PHARMAAA NOG PRINT

ADRENOCORTICAL
AGENTS
BETAMETHASONE
INDICATIONS: It is used for its anti-inflammatory and immunosuppressive

properties. It is commonly employed in the treatment of various inflammatory
conditions, allergic reactions, and autoimmune disorders. It may also be used in
certain dermatological conditions.
MECHANISM OF ACTION: Glucocorticoids inhibit neutrophil apoptosis and

demargination, and inhibit NF-Kappa B and other inflammatory transcription
factors. They also inhibit phospholipase A2, leading to decreased formation of
arachidonic acid derivatives. In addition, glucocorticoids promote anti-
inflammatory genes like interleukin-10
ADVERSE EFFECT: Potential adverse effects include skin atrophy, stinging/burning at the application
techniques site, changes in skin color, acne, and, with prolonged use, systemic effects like adrenal
suppression.
CONTRAINDICATION: It is contraindicated in patients with a known hypersensitivity to
betamethasone or any component of the formulation.
DRUG TO DRUG INTERACTION: Drug-drug Risk of severe deterioration of muscle strength in

myasthenia gravis patients receiving ambenonium, edrophonium, neostigmine, pyridostigmine.
Decreased steroid blood levels with barbiturates, phenytoin, rifampin • Decreased effectiveness of
salicylates with betamethasone
NURSING RESPONSIBILITIES:
• Nurses should educate patients about proper application techniques
• Monitor for signs of adverse effects
• Assess the patient’s overall response to treatment.

DEXAMETHASONE
INDICATIONS: It is used to treat various inflammatory conditions, autoimmune disorders, and certain
cancers. It’s also employed in managing cerebral edema associated with brain tumors or head injury.
MECHANISM OF ACTION: As a corticosteroid, dexamethasone works by suppressing inflammation

and immune responses. It acts on multiple cell types to inhibit the release of inflammatory mediators.
ADVERSE EFFECT: Potential adverse effects include increased risk of infection, fluid retention, mood
changes, and gastrointestinal disturbances. Long-term use may lead to systemic effects like adrenal suppression,
osteoporosis, and metabolic changes.
CONTRAINDICATION: Contraindicated in patients with systemic fungal infections and known

hypersensitivity to dexamethasone.
DRUG TO DRUG INTERACTION: Interactions can occur with drugs that induce or inhibit cytochrome P450
enzymes, affecting dexamethasone metabolism. Concurrent use with certain medications may require dosage
adjustments.
•Monitor vital signs, blood glucose levels, and signs of infection.
•Patient education is crucial, including instructions on proper medication administration and potential
side effects.
•Monitoring for and managing complications related to long-term use is important.
HYDROCORTISONE
INDICATIONS: It is used to treat various inflammatory conditions, such as skin disorders
(eczema, dermatitis), allergic reactions, and certain autoimmune diseases.
MECHANISM OF ACTION: As a corticosteroid, hydrocortisone acts to suppress inflammation and

immune
responses by inhibiting the release of inflammatory mediators
ADVERSE EFFECT: Potential adverse effects include skin atrophy, burning or itching at the application
site, acne, and, with prolonged use or systemic absorption, issues like adrenal suppression and metabolic
changes.
CONTRAINDICATION: Contraindicated with infections, especially tuberculosis, fungal infections,

amebiasis, vaccinia and varicella, and antibiotic resistant infections, allergy to any components of the
preparation used.
DRUG TO DRUG INTERACTION: Interactions may occur with drugs that affect cytochrome P450
enzymes, potentially altering hydrocortisone metabolism. Consultation with a healthcare provider is
essential if using other medications concurrently.
• Monitor for signs of adverse effects
• Educate patients on proper application techniques
• Assess the patient’s response to treatment

METHYLPREDNISOLONE
INDICATIONS: Use for treatment of allergic conditions, arthritis, asthma exacerbations, long-term
asthma maintenance, acute exacerbation of multiple sclerosis, and as an anti-inflammatory and
immunosuppressive agent.
MECHANISM OF ACTION: The short term effects of corticosteroids are decreased vasodilation and
permeability of capillaries, as well as decreased leukocyte migration to sites of inflammation.
Corticosteroids binding to the glucocorticoid receptor mediates changes in gene expression that lead to
multiple downstream effects over hours to days.
ADVERSE EFFECT: Blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat,
increased thirst or urination, irritability, or unusual tiredness or weakness are some adverse effects that
may occur.
CONTRAINDICATION: Should not be given to people that have or have ever had liver, kidney, intestinal, or
heart disease; diabetes; an underactive thyroid gland; high blood pressure; mental illness; myasthenia gravis;
osteoporosis; herpes eye infection; seizures; tuberculosis (TB); or ulcers.
DRUG TO DRUG INTERACTION: This medication should be avoided to be given with Blood thinners
for methylprednisolone could raise the risk of experiencing a blood clot. In other cases,NSAIDs as both
medications raise the risk of stomach bleeding and ulcers,Diabetes medications can more likely to
experience hyperglycemia to the client.Ketoconazole which can cause methylprednisolone to stay in
your body for longer, which raises the risk of side effects.And Phenytoin and phenobarbital can also
lower the amount of methylprednisolone in the body by making it leave your system faster than normal.
Monitored carefully for the development of hyperglycemia, glycosuria, sodium retention with edema or
hypertension, hypokalemia, peptic ulcers, osteoporosis, and hidden infections
PREDNISONE
INDICATIONS: Indicated as an anti-inflammatory or immunosuppressive drug for allergic,
dermatologic, gastrointestinal, hematologic, ophthalmologic, nervous system, renal, respiratory,
rheumatologic, infectious, endocrine, or neoplastic conditions as well as in organ transplant
MECHANISM OF ACTION: It decreases inflammation via suppression of the migration of

polymorphonuclear leukocytes and reversing increased capillary permeability. It also suppresses the
immune system by reducing the activity and the volume of the immune system.
ADVERSE EFFECT: Potential adverse effects include increased risk of infection, fluid retention, mood
changes, gastrointestinal disturbances, and, with prolonged use, systemic effects like adrenal
suppression and osteoporosis.
CONTRAINDICATION: Contraindicated in patients with systemic fungal infections and know

hypersensitivity to prednisone.
DRUG TO DRUG INTERACTION: Oral Birth Control , Drugs with estrogen (birth control pills) may
decrease the metabolism of the drug in the liver and increase the effect of corticosteroids;Diabetes Drugs
as people who take diabetes medications may need increased doses of those because prednisone can
increase blood sugar levels
• Monitor vital signs, blood glucose levels, and signs of infection
• Patient education is crucial, including instructions on proper medication administration and potential
side effects
•Monitoring for and managing complications related to long-term use

DIURETICS
ACETAZOLAMIDE
INDICATIONS: Diuretic medication that treats swelling caused by heart disease. It works by helping
your body make more pee so you can lose salt and excess water from your body. It can also treat
seizures, certain types of glaucoma and prevent symptoms of altitude sickness.
MECHANISM OF ACTION: Drug works to cause an accumulation of carbonic acid by preventing its
breakdown. The result is lower blood pH (i.e., more acidic), given the increased carbonic acid, which
has a reversible reaction into bicarbonate and a hydrogen ion.
ADVERSE EFFECT: Potential adverse effects include metabolic acidosis, electrolyte imbalances,
kidney stones, and allergic reactions. It may also cause drowsiness, dizziness, or changes in taste.
CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to acetazolamide,

severe kidney or liver disease, and certain electrolyte imbalances
DRUG TO DRUG INTERACTION: Interactions may occur with other medications affecting electrolyte
balance, leading to an increased risk of adverse effects. It’s important to inform healthcare providers of all
medications being taken
•Monitor electrolyte levels, kidney function, and the patient’s response to treatment
•Educating patients on the importance of adequate fluid intake
•Monitor signs of adverse effects

METHAZOLAMIDE
INDICATIONS: It is primarily used for the treatment of glaucoma to lower intraocular pressure
acetazolamide, it is a carbonic anhydrase inhibitor.
MECHANISM OF ACTION: Similar to acetazolamide, methazolamide inhibits carbonic anhydrase,

leading to a reduction in aqueous humor formation in the eye, thereby lowering intraocular pressure.
ADVERSE EFFECT: Potential adverse effects include metabolic acidosis, electrolyte imbalances,
kidney stones, and allergic reactions. It may also cause drowsiness, dizziness, or treatment changes in
taste.
CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to methazolamide

severe kidney or liver disease, and certain electrolyte imbalances
DRUG TO DRUG INTERACTION: Interactions may occur with other medications affecting electrolyte
balance potentially increasing the risk of adverse effects. Patients should inform healthcare providers of
all medications being taken.
• Patient education including information on proper administration
•Monitor signs of adverse effects, and the importance of regular follow-up

FUROSEMIDE
INDICATIONS: It is a loop diuretic commonly used to treat conditions such as edema associated with
heart failure, liver cirrhosis, or kidney disorders. It’s also used to manage hypertension.
MECHANISM OF ACTION: Furosemide inhibits the reabsorption of sodium and chloride in the
ascending loop of Henle in the kidneys, promoting diuresis and reducing fluid retention.
ADVERSE EFFECT: Potential adverse effects include dehydration, electrolyte imbalances (such as
hypokalemia), dizziness, and changes in blood pressure. Monitoring renal function is crucial.
CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to furosemide,

anuria (absence of urine production), and electrolyte depletion
DRUG TO DRUG INTERACTION: Interactions may occur with other medications affecting
electrolyte balance. Concurrent use with certain drugs may potentiate the risk of hypokalemia or other
adverse effects.
• Monitor fluid and electrolyte balance, blood pressure, and renal function
• Educating patients about maintaining an adequate fluid and potassium intake
• Monitor signs of dehydration
BUMETANIDE
INDICATIONS: Indicated for the treatment of edema associated with congestive heart failure, hepatic
and renal disease, including the nephrotic syndrome. Almost equal diuretic response occurs after oral
and parenteral administration of bumetanide.
MECHANISM OF ACTIONS: The mechanism of action and effects of bumetanide are similar to those
of furosemide. The drug increases urinary excretion of water, sodium, and chloride by inhibiting
reabsorption of sodium and chloride through interference with the chloride-binding cotransport system
in the ascending loop of Henle.
ADVERSE EFFECTS: Muscle cramps, weakness, unusual tiredness, confusion, severe dizziness,
fainting, drowsiness, unusual dry mouth/thirst, nausea, vomiting, fast/irregular heartbeat.
CONTRAINDICATIONS: Before taking bumetanide, tell your doctor or pharmacist if you are allergic to
it; medical history, especially of: kidney problems, inability to make urine, gout. If you have diabetes,
bumetanide may affect your blood sugar.
DRUG TO DRUG INTERACTIONS: Should not be taken with medicines that change the level of
potassium in your blood, such as steroids or other diuretics. medicines to treat mental health problems,
such as amisulpride, lithium, pimozide or risperidone. non-steroidal anti-inflammatory drugs (NSAIDs),
including diclofenac, ibuprofen or naproxen.
 Check blood pressure regularly while taking this medication
 Give twice a day
 Give 4 hours before bed time to avoid getting up to urinate.
 Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds,
skin
MANNITOL
INDICATIONS: Used to increase urine production (diuretic). It is also used to treat or prevent medical
conditions that are caused by an increase in body fluids/water (e.g., cerebral edema, glaucoma, kidney
failure).
MECHANISM OF ACTIONS: The mannitol dehydrates the vitreous humor. The mannitol draws water out of
the vitreous humor and into the blood vessels as it passes by. When the vitreous humor has less water, after being
dehydrated by the mannitol, it has less mass and thus creates less pressure.
ADVERSE EFFECT: Potential adverse effects include fluid and electrolyte imbalance, dehydration, and
changes in blood pressure. Monitoring for signs of electrolyte disturbances and maintaining adequate
hydration is crucial.
CONTRAINDICATIONS: There are multiple contraindications to giving mannitol, including: Established

anuria due to renal disease, Pulmonary edema or severe pulmonary congestion, Active intracranial bleeding
except for during a current craniotomy, Severe dehydration, Progressive heart failure, Known mannitol
hypersensitivity, Renal damage caused by mannitol also patients with impaired renal function, electrolyte
abnormalities,
DRUG TO DRUG INTERACTIONS: Interactions are limited, but caution should be exercised when
combining mannitol with other diuretics or medications affecting renal function.
 Essential to monitor cardiac function as the fluid shifts can precipitate heart failure
 Additional electrolytes, including sodium, potassium, and osmolality, all require monitoring Urine
output also requires monitoring; failure for urine output to increase after administration of mannitol
should prompt cessation of mannitol and evaluation for possible renal or genitourinary issues
SPIRONOLACTONE
INDICATIONS: Used to treat certain patients with hyperaldosteronism (the body produces too much
aldosterone, a naturally occurring hormone); low potassium levels; heart failure; and in patients with
edema (fluid retention) caused by various conditions, including liver, or kidney disease.
MECHANISM OF ACTIONS: Causes increased amounts of sodium and water to be excreted, while
potassium is retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this
mechanism.
ADVERSE EFFECTS: Potential adverse effects include hyperkalemia (elevated potassium levels),
gynecomastia (enlargement of breast tissue in males), menstrual irregularities and dizziness. Regular
monitoring of potassium levels is essential.
CONTRAINDICATIONS: Contraindicated for patients with anuria, acute renal insufficiency,
significant impairment of renal excretory function, or hyperkalemia, hyponatremia, severe renal
impairment, acute renal failure, anuria, Addison's disease, hypersensitivity to spironolactone.
DRUG TO DRUG INTERACTIONS: Some products that may interact with this drug include: lithium,
drugs that may increase the level of potassium in the blood (such as amiloride, cyclosporine, eplerenone,
tacrolimus, triamterene, birth control pills containing drospirenone).
NURSING INTERVENTION:
 Advise patient to notify health care professional if rash, muscle weakness or cramps; fatigue; or
severe nausea, vomiting, or diarrhea occurs.
 Inform male patients that spironolactone may cause gynecomastia; may require dose decrease.
 Monitor signs of fluid, electrolyte, or acid-base imbalances, including dizziness, clumsiness,

drowsiness, headache, blurred vision, confusion, hypotension, or muscle cramps and weaknes
HYDROCHLOROTHIAZIDE
INDICATION: Used in combination with other medicines to treat high blood pressure (hypertension) and heart
failure. Lowering blood pressure can reduce the risk of strokes and heart attacks. Spironolactone is also used to
lessen the need for hospitalization for heart failure.
MECHANISM OF ACTIONS: This causes increased amounts of sodium and water to be excreted, while
potassium is retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this mechanism. It
may be given alone or with other diuretic agents that act more proximally in the renal tubule.
ADVERSE EFFECTS: Severe skin reactions such as Stevens-Johnson syndrome and exfoliative dermatitis,
kidney failure, blurred vision,and pancreatitis
CONTRAINDICATIONS: Hydrochlorothiazide is contraindicated in cases of anuria or preexisting sulfonamide

allergy. This medication should be used cautiously in patients with severe hepatic impairment due to the potential
risk of developing hepatic coma.In individuals with underlying adrenal insufficiency, hydrochlorothiazide therapy
should be avoided.
DRUG-TO-DRUG INTERACTION: Interactions may occur with other medications affecting electrolyte
balance, especially those that increase potassium loss or decrease renal function. Caution is needed when
combining with certain antidiabetic medications and NSAIDs
 Take this drug in the morning, not the evening.
 This drug may make you urinate more.
 Taking it in the evening can make you need to get up at night to use the bathroom.
 You can crush hydrochlorothiazide tablets.
 Regularly monitored for electrolyte imbalances, including sodium, potassium, calcium, and
magnesium levels.
CARDIAC
AGENTS
FENOLDOPAM
INDICATION: Used primarily for the lowering of blood pressure during episodes of severe hypertension.
MECHANISM OF ACTION Fenoldopam has a unique mechanism of action compared to other antihypertensive
medications: it is a dopamine (D1) receptor agonist that results in decreased peripheral vascular resistance
primarily in renal capillary beds, thus promoting increased renal blood flow, natriuresis, and diuresis. Fenoldopam
has minimal adrenergic effects.:
Adverse Effect: Potential adverse effects include hypotension, tachycardia, headache.
Contraindication: Allergy to propylene glycol and/or sulfites, Precautions to, Hypokalemia (within 6 hours of
infusion), Tachycardia, Angina (due to tachycardia), and Glaucoma
Drug-to-drug interaction: Avoid concomitant use of fenoldopam with beta-blockers. If the drugs are used
together, blood pressure should be monitored frequently because hypotension could result from beta-blocker
inhibition of the sympathetic reflex response to fenoldopam.
Nursing Responsibilities:
 Routine vitals such as blood pressure and heart rate in addition to serial electrocardiograms (ECGs),
renal/hepatic function tests, and serum potassium
 Require monitoring during fenoldopam infusion.
 administration is via a continuous intravenous (IV) infusion using an infusion pump.
ENALAPRIL
INDICATION: It is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension, heart failure,
and certain types of chronic kidney diseases.
MECHANISM OF ACTION: It inhibits the conversion of angiotensin I to angiotensin II, a potent
vasoconstrictor. By blocking this pathway, it leads to vasodilation, reduced aldosterone secretion, and decreased
sodium and water retention, ultimately lowering blood pressure.
ADVERSE EFFECT: Potential adverse effects include hypotension, hyperkalemia, dry cough (due to increased
bradykinin levels), and renal dysfunction. Monitoring potassium levels and renal function is important.
CONTRAINDICATION: Contraindicated in patients with a history of angioedema related to previous ACE

inhibitor use, bilateral renal artery stenosis, and known hypersensitivity to enalapril.
DRUG-TO-DRUG INTERACTION: Interactions may occur with other antihypertensive agents, diuretics, or
medications affecting potassium levels. Caution is needed when combining enalapril with potassium-sparing
diuretics or potassium supplements
• Monitor blood pressure, renal function, and potassium levels regularly
• Patient education including information on potential side effects and the importance of compliance
• Monitor signs of complications like angioedema
CAPTOPRIL
INDICATIONS: It is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension heart

failure, and certain types of chronic kidney diseases.
MECHANISM OF ACTION: Captopril works by blocking a substance in the body that causes blood vessels to
tighten. As a result, the blood vessels relax. This lowers blood pressure and increases the supply of blood and
oxygen to the heart. Captopril is also used to help treat heart failure.
ADVERSE EFFECT: Can easily become dehydrated while taking captopril. This can lead to very low blood
pressure, an electrolyte imbalance, or kidney failure. Blood pressure will need to be checked often, and may need
frequent blood tests. captopril may cause false results on a urine test
CONTRAINDICATION: Contraindicated in patients with a history of angioedema related to previous ACE

inhibitor use, bilateral renal artery stenosis, and known hypersensitivity to captopril.
DRUG TO DRUG INTERACTION: Interactions may occur with other antihypertensive agents, diuretics, or
reduce medications affecting potassium level. Cautions needed when combining captopril with potassium pairing
diuretics or potassium supplements.
• Monitor blood pressure, renal function, and potassium levels regularly

• Patient education including information on potential side effects importance of compliance
• Monitor signs of complications like angioedema
LOSARTAN
INDICATIONS: It is an angiotensin II receptor blocker (ARB) used to treat hypertension and reduce the risk of
stroke in patients with hypertension and left ventricular hypertrophy
MECHANISM OF ACTION: As a corticosteroid, methylprednisolone works by suppressing inflammation and

immune responses. It inhibits the release of inflammatory mediators, reducing symptoms associated with
inflammation.
ADVERSE EFFECT: Potential adverse effects include fluid retention, increased blood pressure, mood changes,
gastrointestinal disturbances, and, with prolonged use, systemic effects like adrenal suppression and osteoporosis.
CONTRAINDICATION: Contraindicated in patients with hypersensitivity to losartan, a history of
angioedema related to previous use of ARBs or ACE inhibitors, and pregnancy.
DRUG TO DRUG INTERACTION: Interactions may occur with drugs that affect cytochrome P450
enzymes, potentially altering methylprednisolone metabolism. Caution is needed when using other
medications concurrently.
• Nurses should monitor vital signs, blood glucose levels, and signs of infection.
• Patient education is crucial, including instructions on proper medication administration and potential side effects.
• Monitoring for and managing complications related to long-term use is important.
TELMISARTAN
INDICATIONS: Used alone or together with other medicines to treat high blood pressure (hypertension). High
blood pressure adds to the workload of the heart and arteries.
MECHANISM OF ACTION: Telmisartan is an angiotensin II receptor blocker (ARB). It works by blocking a
substance in the body that causes blood vessels to tighten. As a result, telmisartan relaxes the blood vessels. This
lowers blood pressure and increases the supply of blood and oxygen to the heart.
ADVERSE EFFECT: Low blood pressure. Symptoms include:faintness, dizziness. Kidney disease. If you
already have kidney disease, this drug may make it worse. Symptoms include: swelling in your feet, ankles, or
hands, unexplained weight gain. Allergic reaction. Symptoms include:swelling of your face, tongue, or
throat ,trouble breathing, skin rash
CONTRAINDICATION: Low blood pressure. Symptoms include:faintness, dizziness. Kidney disease. If you
already have kidney disease, this drug may make it worse. Symptoms include: swelling in your feet, ankles, or
hands, unexplained weight gain. Allergic reaction. Symptoms include:swelling of your face, tongue, or
throat ,trouble breathing, skin rash
DRUG TO DRUG INTERACTION: Should not be taken with Angiotensin receptor blockers (ARBs), such as:
candesartan,eprosartan, irbesartan,losartan, olmesartan ,valsartan,azilsartan. Angiotensin-converting enzyme
(ACE) inhibitors, such as:benazepril ,captopril, enalapril,fosinopril, lisinopril,moexiprilil.Pain medications,
Digoxin, and Lithium.
• Monitor patient response to therapy through blood pressure monitoring.
• Monitor for presence of mentioned adverse effects (e.g. hypotension, GI distress, skin reactions, etc.)
• Monitor for effectiveness of comfort measures. Monitor for compliance to drug therapy regimen.
IRBESARTAN
INDICATIONS: It is an angiotensin II receptor blocker (ARB) used to treat hypertension. It may also be
prescribed for the treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension.
MECHANISM OF ACTION: It selectively blocks the angiotensin II receptor, leading to vasodilation, reduced
secretion of aldosterone, and decreased sodium and water retention. This results in lowering blood pressure.
ADVERSE EFFECT: Potential adverse effects include hypotension, hyperkalemia, and changes in renal
function. It is generally well-tolerated, and the incidence of a persistent dry cough, a side effect seen with ACE
inhibitors, is lower.
CONTRAINDICATION: Contraindicated in patients with hypersensitivity to irbesartan, a history of

angioedema related to previous use of ARBs or ACE inhibitors, and pregnancy.
DRUG TO DRUG INTERACTION: Interactions may occur with other antihypertensive agents, diuretics, or
medications affecting potassium levels. Caution is needed when combining irbesartan with potassium-sparing
diuretics or potassium supplements.
•Monitor blood pressure, renal function, and potassium levels regularly

•Patient education includinginformation on potential side effects and the importance of compliance
•Monitor signs of complications
CANDESARTAN
INDICATIONS: Used to treat hypertension, isolated systolic hypertension, left ventricular hypertrophy and
diabetic nephropathy. It may also be used as an alternative agent for the treatment of heart failure, systolic
dysfunction, myocardial infarction and coronary artery disease.
MECHANISM OF ACTION: Candesartan blocks the vasoconstrictor and aldosterone-secreting effects of

angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as
vascular smooth muscle and the adrenal gland.
ADVERSE EFFECT: Arm, back, or jaw pain,bleeding gums,chest pain or discomfort,chest tightness or
heaviness,chills,cough or hoarseness,dizziness,fainting,fast or irregular heartbeat,fever,joint pain,large, hive-like
swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs,lightheadedness,lower back or
side pain,nausea,nosebleeds, pain or discomfort in the arms, jaw, back, or neck,painful or difficult
urination,shortness of breath,sweating,swelling of the feet or lower legs, vomiting
CONTRAINDICATION: The only major contraindication to candesartan is hypersensitivity to the medication

or any of its components.
DRUG TO DRUG INTERACTION: Other medicines to help lower your blood pressure, including aliskiren,
enalapril, captopril, lisinopril or ramipril,painkillers such as ibuprofen, naproxen, diclofenac, celecoxib or
etoricoxib. Aspirin (if you're taking more than 3g a day). Potassium supplements or salt substitutes containing
potassium. Heparin, a medicine for thinning the blood. Medicines that make you pee more (diuretics).Lithium, a
medicine for mental health problems. And spironolactone, a medicine to treat heart failure
 Start on a low dose of candesartan.

 After a few weeks your doctor will check blood pressure and ask if client is getting any side effects.
 Have blood tests to check how well the kidneys are working and the amount of potassium in the blood.
 For people who are at higher risk of hyperkalaemia or deteriorating renal function, consider checking
renal function and serum electrolytes sooner (within 1 week).
CLONIDINE
INDICATIONS: It is primarily used to treat hypertension. Additionally, it may be prescribed for certain
conditions such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, and withdrawal symptoms
associated with opioid dependence.
MECHANISM OF ACTION: stimulates alpha-2 adrenergic receptors in the brain, leading to reduced
sympathetic outflow. This results in decreased peripheral resistance, heart rate, and blood pressure.
ADVERSE EFFECT: Potential adverse effects include drowsiness, dry mouth, constipation, and hypotension.
Abrupt discontinuation can lead to rebound hypertension.
CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to clonidine or conditions

where a reduction in sympathetic activity might be harmful.
DRUG TO DRUG INTERACTION: Interactions may occur with other medications affecting blood pressure or
central nervous system function. Caution is needed when combining clonidine with other antihypertensive agents
or medications that may cause sedation.
• Monitor blood pressure, heart rate, and side effects regularly
• Educate patients on proper administration, potential side effects, and the importance of gradual
discontinuation
• Monitor signs of complications
METHYLDOPA
INDICATIONS: An antihypertensive indicated to treat high blood pressure (hypertension).
MECHANISM OF ACTION: Alpha-methyldopa is converted to methyl norepinephrine centrally to decrease the

adrenergic outflow by alpha-2 agonistic action from the central nervous system, leading to reduced total
peripheral resistance and decreased systemic blood pressure. Alpha-2 agonistic activity does not affect cardiac
output or renal blood flow.; hence, this drug is useful in hypertensive patients with renal insufficiency.
ADVERSE EFFECT: Common adverse effects include:Nausea, Diarrhea, Headache, Dizziness, Sedation, Dry
mouth, Rash. Rare yet clinically fatal adverse effects include:Hemolytic anemia (Coombs positive), Lupus-like
syndrome, Myocarditis, Pancreatitis, Hepatotoxicity, Immune thrombocytopenia, Reversible leukopenia,
Involuntary choreoathetotic movements, Weight gain, Rebound hypertension.
CONTRAINDICATION: Contraindicated to client with Active hepatic disease, liver disorders due to previous
therapy, direct Coombs positive hemolytic anemia, significant drug history of MAO inhibitor therapy,
pheochromocytoma, known hypersensitivity to methyldopa in any form.
DRUG TO DRUG INTERACTION: Don't take methyldopa if you're taking drugs called monoamine oxidase
inhibitors (MAOIs). Examples include isocarboxazid, phenelzine, linezolid, and tranylcypromine. Blood disorder
warning: Methyldopa may be associated with a deadly type of blood disorder called hemolytic anemia.
 Monitor patient response to therapy through blood pressure monitoring.

 Monitor for presence of mentioned adverse effects (e.g. hypotension, GI distress, skin reactions, etc.)
 Monitor for effectiveness of comfort measures.
 Monitor for compliance to drug therapy regimen
 Monitor the patient for signs and symptoms of jaundice, fever, drowsiness or sedation, and other
preexisting disorders.
 Check the medication record to verify dosing and administration were correct.
NITROGLYCERIN
INDICATIONS: Sublingual nitroglycerin is indicated for the acute relief of an attack or acute prophylaxis of
angina pectoris due to coronary artery disease. Transdermal nitroglycerin is indicated for the prevention of angina
pectoris due to coronary artery disease.
MECHANISM OF ACTION: It is a vasodilator that works by relaxing smooth muscle, particularly in blood
vessels. It dilates coronary arteries, increasing blood flow to the heart, and reduces preload on the heart by
dilating veins.
ADVERSE EFFECT: Potential adverse effects include headache, dizziness, and hypotension. Tolerance can
develop with prolonged use. Nitroglycerin may cause a rapid drop in blood pressure, especially when standing up,
leading to dizziness.
CONTRAINDICATION: Contraindicated in patients with hypersensitivity to nitroglycerin or nitrates. Use

caution in patients with severe anemia, closed-angle glaucoma, and those taking medications for erectile
dysfunction (due to potential additive effects on blood pressure).
DRUG TO DRUG INTERACTION: Interactions may occur with other medications that affect blood pressure,
especially phosphodiesterase inhibitors used for erectile dysfunction.
•Monitor blood pressure
•Assess for side effects
•Educate patients on proper administration and about the potential for headaches
ISOSORBIDE MONONITRATE
INDICATIONS: Indicated for the prevention and management of angina pectoris due to coronary artery disease.
The onset of action of oral isosorbide mononitrate is not sufficiently rapid to be useful in aborting an acute
anginal episode.
MECHANISM OF ACTION: Isosorbide mononitrate is an organic nitrate with vasodilating properties. It is an

anti-anginal agent that works by relaxing the smooth muscles of both arteries and veins, but but predominantly
veins to reduce cardiac preload.
ADVERSE EFFECT: Common side effects of Isordil include:headache,weakness, mild dizziness, and skin
changes such as redness, tingling, or warmth.Serious side effects of Isordil include:heart rate changes,increased
chest pain (angina),fainting or near-fainting,nausea and vomiting,sweating,pale skin, blurry vision, and shortness
of breath.Isordil may cause serious side effects including: lightheadedness,worsening chest pain,fast or slow heart
rate,pounding heartbeats,fluttering in your chest,hives,difficulty breathing, swelling of your face, lips, tongue or
throat.
CONTRAINDICATION: Hypersensitivity to organic nitrates, PDE-5 inhibitors (avanafil, sildenafil, tadalafil, or
vardenafil); concomitant use can cause severe hypotension, syncope, or myocardial ischemia. Concomitant
administration with guanylate stimulator riociguat (may cause hypotension).
DRUG TO DRUG INTERACTION: Do not take riociguat (Adempas), sildenafil (Viagra), tadalafil (Cialis), or
vardenafil (Levitra) while you are using this medicine. Using these medicines together may lower your blood
pressure and cause blurred vision, dizziness, lightheadedness, or fainting.
NURSING RESPONSIBILITIES: Monitor……
 Patients who have low blood pressure and low heart rate
 Patients who are on chronic diuretic therapy
 Elderly patients with underlying autonomic dysfunction
 Patients with right ventricular infarction who are preload sensitive
 Volume-depleted patients, e.g., from chronic diarrhea and vomiting
 Patients who are taking other types of vasodilators
ISOSORBIDE DINITRATE
INDICATIONS: It is a nitrate medication used to prevent and treat angina pectoris, a condition characterized by
chest pain or discomfort due to reduced blood flow to the heart.
MECHANISM OF ACTION: It is a vasodilator that works by relaxing smooth muscle, particularly in blood
vessels. It dilates coronary arteries, increasing blood flow to the heart, and reduces preload on the heart by
dilating veins.
ADVERSE EFFECT: Potential adverse effects include headache, dizziness, and hypotension. Tolerance can
develop with prolonged use. Isosorbide dinitrate may cause a rapid drop in blood pressure, leading to dizziness.
CONTRAINDICATION: Contraindicated in patients with hypersensitivity to isosorbide dinitrate or nitrates.

Use caution in patients with hypotension, severe anemia, and those taking medications for erectile dysfunction
(due to potential additive effects on blood pressure)
DRUG TO DRUG INTERACTION: Interactions may occur with other medications that affect blood pressure,
especially phosphodiesterase inhibitors used for erectile dysfunction.
• Monitor blood pressure

• Assess for side effects
• Educate patients on proper administration and about the potential for headaches
PHENYTOIN
INDICATIONS: Medication used in the management and treatment of epilepsy, generalized tonic-clonic
seizures, complex partial seizures, and status epilepticus. It is in the anticonvulsants class of drugs.
MECHANISM OF ACTION: Phenytoin is a voltage-gated, sodium channel blocker, stabilizing the inactive
state of the sodium channel and prolonging the neuronal refractory period. Phenytoin acts on the sodium channels
in both neuronal and cardiac tissue.
ADVERSE EFFECT: Headache, nausea, vomiting, constipation, dizziness, feeling of spinning, drowsiness,
trouble sleeping, or nervousness may occur. If any of these effects last or get worse, tell your doctor or pharmacist
promptly. Phenytoin may cause swelling and bleeding of the gums.
CONTRAINDICATION: Hypersensitivity to phenytoin or other hydantoins is a contraindication for using
phenytoin. Pregnancy is another absolute contraindication for phenytoin use. Hanson et al. reported a prevalence
of fetal hydantoin syndrome (FHS) of 11% in pregnant women receiving treatment for epilepsy with phenytoin,
with an additional 30% of the in utero-exposed children expressing some of the syndrome’s features such as
epicanthic folds, hypertelorism, broad flat nasal bridges, an upturned nasal tip, wide prominent lips and, also,
distal digital hypoplasia, intrauterine growth retardation, and diminished mental capacity.
DRUG TO DRUG INTERACTION: Can't take with other medicines used to treat epilepsy, such as
carbamazepine, clonazepam, lamotrigine, phenobarbital, sodium valproate, topiramate, oxcarbazepine,
ethosuximide or vigabatrin.Medicines used to treat HIV.Hormonal contraceptives or hormone replacement
therapy (HRT)
 Liver damage and haemopoietic disorders have been associated with phenytoin therefore baseline liver
function tests and full blood count should be taken.
 Serum drug monitoring is required.
LIDOCAINE
INDICATIONS: It is a local anesthetic used to produce temporary loss of sensation in a specific area of the
body. It is often used for minor surgical procedures, dental work, and to manage certain types of pain, including
arrhythmias when administered intravenously
MECHANISM OF ACTION: It works by blocking sodium channels, preventing the initiation and conduction of
nerve impulses. This results in a reversible loss of sensation in the targeted area.
ADVERSE EFFECT: Potential adverse effects include local reactions at the injection site, dizziness, nausea,
and, rarely, allergic reactions. Excessive systemic absorption can lead to more serious side effects, such as
seizures or cardiovascular effects.
CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to lidocaine or amide- type

local anesthetics. Caution is needed in patients with certain heart conditions, liver dysfunction, or a history of
seizures.
DRUG TO DRUG INTERACTION: Lidocaine may interact with other medications that affect cardiac
conduction or metabolism. Close monitoring is necessary when combined with antiarrhythmics, beta-blockers, or
cimetidine.
• Assess for allergies

• Monitor vital signs during and after administration, signs of systemic toxicity
• Proper documentation and patient education on potential side effects
QUINIDINE
INDICATIONS: Indicated for the management and prophylactic therapy of atrial fibrillation/flutter, as well as
the suppression of recurrent documented ventricular arrhythmias. It is also used in the treatment of Brugada
syndrome, short QT syndrome and idiopathic ventricular fibrillation.
MECHANISM OF ACTION: Like all other class I antiarrhythmic agents, quinidine primarily works by
blocking the fast inward sodium current (INa). Quinidine's effect on INa is known as a 'use dependent block'. This
means at higher heart rates, the block increases, while at lower heart rates, the block decreases.
ADVERSE EFFECT: Fever and hypersensitivity reactions occur in individuals who are allergic to the
drug.Hypokalemia or hypomagnesemia can potentially lead to drug toxicity when taking quinidine.Hemolysis is a
possible occurrence in patients with G6PD deficiencies when using quinidine.
CONTRAINDICATION: Contraindicated to clients with Hypersensitivity. Thrombocytopenic purpura hx,

quinidine or quinine-assoc. Myasthenia gravis, Intraventricular conduction defects, Complete AV block w/
junctional rhythm, Complete AV block w/ idioventricular rhythm, ongenital long QT syndrome, uncorrected
Electrolyte abnormalities.
DRUG TO DRUG INTERACTION: Quinidine sulfate should not be used with the following medications
because very serious (possibly fatal) interactions may occur: HIV protease inhibitors, azole antifungals,
propafenone, cisapride, arbutamine, or mefloquine.
Check apical pulse, BP, and cardiac monitor prior to administration of quinidine.
Monitor blood pressure, QRS duration, and QT interval frequently for patients receiving quinidine.
If QRS widens > 50%, notify physician.
Serum quinidine levels should be between 2 – 5 mcg/ml.
PROPRANOLOL
INDICATIONS: It is a non-selective beta-blocker used to treat various conditions, including hypertension,
angina pectoris, arrhythmias, and migraines. It’s also used in the management of certain cardiovascular conditions
and anxiety.
MECHANISM OF ACTION: It blocks beta-adrenergic receptors, reducing the effects of adrenaline

(epinephrine) and noradrenaline. This results in decreased heart rate, blood pressure, and myocardial contractility.
ADVERSE EFFECT: Potential adverse effects include fatigue, dizziness, bradycardia (slow heart rate), and,
rarely, bronchoconstriction. Abrupt discontinuation should be avoided to prevent rebound hypertension or
exacerbation of angina.
CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to propranolol, bradycardia,

heart block, and certain respiratory conditions like asthma or COPD.
DRUG TO DRUG INTERACTION: Propranolol may interact with other medications affecting blood pressure,
heart rate, or those metabolized by the liver. Caution is needed when combining with other antihypertensive
agents or medications that affect cardiac conduction.
•Monitor vital signs, especially blood pressure, and ECG monitoring
•Assess for signs of worsening heart failure or bronchoconstriction
•Educate patients on the importance of compliance
AMIODARONE
INDICATIONS: Use for treatment of recurrent hemodynamically unstable ventricular tachycardia and recurrent
ventricular fibrillation. Amiodarone is a benzofuran derivative, anti-arrhythmic drug used commonly in a variety
of settings.
MECHANISM OF ACTION: It blocks potassium currents that cause repolarization of the heart muscle during
the third phase of the cardiac action potential. As a result amiodarone increases the duration of the action potential
as well as the effective refractory period for cardiac cells (myocytes).
ADVERSE EFFECT: The most common adverse effects of amiodarone include nausea, vomiting, weight loss,
bluish-grey discoloration of the skin, hypothyroidism or hyperthyroidism, liver disease, and photosensitivity.
CONTRAINDICATION: Contraindications. Amiodarone hydrochloride tablets are contraindicated in patients

with Cardiogenic shock. Sick sinus syndrome, second- or third-degree AV block, bradycardia leading to syncope
without a functioning pacemaker. Known hypersensitivity to the drug or any of its components
DRUG TO DRUG INTERACTION: Other medications can affect the removal of amiodarone from your body,
which may affect how amiodarone works. Examples include azole antifungals (such as itraconazole), cimetidine,
cobicistat, protease inhibitors (such as fosamprenavir, indinavir), rifamycins (such as rifampin), saquinavir, St.
John's wort, among others.
Monitor the EKG continuously during IV amiodarone infusion and initiation of PO therapy.
Monitor patient's respiratory status carefully.
Patients taking amiodarone long-term should get regular chest x-rays and pulmonary function tests.
Watch for signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous
distention, and exercise intolerance
Watch for signs of pulmonary toxicity, pulmonary fibrosis, and ARDS.
DILTIAZEM
INDICATIONS: It is a calcium channel blocker used to treat various cardiovascular conditions, including
hypertension, angina pectoris, and certain types of arrhythmias (atrial fibrillation, atrial flutter)
MECHANISM OF ACTION: It inhibits calcium influx into cardiac and smooth muscle cells, leading to
vasodilation and decreased myocardial contractility. This results in reduced heart rate, blood pressure, and oxygen
demand.
ADVERSE EFFECT: Potential adverse effects include dizziness, headache, peripheral edema, and constipation.
In rare cases, it may cause more serious side effects like heart block or worsening heart failure
CONTRAINDICATION: Contraindicated in patients with known hypersensitivity to diltiazem, severe

hypotension, sick sinus syndrome, second- or third-degree atrioventricular block (unless a pacemaker is present),
and certain acute cardiac conditions.
DRUG TO DRUG INTERACTION: Diltiazem can interact with various medications, especially those affecting
heart rate or blood pressure. It may potentiate the effects of beta-blockers, increase digoxin levels, and interact
with certain antiarrhythmics.
•Monitor blood pressure, heart rate, and signs of heart failure
•Assess for side effects
•Educate patients about proper medication administration and compliance

VERAPAMIL
INDICATIONS: Indications for verapamil include angina (chronic stable, vasospastic or Prinzmetal variant),
unstable angina (crescendo, preinfarction), hypertension as add-on therapy, paroxysmal supraventricular
tachycardia (PSVT) prophylaxis, and supraventricular tachycardia (SVT).
MECHANISM OF ACTION: Verapamil and the other calcium-channel blockers block the slow inward calcium
current in the slow response cells of the sinus node and the atrioventricular node. This cellular activity decreases
sinus node automaticity, slows atrioventricular node conduction, and prolongs refractoriness.
ADVERSE EFFECT: Check with your doctor right away if you have the following symptoms: blurred vision;
confusion; severe dizziness, faintness, or lightheadedness when getting up from a lying or sitting position
suddenly; sweating; or unusual tiredness or weakness .
CONTRAINDICATION: Contraindicated in severe left ventricular dysfunction, hypotension (systolic

pressure less than 90 mm Hg) or cardiogenic shock, sick sinus syndrome (except in patients with a functioning
artificial ventricular pacemaker), second- or third-degree AV block (except in patients with a functioning artificial
ventricular pacemaker), in patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g.,
Wolff-Parkinson-White) and in patients with known hypersensitivity to verapamil hydrochloride.
DRUG TO DRUG INTERACTION: Other medications can affect the removal of verapamil from your body,
which may affect how verapamil works. Examples include erythromycin, rifamycins (such as rifampin), ritonavir,
St. John's wort, among others.Verapamil can slow down the removal of other medications from your body, which
may affect how they work Examples of affected drugs include asunaprevir, colchicine, elacestrant, fezolinetant,
flibanserin, ivabradine,lomitapide, midazolam, triazolam, among others.
Assess routinely for signs of CHF and pulmonary edema (dyspnea, cough, shortness of breath, rales/crackles,
jugular venous distention)
Assess blood pressure periodically and compare to normal values (See Appendix F) to help document
antihypertensive effects.
DIGOXIN
INDICATIONS: It is a medication used to treat heart failure and certain types of arrhythmias, particularly atrial
fibrillation and atrial flutter
MECHANISM OF ACTION: It increases the force of myocardial contractions by inhibiting the sodium-
potassium ATPase pump, leading to an increase in intracellular sodium. This results in increased intracellular
calcium, enhancing myocardial contractility. Additionally, digoxin has effects on the electrical activity of the heart
ADVERSE EFFECT: Potential adverse effects include nausea, vomiting, anorexia, and visual disturbances (such
as changes in color perception or halos around lights). Toxicity can occur, especially with higher doses, leading to
serious cardiac arrhythmias.
CONTRAINDICATION: Contraindicated in patients with known hypersensitivity to digoxin, ventricular

fibrillation, and certain types of heart block. Caution is needed in patients with renal impairment.
DRUG TO DRUG INTERACTION: Digoxin interacts with various medications, including those affecting heart
rate or potassium levels. It may interact with diuretics, antacids, and other medications that affect renal function
•Monitor serum digoxin levels, renal function, and potassium levels
•Assess for signs of toxicity, especially visual disturbances and arrhythmias
•Educate patients about the importance of compliance

ADENOSINE
INDICATIONS: Adenosine is a naturally occurring substance that relaxes and dilates blood vessels. Adenosine
also affects the electrical activity of the heart. Adenosine is used to help restore normal heartbeats in people with
certain heart rhythm disorders. Adenosine is also used during a stress test of the heart
MECHANISM OF ACTION: Adenosine has a role in slowing down the heart rate enough to assist in diagnosis.
It can also terminate specific reentrant tachycardia involving the AV node, including AV nodal reentrant
tachycardia (AVNRT), orthodromic AV reentrant tachycardia (AVRT), and antidromic AVRT.
ADVERSE EFFECT: The most common adverse reactions are flushing, chest discomfort, dyspnea, facial
flushing, headache, throat/neck/jaw discomfort, gastrointestinal discomfort, and lightheadedness/dizzines
CONTRAINDICATION: Dipyridamole potentiates the action of adenosine, requiring the use of lower doses.
Caffeine's principal mode of action is as an antagonist of adenosine receptors in the brain.Methylxanthines have a
purine structure and bind to some of the same receptors as adenosine.Methylxanthines act as competitive
antagonists of adenosine and can blunt its pharmacological effects.Caffeine acts by blocking binding of adenosine
to the adenosine A1 receptor, which enhances release of the neurotransmitter acetylcholine.
 Continuous ECG printout during and immediately after administration IS ESSENTIAL. File
record in patient notes
 Where practical record blood pressure prior to first dose
 Continuous cardio-respiratory monitoring. Observe closely for arrhythmia.
 Monitor and assess patient response to therapy.
 Observe for signs of adverse effects and arrhythmias
 Ensure resuscitation equipment available.
ATROPINE
INDICATIONS: This medicine is used to reduce saliva and fluid in the respiratory tract during surgery. It is also
used to treat insecticide or mushroom poisoning. It can be used in an emergency to treat a slow heartbeat.
MECHANISM OF ACTION: Atropine inhibits the muscarinic actions of acetylcholine on structures innervated
by postganglionic cholinergic nerves, and on smooth muscles, which respond to endogenous acetylcholine but are
not so innervated.
ADVERSE EFFECT: Palpitations, dilated pupils, difficulty swallowing, hot dry skin, thirst, dizziness,
restlessness, tremor, fatigue, and problems with coordination.
CONTRAINDICATION: contraindicated in patients with glaucoma, pyloric stenosis, thyrotoxicosis, fever,

urinary tract obstruction and ileus
DRUG TO DRUG INTERACTION: Significant potentiation of anticholinergic effects with amantadine,

antihistamines, tricyclic antidepressants, quinidine, disopyramide; Atropine decreases the effects of levo-dopa;
Atropine enhances extrapyramidal effects with methotrimeprazine; Antipsychotic effects of phenothiazines are
decreased due to decreased absorption.
Monitor apical pulse prior to administration.
Cardiac monitors should be used on patients receiving atropine IV boluses.
Monitor temperature in infants and children for "atropine fever".
Measures to relieve dry mouth: adequate fluid hydration, oral hygiene (don't use alcohol based mouthwashes), ice
chips, sugarless gum, or hard candies to suck on.
Reduce lighting to decrease photophobia.
Monitor GI motility (BMs and flatus) and urine output while patient is receiving atropine.
AMLODIPINE
INDICATIONS: Amlodipine is used alone or in combination with other medications to treat high blood pressure
in adults and children 6 years and older. It is also used to treat certain types of angina (chest pain) and coronary
artery disease (narrowing of the blood vessels that supply blood to the heart)
MECHANISM OF ACTION: Amlodipine works by blocking the voltage-dependent L-type calcium channels,
thereby inhibiting the initial influx of calcium. Compared to nifedipine and other medications in the
dihydropyridine class, amlodipine has the longest half-life at 30 to 50 hours
ADVERSE EFFECT: Stomach problems – severe pain in stomach, with or without diarrhea (whether it has
blood in it or not), feeling sick and being sick (nausea and vomiting) – these can be signs of pancreatitis. The
whites of the eyes turn yellow, or skin turns yellow although this may be less obvious on brown or black skin –
this can be a sign of liver problems
CONTRAINDICATION: Contraindicated in patients with known hypersensitivity to amlodipine or its dosage
form components. In addition, amlodipine is relatively contraindicated in patients with cardiogenic shock, severe
aortic stenosis, unstable angina, severe hypotension, heart failure, and hepatic impairment.
DRUG TO DRUG INTERACTION: Antibiotics such as clarithromycin, erythromycin or rifampicin. Calcium

channel blockers like diltiazem or verapamil. Itraconazole or ketoconazole, antifungal medicines. Medicines to
treat HIV or HCV (hepatitis C virus). Anti-epilepsy medicines such as carbamazepine, phenytoin, phenobarbital
(phenobarbitone) or primidone. Medicines to suppress your immune system, such as cyclosporine or
tacrolimus .More than 20mg a day of the cholesterol-lowering medicine simvastatin
Monitor BP and pulse before therapy, during dose titration, and periodically during therapy.
Monitor ECG periodically during prolonged therapy. Monitor intake and output ratios and daily weight.
Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
VALSARTAN
INDICATIONS: It is commonly used to treat hypertension and heart failure. It may also be prescribed
following a heart attack.
MECHANISM OF ACTIONS: It is an angiotensin II receptor blocker (ARB). It blocks the effects of

angiotensin II, leading to vasodilation and decreased secretion of aldosterone. This results in reduced
blood pressure and decreased workload on the heart.
ADVERSE EFFECTS: Common adverse effects include dizziness, hypotension, and hyperkalemia.
Rare but serious side effects may include renal impairment and angioedema.
CONTRAINDICATIONS: Valsartan is contraindicated in patients with a history of hypersensitivity to

the drug. It should be used cautiously in patients with renal impairment and those who are pregnant.
DRUG TO DRUG INTERACTIONS: Concomitant use of potassium-sparing diuretics, potassium
supplements, or salt substitutes containing potassium may increase the risk of hyperkalemia when taken
with valsartan
•Monitor blood pressure and potassium levels regularly
•Assess for signs of hypotension, especially during the initial period of therapy
•Educate patients about the importance of medication adherence and the need for regular follow-up
appointments
OLMESARTAN
INDICATIONS: It is commonly prescribed for the treatment of hypertension.
MECHANISM OF ACTIONS: It is an angiotensin II receptor blocker (ARB). It works by blocking the

effects of angiotensin II, leading to vasodilation and a reduction in blood pressure.
ADVERSE EFFECTS: Common adverse effects may include dizziness and gastrointestinal symptoms.
In rare cases, it may cause changes in kidney function and increased levels of potassium in the blood.
CONTRAINDICATIONS: Olmesartan is contraindicated in patients with a history of hypersensitivity

to the drug. It is also not recommended during pregnancy.
DRUG TO DRUG INTERACTIONS: Olmesartan may interact with other antihypertensive agents,
leading to additive effects. Concomitant use with potassium-sparing diuretics or potassium supplements
may increase the risk of hyperkalemia
•Monitor blood pressure regularly and assess for signs of hypotension
•Check kidney function and potassium levels periodically
•Educate patients about the importance of medication adherence and potential side effects
ATENOLOL
INDICATIONS: It is commonly prescribed to treat hypertension, angina, and to prevent cardiovascular

events in patients with a history of myocardial infarction
MECHANISM OF ACTIONS: Atenolol is a beta-blocker that works by blocking the effects of

adrenaline on the heart. It reduces heart rate, cardiac output, and blood pressure by inhibiting beta-
adrenergic receptors.
ADVERSE EFFECTS: Common adverse effects may include fatigue, cold extremities, and
bradycardia. Atenolol should be tapered off gradually to avoid rebound hypertensio
CONTRAINDICATIONS: Atenolol is contraindicated in patients with sinus bradycardia, heart block

greater than the first degree, and cardiogenic shock. It should be used cautiously in patients with asthma
or other bronchospastic conditions
DRUG TO DRUG INTERACTIONS: Atenolol may interact with other antihypertensive medications
and drugs that affect heart rate or rhythm. It’s important to monitor for additive effects when used in
combination
•Monitor blood pressure, heart rate, and signs of heart failure regularly
•Educate patients about the importance of not abruptly stopping the medication and the need for gradual
dose reduction if discontinuation is required
•Assess respiratory function in patients with a history of respiratory conditions, as beta-blockers can
potentially exacerbate bronchospasm
METOPROLOL
INDICATIONS: FDA-approved to treat angina, heart failure, myocardial infarction, atrial

fibrillation/flutter, and hypertension. Off-label uses include supraventricular tachycardia and thyroid
storm. Both oral and intravenous preparations are available
MECHANISM OF ACTIONS: Metoprolol is a cardio selective beta-1-adrenergic receptor inhibitor

that competitively blocks beta1 receptors with minimal or no effects on beta-2 receptors at oral doses of
less than 100 mg in adults. It decreases cardiac output by negative inotropic and chronotropic effects.
ADVERSE EFFECTS: Blurred vision, chest pain or discomfort, confusion, dizziness, faintness, or
lightheadedness when getting up suddenly from a lying or sitting position, slow or irregular heartbeat, Sweating,
unusual tiredness or weakness, Bloating or swelling of the face, arms, hands, lower legs, or feet, chest tightness,
cough, decreased urine output, difficult or labored breathing, difficulty with speaking, dilated neck veins,
disturbed color perception, double vision, fast, pounding, or racing heartbeat or pulse, around lights, headache,
inability to move the arms, legs, or facial muscles, inability to speak, irregular breathing, loss of vision, night
blindness, noisy breathing, overbright appearance of lights, pain, tension, and weakness upon walking that
subsides during periods of rest, paleness or cold feeling in the fingertips and toes, rapid weight gain,seeing,
hearing, or feeling things that are not there ,short-term memory loss
CONTRAINDICATIONS: contraindicated in patients with bradycardia, heart block greater than the
first degree, cardiogenic shock, and certain other cardiac conditions Caution is advised in patients with
asthma or other bronchospastic conditions.
 Monitor blood pressure, ECG, and pulse frequently during dose adjustment and periodically during
therapy.
 Assess hypersensitivity to metoprolol
 Monitor vital signs and ECG every 5 – 15 minutes during and for several hours after parenteral
administration. If the heart rate is<40 bpm, especially if cardiac output is also decreased, administer
atropine 0.25 – 0.5 mg IV.
PROPRANOLOL
INDICATIONS: It is used for various conditions, including hypertension, angina, cardiac arrhythmias,
migraine prophylaxis, and as an adjuvant in the management of certain cardiovascular conditions.
MECHANISM OF ACTIONS: It is a non-selective beta-blocker that blocks both beta-1 and beta-2
adrenergic receptors. By doing so, it reduces heart rate, cardiac output, and blood pressure, as well as
inhibits the effects of adrenaline.
ADVERSE EFFECTS: Common adverse effects include fatigue, cold extremities, and bradycardia. It
should be tapered off gradually to avoid rebound hypertension.
CONTRAINDICATIONS: Propranolol is contraindicated in patients with bradycardia, heart block

greater than the first degree, cardiogenic shock, and certain other cardiac conditions. Caution is advised
in patients with asthma or other bronchospastic conditions.
DRUG TO DRUG INTERACTIONS: Propranolol may interact with other antihypertensive
medications, drugs affecting heart rate, and medications metabolized by the liver. It can also interfere
with the effects of epinephrine.
• Monitor blood pressure, heart rate, and signs of heart failure regularly
• Educate patients about the importance of compliance with the prescribed dosage and the need for
gradual dose reduction if discontinuation is required
• Assess respiratory function in patients with a history of respiratory conditions, as beta-blockers can
potentially exacerbate bronchospasm
CARVEDILOL
INDICATIONS: Carvedilol is a non-selective adrenergic blocker indicated for the chronic therapy of
heart failure with reduced ejection fraction (HFrEF), hypertension, and left ventricular dysfunction
following myocardial infarction (MI) in clinically stable patients.
MECHANISM OF ACTIONS: Carvedilol's action on alpha-1 adrenergic receptors relaxes smooth

muscle in vasculature, leading to reduced peripheral vascular resistance and an overall reduction in blood
pressure. At higher doses, calcium channel blocking and antioxidant activity can also be seen.
ADVERSE EFFECTS: Check with your doctor right away if you are having chest pain or discomfort, dilated
neck veins, irregular breathing or heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing,
unusual tiredness or weakness, or weight gain.
For congestive heart failure patients: Check with your doctor if you have unexplained weight gain or increased
trouble breathing. These may be signs of a worsening of your condition.
For patients who wear contact lenses: Carvedilol may cause your eyes to form tears less than they do normally.
Check with your doctor if you have dry eyes.
CONTRAINDICATIONS: Can’t take drugs if ever had an allergic reaction to carvedilol or any other
medicines,lung disease or asthma,heart failure that is getting worse, have low blood pressure (hypotension) or a
slow heart rate, a liver problem,serious circulation problems in your arms and legs, such as Raynaud's.
DRUG TO DRUG INTERACTIONS: Interactions with other blood pressure medications, cyclosporine, and
rifampin can also pose an issue.
 Monitor BP and pulse frequently during dose adjustment period and periodically during therapy.
 Assess for orthostatic hypotension when assisting patient up from supine position.
 If heart rate decreases below 55 beats/min, decrease dose.
 Monitor intake and output ratios and daily weight.
NIFEDIPINE
INDICATIONS: It is commonly prescribed for the treatment of hypertension and angina
MECHANISM OF ACTIONS: It is a calcium channel blocker that inhibits the influx of calcium ions into
vascular smooth muscle cells. By doing so, it leads to vasodilation and reduces peripheral vascular resistance,
thereby lowering blood pressure.
ADVERSE EFFECTS: Common adverse effects may include flushing, headache, and peripheral
edema. Extended-release formulations are designed to minimize the incidence of reflex tachycardia.
CONTRAINDICATIONS: Nifedipine is contraindicated in patients with a known hypersensitivity to
the drug. Caution is advised in patients with heart failure and those prone to hypotension
DRUG TO DRUG INTERACTIONS: Nifedipine may interact with other antihypertensive

medications and drugs metabolized by the CYP3A4 enzyme. Concurrent use with grapefruit juice
should be avoided due to the potential for increased nifedipine concentrations
• Monitor blood pressure regularly and assess for signs of hypotension
• Educate patients about the importance of compliance with the prescribed dosage and the
potential for side effects
• Advise patients to avoid consuming grapefruit juice while taking nifedipine
FELODIPINE
INDICATIONS: It is primarily used to treat hypertension.
MECHANISM OF ACTIONS: It is a calcium channel blocker that inhibits the influx of calcium ions into
vascular smooth muscle cells. This results in vasodilation, reducing peripheral vascular resistance and lowering
blood pressure.
ADVERSE EFFECTS: Common adverse effects may include flushing, headache, and peripheral edema.
Extended-release formulations aim to minimize these side effects.
CONTRAINDICATIONS: Felodipine is contraindicated in patients with a known hypersensitivity to the drug.

Caution is advised in patients with heart failure and those prone to hypotension
DRUG TO DRUG INTERACTIONS: Felodipine may interact with other antihypertensive medications.
Concurrent use with CYP3A4 inhibitors or inducers may affect felodipine metabolism.
• Monitor blood pressure regularly and assess for signs of hypotension
• Educate patients about the importance of compliance with the prescribed dosage and potential side
effects
• Advise patients on lifestyle modifications, such as dietary changes and exercise, to complement the
antihypertensive effects of felodipine
NICARDIPINE
INDICATIONS: Nicardipine is indicated for the treatment of hypertension, including hypertensive

urgency and hypertensive emergency.
MECHANISM OF ACTIONS: It is a calcium channel blocker that inhibits the influx of calcium ions
into vascular smooth muscle cells. By doing so, it induces vasodilation, leading to a decrease in
peripheral vascular resistance and blood pressure.
ADVERSE EFFECTS: Hypotension, headache, and tachycardia may occur. In patients who are taking
beta-blocking agents, Nicardipine may precipitate or exacerbate heart failure.
CONTRAINDICATIONS: Nicardipine is contraindicated in patients with known hypersensitivity to

the drug. Caution is advised in patients with heart failure and those prone to hypotension
DRUG TO DRUG INTERACTIONS: Drugs that inhibit the enzyme CYP3A4 (eg, cimetidine,
itraconazole and grapefruit juice) may increase plasma concentrations of nicardipine. Combination
therapy with calcium channel blockers specifically nicardipine with itraconazole has been shown to
increase the risk of adverse reactions.
 close monitoring of blood pressure and heart rate is required.

 Avoid grapefruit juice 1 hr before or 2 hr after a dose. extended-release:
 Should be taken with food.
 Avoid grapefruit juice 1 hr before or 2 hr after a dose.
 Avoid taking w/ high fat meals.
 Avoid systemic hypotension when administering the drug to patients who have sustained an acute
cerebral infarction or hemorrhage.
DOBUTAMINE
INDICATIONS: Dobutamine is indicated for patients who require a positive inotropic support in the
treatment of cardiac decompensation due to depressed contractility.
MECHANISM OF ACTIONS: Dobutamine is used as a pharmacological agent and has both

ionotropic and chronotropic effects depending on the dose. Because of its inotropic effects on the
myocardium through binding and activating the beta-1 receptors selectively.
ADVERSE EFFECTS: Can rarely reduce the potassium concentrations to hypokalemic levels. Other
rare adverse effects have occurred in one to three percent of the patients, including nausea, headaches,
chest pain, palpitations, and shortness of breath
CONTRAINDICATIONS: The medication is contraindicated in patients with acute myocardial

infarction, unstable angina, left main stem disease, severe hypertension, arrhythmias, acute myocarditis
or pericarditis, hypokalemia and idiopathic hypertrophic sub-aortic stenosis
DRUG TO DRUG INTERACTIONS: Drug Incompatibilities: sodium bicarbonate, aminophylline,
bretylium, bumetanide, calcium chloride, calcium gluconate, diazepam, doxapram, digoxin, epinephrine,
furosemide, heparin, insulin, magnesium sulfate, nitroprusside, phenytoin, potassium chloride,
potassium phosphate, acyclovir.
Monitor BP, heart rate, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, central venous
pressure (CVP), and urinary output continuously during the administration.
Report significant changes in vital signs or arrhythmias.
Hypovolemia should be corrected with suitable volume expanders before treatment with dobutamine is instituted
IVABRADINE
INDICATIONS: Ivabradine is a HCN channel blocker used to reduce the risk of hospitalization for
worsening heart failure in adult patients and for treatment of stable symptomatic heart failure as a result
of dilated cardiomyopathy in pediatric patients.
MECHANISM OF ACTIONS: Ivabradine is a heart-rate-lowering agent that acts by selectively and

specifically inhibiting the cardiac pacemaker current (If), a mixed sodium-potassium inward current that
controls the spontaneous diastolic depolarization in the sinoatrial (SA) node and hence regulates the
heart rate.
ADVERSE EFFECTS: Ivabradine can cause bradycardia, sinus arrest, and heart block. Sinus node
dysfunction, first- or second-degree atrioventricular block, bundle branch block, ventricular
dyssynchrony, and or concomitant use of other heart-rate reducing drugs increase the risk of
bradycardia.
CONTRAINDICATIONS: Contraindicated in the following situations: Decompensated heart failure.
Blood pressure less than 90/50. Conduction abnormalities, e.g., sick sinus syndrome, sinoatrial block, or
third-degree AV block, unless a pacemaker determines the heart rate.
DRUG TO DRUG INTERACTIONS: Do not use this medicine if you are also using clarithromycin
(Biaxin), itraconazole (Sporanox), ketoconazole (Nizoral), nefazodone (Serzone), nelfinavir (Viracept),
or telithromycin (Ketek). Using these medicines together may cause serious unwanted effects.
• Advise females of reproductive potential to use effective contraception during therapy and to avoid
breastfeeding during therapy
• regular heart rate and blood pressure checks are recommended.
• should be regularly monitored for the presence of atrial fibrillation, which includes regular
monitoring of cardiac rhythm.
SOTAGLIFLOZIN
INDICATIONS: The FDA has approved sotagliflozin for the reduction of major heart-failure events in
patients with and or diabetes, an indication that closely mirrors that for empagliflozin and dapagliflozin
MECHANISM OF ACTIONS: Sotagliflozin inhibits renal sodium-glucose co-transporter 2

(determining significant excretion of glucose in the urine, in the same way as other, already available
SGLT-2 selective inhibitors) and intestinal SGLT-1, delaying glucose absorption and therefore reducing
post prandial glucose.
ADVERSE EFFECTS: Dizziness, faintness, or lightheadedness when getting up suddenly from a lying
or sitting position, dry mouth, Fever, increased thirst, increased urination, loss of consciousness,pain,
tenderness, redness, or swelling of the area between and around your anus and genitals,stomach pain.
CONTRAINDICATIONS: Sotagliflozin should not be used in patients with severe renal impairment,
end stage renal disease (ESRD) or in patients on dialysis as it has not been studied in these patients
Hepatic impairment No dose adjustment is recommended in patients with mild hepatic impairment.
DRUG TO DRUG INTERACTIONS: Sotagliflozin has serious interactions with the following drugs:
carbamazepine. phenobarbital. Phenytoin.
monitoring blood glucose and blood pressure in elderly patients is vital to prevent harm.
Ketone monitoring during treatment
Monitor side effects

ISOXSUPRINE
INDICATIONS: It is often used to improve blood flow in certain conditions. It may be prescribed to
manage symptoms related to peripheral vascular disease, such as intermittent claudication (pain in the
legs due to reduced blood flow).
MECHANISM OF ACTIONS: It’s vasodilatory effects are attributed to its ability to relax smooth
muscles in blood vessels, leading to increased blood flow to certain areas of the body.
ADVERSE EFFECTS: Common side effects may include nausea, dizziness, and flushing. It’s
important to monitor for signs of hypotension.
CONTRAINDICATIONS: Isoxsuprine is generally contraindicated in patients with hypersensitivity to

the drug and those with conditions where an increase in heart rate or vasodilation may be problematic.
DRUG TO DRUG INTERACTIONS: Isoxsuprine may interact with other vasodilators or medications
that affect blood pressure. Caution is advised when used concurrently with other drugs that may
potentiate its effects.
•Monitor blood pressure and heart rate regularly during administration
•Educate patients about potential side effects, and encourage reporting any adverse reactions promptly
•Assess for contraindications and potential drug interactions before administration

HYDRALAZINE
INDICATIONS: Hydralazine is used to treat high blood pressure (hypertension). It is also used to
control high blood pressure in a mother during pregnancy (pre-eclampsia or eclampsia) or in emergency
situations when blood pressure is extremely high (hypertensive crisis).
MECHANISM OF ACTIONS: Hydralazine is an arteriolar dilator acting directly on the smooth

muscle of arterioles by mechanisms that are incompletely understood but result in reduced peripheral
vascular resistance and reduced blood pressure.
ADVERSE EFFECTS: Headache, pounding/fast heartbeat, loss of appetite, nausea, vomiting, diarrhea,
or dizziness may occur as your body adjusts to the medication
CONTRAINDICATIONS: Hypersensitivity to hydralazine; coronary artery disease; mitral valvular

rheumatic heart disease are contraindications for its use.
DRUG TO DRUG INTERACTIONS: Hydralazine has serious interactions with the following drugs:,
iofexidine,ionafarnib, pexidartinib, and pretomanid
Closely and frequently monitor maternal vital signs and the fetal heart rate (FHR) pattern after
hydralazine administration because of the potential for hypotension
Monitor CBC, electrolytes, LE cell prep, and ANA titer prior to and periodically during prolonged
therapy. May cause a positive direct Coombs' test result.
TOLVAPTAN
INDICATIONS: It is indicated for the treatment of euvolemic or hypervolemic hyponatremia,

including the syndrome of inappropriate antidiuretic hormone (SIADH).
MECHANISM OF ACTIONS: It is a selective vasopressin V2 receptor antagonist. It works by

blocking the effect of vasopressin, a hormone that can cause the kidneys to retain water, leading to
increased urine output and correction of hyponatremia.
ADVERSE EFFECTS: Common side effects may include thirst, dry mouth, and increased urination.
More serious side effects, such as overly rapid correction of hyponatremia, may occur if not used
properly.
CONTRAINDICATIONS: Tolvaptan is contraindicated in patients with an allergy to tolvaptan or any

components of the formulation. It should not be used in patients with hypovolemic hyponatremia
DRUG TO DRUG INTERACTIONS: Tolvaptan may interact with other medications that affect the
kidneys or electrolyte balance. It’s crucial to review the patient’s complete medication list for potential
interactions.
•Monitor serum sodium levels and urine output regularly
•Educate patients about the importance of complying with prescribed dosages and the need for monitoring
•Assess for signs of dehydration and overcorrection of hyponatremia

EPINEPHRINE
INDICATIONS: Indicated in the emergency treatment of type I allergic reactions, including

anaphylaxis. It is also used to increase mean arterial blood pressure in adult patients with hypotension
associated with septic shock.
MECHANISM OF ACTIONS: Through its action on alpha-1 receptors, epinephrine induces increased
vascular smooth muscle contraction, pupillary dilator muscle contraction, and intestinal sphincter
muscle contraction. Other significant effects include increased heart rate, myocardial contractility, and
renin release via beta-1 receptors
ADVERSE EFFECTS: Central nervous system (CNS): Anxiety, dizziness, nervousness, agitation,
headache, Parkinson disease exacerbation; Cardiovascular: Arrhythmias, chest pain, hypertension,
palpitations, tachycardia, cerebrovascular accidents, ventricular ectopy, vasospasm, tissue ischemia;
Dermatologic: Gangrene at the injection site (especially in buttocks), skin necrosis with extravasation;
CONTRAINDICATIONS: Contraindicated to pregnancy,labor and delivery, breastfeeding , pediatrics,
geriatrics, and several locations should be avoided when injecting epinephrine, specifically the digits,
nose, penis, and toes, as these areas are more prone to ischemia. Avoid using epinephrine in tissues
supplied by end arteries.
DRUG TO DRUG INTERACTIONS: Epinephrine has severe interactions with the following
drugs:disopyramide,ibutilide,Indapamide, iobenguane I 123, Isocarboxazid, Linezolid, Lurasidone,
Pentamidine, Phenelzine, Pimozide, Procainamide, Quinidine, selegiline transdermal, Sotalol,
tranylcypromine
Monitor BP, pulse, respirations, and urinary output and observe patient closely following IV
administration. Epinephrine may widen pulse pressure. If disturbances in cardiac rhythm occur,
withhold epinephrine and notify physician immediately.
NOREPINEPHRINE
INDICATIONS: Norepinephrine is indicated for blood pressure control in certain acute hypotensive
states (e.g., pheochromocytoma ectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial
infarction, septicemia, blood transfusion, and drug reactions).
MECHANISM OF ACTIONS: Acts predominantly on alpha-adrenergic receptors to produce

constriction of resistance and capacitance vessels, thereby increasing systemic blood pressure and
coronary artery blood flow.
ADVERSE EFFECTS: Potential adverse effects include increased blood pressure, decreased urine
output, and tissue necrosis if extravasation occurs.
CONTRAINDICATIONS: Contraindicated in patients with hypotension due to hypovolemia.
DRUG TO DRUG INTERACTIONS: Concurrent use with MAO inhibitors may result in exaggerated
pressor effects.
•Monitor blood pressure and heart rate
•Assess for any adverse reactions
•Educate the patient and their family about the purpose of norepinephrine, potential side effects
ANTI- EMETIC
OR
ANTIVERTIGO AGENTS
ONDANSETRON
INDICATIONS: prevention of chemotherapy-induced and radiation-induced nausea and vomiting, the

prevention of postoperative nausea and vomiting, and off-label use for the prevention of nausea and
vomiting associated with pregnancy.
MECHANISM OF ACTION: blocks nausea and vomiting by 5-HT3 receptor antagonism at two
specific sites: (i) centrally, in the area postrema/NTS; and (ii) peripherally on vagus nerve terminals.
ADVERSE EFFECT: Some adverse effect are headache, constipation, weakness, tiredness, chills,
drowsiness
CONTRAINDICATION: contraindicated for patients known to have hypersensitivity (e.g.,
anaphylaxis) to this product or any of its components. Anaphylactic reactions have been reported in
patients taking ondansetron
DRUG TO DRUG INTERACTION: Some products that may interact with this drug are:
apomorphine, tramadol. Many drugs besides ondansetron may affect the heart rhythm (QT
prolongation), including dofetilide, pimozide, procainamide, amiodarone, quinidine, sotalol, macrolide
antibiotics (such as erythromycin), among others.
Assess patient for extrapyramidal effects (involuntary movements, facial grimacing, rigidity, shuffling
walk, trembling of hands) periodically during therapy.
Monitor ECG in patients with hypokalemia, hypomagnesemia, HF, bradyarrhythmias, or patients
taking concomitant medications that prolong the QT interval.
LORAZEPAM
INDICATIONS: FDA-approved for short-term (4 months) relief of anxiety symptoms related to

anxiety disorders, anxiety-associated insomnia, anesthesia premedication in adults to relieve anxiety or
to produce sedation/amnesia, and treatment of status epilepticus.
MECHANISM OF ACTION: binds to benzodiazepine receptors on the postsynaptic GABA-A ligand-

gated chloride channel neuron at several sites within the central nervous system (CNS). It enhances the
inhibitory effects of GABA, which increases the conductance of chloride ions in the cell.
ADVERSE EFFECT: Lorazepam may cause side effects such as drowsiness, dizziness, tiredness,
weakness, unsteadiness, diarrhea, nausea, changes in appetite, restlessness or excitement, constipation,
blurred vision, changes in sex drive or ability
CONTRAINDICATION: contraindicated in patients with – hypersensitivity to benzodiazepines or to

any components of the formulation. – acute narrow-angle glaucoma. Concomitant use of
benzodiazepines, including Ativan, and opioids may result in profound sedation, respiratory depression,
coma, and death.
DRUG TO DRUG INTERACTION: Lorazepam causes drowsiness, so caution should be used when
combining it with other medications that cause drowsiness. These could include: Antihistamines such as
diphenhydramine (Benadryl®) Narcotic pain medication such as morphine, oxycodone (OxyContin®),
and hydrocodone (Vicodin® and Lortab®)
NURSING RESPONSIBILITY: Continually monitor for signs of cardiac arrest, especially after rapid
IV administration. Signs include sudden chest pain, pain radiating into the arm or jaw, shortness of
breath, dizziness, sweating, anxiety, nausea, and loss of consciousness. Seek immediate medical
assistance if patient develops these signs.
DIPHENHYDRAMINE
INDICATIONS: used to relieve red, irritated, itchy, watery eyes; sneezing; and runny nose caused by
hay fever, allergies, or the common cold. Diphenhydramine is also used to relieve cough caused by
minor throat or airway irritation.
MECHANISM OF ACTION: acts as an inverse agonist at the H1 receptor, thereby reversing the
effects of histamine on capillaries, reducing allergic reaction symptoms. The H1 receptor is similar to
muscarinic receptors.
ADVERSE EFFECT: Common side effects include feeling sleepy, dizzy or unsteady on your feet. You
may also have difficulty concentrating and have a dry mouth. You can become dependent on
diphenhydramine if you take it continuously for a period of time. It may also stop working as well.
CONTRAINDICATION: Patients with impaired renal or hepatic function should use antihistamines
with caution. Hypertension, cardiovascular disease, urinary retention, increased ocular pressure are
relative contraindications to the use of antihistamines.
DRUG TO DRUG INTERACTION: Taking Benadryl along with other antihistamines can increase the
risk of side effects. This includes drugs like meclizine (Antivert), loratadine (Claritin), cetirizine
(Zyrtec), hydroxyzine (Vistaril), and promethazine (Promethegan).
Report a sustained or symptomatic decrease in blood pressure (hypotension) or other cardiac symptoms
(palpitations).
Monitor respiratory function at rest and during exercise.
.METOCLOPRAMIDE
INDICATIONS: relieves symptoms such as nausea, vomiting, heartburn, a feeling of fullness after
meals, and loss of appetite. Metoclopramide is also used to treat heartburn for patients with
gastroesophageal reflux disease (GERD). GERD is esophageal irritation from the backward flow of
gastric acid into the esophagus.
MECHANISM OF ACTION: inhibiting dopamine D2 and serotonin 5-HT3 receptors in the
chemoreceptor trigger zone (CTZ) located in the area postrema of the brain.
ADVERSE EFFECT: Feeling sleepy and a lack of energy. Do not drive, cycle or use tools or
machinery, Low mood. This should pass after a couple of days but if it does not, speak to your doctor as
you may need a different type of anti-sickness medicine, Feeling dizzy or faint (low blood pressure),
Diarrhea.
CONTRAINDICATION: contraindicated in patients with the following: Known hypersensitivity to

metoclopramide or excipients Gastrointestinal bleeding.
DRUG TO DRUG INTERACTION: Taking metoclopramide with certain medications raises your risk
of side effects from metoclopramide. Examples of these drugs include: Sedatives, hypnotics, narcotics,
antihistamines, and tranquilizers.
Assess for extrapyramidal symptoms and tardive dyskinesia (more likely in older patients).
- Assess for gastrointestinal complaints, such as nausea, vomiting and constipation.
- In oral administration, for better absorption allow 30
GASTROINTESTINAL
AGENTS
MAGNESIUM HYDROXIDE
INDICATIONS: reduces stomach acid, and increases water in the intestines which may induce bowel
movements. Magnesium hydroxide is used as a laxative to relieve occasional constipation. Magnesium
hydroxide is also used as an antacid to relieve indigestion, sour stomach, and heartburn.
MECHANISM OF ACTION: works by increasing the osmotic effect in the intestinal tract and drawing
water in
ADVERSE EFFECT: Nausea, vomiting. Stomach pain or blockage. An unusual or allergic reaction to
magnesium hydroxide, other medications, foods, dyes, or preservatives.
CONTRAINDICATION: Renal failure, Existing electrolyte imbalance, Appendicitis symptoms or
acute surgical abdomen, Myocardial damage or heart block, Fecal impaction or rectal fissures, Intestinal
obstruction or perforation, Undiagnosed abdominal pain, Effects of Drug Abuse
DRUG TO DRUG INTERACTION: can decrease the absorption of other drugs such as atazanavir,
gabapentin, digoxin, mycophenolate, phosphate supplements (such as potassium phosphate),
tetracycline antibiotics (such as doxycycline, minocycline), certain azole antifungals (ketoconazole,
itraconazole), and quinolone
Monitor patient response to the drug.
Monitor for adverse effects (GI effects, imbalances in serum electrolytes, and acid-base status)
Monitor the effectiveness of comfort measures and compliance with the regimen.
ALUMINUM HYDROXIDE
INDICATIONS: relief of heartburn, sour stomach, and peptic ulcer pain and to promote the healing of
peptic ulcers.
MECHANISM OF ACTION: basic inorganic salt that acts by neutralizing hydrochloric acid in gastric
secretions. Aluminum hydroxide is slowly solubilized in the stomach and reacts with hydrochloric acid
to form aluminum chloride and water. It also inhibits the action of pepsin by increasing the pH and via
adsorption.
ADVERSE EFFECT: primary side effects of aluminum hydroxide include hypomagnesemia,
hypophosphatemia, constipation, and anemia.
CONTRAINDICATION: is contraindicated for patients with documented hypersensitivity to the drug.

Prolonged administration should not be considered in a patient with renal impairment or a patient on
dialysis, as impaired clearance of excess aluminum may precipitate the drug's adverse effects.
DRUG TO DRUG INTERACTION: product contains aluminum, which may react with other
medications (including digoxin, iron, tetracycline antibiotics, pazopanib, quinolone antibiotics such as
ciprofloxacin), preventing them from being fully absorbed by your body.
Monitor patient response to the drug (relief of GI symptoms caused by hyperacidity).

Monitor for adverse effects (GI effects, imbalances in serum electrolytes, and acid-base status).
Monitor the effectiveness of comfort measures and compliance with the regimen.
CALCIUM CARBONATE
INDICATIONS: used as a calcium supplement, also acts in the small intestine by chelating with oxalate
to prevent absorption and renal calculi formation. Lastly, calcium carbonate also works in the blood to
treat or prevent negative calcium balance seen in low serum calcium conditions.
MECHANISM OF ACTION: It is a basic compound that acts by neutralizing hydrochloric acid in

gastric secretions. Subsequent increases in pH may inhibit the action of pepsin. An increase in
bicarbonate ions and prostaglandins may also confer cytoprotective effects.
ADVERSE EFFECT: Tell your doctor right away if you have any serious side effects, including: loss
of appetite, nausea/vomiting, unusual weight loss, bone/muscle pain, mental/mood changes (such as
confusion), headache, increased thirst/urination, unusual weakness/tiredness, signs of kidney problems
(such as change in the amount of urine).
CONTRAINDICATION: contraindicated in hypersensitivity, renal calculus, high urine calcium levels,

elevated serum calcium, low serum phosphate, achlorhydria, or suspected digoxin toxicity.
DRUG TO DRUG INTERACTION: decrease the absorption of other drugs. Some examples of affected
drugs include tetracycline antibiotics (such as doxycycline, minocycline), bisphosphonates (such as
alendronate), estramustine, iron, levothyroxine, pazopanib, strontium, quinolone antibiotics (such as
ciprofloxacin, levofloxacin)
Assess patients regularly for response to calcium carbonate therapy, monitor calcium levels, and
evaluate for adverse effects.
Communicate effectively with patients about the benefits, risks, and proper use of calcium carbonate.
LOPERAMIDE
INDICATIONS: treatment of various forms of diarrhea, including traveler's diarrhea, irritable bowel
syndrome associated with chronic diarrhea, acute nonspecific diarrhea in patients two years of age and
older, and is indicated for reducing ileostomy
MECHANISM OF ACTION: Loperamide binds to the opiate receptor in the gut wall. Consequently, it
inhibits the release of acetylcholine and prostaglandins, thereby reducing peristalsis, and increasing
intestinal transit time. Loperamide increases the tone of the anal sphincter, thereby reducing
incontinence and urgency.
ADVERSE EFFECT: bloating, blood in the stools, constipation, fever, loss of appetite, nausea or
vomiting, or stomach pain. This medicine may cause serious allergic reactions, including anaphylaxis,
which can be life-threatening and requires immediate medical attention.
CONTRAINDICATION: patients with a known hypersensitivity to loperamide; in patients with

abdominal pain in the absence of diarrhea; in infants below 24 months of age; as the primary therapy- in
patients with acute dysentery, which is characterized by blood in stools and high fever, in patients with
acute ulcerative
DRUG TO DRUG INTERACTION: pramlintide, recent/current antibiotic use, cholestyramine,

ritonavir, saquinavir. These drugs can increase the risk for serious side effects
 Monitor therapeutic effectiveness. Chronic diarrhea usually responds within 10 d. If
improvement does not occur within this time, it is unlikely that symptoms will be controlled by
further administration.
 Discontinue if there is no improvement after 48 h of therapy for acute diarrhea.
 Monitor fluid and electrolyte balance.
OMEPRAZOLE
INDICATIONS: used to manage and treat several conditions, including uncomplicated heartburn,
peptic ulcer disease, gastrointestinal reflux disease, Zollinger-Ellison syndrome, multiple endocrine
adenomas, systemic mastocytosis, erosive esophagitis, gastric ulcers, and helicobacter pylori
MECHANISM OF ACTION: is a proton pump inhibitor that inhibits secretion of gastric acid by
irreversibly blocking the enzyme system of hydrogen/potassium adenosine triphosphatase, the “proton
pump” of the gastric parietal cell.
ADVERSE EFFECT: Headaches, Feeling sick (nausea), Being sick (vomiting) or diarrhoea, Stomach
pain, Constipation, Farting (flatulence).
CONTRAINDICATION: contraindicated in patients with a history of hypersensitivity to the drug or

any excipients from the dosage form. Hypersensitivity reactions like anaphylactic shock, angioedema,
interstitial nephritis, anaphylaxis, urticaria, and bronchospasm may occur
DRUG TO DRUG INTERACTION: heart medicines, such as digoxin. cilostazol, a medicine that
treats peripheral arterial disease (PAD)
- Monitor improvements in GI symptoms (gastritis, heartburn, and so forth) to help determine if

drug therapy is successful.
-Monitor other CNS side effects (drowsiness, fatigue, weakness, headache), and report severe or
prolonged effects
LANSOPRAZOLE
INDICATIONS: used for indigestion, heartburn, acid reflux and gastroesophageal-reflux-disease

(GORD). Lansoprazole is also taken to prevent and treat stomach ulcers. Sometimes, lansoprazole is
taken for a rare condition caused by a tumour in the pancreas or gut called Zollinger-Ellison syndrome.
MECHANISM OF ACTION: to selectively inhibit the membrane enzyme H+/K+ ATPase in gastric
parietal cells.
ADVERSE EFFECT: headache, diarrhoea and stomach pain.

CONTRAINDICATION: patients with known severe hypersensitivity to any component of the
formulation of PREVACID. Hypersensitivity reactions may include anaphylaxis, anaphylactic shock,
angioedema, bronchospasm, acute interstitial nephritis, and urticaria
DRUG TO DRUG INTERACTION: Lansoprazole decreases stomach acid so it may change with
these products ampicillin, atazanavir, erlotinib, levoketoconazole, nelfinavir, pazopanib, rilpivirine,
sparsentan, certain azole antifungals (itraconazole, ketoconazole, posaconazole), among others.
Monitor improvements in GI symptoms (gastritis, heartburn, and so forth) to help determine if drug
therapy is successful.
Assess dizziness that might affect gait, balance, and other functional activities
Report balance problems and functional limitations to the physician, and caution the patient and
family/caregivers to guard against falls and trauma.
PANTOPRAZOLE
INDICATIONS: used to treat damage from gastroesophageal reflux disease (GERD), a condition in
which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus
(the tube between the throat and stomach) in adults and children 5 years of age and older.
MECHANISM OF ACTION: proton pump inhibitor (PPI) that binds irreversibly and specifically to
the proton pump, thereby reducing gastric acid secretion. Pantoprazole has a relatively long duration of
action compared with other PPIs, and a lower propensity to become activated in slightly acidic body
compartments.
ADVERSE EFFECT: stomach cramps, bloated feeling, watery and severe diarrhea which may also be
bloody sometimes, fever, nausea or vomiting, or unusual tiredness or weakness.
CONTRAINDICATION: patients with a history of hypersensitivity to the drug itself, components of

the formulation, and/or other benzimidazole PPIs, including omeprazole, lansoprazole, rabeprazole,
esomeprazole, or dexlansoprazole.
DRUG TO DRUG INTERACTION: ampicillin, atazanavir, erlotinib, levoketoconazole, nelfinavir,

pazopanib, rilpivirine, sparsentan, certain azole antifungals (itraconazole, ketoconazole, posaconazole),
among others.
Assess the patient's medical history.

Monitor for side effects.
Assess for signs of gastrointestinal bleeding.
RANITIDINE
INDICATIONS: treatment and prevention of ulcers of the stomach and intestines and treatment of
gastroesophageal reflux disease.
MECHANISM OF ACTION: reduces the secretion of gastric acid by reversible binding to histamine
(H2) receptors
ADVERSE EFFECT: stomach pain, loss of appetite, dark urine, jaundice (yellowing of the skin or
eyes), fever, chills, cough with mucus, chest pain, feeling short of breath, fast or slow heart rate, easy
bruising or bleeding, problems with your skin or hair.
CONTRAINDICATION: patients known to have hypersensitivity to the drug or any of the
ingredients. Acute porphyria, Treatment with ranitidine may mask the symptoms of other gastric disease,
Raised liver enzymes may occur with high doses.
DRUG TO DRUG INTERACTION: atazanavir, dasatinib, certain azole antifungals (such as

itraconazole, ketoconazole), levoketoconazole, pazopanib, sparsentan
 Assess patient abdominal pain
 Monitor for vomiting of the patient

BISACODYL
INDICATIONS: used to treat constipation. It may also be used to clean out the intestines before a
bowel examination/surgery. Bisacodyl is known as a stimulant laxative. It works by increasing the
movement of the intestines, helping the stool to come out.
MECHANISM OF ACTION: works by stimulating enteric neurons to cause peristalsis, i.e., colonic
contractions.
ADVERSE EFFECT: feeling sick (nausea), diarrhoea, stomach pain or cramps. Only give bisacodyl to
children and young people if a doctor or pharmacist recommends it. Do not take bisacodyl tablets or use
bisacodyl suppositories every day for more than 5 days.
CONTRAINDICATION: Hypersensitivity, Obstruction or severe impaction, Symptoms of
appendicitis or acute surgical abdomen, Vomiting, Rectal bleeding
DRUG TO DRUG INTERACTION: Bisacodyl tablets may reduce the effectiveness of other
medications. There may be an interaction between bisacodyl and any of the following: antacids (e.g.,
aluminum hydroxide, calcium carbonate, magnesium hydroxide) corticosteroids (e.g., dexamethasone,
hydrocortisone, prednisone)
Evaluate periodically patient’s need for continued use of drug; bisacodyl usually produces 1 or 2 soft
formed stools daily.
Monitor patients receiving concomitant anticoagulants. Indiscriminate use of laxatives results in

decreased absorption of vitamin K.
SODIUM BIPHOSPHATE
INDICATIONS: to treat constipation and to clean the bowel before colon surgery, x-rays, or
endoscopy examinations.
MECHANISM OF ACTION: produces osmotic effect primarily in small intestine by drawing water
into the intestinal lumen.
ADVERSE EFFECT: Bloating, nausea,vomiting or stomach pain.
CONTRAINDICATION: person with hypersensitivity

DRUG TO DRUG INTERACTION: Avoid taking other oral medicines within 2 hours before or after
you take sodium biphosphate and sodium phosphate. Avoid using other laxatives or enemas that contain
sodium phosphate
Serum calcium, vitamin D, and renal function require baseline monitoring before initiating
bisphosphonates.
Monitor patients with underlying cardiovascular disease, renal disease, bowel perforation, misuse or
overdose.
LACTULOSE
INDICATIONS: use as a laxative in the treatment of chronic constipation in adults and geriatric
patients.
MECHANISM OF ACTION: metabolized in the colon by colonic bacteria to monosaccharides, and

then to volatile fatty acids, hydrogen, and methane.
ADVERSE EFFECT: Diarrhoea, Bloating, Wind (farting and burping), Feeling sick (nausea), Being
sick (vomiting), Stomach pain
CONTRAINDICATION: Contraindicated in patients who require a low galactose diet viz.
Galactosemia, and in gastrointestinal obstruction.
DRUG TO DRUG INTERACTION: There are no known problems mixing lactulose with other
medicines or herbal remedies.
Explain purpose of lactulose to patient.
Instruct patient to take lactulose as directed. Encourage patients to use other forms of bowel regulation,
such as increasing bulk in the diet, increasing fluid intake, and increasing mobility. Normal bowel habits
are individualized and may vary from 3 times/day to 3 times/wk.
ESOMEPRAZOLE
INDICATIONS: used to treat conditions where there is too much acid in the stomach.
MECHANISM OF ACTION: proton pump inhibitor that suppresses gastric acid secretion by specific
inhibition of H+/K+-ATPase in the gastric parietal cell.
ADVERSE EFFECT: Feeling sick, Being sick, Diarrhoea, Constipation, Stomach pain, Farting
(flatulence)
CONTRAINDICATION: patients with known hypersensitivity to substituted benzimidazoles or to any

component of the formulation.
DRUG TO DRUG INTERACTION: heart medicines such as digoxin, cilostazol, a medicine that treats
peripheral arterial disease, antifungal medicines such as itraconazole, ketoconazole, posaconazole or
voriconazole, methotrexate, a medicine that treats psoriasis and rheumatoid arthritis, HIV medicines.
NURSING RESPONSIBILITIES: Monitor improvements in GI symptoms (gastritis, heartburn, and so

forth) to help determine if drug therapy is successful.
HnBB
INDICATIONS: used for abdominal pain and spasms in organs
MECHANISM OF ACTION: binds to muscarinic receptors, blocking them (thanks to its nitrogen
atom), and thereby rendering them inaccessible to ACh
ADVERSE EFFECT: tachycardia, hypotension, and anaphylaxis.
CONTRAINDICATION: patients with myasthenia gravis, megacolon, glaucoma and in patients with
known hypersensitivity to hyoscine butylbromide.
DRUG TO DRUG INTERACTION: codeine, medicines for allergies such as antihistamines,

medicines for depression, such as amitriptyline, medicines for mental health problems like
schizophrenia or bipolar disorder, such as clozapine or chlorpromazine, amantadine (taken for
Parkinson's disease)
Drug compatibility should be monitored closely in patients requiring adjunctive therapy
Avoid driving & operating machinery after parenteral administration.
Avoid strict heat

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ADRENOCORTICAL

INDICATIONS: It is used for its anti-inflammatory and immunosuppressive

MECHANISM OF ACTION: Glucocorticoids inhibit neutrophil apoptosis and

DRUG TO DRUG INTERACTION: Drug-drug Risk of severe deterioration of muscle strength in

• Nurses should educate patients about proper application techniques

• Monitor for signs of adverse effects

• Assess the patient’s overall response to treatment.

MECHANISM OF ACTION: As a corticosteroid, dexamethasone works by suppressing inflammation

CONTRAINDICATION: Contraindicated in patients with systemic fungal infections and known

•Monitor vital signs, blood glucose levels, and signs of infection.

•Monitoring for and managing complications related to long-term use is important.

(eczema, dermatitis), allergic reactions, and certain autoimmune diseases.

MECHANISM OF ACTION: As a corticosteroid, hydrocortisone acts to suppress inflammation and

responses by inhibiting the release of inflammatory mediators

CONTRAINDICATION: Contraindicated with infections, especially tuberculosis, fungal infections,

• Monitor for signs of adverse effects

• Educate patients on proper application techniques

• Assess the patient’s response to treatment

MECHANISM OF ACTION: It decreases inflammation via suppression of the migration of

CONTRAINDICATION: Contraindicated in patients with systemic fungal infections and know

• Monitor vital signs, blood glucose levels, and signs of infection

•Monitoring for and managing complications related to long-term use

CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to acetazolamide,

•Educating patients on the importance of adequate fluid intake

•Monitor signs of adverse effects

MECHANISM OF ACTION: Similar to acetazolamide, methazolamide inhibits carbonic anhydrase,

CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to methazolamide

• Patient education including information on proper administration

•Monitor signs of adverse effects, and the importance of regular follow-up

CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to furosemide,

 Check blood pressure regularly while taking this medication

 Give twice a day

 Give 4 hours before bed time to avoid getting up to urinate.

CONTRAINDICATIONS: There are multiple contraindications to giving mannitol, including: Established

 Monitor signs of fluid, electrolyte, or acid-base imbalances, including dizziness, clumsiness,

CONTRAINDICATIONS: Hydrochlorothiazide is contraindicated in cases of anuria or preexisting sulfonamide

 Take this drug in the morning, not the evening.

 This drug may make you urinate more.

 You can crush hydrochlorothiazide tablets.

Adverse Effect: Potential adverse effects include hypotension, tachycardia, headache.

 Require monitoring during fenoldopam infusion.

 administration is via a continuous intravenous (IV) infusion using an infusion pump.

CONTRAINDICATION: Contraindicated in patients with a history of angioedema related to previous ACE

• Monitor blood pressure, renal function, and potassium levels regularly

INDICATIONS: It is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension heart

CONTRAINDICATION: Contraindicated in patients with a history of angioedema related to previous ACE

• Monitor blood pressure, renal function, and potassium levels regularly

• Monitor signs of complications like angioedema

MECHANISM OF ACTION: As a corticosteroid, methylprednisolone works by suppressing inflammation and

• Monitor patient response to therapy through blood pressure monitoring.

CONTRAINDICATION: Contraindicated in patients with hypersensitivity to irbesartan, a history of

•Monitor blood pressure, renal function, and potassium levels regularly

•Monitor signs of complications

MECHANISM OF ACTION: Candesartan blocks the vasoconstrictor and aldosterone-secreting effects of

CONTRAINDICATION: The only major contraindication to candesartan is hypersensitivity to the medication

 Start on a low dose of candesartan.

CONTRAINDICATION: Contraindicated in patients with a known hypersensitivity to clonidine or conditions

MECHANISM OF ACTION: Alpha-methyldopa is converted to methyl norepinephrine centrally to decrease the

 Monitor patient response to therapy through blood pressure monitoring.

CONTRAINDICATION: Contraindicated in patients with hypersensitivity to nitroglycerin or nitrates. Use

•Monitor blood pressure

•Assess for side effects

MECHANISM OF ACTION: Isosorbide mononitrate is an organic nitrate with vasodilating properties. It is an

NURSING RESPONSIBILITIES: Monitor……