes and tongue.
Relevant to the Medication (liquid). Measure a dose with 3.) Monitor bowel activity
the supplied measuring device and stool consistency
Treatment of bone and joint (not a kitchen spoon). Take carefully.
infections, bronchitis and other with food. 4.) Monitor I&O and renal
LRTIs, gonorrhea, meningitis, - Antibiotic medicines can function reports for
pharyngitis, UTI

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Drug - Drug Interaction cause diarrhea. Tell your nephrotoxicity.
doctor if you have diarrhea that 5.) Monitor for drug
Some of the most important adverse interactions with antibiotics is watery or bloody. adverse effects:
are those which involve other drugs which have a low pruritus, abdominal
toxicity/efficacy ratio. These include anticoagulants such as pain, mouth sores
warfarin, anticonvulsants such as phenytoin and phenobarbitone 6.) Clostridium difficile–
and oral antidiabetic drugs like tolbutamide. associated diarrhea
(CDAD): bowel pattern
Side Effects daily; if severe diarrhea
Dizziness, headache, seizures, Diarrhea, nausea, vomiting, occurs, product should
anorexia, chills, diarrhea, fever, thick, white vaginal discharge be discontinued.
with no odor or with a mild odor, itching of the vagina area

5. ANALGESICS
Prescribed Medication Prescribed Dosage: 50 mg IVTT q8h
Brand Name: Buprenex Therapeutic Dosage: titrate in 25 mg increments every 3 days
Generic Name: Tramadol Hydrochloride to reach a dose of 25 mg four times a day; thereafter increase by
50 mg as tolerated every 3 days

Drug Classification (General Mechanism of Action Patient Teachings Nursing Responsibilies

Action)

Opiate (narcotic) analgesics Binds with opioid receptors in Instruct and teach patient that: Assess:
the CNS, altering perception of - Take tramadol exactly as
and emotional response to prescribed by your doctor. 1.) Pain: location, type,
pain. Follow the directions on your character; give before pain
prescription label and read all becomes extreme
Laboratory Tests/Results Indications medication guides. Never use 2.) I&O ratio: check for
Relevant to the Medication

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 moderate to severe pain, tramadol in larger amounts, or decreasing output; may
postoperative pain, adjunct to for longer than prescribed. indicate urinary retention
surgical anesthesia with a local - Tramadol can be taken with 3.) Need for product;
anesthetic or without food, but take it the dependency
same way each time. 4.) Bowel pattern; for
Drug - Drug Interaction - Swallow the capsule or tablet constipation; increase
whole to avoid exposure to a fluids, bulk in diet
Tramadol should not be used in combination with MAO potentially fatal overdose. Do 5.) CNS changes: dizziness,
inhibitors or serotonin-precursors (such as L-tryptophan, not crush, chew, break, open, drowsiness, hallucinations,
oxitriptan) or dissolve. euphoria, LOC, pupil
Side Effects - Do not keep leftover reaction; avoid use with
tramadol. Just one dose can other CNS depressants
Dizziness, CNS stimulation, somnolence, headache, anxiety, cause death in someone using 6.) Hypersensitivity: usually
confusion, euphoria, seizures, hallucinations, sedation, it accidentally or improperly. after beginning treatment
neuroleptic malignant syndrome–like reactions, fever

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