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Michelle B. Espaltero DRUG STUDY Patient name: P.R. Room number: 121 1.

Generic Name: Isosorbide mononitrate Brand Name: Imdur Classification: antianginals Indication: Acute treatment of Anginal attancts. Prophylactic management of angina pectoris. Treatment of CHF. Mechanism of Action: Produce vasodilation. Decrease left ventricular end- diastolic pressure and left ventricular end- diastolic volume (preload). Net effect is reduced myocardial oxygen consumption. Increase coronary blood flow by dilating coronary arteries and improving collateral flow of ischemic regions. Therapeutic Effect: Relief and prevention of angina attacks. Side Effects: CNS- dizziness, headache; CV- hypotension, tachycardia, paradoxic bradycardia, syncope; GI- nausea, vomiting; Misc- flushing, tolerance. Contraindication: Hypersensitivity; concurrent use of sidanafil, vardanefil or tadalfil. Use cautiously in: Volume depleted patients, right ventricular infarction, Hypertrophic cardiomyopathy: Geri- Older patients may be more sensitive to hypotension (start with lower doses) OB- Pregnancy (May compromise maternal/ fetal circulation) or lactation; Pedi- Children Nursing Responsibility: Assessment: - Assess location, duration, intensity and precipitating factors of angina pain. - Monitor blood pressure and pulse routinely during period of dosage adjustment. Implementation: PO: do not crush, break or chew. SL: tablets should be held under toungue until dissolved. - Avoid eating, drinking or smoking until tablet is dissolved. Patient/ Family Teaching: - 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. - Advise to avoid concurrent use of alcohol. - Inform that headache is a common side effect that should decrease with continuing therapy.

2. Generic Name: Insulin detemir Brand Name: Levemir Classification: anti- diabetics Indication: Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus Mechanism of Action: Lower blood glucose by: stimulating glucose uptake in skeletal muscle and fat, inhibiting heapatic glucose production. Other actions: inhibition of lipolysis and proteolysis, enhanced protein synthesis. Therapeutic Effects: Control of hyperglycemia in diabetic patients

constipation.Assess patient for signs and symptoms of hypoglycaemia (anxiety. potassium and calcium. . Increases renal excretion of water. nervousness. pruritus. After initial use. swelling. cold sweats. Keep away from direct sunlight. drowsiness. alcohol swabs). . Nursing Responsibility: Assessment: . fruit. dyspepsia. .Monitor body weight periodically. flushed.Children <6 yr (safety not established). Changes in weight may necessitate changes in insulin dose. storage. hepatic impairment or renal disease. Use Cautiosly In: Stress and infections ( may temporarily increase insulin requirements) Renal/ Hepatic impairment (may dec. dry skin. . chloride.Monitor blood glucose every 6 hour during therapy Implementation: . Endo. unusual thirst). confusion. chills. Store unopened vials and cartridge in the refrigerator. a prefilled syringe may be stored in a cool place for 42 days. GI. do not freeze. N/V. Patient/ Family Teaching: .Emphasize the importance of compliance with nutritional guidelines and reguar exercise as directed. excessive hunger. deep breathing. difficulty in concentration. . Miscallergic reactions including anaphylaxis.Instruct patient sign and symptoms of hypo/ hyperglycemia and what to do if they occur. nausea.Patients with diabetes mellitus should carry a source of sugar (candy. glucose gel). Efectiveness persists in impaird renal function. Generic Name: Furosemide Brand Name: Lasix Classification: diuretics Pharmacologic: loop diuretics Indication: Edema due to heart failure. Side Effects: CNS.lipodystrophy. Include type of insulin.like breath odor.Pregnancy (may temporarily increase insulin requirements).Side Effects: Endo. 3. tingling of hands. pancreatitis. Contraindication: Hypoglycemia. lips or tongue. Therapeutic Effect: Diuresis and subsequent mobilization of excess fluids ( edema.Notify physician of medication regimen prior to treatment or surgery. EENT. . and palce to discard syringes. Decrease blood pressure. nausea. unsteady gait) and hyperglycemia ( confusion. Insulin requirements). vertigo.Explain to patient that this medication controls hyperglycemia but does not cure diabetes.anorexia. vomiting. headache. restlessness. magnesium. drowsiness. cartridge pens. mood changes. loss of appetite. rash. Allergy or hypersensitivity to a particular type of insulin. Mechanism of Action: Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. . discoloured. or any unusually viscous. tremor. Hypertension. headache.photosensitivity.blurred vision. If unable to refrigerate can be kept in a cool place unrefrigerated for up to 28 days. CVhypotension. diarrhea. sodium. Derm. Local. OB. pleural effusion). polyuria. . vomiting. preservatives or other additives. GU.hearing loss.Subcut: Rotate injection sites. cool pale skin. dizziness. weakness. equipment ( syringe.Hypoglycemia.excessive urination.hyperglycemia. rapid.Instruct proper technique for administration. Pedi. pruritus. tiredness. erythema.Do not use if cloudy. dry mouth. . feet. tinnitus. tachycardia.

back pain. neutropenia. dyspepsia.Caution patient to change position slowly to minimize orthostatic hypotension. especially hypotension and electrolyte imbalance at usual doses. hyponatremia. Side Effects: CNS.paresthesia.Monitor electrolytes. dizziness. MS. .depression. lung sounds. Misc. . Generic Name: Clopidogrel Brand Name: Plavix Classification: anti. edema. Hemat. .may be taken with food or milk to minimize gastric irritation. Derm. Risk of side effects.hypercholesterolemia.GI bleeding.Bleeding. electrolyte depletion. acute coronary syndrome (unstable angina/ non Q. purpura. serum glucose. . gastritis. rash.fever hypersensitivity reactions. Mechanism of Action: Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. Nursing Responsibility: Assessment: .PO. Misc.wave MI). Patient/ Family Teaching: . Neuro. . Notify physician if thirsty.chest pain. MS.Instruct patient to consult health care professional regarding a diet high in potassium.arthralgia. Some liquid products may contain alcohol. Pedi: Increased risk of renal calculi and patent ducus arteriosus in premature neonates. Implement fall strategies. Contraindication: Hypersensiticyt. thrombocytopenia.Notify physician if weight gain more than 3 lbs.pruritus.Caution to use sunscreen and protective clothing to prevent photosensitivity reactions. and uric acid levels before and periodically through out therapy. Pregnancy and lactation. Implementation . dry mouth. hypovolemia.muscle cramsp. Hepatic coma or anuria. GI. Monitor daily weight. hypokalemia. stroke or peripheral vascular disease. agranulocytosis. . headache.Assess fluid status. hypertension. 4. reanal and hepatic function. weakness. .Monitor BP and pulse before and during administration. Metab. skin turgor and mucous membranes. metabolic alkalosis. CV. in one day. intake and output ratios. . lethargy. dyspnea. leukopenia. hypomagnesemia. Cross sensitivity with thiazides and sulphonamides may occur. amount and location of edema. Geriatric patients mayhave inc. avoid in patients with alcohol tolerance. Hemat. Tablets may be crushed if patient has difficulty swallowing. diarrhea. fatigue. hypochlormeia.Aplastic Anemia. nephrocalcinosis. abdominal pain. Diabetes Mellitus. Increasing azotemia. EENT. hypotension or oliguria occurs. haemolytic anemia.epistaxis.Assess for allergy of sulphonamides.fever. increased BUN.cough. Use cautiously in: Severe liver disease.hyperuricemia.platelet agents Pharmacologic: Platelet aggregation inhibitor Indication: Reduction of atherosclerotic events in patients at risk for such events including recent MI. thrombocytopenic purpura.Geri: Diuretic use is associated with increase risk of falls in older adults. Resp.

flaccidity. constrictive pericarditis. Implementation: .Monitor apical pulse for full 1 minute before administering. known alcohol intolerance (elixir only) Nursing Responsibility: Assessment: . . Cross sensitivity with other benzodiazepines may occur. Prolongs refreactory period of the AV node. Fall precaution of geriatric patients.Arrhythmias. Capsule should be swallowed whole. Symptoms are dose related and most severe during initial therapy. GI.Instruct to notify physician if unusual tiredness. EENT. Patient/ Family Teaching: . Idiopathic hypertrophic subaortic stenosis. delirium. do not open. . Preexisting CNS depression. . agitations. and location of Seizure activity. Decreases conduction through the SA and AV nodes.May cause drowsiness. may be given with food or fluids. yellow or green vision.gynecomastia. fever.blurred vision. Lactation: may cause CNS depression. In lactation discontinue drug or bottle feed.Contraindication: Hypersensitivity. Mechanism of Action: Increases the force of myocardial contraction.Seizure: Observe and record intensity.PO: if gastric irritation is a problem. Contraindication: Hypersensitivity. bradycardia. uncontrolled ventricular arrhythmias. Protect from injury.Alcohol Withdrawal: Assess for tremors. N/V. Paroxsysmal atrial tachycardia. because absorption may be delayed.arrhythmics. mood behaviour) prior to and periodically during therapy. diarrhea.Anxiety: Assess degree of manifestations of anxiety and mental status (orientation. rhythm. sore throat.chronotropic effect). clay. . Endo.Caution to avoid alcohol or other CNS depressants concurrently with the medication.colored stools. Angle closure glaucoma. Tachyarrhythmias: Atrial fibrillation and atrial flutter ( slows ventricular rate). Withhold and notify if PR is <60bpm in adult and <70 bpm if child or <90 bpm in infant.fatigue.Avoid administration of antacid within 1 hr of medication. . 5. Metab: electrolyte imbalances with acute digoxin toxicity. inotropics Pharmacologic: digitalis glycosides Indication: Treatment of CHF. ECG changes. Nursing Responsibility: Assessment: . Generic Name: Digoxin Brand Name: Lanoxin Classification: Anti.Monitor BP periodically in patients receiving digoxin. Institute seizure precautions. SA block.anorexia. A-V block. headache. Side Effects: CNS. and clumsiness. . Notify significant changes in rate. OB. bleeding. CV. . . may increase in severity or disappear with concurrent or long term therapy.Assess for drowsiness. Avoid activities requiring alertness until response to drug is known. or quality of pulse. unsteadiness. weakness. Therapeutic Effects: Increase cardiac output ( + inotropic) and slowing of the heart rate ( . duration. Severe uncontrolled pain. feeding difficulties and seizure in infant. AV block. hallucinations. yellowing of the skin or behavioural changes.

abdominal cramps.PO: administer consistently with regard to meals.Assess for abdominal distention.Administer Digoxin immune fab (digibind) if life.threatening arrhythmias occurs. 6. MS. . Generic Name: Bisacodyl Brand Name: Dulcolax Classification: Laxatives Pharmacologic: Stimulant laxatives Indication: Treatment of constipation.Teach patient to take PR and contact physician if PR is <60 or >100 bpm. impaired renal function. Alters fluid and electrolyte transport. tetany (with chronic use). F/E. consistency and amount of the stool produced.burning. It binds to the digitalis glycoside molecule in the blood and excreted by the kidneys. Aureus and S.losing enteropathy. Nursing Responsibility: Assessment: . Patient/ Family Teachings: . diarrhea.Assess lesions before and daily during therapy. . Part of a bowel regimen in spinal cord injury patients. Therapeutic Effects: Inhibition of bacterial growth and reproduction. Misc. Generic Name: Mupirocin Brand Name: Bactroban Classification: anti. pain. Pyogenes.Assess color. . presence of bowel sounds. Tablets can be crushed and administered with foods or fluids difficulty of swallowing.muscle weakness (with chronic use). Contraindication: Hypersensitivity to mupirocin or polyethylene glycol Use cautiously in: Pregnancy or Lactation. . itching.infectives Indication: Topical. Advise to notify immediately if symptoms of CHF occur. nausea.PO: taken on an empty stomach will produce more rapid results.hypokalemia (with chronic use). Assess for peripheral edema.protein. burn patients. producing fluid accumulation in the colon. Mechanism of Action: Inhibits bacterial protein synthesis. Side Effects: Derm.treatment of: Impetigo. . secondarily infected traumatic skin lesions ( up to 10 cm in length) caused by S. and auscultate lungs for rales/ crackles throughout therapy. rectal burning. . Implementation: . Implementation: . Mechanism of Action: Stimulates peristalsis. stinging.Take with a full glass of water. and usual pattern of bowel function.- Monitor I/O ratio and daily weights. Evacuation of the bowel before radiologic studies or surgery. 7. Contraindication: Nursing Responsibility: Assessment: .May be administered at bedtime for morning results. Therapeutic Effects: Evacuation of the colon Side Effects: GI.Review S/Sx of digitalis toxicity with patient and family.

migraine headache (prophylaxis). increased liver function and studies. angina pectoris. nervousness. glaucoma ( ophthalmic use). smoking cessation. EENT. gastric pain. pulmonary edema. Room Number: 122 1. Mechanism of Action: Blocks stimulation of beta 1 ( myocardial).hypertensive Pharmacologic: Beta Blockers Indication: Hypertension. lowsodium diet. peripheral vasoconstriction. Nursing Responsibility: Asssessment: .hyperglycemia. weight gain. dry mouth. CHF. stuffy nose. Therapeutic Effects: Decrease BP and heartrate. If heart rate is <60 bpm or if arrhythmias occurs hold medication and notify. acute bronchospasm and some forms of valvular heart disease. mental status changes. joint pain.Take apical pulse prior to administering. Does not usually affect beta2 (pulmonary. diarrhea. drug induced hepatitis. dizziness. . Patient’s Name: U. CV. MS. peripheral edema. jugular vein distention). hypotension. Contraindications: Uncompensated CHF. anxiety. insomnia. . Implementation: . nightmares. CHF. Assess patient routinely for S/Sx of CHF ( dyspnea. N/V. Derm.arthralgia. Apply a small amount of mupirocin to the affected area 3x daily and rub in gently. tachyarrhythmias. hypertrphic subaortic stenosis. regular exercise. moderation of alcohol consumption and stress management.bradycardia.D.Monitor I/O ratios and daily weight. . Endo. Misc.blurred vision. flatulence. Libido. GI. back pain.drug induced lupus syndrome. Treated area may be covered with gauze if desired.bronchospasm.fatigue.erectile dysfunction.Teach appropriate hygienic measures to prevent spread. hypoglycaemia. urinary frequency. Generic Name: Levobetaxolol Brand Name: Betaxon Classification: anti. wheezing. crackles/ rales. dec.adrenergic receptors.Wash affected area with soap and water and dry thoroughly. uterine). depression. bradyarrhythmias and heart block. vascular.Encourage to comply with additional interventions for hypertension ( weight reduction. Patient/ family Teaching: .Change position slowly to minimize orthostatic hypotension. drowsiness.Consult physician before taking any OTC medications or herbal medicines especially cold remedies. weakness. Patient/ Family Teachings: . memory loss. Resp.Implementation: . Side Effects: CNS.Monitor BP and pulse frequently during dose adjustment and periodically throughout therapy. heartburn. MI (prevention). Decreased frequency of attacks of angina pectoris. GU.adrenergic sites.constipation.rashes. .

stroke. . Misc: fever. use in pregnancy only if clearly indicated Side Effects: CNS: depression. dyspnea. Generic Name: Telmisartan Brand Name: Micardis Classification: anti. stroke. CV: chest pain. EENT: epistaxis. do not double doses Advise patient to notify health care professional promptly if fever. purpura. Generic Name: Clopidogrel Brand Name: Plavix Mechanism of Action: Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors Therapeutic Effect(s): Decreased occurrence of atherosclerotic events in patients at risk Indication: Reduction of atherosclerotic events (MI. abdominal pain. or unusual bleeding or bruising occurs Advise patient to notify health care professional of medication regimen prior to treatment or surgery Advise patient to consult health care professional before taking any Rx. fatigue. acute coronary syndrome (unstable angina/non–Q-wave MI). rash. Resp: cough.  • • • Nursing Responsibility: Instruct patient to take medication exactly as directed. GI: GI BLEEDING. hypersensitivity reactions. or peripheral vascular disease Contraindication: • Hypersensitivity • Pathologic bleeding (peptic ulcer. chills. dyspepsia. or other pathologic conditions) • History of GI bleeding/ulcer disease • Concurrent use of strong CYP2C19 inhibitors • Severe hepatic impairment • OB: Lactation: Pedi: Safety not established. NEUTROPENIA.hypertensives Pharmacologic: Angiotensin II receptor antagonists Indication: diabetic nephropathy and hypertension. headache. back pain. or herbal products. dizziness.2. intracranial hemorrhage) • Lactation Use Cautiously in: • Patients at risk for bleeding (trauma. Derm: pruritus. Management of CHF in combination of ACE and beta blocker. Hemat: BLEEDING. OTC. gastritis. vascular death) in patients at risk for such events including recent MI. Take missed doses as soon as possible unless almost time for next dose. Metabolic: hypercholesterolemia. THROMBOTIC THROMBOCYTOPENIC PURPURA. diarrhea. sore throat. surgery. MS: arthralgia. edema. Prevention of stroke in patients with hypertension and left ventricular hypertrophy. hypertension. especially those containing aspirin or NSAIDs or proton pump inhibitors 3.

. crush or cut these types of tablets. Miscangioedema Contraindications: Hypersensitivity. rhinitis. 4. Derm.PO: may ne administered without regard to meals. . Mechanism of Action: Therapeutic Effects: Side Effects: stomach discomfort.Store in a cool. dry place. sitting. EENT. Implementation: . diarrhoea. You may take it with or immediately after food to reduce certain side effects that it may cause. facial swelling) .dizziness.Best taken on an empty stomach. fatigue. .Caution to avoid driving or any other activities requiring alertness until response is known. weakness. Lactation: Discontinue drug or provide formula. insomnia.Swallow it whole with a glass of water. sinusitis. . Contraindication: Nursing Responsibility: . Side Effects: CNS. tachycardia.arthralgia.Assess patient for signs of angioedema ( dyspnea. discontinuation of smoking. Do not chew. Nursing Responsibility: Assessment: . chest pain. GUimpaired renal function. edema. tea.Should not be taken within 1 hour before or 2 hours after taking antacids. MS. vomiting. CVhypotension. Patient/ Family Teachings: . Therapeutic Effects: Lowering of BP. OB: Can cause injury or fetal death. anxiety. and stress management. pharyngitis.nasal congestion. including vascular smooth muscle and the adrenal glands. coffee. milk or whole grains as this may reduce its absorption. lowsodium diet. milk or whole grains. GI. standing) and pulse periodically.Encourage to comply with additional interventions for hypertension ( weight reduction.Assess BP (lying.abdominal pain.CHF: Monitor daily weight and assess patient routinely for resolution of fluid overload. nausea or vomiting. Notify any significant changes. If you are taking Sorbifer Durules for a longer period of time. nausea. drug induced hepatitis. N/V. moderation of alcohol consumption. . myalgia. at least 1 hour before or 2 hours after a meal. . coffee. you may also develop constipation. diarrhea. back pain. dyspepsia. These side effects are normal and not a cause for worry. . stomach cramps and darkcoloured (black or brown) stools.Caution patient to avoid salt substitutes containing high levels of potassium or sodium unless directed by physician. regular exercise.Mechanism of Action: Blocks vasoconstrictor and aldosterone producing effects of angiotension II at receptor sites.Should not be taken within 1 hour before or 2 hours after taking tea. . in which the body does not produce enough red blood cells due to a lack of iron. such as stomach discomfort. F/E: hyperkalemia.rashes. Generic Name: Iron + Vitamin C Brand Name: Sorbifer durules Classification: Ferrous Sulfate Indication: It is used to treat a blood disorder known as iron-deficiency anaemia. depression. Slowed progression of diabetic nephropathy. headache.

neutropenia.N.5. Assess fever. Generic Name: Mupirocin Brand Name: Bactroban Classification: anti. Derm: rash. secondarily infected traumatic skin lesions ( up to 10 cm in length) caused by S.burning. note presence of associated signs (diaphoresis. . Patient’s Name: E.treatment of: Impetigo. Pyogenes. leukopenia.Wash affected area with soap and water and dry thoroughly. stinging. Aureus and S. Room Number: 123 1. Fever Mechanism of Action: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever. Implementation: . tachycardia.H. Errors have resulted in serious liver damage. Contraindication: Hypersensitivity to mupirocin or polyethylene glycol Use cautiously in: Pregnancy or Lactation. Therapeutic Effects: Inhibition of bacterial growth and reproduction. GI: HEPATICFAILURE. pancytopenia. nonopioid analgesics Indication: Mild pain. primarily in the CNS Side Effects: Hema: haemolytic anemia. Side Effects: Derm. Generic Name: Paracetamol Brand Name: Biogesic Classification: antipyretics. and malaise). pain. urticaria. Nursing Responsibility: BEFORE: DURING: AFTER: Advise parents or caregivers to check concentrations of liquidpreparations. Treated area may be covered with gauze if desired. Nursing Responsibility: Assessment: . Advise patient to consult health care professional if discomfort or fever is not relieved by routine doses of this drug or if fever is greater than 39.Assess lesions before and daily during therapy.infectives Indication: Topical. HEPATOTOXICITY(overdose) GU: renal failure (high doses/chronic use). Hepa: jaundice Metabolic: hypoG. Adults should not take acetaminophen longer than 10 days and children not longer than 5 days unless directed by health care professional. Mechanism of Action: Inhibits bacterial protein synthesis.Teach appropriate hygienic measures to prevent spread.5°C (103°F) or lasts longer than 3 days. burn patients. impaired renal function. Advise mother or caregiver to take medication exactly as directed and not to take more than the recommended amount. Patient/ family Teaching: . Apply a small amount of mupirocin to the affected area 3x daily and rub in gently. itching.

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nn      ° n-f¯  ¾fn  f° -f¯ nf .

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°f° nf°¾ D°n¯½ °¾f .

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f°– ½¾°¾¯°¯ ¾fn½ °¾°   .

°¾ ½¾nf° €  f°– f° @.

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   ° n-f¯ .

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°n °¾ €¾°–.

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°n¯ °f°€.

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   ° n-f¯ 9ffn f¯ f° -f¯  – ¾n .

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