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DRUG ANALYSIS Jennica Celine S.

Ponce II-8 RLE 2 Patient s Name: Remedios Castillo Room: 209B CC: dyspnea Medical Dx: ASHD CAD NSTEMI Class IV-D, DM Type 2 right foot, HPN Stage 2

GENERIC NAME TRIMETAZIDINE

BRAND NAMES Vastarel MR, Vastarel LM, Vastarel LP, Flavedon MR, Vestar

CLASSIFICATION Anti-ischemic / Anti-anginal

INDICATION - Ischemic heart disease (angina pectoris, sequelae of infarction - Adjuvant symptomatic treatment of vertigo and tinnitus - Adjuvant treatment of decreased visual acuity *taken because patient is a known case of ASHD CAD NSTEMI Class IV-D to prevent any anginal/ stroke attacks

CONTRAINDICATION Hypersensitivity to Trimetazidine, pregnancy

MODE OF ACTION Improves myocardial glucose utilization through inhibition of fatty acid metabolism

SIDE EFFECTS GI discomfort, nausea, vomiting, headache, vertigo

ADVERSE EFFECTS Parkinsonism, gait disorders, tremors, visual hallucinations

NURSING RESPONSIBILITIES - Assess location, duration and intensity of anginal pain - Monitor BP and PR before and after administering the drug - Notify prescribing signs of heart failure such as swelling of the hands and feet or shortness of breath - Instruct to avoid strenuous or hazardous activities requiring alertness to prevent risks of falls and injury

ATORVASTATIN

Lipitor, Xarator

Antihyperlipide mic/ HMG CoA reductase inhibitor

Hypercholesterolem ia, Type III hyperlipoproteinem ia, elevated serum triglycerides *taken by patient to reduce her cholesterol and lipoprotein levels which contributes to increased

Pregnancy (category X), hypersensitivity, active liver disease, breastfeeding or of childbearing potential who do not use adequate contraceptive measures

Selectively inhibits HMGCoA reductase, which converts HMG-CoA to mevalonate, a precursor of sterols; lowers cholesterol

Headache, myalgia, athralgia, nausea, abdominal cramps, flatulence

Rhabdomyolysis with acute renal failure; liver failure

- Obtain LFT s as baseline; discontinue if AST or ALT levels increase to 3x than normal - Ensure patient has tried cholesterollowering diet regimen for 3-6 months before beginning therapy - Administer without

deposits and accumulation of both in the blood vessel walls thereby reducing severity of ASHD condition.

and lipoprotein levels

regard to food, but at same time each day, preferably in the evening. Do not take with grapefruit juice - Do not combine with other HMGCoA reductase inhibitors or fibrates Increased volume and frequency of urination, dizziness, confusion, drowsiness, increased thirst Gynecomastia, agranulocytosis, postmenopausal bleeding, hyperkalemia, hyponatremia - Give daily doses early so that increased urination does not interfere with sleep - Measure and record regular weight to monitor mobilization of edema fluid - Avoid giving food rich in potassium - Arrange for regular evaluation of serum electrolytes and BUN

SPIRINOLACTONE

Aldactone, Novospiroto n

Aldosterone antagonist / Potassiumsparing diuretic

Short-term preop treatment of primary hyperaldosteronism , long-term maintenance for idiopathic hyperaldosteronism ; essential HPN, edematous CHF, hypokalemia, liver cirrhosis and nephritic syndrome *patient is on IC and bladder training; taken to prevent any urinary retention and accumulation of fluid which may lead to bladder distention; also to increase excretion of sodium and water to prevent edema

Pregnancy (category D), acute renal insufficiency, anuria, hyperkalemia

antagonizes aldosterone in the distal tubules, increasing sodium and water excretion

ESOMEPRAZOLE

Nexium, Nexium IV

Antisecretory / Proton pump inhibitor

Erosive reflux esophagitis. Prevents relapse of healse esophagitis, symptomatic treatment of gastroesophageal reflux disease (GERD). Helicobacter pylori associated ulcer disease *patient is on NGT and is not allowed to take any other food except for scheduled meals; taken to prevent occurrences of gastric acidity which may lead to GI discomfort and increased gastric acid secretion that may lead to gastric acid reflux (heart burns)

Known hypersensitivity to esomeprazole, substituted benzimidazoles or any other constituents of the formulation; children

Inhibits the H-K-ATPase pump (proton pump) in gastric parietal cells effectively blocking the final step in acid production, thereby reducing gastric acidity

Dizziness, headache, nausea, vomiting, diarrhea, symptoms of URTI, cough

Asthenia, dream abnormalities, insomnia, inflammation, alopecia, epistaxis

- If administering antacid, they may be administered concominantly with esomeprazole - Administer IV for maximum of 10 days; switch to oral form as soon as possible - Instruct not to crush or chew oral forms - Obtain baseline liver function tests and monitor periodically during therapy - Maintain supportive treatment - Comfort measures - Safety precautions (side rails)

ISOSORBIDE MONONITRATE (ISMN)

Angistad, Angistad SR, Elantad, Elantad Long, Imdur Durules, Isomonit, Monosorb, Schwarz ISMN 60

Antianginal / Nitrate / Vasodilator

Preventive and long-term treatment of angina pectoris/ post myocardial infarction angina; severe CHF; pulmonary HPN *patient has ASHD which blocks the flow of blood to her body due to accumulation of deposits in the vessel wall; taken to

Allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, narrow-angle glaucoma, orthostatic hypotension

Increases supply of oxygen to the heart by dilating both the arteries and veins which supply the heart itself

Dizziness, lightheadedness, headache, flushing of the neck or face

Syncope, blurred vision, persistent or severe headache, rash, more persistent or more severe angina attacks, fainting

- Discourage swallowing in sublingual administration - Create a nitrate-free period to minimize tolerance - Give oral preparations on an empty stomach, 1 hr before or 2 hrs after meals; take with meals if severe uncontrollable headache occurs - Keep life support

dilate the blood vessels and increase oxygen supply

equipment readily available if overdose occurs - Gradually reduce dose if angina treatment is being terminated to prevent withdrawal Hypersensitivity, acute intoxication with alcohol, hynotics, centrally acting analgesics, opioids or psychotropic agents Centrally acting analegesic not chemically related to opioids but binds to muopioid receptors and inhibits reuptake of norepinephri ne and serotonin Dizziness, sedation, drowsiness, impaired visual acuity, nausea, loss of appetite Seizures, anaphylactoid reactions, - Control environment (lighting, temperature) if sweating or CNS effects occur - Limit use in patients with past or present history of addiction to or dependence on opioids - Avoid alcohol - Instruct patient to change positions slowly to prevent orthostatic hypotension - Instruct to refrain from performing activities that require alertness - Instruct to avoid driving or other hazardous activities until stabilized on medication - Avoid alcohol and other CNS depressants so as not to enhance sedative effect of the drug - Avoid smoking / smoke-filled

TRAMADOL

Dolotral, Euro-Med Tramadol HCl, Gesidol, Milador, Peptrad, Siverol, TDL, Tradonal, Tramal

Analgesic (centrally-acting) / Opioid analgesic

Moderate to severe pain

ERDOSTEINE

Erdotin, Dostin, Mucotec

Mucolytic

Acute and chronic respiratory disease; acute exacerbations of chronic bronchitis; productive cough *patient has productive cough with clear, watery sputum; taken to liquefy and aid in expectoration of

Active peptic ulcer

contains two sulfhydryl groups, which are freed after metabolic transformatio n in the liver. The liberated sulfhydryl groups break the disulphide

Nausea, vomiting, headache, loose stools

Epigastralgia, spasmodic colitis

sputum

bonds, which hold the glycoprotein fibers of mucus together making the bronchial secretions more fluid and enhances elimination hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment Inhibits cell wall synthesis during bacterial multiplication Agitation, constipation, diarrhea, dizziness, headache, indigestion, nausea, pain, swelling, or redness at the injection site, sleeplessness , vomiting Phlebitis, thrombophlebiti s, edema, syncope, cardiac failure, mycordial infarction, convulsions, ulcerative stomatitis, tinnitus, pseudomembra nous colitis, photophobia, symptomatic hypoglycemia

environment

PIPTAZO (PIPERACILLINTAZOBACTAM)

Zosyn, Tazocin

Antibacterials (beta-lactamase inhibitors)

Moderate to severe nosocomial pneumonia; for beta-lactamase producing strains in appendicitis or peritonitis; complicated and uncomplicated UTI; ischemia / diabetic foot infection *patient is a known case of DM Type 2 on right foot; taken to decrease risk of infection on the affected foot. (there is elevated neutrophil and WBC levels = 0.92 mg/dl and 13.30 mg/dl respectively Feb. 16, 2010)

- Ask patient if there is penicillin allergy - Monitor hematologic and coagulative parameters - Monitor sodium intake because drug contains 2.35 mEq sodium/g of piperacillin - Instruct to report adverse reactions promptly - Instruct to notify nurse about IV site discomfort

PARACETAMOL

Aldep, Alvedon, Biogesic, Calpol, Dolexpel, Medgenol, Naprex, Tempra, Tylenol

Analgesic

Relief of mild to moderate pain; treatment of fever *patient sometimes experiences febrile episodes and is taken to reduce fever (last Wednesday, Feb. 17, 2010 at around 11:30am, Temp = 37.8 C)

Hypersensitivity; intolerance to tartrazine (yellow dye #5), alcohol, table sugar, saccharin

Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation. Relieves pain by inhibiting prostaglandin synthesis at the CNS

Stimulation, drowsiness, nausea, vomiting, abdominal pain

Hepatotoxicity, hepatic seizures, renal failure, leukopenia, neutropenia, hemolytic anemia, delirium followed by vascular collapse, convulsions, coma, death

- Monitor liver and renal functions - Check input and output ratio - Advise patient to avoid taking more than one product containing paracetamol at one time to avoid toxicity - Avoid alcohol to prevent acute poisoning with liver damage - Inform patient that urine may become dark brown as a result of phenacetin (metabolite of paracetamol) - Teach patient to recognize signs of chronic overdose ( bleeding, bruising, malaise, fever, sore throat) - Monitor fasting blood glucose 2 hrs after meals and glycosylated Hgb - Monitor body weight periodically - Assess for hypoglycemic reaction that may occur during peak time - Observe injection sites for signs and symptoms of local hypersensitivity such as redness,

INSULIN

Humalin N & Humalin R

Anti-diabetic

Management of type 1 DM or insulin-dependent DM (IDDM) and type 2 DM or noninsulin-dependent DM (NIDDM) which cannot be controlled by diet, exercise and weight reduction alone *patient is a DM Type 2 case and takes insulin to regulate/ decrease

Hypoglycemia, insulinoma, hypersensitivity reactions, IV administration of insulin suspension, diabetic coma

Decreases blood glucose; by transport of glucose into cells and the conversion of glucose to glycogen indirectly increases blood pyruvate and lactate, decreases phosphate

Redness, swelling, itching, or mild pain at the injection site.

Lipodystrophy, insulin resistance, severe allergic reactions, hypoglycemia, visual impairment, edema and refraction anomalies

blood glucose during elevated levels

and potassium

itching or burning - If via SQ route, give after warming to room temperature by rotating palms to prevent injecting cold insulin - Advice patient to avoid vigorous exercise immediately after injection to prevent risk of high glucose level - Instruct not to smoke within 30 mins because it decreases insulin absorption - Avoid alcohol because it lowers glucose level Nausea, vomiting, headache, palpitations Irregular heartbeat, shortness of breath, swelling of hands and feet, pronounced dizziness, constipation - Monitor patient s BP, cardiac rhythm and output carefully; may develop increased frequency, duration or severity of angina in acute MI after initiation of therapy - Administer drug without regard to meals; take with meals if GI upset occurs - Advice patient to avoid hazardous activities until stabilized on drug and dizziness is no longer a problem - Instruct to comply

AMLODIPINE

Amcal, Amvasc, Lopicard, Norvasc, Pharex Amlodipine besylate, Vasalat

Antihypertensive/ Antianginal / Calcium channel blocker

HPN; chronic stable angina; vasospastic (Prinzmetal or variant) angina *patient is known case of HPN Stage 2 and takes this drug to decrease BP to at least 120/80 (usual high BP is 160/80); also taken as maintenance

Sick sinus syndrome; second- or thirddegree atrioventricular block, except with a functioning pacemaker

Inhibits influx of calcium ion across cell membranes to produce relaxation of coronary vascular smooth muscle, decrease peripheral vascular resistance of smooth muscle and increases myocardial oxygen delivery in

patients with vasospastic angina

with the drug regimen - Do not withdraw abruptly; may case frequency and duration of chest pain; taper dose gradually