UNIVERSITY OF SAN JOSE – RECOLETOS

School of Allied Medical Science

Nursing

DRUG STUDY
Name of Student: Kathline S. Migallen Year Level: BSN – 4 Date: September 04, 2023 Area of Exposure: PSH Ward
Client Initials: DS Diagnosis/es: Ischemic Heart Disease in Heart Failure Doctor/s: Dr.

Classification and Indication and Side Effects / Nursing

Name of Drug Contraindication
Mechanism of Action Dosage Adverse Reaction Responsibilities

Generic Name: Pharmacotherapeutic ➢ Heart Hypersensitivity to Side Effects: BEFORE:

Class:
Sacubitril-valsartan
Combination of sacubitril, a
Brand Name: neprilysin inhibitor, and
valsartan, an angiotensin II
Entresto
receptor blocker.
Clinical Class: Reduces risk
of complications in HF
MOA:
Sacubitril inhibits neprilysin,
increasing peptide levels that
Source:
are degraded by neprilysin
(e.g., natriuretic peptides).
(Saunders, 2021
Valsartan directly
Nursing Drug
antagonizes angiotensin II
Handbook)
receptors; blocks
vasoconstrictor, aldosterone
secreting effects of
angiotensin II, inhibiting
binding of angiotensin II to
AT1 receptors. Therapeutic
Effect: Decreases risk of
Failure sacubitril or valsartan;
history of angioedema Occasional (9%): - Perform hand
related to angiotensin- Cough, dizziness. washing/hygiene
Dosage: - Check the doctor’s
converting enzyme
(ACE) inhibitor or order
50mg/tab, 1tsb
angiotensin receptor - Check the
Orally, 2x a day Adverse Reactions:
blockers (ARB); medication thrice
- Check the right
concomitant use or Angioedema (less
dose, right route,
within 36 hrs of ACE than 1% of pts),
inhibitors; concomitant hypotension (18% of and right patient
use of aliskiren in pts pts), orthostatic - Check the
with diabetes. hypotension (2% of Medication sheet
pts), prior to
administration of
impairment/decrease
drugs
in renal function due
to inhibition of renin-
DURING:
angiotensin-
aldosterone system - Monitor BMP, esp.
(5% of pts), elevation serum BUN,
of serum creatinine creatinine,
greater than 50%
potassium.
from baseline (1.4%
- Monitor for
of pts), renal
hyperkalemia,
impairment including
hypotension. If
oliguria, azotemia,
mortality in pts with chronic
HF; produces vasodilation;
decreases peripheral
resistance; decreases B/P.
acute renal failure hypotension
(5% of pts), occurs, place pt in
hyperkalemia (12% supine position,
of pts), serum feet slightly
potassium elevation elevated; consider
greater than 5.5 interrupting
mEq/L (4% of pts) treatment or
have occurred.
altering dose of
diuretic,
antihypertensive
drugs and screen
for
dehydration/serum
sodium depletion.
- If pt positive for
dehydration, be
cautious with PO/IV
administration.
- Overhydration may
exacerbate HF.
- Assist with
ambulation if
dizziness occurs.
- Monitor for
hypersensitivity
reaction, including
angioedema. If
angioedema
occurs, interrupt
treatment and
institute therapy to
protect airway
patency
Patient Teaching:

- Go slowly from
lying to standing.
- Be cautious of fluid
intake.
Overhydration may
lead to worsening
of HF, while
underhydration may
lead to low blood
pressure.
- Report urine
changes such as
darkened urine,
decreased output.
- Immediately report
allergic reactions
such as difficulty
breathing, itching,
rash, tongue
swelling; symptoms
of high potassium
levels such as
extreme fatigue,
muscle weakness
- Diuretics (water
pills) may increase
risk of low pressure
or low potassium
levels.

AFTER:

- Evaluate the
findings
- Document the
procedure
 UNIVERSITY OF SAN JOSE – RECOLETOS
School of Allied Medical Science
Nursing

DRUG STUDY
Name of Student: Kathline S. Migallen Year Level: BSN – 4 Date: September 04, 2023 Area of Exposure: PSH Ward
Client Initials: DS Diagnosis/es: Ischemic Heart Disease in Heart Failure Doctor/s: Dr.

Side Effects /
Classification and Indication and Nursing
Name of Drug Contraindication Adverse
Mechanism of Action Dosage Responsibilities
Reaction

Generic Name: Pharmacotherapeutic ➢ Heart Hypersensitivity to Side Effects: BEFORE:

Ivabradine Class: Hyperpolarization- Failure ivabradine. Acute Occasional (10%–
activated cyclic nucleotide- decompensated HF, B/P 3%): Bradycardia, - Perform hand
Brand Name: gated (HCN) channel blocker. less than 90/50 mm Hg, hypertension, washing/hygiene
Coralan Dosage: - Check the doctor’s
sick sinus syndrome; phosphenes (visual
Clinical Class: Reduces risk 5mg/tab, 1tab orally, order
sinoatrial block or third- disturbances,
of worsening HF. 2x a day - Check the
degree AV block (unless luminous
a functional pacemaker phenomena), visual medication thrice
is present), resting heart brightness. - Check the right
MOA: Reduces rate less than 60 bpm dose, right route,
prior to initiation, severe Adverse Reactions: and right patient
spontaneous pacemaker
activity of the cardiac sinus hepatic impairment, - Check the
May increase risk of
node by blocking HCN pacemaker dependence Medication sheet
atrial fibrillation
channels that are responsible (heart rate maintained prior to
(8.3% of pts). administration of
Source: for cardiac current, which exclusively by a Bradycardia, sinus
regulates heart rate. Does not pacemaker), drugs
(Saunders, 2021 arrest, or heart block
affect ventricular concomitant use of
Nursing Drug may occur. DURING:
repolarization or myocardial strong CYP3A4 Bradycardia occurred
Handbook)
contractility. Also inhibits inhibitors. in 10% of pts. Risk - Frequently monitor
retinal current involved in factors for HR, B/P. Diligently
reducing bright light in retina. bradycardia may monitor for atrial
include sinus node fibrillation,
dysfunction, bradycardia,
Therapeutic Effect: Reduces
heart rate.
conduction defects syncope. If
(e.g., first- or symptomatic
second-degree AV bradycardia occurs,
block, bundle branch temporary cardiac
block), ventricular pacing or infusion
dyssynchrony, or use of beta-stimulating
of negative agents may be
chronotropic drugs. warranted.
Phosphenes, a - Monitor for
transient enhanced hypersensitivity
brightness in the reaction.
visual field (which - Monitor for visual
may include halos, changes. Initiate
stroboscopic or fall precautions.
kaleidoscopic effect,
colored bright lights, Patient Teaching:
or multiple images)
- Take medication
may occur.
with meals.
Phosphenes are
- Avoid grapefruit
usually triggered by
products, herbal
sudden variations in
supplements such
light intensity and
as St. John’s wort.
generally occur
- Treatment may
within the first 2 mos
cause fetal harm.
of treatment. Other
Female pts of
adverse reactions
reproductive
such angioedema,
potential should use
diplopia, erythema,
effective
hypotension,
contraception
pruritus, rash,
during treatment.
syncope, urticaria,
- Report symptoms
vertigo, visual
of low heart rate
impairment occur
such as confusion,
rarely. Overdose may
dizziness, fatigue,
lead to severe and
fainting, low blood
prolonged
pressure, pallor.
bradycardia requiring
temporary cardiac - Report symptoms
pacing or infusion of of atrial fibrillation
IV beta-stimulating such as chest
agents. pressure,
palpitations,
shortness of breath.
- Treatment may
cause luminous
phenomena
(phosphenes), a
transient visual
brightness that may
include halos, light
sensitivity, or
colored bright
lights.
- Avoid tasks that
require alert ness,
motor skills until
response to drug is
established.
- Report allergic
reactions such as
hives, itching, rash,
tongue swelling.

AFTER:

- Evaluate the
findings
- Document the
procedure
 UNIVERSITY OF SAN JOSE – RECOLETOS
School of Allied Medical Science
Nursing

DRUG STUDY
Name of Student: Kathline S. Migallen Year Level: BSN – 4 Date: September 04, 2023 Area of Exposure: PSH Ward
Client Initials: DS Diagnosis/es: Ischemic Heart Disease in Heart Failure Doctor/s: Dr.

Side Effects /
Classification and Indication and Nursing
Name of Drug Contraindication Adverse
Mechanism of Action Dosage Responsibilities
Reaction

Generic Name: Pharmacologic Class: ➢ Acute Hypersensitivity to Side Effects: BEFORE:

Ticagrelor P2Y12 platelet aggregation Coronary ticagrelor. History of Occasional (13%–
Syndrome - Perform hand
inhibitor. intracranial hemorrhage, 7%): Dyspnea,
Brand Name: washing/hygiene
active pathologic headache.
Brilinta Clinical Class: Antiplatelet - Check the doctor’s
Dosage: bleeding, severe hepatic Rare (5%–3%):
order
90mg/tab, 1 tab impairment. Cough, dizziness,
- Check the medication
orally, 2x a day nausea, diarrhea, thrice
MOA: back pain, fatigue. - Check the right dose,
Reversibly inhibits platelet right route, and right
P2Y12 ADP receptor to patient
prevent signal transduction Adverse Reactions: - Check the
and platelet activation. Medication sheet
Therapeutic Effect: Reduces Life-threatening prior to
platelet aggregation. events including administration of
Source: drugs
intracranial bleeding,
(Saunders, 2021 epistaxis, DURING:
intrapericardial
Nursing Drug
bleeding with cardiac - Routinely screen for
Handbook)
tamponade, bleeding.
hypovolemic shock - Assess skin for
requiring bruising, hematoma.
vasopressive support - Monitor renal
function, uric acid,
or blood transfusion
reported. Pts with digoxin levels if
history of sick sinus applicable.
syndrome, second- or - Report hematuria,
third-degree AV epistaxis, coffee-
ground emesis,
block, bradycardic
black/tarry stools.
syncope has
- Monitor ECG for
increased risk of
chest pain, shortness
bradycardia. May of breath, syncope.
induce episodes of
atrial fibrillation, Patient Teaching:
hypotension,
- It may take longer to
hypertension.
stop bleeding during
Gynecomastia
therapy.
reported in less than
- Do not vigorously
1% of men. blow nose.
- Use soft toothbrush,
electric razor to
decrease risk of
bleeding.
- Immediately report
bloody stool, urine,
or nosebleeds.
- Report all newly
prescribed
medications.
- Inform physician of
any planned dental
procedures or
surgeries.

AFTER:

- Evaluate the findings

- Document the
procedure
 UNIVERSITY OF SAN JOSE – RECOLETOS
School of Allied Medical Science
Nursing

DRUG STUDY
Name of Student: Kathline S. Migallen Year Level: BSN – 4 Date: September 04, 2023 Area of Exposure: PSH Ward
Client Initials: DS Diagnosis/es: Ischemic Heart Disease in Heart Failure Doctor/s: Dr.

Side Effects /
Classification and Indication and Nursing
Name of Drug Contraindication Adverse
Mechanism of Action Dosage Responsibilities
Reaction

Generic Name: Pharmacotherapeutic ➢ Antacid Hypersensitivity to Side Effects: BEFORE:

Calcium Carbonate Class: Electrolyte replenisher ➢ Supplement calcium formulation. All Frequent: PO:
preparations: Calcium- Chalky taste. - Perform hand
Brand Name: Clinical Class: Antacid, based renal calculi, Parenteral: Pain, washing/hygiene
Caltrate antihypocalcemic, Dosage: - Check the doctor’s
hypercalcemia, rash, redness,
antihyperkalemic, 500mg, 1 Tab orally, order
ventricular fibrillation. burning at injection
antihypermagnesemic, OD - Check the
Calcium chloride: site; flushing, nausea,
antihyperphosphatemic Digoxin toxicity. vomiting, medication thrice
diaphoresis, - Check the right
hypotension. dose, right route,
MOA: Occasional: PO: and right patient
Essential for function, Mild constipation, - Check the
integrity of nervous, fecal impaction, Medication sheet
muscular, skeletal systems. peripheral edema, prior to
Source: Plays an important role in metabolic alkalosis administration of
normal cardiac/renal function, (muscle pain, drugs
(Saunders, 2021
respiration, blood restlessness, slow
Nursing Drug DURING:
coagulation, cell membrane respirations, altered
Handbook)
and capillary permeability. taste). Calcium - Monitor serum
Assists in regulating carbonate: Milk- BMP, calcium,
release/storage of hormones/ alkali syndrome ionized calcium,
neurotransmitters. (headache, decreased magnesium,
Neutralizes/reduces gastric appetite, nausea, phosphate; B/P,
acid (increases pH). Calcium
acetate: Binds with dietary
phosphate, forming insoluble
calcium phosphate. Calcium
chloride, calcium gluconate:
Moderates nerve and muscle
performance by regulating
action potential excitation
threshold.
Therapeutic Effect:
Replaces calcium in
deficiency states; controls
hyperphosphatemia in end-
stage renal disease; relieves
heartburn, indigestion.
vomiting, unusual cardiac rhythm,
fatigue). Rare: renal function.
Urinary urgency, - Monitor for signs
painful urination. of hypercalcemia
Patient Teaching:
Adverse Reactions: - Do not take within
1–2 hrs of other
Hypercalcemia: oral medications,
Early signs: fiber-containing
Constipation, foods.
headache, dry mouth, - Avoid excessive
increased thirst, use of alcohol,
irritability, decreased tobacco, caffeine.
appetite, metallic
taste, fatigue, AFTER:
weakness,
depression. - Evaluate the
findings
Later signs:
- Document the
Confusion, procedure
drowsiness,
hypertension,
photosensitivity,
arrhythmias, nausea,
vomiting, painful
urination
 UNIVERSITY OF SAN JOSE – RECOLETOS
School of Allied Medical Science
Nursing

DRUG STUDY
Name of Student: Kathline S. Migallen Year Level: BSN – 4 Date: September 04, 2023 Area of Exposure: PSH Ward
Client Initials: DS Diagnosis/es: Ischemic Heart Disease in Heart Failure Doctor/s: Dr.

Name of Classification and Indication and Side Effects / Nursing

Contraindication
Drug Mechanism of Action Dosage Adverse Reaction Responsibilities

Generic Name: Clinical Class: antianginal ➢ Recommended Parkinson's disease, parkins Side Effects: BEFORE:
Trimetazidine in long term onian symptoms, tremors,
treatment of restless leg syndrome and Dizziness, low blood - Perform hand
Brand Name: coronary pressure with change washing/hygiene
MOA: other movement related
Vastarel insufficiency; of position, pruritus, - Check the
angina disorders. Severe renal
Improves myocardial glucose impairment (CrCl<30 nausea, vomiting doctor’s order
pectoris
utilization through stopping of mL/min). - Check the
Adverse Reactions: medication thrice
fatty acid metabolism by
limitation Dosage: 35mg/tab, 1 Rashes, tachycardia, - Check the right
of intracellular acidosis, tab orally, 2x a day orthostatic dose, right route,
correction of disturbances hypotension, arterial and right patient
of transmembrane ion hypotension, flushing - Check the
exchanges, and prevention Medication sheet
of excessive production of free prior to
Source: radicals administration of
drugs
(Saunders, 2021
Nursing Drug DURING:
Handbook)
- Monitor blood
pressure and
pulse rate before
and after giving
the meds.
- Assess for
hypersensitivity
 to trimetazidine,
with heart failure
- Administer drug
after patient has
eaten with a full
glass of water.
- Provide safety
measures if
lethargy occurs.

AFTER:

- Evaluate the
findings
- Document the
procedure
 UNIVERSITY OF SAN JOSE – RECOLETOS
School of Allied Medical Science
Nursing

DRUG STUDY
Name of Student: Kathline S. Migallen Year Level: BSN – 4 Date: September 04, 2023 Area of Exposure: PSH Ward
Client Initials: DS Diagnosis/es: Ischemic Heart Disease in Heart Failure Doctor/s: Dr.

Name of Classification and Indication and Side Effects / Nursing

Contraindication
Drug Mechanism of Action Dosage Adverse Reaction Responsibilities

Generic Name: Clinical Class: ➢ Gastrointestin Hypersensitivity to itopride Side Effects: BEFORE:
Itopride gastroprokinetic agent, al symptoms or benzamides; lactation, GI
of functional hemorrhage, obstruction or Mild to moderate - Perform hand
Brand Name: ➢ Chronic abdominal pain and washing/hygiene
perforation.
Ganaton gastritis diarrhea - Check the
MOA: doctor’s order
Increases acetylcholine Adverse Reactions: - Check the
concentrations by inhibiting Dosage:
50mg/cap, 1 cap Rash, giddiness, back medication thrice
dopamine D2 receptors and - Check the right
acetylcholinesterase. Higher orally, OD or chest pain,
increased salivation, dose, right route,
acetylcholine increases GI and right patient
peristalsis, increases the lower galactorrhea and
gynecomastia. - Check the
esophageal sphincter pressure,
Medication sheet
stimulates gastric motility,
prior to
accelerates gastric emptying,
Source: administration of
and improves gastro-duodenal
drugs
(Saunders, 2021 coordination.
Nursing Drug DURING:
Handbook)
- Monitor blood
pressure and
pulse rate before
and after giving
the meds.
- Assess for
hypersensitivity
to itopride, or
 benzamides;
lactation, GI
hemorrhage,
obstruction or
perforation.

AFTER:

- Evaluate the
findings
- Document the
procedure