NAME: Shene Claire S.

Vigilla DATE: December 11, 2022

CLINICAL INSTRUCTOR: Prof. Rhoda Grace Ruelos SCORE: _______________________

Name of Drug, Dosage, Mechanism of Action Indication/Contraindication Side effects/Adverse Effect Key Nursing Responsibilities and
Route, and Generic Name Management
and Classification

Generic name: Metoprolol Metoprolol primarily blocks Beta-1 receptors Indication: Metoprolol is indicated for the
Succinate in the heart, causing decreased heart rate treatment of angina, heart failure,
and decreased blood pressure. However, myocardial infarction, atrial fibrillation, atrial
Brand Name: Lopressor higher doses can also block Beta-2 receptors flutter, and hypertension. Some off-label
in the lungs, causing bronchoconstriction. uses of metoprolol include supraventricular
Route: Oral tachycardia and thyroid storm. All the
indications of metoprolol are part of
Dosage: 100mg daily cardiovascular diseases.
Classification: Beta Contraindication: Metoprolol is
Blocker contraindicated in patients with severe
bradycardia, sick sinus syndrome, second
or third-degree AV block, cardiogenic
shock, decompensated heart failure, and
sick sinus syndrome unless a functioning
pacemaker is present.
The most serious potential adverse
effects are shortness of breath,
bradycardia, and worsening heart
failure.
Other adverse effects include fatigue,
dizziness, depression, insomnia,
nightmares, GI upset, erectile
dysfunction, dyspnea, and wheezing.
Black Box Warning: When stopping
therapy, taper dosage over 1 to 2
weeks because abrupt discontinuation
may cause chest pain or MI
Do not abruptly cease medication as
arrhythmias, hypertension, or ischemia
may develop.
Do not crush ER formulations
Give the drug with food to facilitate
absorption
Always assess apical HR and if less
than 60, do not administer and call the
prescriber unless other parameters are
provided
Monitor blood sugar in diabetic patients
because the drug can mask symptoms
of hypoglycemia

Patients and families should be

instructed to check pulse and blood
pressure and report abnormalities to the
healthcare provide
 Name of Drug, Dosage, Mechanism of Action Indication/Contraindication Side effects/Adverse Effect Key Nursing Responsibilities and
Route, and Generic Name Management
and Classification

Generic Name: Lisinopril Lisinopril is an angiotensin-converting
enzyme inhibitor (ACEI) used to treat
Brand Name: Zestril hypertension, heart failure, and myocardial
infarction. Lisinopril and captopril are the only
Route: Oral ACEIs that are not prodrugs. It functions by
inhibiting the angiotensin-converting enzyme
Dosage: 5mg daily as well as the renin-angiotensin-aldosterone
system. ACEIs are commonly used as a
Classification: ACE first-line therapy in the treatment of
inhibitor hypertension, along with thiazide diuretics or
beta blockers.
Indication: Lisinopril is indicated for the
treatment of acute myocardial infarction,
and hypertension in patients ≥6 years, and
as an adjunct therapy for heart failure. A
combination product with
hydrochlorothiazide is indicated for the
treatment of hypertension.
Contraindication: Concurrent aliskiren use
in patients with diabetes or patients with
renal impairment; hereditary or idiopathic
angioedema or history of angioedema
related to previous treatment with ACE
inhibitor; hypersensitivity to lisinopril, or
other ACE inhibitors, or their components.
Side effects: Fatigue, weakness, and
fainting. Low blood pressure.
Headache, dizziness, tingling, and
decreased sexual activity.
Adverse effect: Lisinopril causes the
kidneys to retain potassium, which
may lead to hyperkalemia. It may
happen more in older male users
Do not give to a patient who is
hemodynamically unstable after an
MI; monitor patient for anaphylaxis;
notify the prescriber if the patient has a
persistent, nonproductive cough;
monitor for dehydration, monitor
the patient's serum potassium level;
measure BP prior to medicating.
Explain drug helps to control but doesn't
cure HTN, inform the patient to take the
drug at the same time every day (very
important); emphasize the need to take
the drug as ordered.
Instruct patient to report nonproductive
cough, advise patient to drink plenty of
fluids and avoid excessive sweating;
caution patient not to use salt
substitutes that contain potassium
 Name of Drug, Dosage, Mechanism of Action Indication/Contraindication Side effects/Adverse Effect Key Nursing Responsibilities and
Route, and Generic Name Management
and Classification

Generic Name: Verapamil Inhibits the transport of calcium into
ER myocardial and vascular smooth muscle cells,
resulting in inhibitions of
Brand Name: Calan excitation-contraction coupling and
subsequent contraction
Route: Oral Decrease SA and Av conduction and
prolongs Av nide refractory period in
Dosage: 100mg daily conduction tissue.
Classification: Therapeutic Effect: Systematic vasodilation
Calcium-channel blocker resulting in decreased blood pressure.
Coronary vasodilation results in decreased
blood pressure.
Coronary vasodilation results in decreased
frequency and severity of attacks of angina.
Suppression of ventricular tachyarrhythmias.
Indication: Management of hypertension,
angina pectoris, and/or vasospastic
(Prinzmetal’s)
angina. Management of supraventricular
arrhythmias and rapid ventricular rates in
atrial flutter or fibrillation.
Contraindication: Hypersensitivity; Sick
sinus syndrome; 2nd- or 3rd-degree AV
block(unless an artificial pacemaker is in
place); BP<90mmHg; CHF, severe
ventricular dysfunction, or cardiogenic
shock, unless associated with
supraventricular tachyarrhythmias;
ConcurrentIV beta-blocker therapy
Side effects:
CNS: abnormal dreams, anxiety,
confusion, dizziness/lightheadedness,
drowsiness, headache,
Resp: cough, dyspnea, shortness of
breath.
GI: abnormal liver function studies
anorexia, constipation, diarrhea, dry
GU: dysuria, nocturia, polyuria, sexual
dysfunction, urinary frequency.
Derm: dermatitis, erythema
multiforme, flushing, increased
sweating
Adverse Effect: Arrhythmias, CHF,
Steven Johnson Syndrom
Monitor blood pressure and pulse before
therapy, during dosage titration, and
periodically throughout therapy.
Monitor ECG periodically during
prolonged therapy. Verapamil may
cause prolonged PR intervals.
Monitor intake and output ratios and
daily weight. Assess for signs of CHF
(peripheral edema, rales/crackles,
dyspnea, weight gain, jugular venous
distention)
Monitor renal and hepatic functions
periodically during long-term therapy.
May cause an increase in hepatic
enzymes after several days of therapy,
which return to normal on
discontinuation of therapy
 Name of Drug, Dosage, Mechanism of Action Indication/Contraindication Side effects/Adverse Effect Key Nursing Responsibilities and
Route, and Generic Name Management
and Classification

Generic Name: Increases excretion of sodium and water
Hydrochlorothiazide by inhibiting sodium reabsorption in the
distal tubule. Promotes excretion of chloride,
Brand Name: Microzide potassium, magnesium, and bicarbonate.
May produce arteriolar dilation.
Route: Oral
Therapeutic Effects: Lowering of BP in
Dosage: 25mg daily hypertensive patients and diuresis with
mobilization of edema.
Classification: Diuretics
Indication: Management of
mild to moderate hypertension.
Treatment of edema associated
with: HF, Renal dysfunction,
Cirrhosis, Glucocorticoid therapy, and
Estrogen therapy.
Contraindication: Hypersensitivity
(cross-sensitivity with other thiazides
or sulfonamides may exist)
Some products contain tartrazine
and should be avoided in patients
with known intolerance.
Side effect: Monitor BP, intake, output, and daily
CNS: Dizziness, drowsiness, lethargy, weight and assess feet, legs, and
weakness sacral area for edema daily.
CV: hypotension
GI: anorexia, cramping, hepatitis, Assess the patient, especially if taking
nausea, vomiting digoxin, for anorexia, nausea,
Endo: hyperglycemia vomiting, muscle cramps, paresthesia,
and confusion. Notify the health care
Adverse effect: professional if these signs of electrolyte
Derm: Stevens-Johnsons Syndrome imbalance occur. Patients taking digoxin
are at risk of digoxin toxicity because of
the
potassium-depleting effect of the diuretic
Assess patient for allergy to
sulfonamides. Assess patient for skin
rash frequently during therapy.
Discontinue diuretic at the first sign of
rash;

Monitor the frequency of prescription

refills to determine compliance.
5. Lab Test Considerations: Monitor
electrolytes (especially potassium),
blood glucose, BUN, and serum
 Name of Drug, Dosage, Mechanism of Action
Route, and Generic Name
and Classification
Generic Name: Aspirin Analgesic and antirheumatic- inhibits
prostaglandin (an inflammatory mediator)
Brand Name: Asaprim synthesis.
Route: Oral Antipyretic effect – this action is not fully
understood but drug study of aspirin is
Dosage: 75mg daily correlated with the ability of the drug to act in
the thermoregulatory center of the
Classification: hypothalamus by blocking the endogenous
Nonsteroidal pyrogen through inhibiting the synthesis of
antiinflammatory drug prostaglandin intermediary.
Antiplatelet–aspirin drug study reveals the
ability of the drug to inhibit thromboxane A2
(a potent vasoconstrictor and inducer of
platelet aggregation) synthesis
Indication/Contraindication
Indication: Mild to moderate pain, fever,
Inflammatory conditions such as
rheumatic fever, arthritis, and
spondyloarthropathies
Reduction of risk of recurrent transient
ischemic attack
(precursor to stroke) or cardiovascular
accident (stroke) in
patients with a history of TIA due to fibrin
platelet emboli or ischemic stroke
Contraindications:
People with an allergy to salicylates or
NSAIDs. This is more common in
people with nasal polyps, asthma, and
chronic urticaria.
People with hemophilia, allergy to tartrazine
(cross-sensitivity is common), bleeding
ulcers, blood coagulation defects, and with
Vitamin K deficiency (increased risk of
bleeding)
Side effects/Adverse Effect
Adverse effect:
Acute aspirin toxicity – respiratory
alkalosis, hemorrhage, tachypnea,
confusion, asterixis, pulmonary
edema, seizures, tetany, metabolic
acidosis, renal and
respiratory failure
Aspirin intolerance – exacerbation of
bronchospasm, rhinitis
Gastrointestinal: nausea, dyspepsia,
heartburn, epigastric discomfort,
anorexia, hepatotoxicity
Hematologic: occult blood loss,
hemostatic defects
Hypersensitivity: anaphylactoid
reactions to anaphylactic shock
Salicylism: dizziness, tinnitus, difficulty
hearing, nausea, vomiting, diarrhea,
Key Nursing Responsibilities and
Management
creatinine, and uric acid levels before
and periodically throughout therapy.
Assess patient’s orientation
to time and place as the
drug may cause dizziness
and confusion.
Give drug with food or after
meal if GI upset occurs.
Assess skin color and
presence of lesions as this
may indicate hepatotoxicity,
allergy, bleeding, and other
complications.
Observe patient for signs
and symptoms of bleeding
such as easy bruising,
bleeding in the gums, and
nosebleeds.
Monitor vital signs.
Instruct to avoid OTC drugs
as many of those contain
aspirin so serious overdose
can occur.
Encourage client to increase
oral fluid intake to facilitate
 Name of Drug, Dosage, Mechanism of Action Indication/Contraindication Side effects/Adverse Effect Key Nursing Responsibilities and
Route, and Generic Name Management
and Classification

mental confusion the excretion of drugs.

Caution with people who have impaired
renal function, children and
teenagers (risk for developing Reye’s
Syndrome), patients who will have surgery
within 1 week, and pregnant women (it
readily crosses the placenta and is a
possible teratogen) as well as lactating
mothers.

1. What is the nurse’s best response to the patient’s question “Why do I have to take so many medications?”

The nurse should explain that each medication works in different ways within the body to treat high blood pressure. It is vital to explain the importance of maintaining blood pressure within the normal
range to prevent additional complications such as heart attack, heart failure, stroke, and kidney failure. The nurse should also explain each of the medicine’s mechanisms of action, indications, and
side effects. Metoprolol is a selective Beta-1 blocker that decreases the heart rate and force of contraction to reduce blood pressure. Lisinopril is an ACE inhibitor that reduces blood pressure through
vasodilation and reduces fluid retention. Verapamil is a calcium channel blocker that causes vasodilation to reduce blood pressure. Hydrochlorothiazide is a thiazide diuretic that reduces fluid
retention. For this patient, all four medications may be required to maintain blood pressure within the normal range.