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DRUGS Generic name: Amlodipine Brand name: Norvasc Classification: Antianginals: Calcium channel blocker Generic name: Aspirin

(ASA.) Brand name: Ecotrin Classification: Antiplatelet drug: salicylate

MECHANISM OF ACTION Inhibits calcium ion influx across cardiac and smooth-muscle cells #, dilates coronary areteries and arterioles, and decreases blood pressure and myocardial oxygen demand. Thought to produce analgesia and exert its anti-inflammatory effect by inhibiting prostaglandin and other substances that sensitize pain receptors. Drug may relieve fever through central action in the hypothalamus heatregulating center. In low doses, drug also appears to interfere with clotting by keeping a plateletaggregating substance from forming. Inhibits platelet aggregation and is thought to promote repuerfusion and reduce the likelihood of rethrombosis.

INDICATION For chronic stable angina, vasospastic angina

CONTRAINDICATION

SIDE EFFECTS/ ADVERSE EFFECTS Contraindicated in Headache, fatigue, patients hypersensitive to somnolence, dizziness, drug, use cautiously in pts. flushing, palpitations, Receiving vasodilators nausea, abdominal and and reduce dosage in muscle pain, rash, dyspnea patients with severe and edema hepatic disease. Contraindicated in patients hypersensitive to drug and in those with NSAID-induced sensitivity reactions, bleeding disorders. Use cautiously in patient with GI lesions, impaired renal function, hypoprothrombinemia, Vitamin K deficiency, severe hepatic impairment. Adverse reactions include tinnitus, hearing loss, nausea, GI bleeding, thrombocytopenia, rash, prolonged bleeding time, hyprsensitivity reaction Common: dyspepsia, GI distress urticaria. For interactions with anticoagulants, it may increased risk for bleeding. Use with extreme caution if used together.

NURSES RESPONSIBILITY Monitor patient carefully. Monitor BP frequently during initiation of therapy.

To prevent thrombosis To reduce risk of MI in patients with previous MI or unstable angina

Monitor patients for hypersensitivity reactions, such as anaphylaxis and asthma. Advise patient on a low salt diet

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Generic name: Atorvastatin Brand name: Lipitor Classification: Antilipemics

Inhibits HMG-COA reductase, an early (and rale-limiting) step in cholesterol biosynsthesis

Reduction of elevated total L LDL cholesterol, apolipoprotein B & triglycerides & increase HDL cholesterol in pts. primary hypercholesterolemia

Withhold or stop drug in pts. at risk for renal failure caused by rhabdomyolysis resulting from trauma, in serious acute conditions like myopathy

GI disturbances, headache, myalgia asthenia, insomnia muscle cramps, bronchitis, rash infection, flu like syndrome allergic reactions

Generic name: Captopril Brand name: Capoten Classification: Antihypertensive: ACE inhibitor

Inhibits ACE, preventing conversion of Angiotensin II, a potent vasoconstrictor less angiotensin II decreasing aldosterone secretion, which reduces sodium & water retention & lowers blood pressure.

Hypertension diabetic nephropathy

Contraindicated in pts. hypersensitive to drug or ACE inhibitors use cautiously in pts. impaired renal function

CNS: dizziness fatigue; rash, pruritus, flushing, angioedema, loss of taste perception; stomatitis, GI irritation & abdominal pain; leucopenia; cough

Generic name: Ciprofloxacin Brand name: Cipro Classification: Anti-infectives:

Inhibits bacterial DNA synthesis, mainly by blocking DNA gyrase; bactericidal.

Mild to moderate UTI, uncomplicatetd UTI, prophylaxis.nosocomial pneumonia

Contraindicated in patients sensitive to fluoroquinolones. Use cautiously in patients with CNS disorders, such as severe cerebral arteriosclerosis or seizure disorders and in those aar

Advise patient for fluid intake of 23 L/d is advised, if not contraindicated. Ask report sudden, unexplained joint pain. Restrict caffeine due to the following effects (e.g., nervousness,

Use only after diet & other condition therapy prove infective Pt should follow a standard low cholesterol diet before & during therapy. Before starting treatment assess pt for underlying causes for hypercholesterolemia. Monitor patients blood pressure & pulse rate frequently elderly pts may be moir sensitive to drugs hypotensive effects in patients impaired renal function or collagen vascular disease, monitor WBC and differential counts before starting treatment, every 2 wks for the first 3 months of therapy and periodically thereafter. Monitor patients intake and ooutput and observe patient for signs of crystalluria. Tendon rupture may occur in patients receiving quinoones. If pain or inflammation occurs or if 43

fluoroquinolones

risk for seizure. Drug may cause CNS stimulation.

insomnia, anxiety, tachycardia). Encourage to report possible toxicity, nausea, diarrhea, vomiting, and abdominal pain or discomfort. Instruct to use caution with hazardous activities until reaction to drug is known. GI Bleeding purpora, bruising, hematoma, epistaxis, hematutia, ocular hemorrhage intracranial bleeding, abdominal pain, dyspepsia gastritis & constipation, rash, pruritus

patient ruptures a tendon, stop drug. Assess for S&S of superinfections

Generic name: Clopidogrel bisulfate Brand name: Plavix Classification: Antiplatelet agents Generic name: Diazepam Brand name: Valium Classification: Anxiolytics: benzodiazepene

Inhibits the binding of adenosine diphosphale to its platelet, receptors infecting ADP-mediated activation and subsequent platelet aggregation clopedogrel irreversibly modifies the platelet ADP receptor

To reduce thrombotic events with acute coronary syndrome, atherosderosis documented by recent MI, or established peripheral artenal disease.

A benzodiazepine that Indicated for anxiety, probably potentiates the muscle spasm effects of GABA, depress the CNS, and suppresses the spread of seizure activity. Diazepam reduces the fear sensation, and the anxiety. It reduces the psychomotor agitation. Diazepam possesses hypotensive effect and

Contraindicated in patients hypersensitive to drug or its components and in those with pathologic bleeding (such as peptic ulcer) use cautiously in patients at risk for increased bleeding from trauma or other pathologic conditions Diazepam should not be administered in patients with liver or kidney disorders; myasthenia gravis; acute alcohol intoxication; depressive conditions; psychosis; brain diseases; shock; coma; drug abuse or drug dependence; glaucoma; hyperkinesis; hypoalbuminemia;

Platelet aggregation wont return normal for at least 5 days after drug has been stopped Dont confuse plavix with Paxil

Somnolence; headache; dizziness; apathy; depressive conditions; ataxia; tremor; hypotension; bradycardia; collapse; constipation; reduced libido. In abrupt discontinuation of the preparation anxiety and aggressive conditions may appear.

MONItor periodic hepatic, renal and hematopoietic function studies in patients receiving repeated or prolonged therapy. Monitor for dizziness, and change in mental status, Patients are at an increased risk for falls.

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prominent peripheral myorelaxing action.

Generic name: Enoxaparin Na Brand name: Levonox Classification: Anticoagulant:lowmolecular-wight heparin

Accelerates formation of antithrombin IIIthrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin. Drug has a higher antifactorXa-to-antifactor-IIa activity ratio than heparin.

To prevent ischemic complications of unstable angina and non-Q-wave with oral aspirin therapy. It is indicated also for acute ST-segment elevation MI.

porphyria; chronic obstructive pulmonary disease; apnea; pregnancy in the first and the last trimester; lactation; dysphagia in childhood; hypersensitivity to the benzodiazepines. Contraindicated to patients hypersensitive to drug, heparin, or pork products; in those active with major bleeding; and in those with thrombocytopenia and antiplatelet antibodies in presence of drug

Confusion, fever, pain, edema, nausea , diarrhea ecchymoses, bleeding complications irritation, pain hematoma, nd erythema at injection site, rash, and for severe ccases anaphylaxis

Monitor and regularly inspect for bleeding gums, bruises on arms or legs, petechiae, nosebleeds, melena, tarry stools, hematuria, hematemesis. Instruct patient to watch signs for bleeding or abnormal bruising and to notify physician immediately if any occur. Monitor weight, BP and pulse rate routinely with long-term use and during rapid diuresis. Monitor fluid intake and output and electrolyte, BUN, and carbon dioxide levels frequently. Watch for signs of hypokalemia, such as muscle weakness and cramps. Monitor also 45

Generic name: Furosemide Brand name: lasix Classification: Loop diuretic

Inhibits sodium and Edema chloride reabsorption at the proximal and distal tubules and the ascending loop Henle.

Contraindicated in patients hypersensitive to drug and in those with anuria. Use ccautiously in patients with hepatic cirrhosis and in those allwrgic to sulfonamides.

Common side effect of furosemide include low blood pressure dehydration and electrolyte depletion (sodium and potasssium). Less common side effects include jaundice, tinnitus, sensitivity to light, rash, pancreatitis, nausea, diarrhea, abdominal pain and dizziness. Increase

Generic name: Hydrochlorothiazide Brand name: hydroDIURIL Classification: Thiazide diuretic

Increases sodium and water excretion by inhibiting sodium and chloride reabsorption in distal segment of the nephron.

Edema and hypertension.

uric acid level, especially in patients with history of gout, and monitor glucose level for diabetic patients. Instruct patient to stand slowly to prevent dizziness and to limit alcohol intake and strenuous exercise. Advise to report immediately ringing of ears, severe abdominal pain or sore throut and fever, these symptoms may indicate toxicity. Contraindicated to Weakness, dizziness, or Monitor fluid intake and patients with anuria and vertigo, hypotension, output, weight, BP, and patients hypertensive to Diarrhea, nausea,, electrolyte levels. Watch other thiazides or other vomiting, constipation, and for signs and symptoms sulphonamide derivative. stomach cramps, of hypokalemia, such as Use cautiously in children hyperglycemia, Electrolyte, muscle weakness and and in patients with severe imbalances, cramps. Monitor renal disease, impaired hyponatremia,hypokalemia, creatinine and BUN levels hepatic function, or and hypochloremia, regularly. Monitor also progressive hepatic Sensitivity to the sun, uric acid level, especially disease. Muscle spasm, in patients with history of Pancreatitis , Hair loss , gout, and monitor glucose Erectile dysfunction, also level for diabetic patients. referred to Instruct patient to take as ED or impotence, drug with food to Muscle cramps, minimize GI upset. Respiratory distress, Encourage to use 46

blood sugar and uric acid levels also may occur.

Anaphylactic reactions for very severe cases. Generic name: iprotropium/albuterol (salbutamol) Brand name: Atrovent Classification: Bronchodilators It works in the airways by opening breathing passages and relaxing muscles. It inhibits vagally mediated reflexes by antagonizing acetylcholine at muscarinic receptors on bronchial smooth muscle. Quick relief for bronchospasm and for the prevention of exerciseinduced bronchospasm. It is also used to treat or prevent wheezing and shortness of breath caused by ongoing breathing problems Contraindicated in patients hypersensitive to drug, atropine. Use cautiously inn patients with angle-closure glaucoma, prostatic hyperplasia. Dizziness, palpitations, headache, hypertension, nausea, GI distress, dry mouth, back pain, rash, increased sputum, worst cases, hypersensitivity

sunblock to prevent photosensitivity reactions. Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 6090 min after drug administration. Monitor for: S&S of fine tremor in fingers, which may interfere with precision handwork; CNS stimulation, particularly in children 26 y, (hyperactivity, excitement, nervousness, insomnia), tachycardia, GI symptoms. Report promptly to physician. Lab tests: Periodic ABGs, pulmonary functions, and pulse oximetry.

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Generic name: Isosorbide dinitrale

Brand name: Isordil Classification: Antianginals Generic name: Lactulose Brand name: Cholac, Cephulac Classification: Laxative: disaccharide

Thought to reduce cardiac oxygen demand by decreasing preload & afterload: also, may increase blood flow through the collateral coronary vessels

Acute anginal attacks

Contraindicated potentials hypersensitivity or idiosyncrasy to nitrates & in those severe hypotension

Flushing, vascular headache, cerebral ischemia associated postural hypotension, N/V weakness, restless, pallor, persipiration & collapse

To prevent tolerance a nitrate-free interval of 8 to 12 hours per day is recommended.

Produces an osmotic effect in colon;; resulting distention promotes peristalsis. Also decreases ammonia, probably as a result of bacterial degredation, which lowers the pH of colon contents.

Acute constipation preparation, for bowel elimination. Especially indicated for MI patients to avoid straining and workload.

Contraindicated in patients on a lowgalactose diet. Use cautiously in patients with diabetes mellitus.

Abdominal cramps, belching, diarrhea, flatulence, gaseous distention, nausea, vomiting.

Generic name: Acetaminophen / Paracetamol Brand name: Panadol

Thought to produce analgesia by inhibiting prostaglandin and other substances that sensitixze pain receptors. Drug may relieve fever through

For mild pain and fever

Contraindicated in patients hypersensitive to drug.

Haemolytic anemia, leukopenia, neutropenia, pancytopenia, jaundice, hypoglycaemia, rash, urticaria.

Monitor sodium level for hypernatremia, especially when giving in higher doses to treat hepatic encephalopathy. Monitor mental status and potassium levels when giving to patients with hepatic encephalopathy. Informs patient about adverse reactions and tell him to notify physician if reactions become bothersome or if diarrhea occurs. Do not exceed the recommended dosage. Consult physician if needed for children < 3 yr; if needed for 48

Classification: Non-opiod analgesic and antipyretic

central action in the hypothalamic heatregulating center.

longer than 10 days; if continued fever, severe or recurrent pain occurs (possible serious illness). Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products. Give drug with food if GI upset occurs. Discontinue drug if hypersensitivity reactions occur. Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote; basic life support measures may be necessary.

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Generic name: Ranitidine HCL Brand name: Zantac Classification: Anti-ulcer drug:H2 recceptor drug Generic name: Tramadol Brand name: Dolmal Classification: Opioid Analgesics

Completely inhibits action of histamine on the H2 at receptors sites of parietal cells, decreasing gastric acid secretion

NSAID-associated peptic ulceration

Contraindicated in patients hypersensitive to drug and those acute porphyria acute dosage in pt. impaired renal function

Occasionally, reversible hepatitis. Rarely agranulocytosis, acute pancreatic, hypersensitivity, reversible mental confusion, skin rash; headache Respiratory depression, palpitations, chills, chest pain, decrease in BP, arrhythmia, vomiting, nausea, GI distention, borborygymi, urticaria, excessive bronchial secretions

Assess pt. for abdominal pain. Note presence of blood in emesis, stool or gastric aspirate

A centrally acting synthetic analgesic compound not chemically related to opioid. Thought to bind to opioid receptors & of norepinephrine & serotonin

For moderate to severe pain

Contraindicated in patients hypersensitive to drug or other opioids, in breast feeding women and in those acute intoxication from alcohol use cautiously in pts. at risk for renal or hepatic impairment

Releases pts level of pain at least 30 min. after administration. Monitor CV and respiratory status w/hold dose & notify prescribe if RR is below 12 cm. Monitor bowel & bladder function anticipate need for laxative for better analgesic effect give drug before onset of pain.

Source:.Nursing Drug Handbook, 2009.

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