Pharma Drug Study

Mindanao State University – Iligan Institute of Technology
PHARMACOLOGY
DRUG STUDY
Brand Name: Lanoxin Generic Name: Digoxin Drug Classification: Cardiac Glycosides
Dosage, Route & Frequency Drug-Drug & Drug-Food Side Effects Adverse Reactions
Drug Action Indications Contraindications
Recommended Prescribed Interactions (By System) (By System)
Digitalizing Dose HF: Inhibits DRUG:  Rapid  Hypersensitivity to CNS: CNS:
Adult: sodium/potassium ATPase Amiodarone may  digitalization and Digoxin  Dizziness  Fatigue
PO 10–15 mcg/kg (1 pump in myocardial cells. concentration/toxicity. maintenance  Ventricular  Headache  Muscle
mg) in divided doses Promotes calcium influx. Beta blockers (e.g., therapy in CHF Fibrillation GI: Weakness
over 24–48 h Supraventricular metoprolol), calcium channel  Atrial Fibrillation Patients with:  Diarrhea  Headache
IV 10–15 mcg/kg (1 Arrhythmias: Suppresses blockers (e.g., diltiazem) may  Atrial Flutter  Renal Impairment Skin:  Facial Neuralgia
mg) in divided doses AV node conduction. have additive effect on (slows  Sinus Nodal  Rash  Mental
over 24 h slowing AV nodal conduction. Ventricular Rate) Disease EENT: Depression
Child: Therapeutic Effect: HF:  Potassium-depleting diuretics  Paroxysmal  Acute MI (within  Visual  Paresthesias
PO/IV <2 y, 40–60 contractility. (e.g., furosemide) may  Atrial 6mos) disturbances  Hallucinations
mcg/kg; 2–10 y, 20– Supraventricular toxicity due to hypokalemia. Tachycardia  Second- or Third-  Confusion
40 mcg/kg; >10 y, Arrhythmias:  effective Sympathomimetics (e.g., degree Heart  Drowsiness
10–15 mcg/kg (1.5–2 refractory period/decreases norepinephrine) may  risk of Block (unless  Agitation
mg) conduction velocity, arrhythmias. functioning
Neonate: decreases heart rate.  Dizziness
HERBAL: pacemaker)
PO/IV 30–50 mcg/kg CV:
Ephedra may  risk of  Concurrent use of
Premature neonate: Pharmacokinetics  Arrhythmias
arrhythmias. Licorice may strong Inducers or
PO/IV 20 mcg/kg A: 60–80% absorbed after  Hypotension
cause sodium and water Inhibitors of P-
oral administration of tablets;  AV block
retention, loss of potassium. Glycoprotein (e.g.,
Maintenance Dose 70–85% absorbed after EENT:
FOOD: Cyclosporine)
Adult: administration of elixir; 80%  Visual
Meals with  fiber (bran) or  Hyperthyroidism
PO/IV 0.1–0.375 absorbed from IM sites (IM disturbances
high in pectin may   Hypothyroidism
mg/d route not recommended due GI:
Child: to pain/irritation).
absorption.  Hypokalemia  Anorexia
LAB VALUES: None known.  Hypocalcemia
PO/IV <2 y, 7.5–9 D: Widely distributed;
Administer digoxin 1hr before  Nausea
mcg/kg/d; 2–10 y, 6– crosses placenta and enters
or 2hrs after such a meal.  Vomiting
7.5 mcg/kg/d; >10 y, breast milk.  Diarrhea
0.125–0.25 mg/d M & E: Excreted almost  Dysphagia
Neonate: 6–7.5 entirely unchanged by the
mcg/kg/d kidneys. Other:
Premature neonate: Half-life: 36–48 hr ( in renal  Diaphoresis
3.75 mcg/kg/d impairment)  Recurrent
Malaise
Responsibilities in the Nursing Process (ADPIE) Responsibilities in the Nursing Process (ADPIE)
Assessment  Do not change medication from capsules to tablets/elixir because capsules has a
 Monitor the pt’s apical pulse (1 full min.), note the rate, the rhythm and the quality before greater bioavailability than tablets/elixir.
administering the drug. Discontinue medication and report to the pt’s physician when apical  IM: Administer deep into gluteal muscle and massage after administration to reduce
pulse decreases (<50 or 60/min in adults and <60 or 70/min in children). pain and discomfort. Do not administer more than 2 mL of digoxin in each IM site. IM
 Obtain the pt's baseline data (quality of peripheral pulses, BP, clinical symptoms, serum is not generally recommended.
electrolytes, creatinine clearance) to have basis for making assessments. IV Administration:
 Monitor for signs and symptoms of drug toxicity: cardiac arrhythmias are reliable signs of early  Direct IV: Diluent: May be administered undiluted. May also dilute 1 mL of digoxin
toxicity in children and in adults, which are rarely initial signs in children, are anorexia, nausea, in 4 mL of sterile water for injection, D5W, or 0.9% NaCl. Less diluent will cause
vomiting, diarrhea, and visual disturbances. precipitation. Use diluted solution immediately. Rate: Administer over at least 5 min.
 Monitor the pts intake and output ratio during digitalization, particularly in pts with impaired Patient/Family Teaching:
renal function. Also monitor for edema daily and auscultate chest for rales.  Always do a follow-up visit to monitor results of blood tests.
Potential Nursing Diagnoses:  Monitor pt’s apical pulse and report pulse to physician if 60 or less/min.
 Decreased cardiac output (Indications)  Administer doses ordered by physician at exact time/schedule for administration, but
Implementation: also assess pt first before administration.
 Lanoxin is not similar or the same with levothyroxine or naloxone.  Tell the pt/SO to consult first the physician before taking OTC medications.
 High Alert: Digoxin has a narrow therapeutic range. Medication errors associated with digoxin Evaluation/Desired Outcomes:
include miscalculation of pediatric doses and insufficient monitoring of digoxin levels. Have  Decrease in severity of HF.
second practitioner independently check original order and dose calculations. Monitor  Increase in cardiac output.
therapeutic drug levels.  Decrease in ventricular response in atrial tachyarrhythmias.
 PO: Administer oral preparations consistently with regard to meals. If pt has difficulty  Termination of paroxysmal atrial tachycardia.
swallowing, crush tablets and administer with food or fluid. Use a calibrated measuring device
for liquid preparations. Do not use calibrated dropper because this is not accurate for doses of
less than 0.2 mL or 10 mcg.
Sources:
 Wilson, Shannon, & Shang (2007). Prentice Hall Nurse’s Drug Guide. Digoxin. Retrieved from
http://www.robholland.com/Nursing/Drug_Guide/data/monographs/monoframe.html?vfile=D045.html
 Kizior, R., & Hodgson, K. (2019). Saunders Nursing Drug Handbook 2019 PDF.
 Vallerand, A., Sanoski, C., & Deglin, J. (2015). Davis’s Drug Guide for Nurses Fourth Edition PDF.
PHARMACOLOGY
DRUG STUDY
Brand Name: Natrecor Generic Name: Nesiritide Drug Classification: Atrial Natriuretic Peptide Hormone
Dosage, Route & Frequency Drug-Drug & Drug- Side Effects Adverse Reactions (By
Recommended Prescribed Food Interactions (By System) System)
Acute Binds to guanyl DRUG: None Acute treatment of  Hypersensitivity CNS: CNS:
Decompensated cyclase receptors in reported. decompensated  Cardiogenic Shock  Headache  Anxiety
CHF vascular smooth CHF in pts who  Systolic BP <100 mm Hg  Dizziness  Confusion
Adult: muscle and endothelial have dyspnea at  Low cardiac filling  Numbness  Dizziness
IV 2 mcg/kg bolus cells, producing  rest or with minimal Pressure  Tremors  Headache
administered over intracellular guanosine activity.  Significant Valvular CV:  Hypotension
60s, followed by a 3’5’-cyclic Stenosis  Hypotension  Insomnia
continuous infusion of monophosphate  Restrictive/Sub-tractive GI:  Drowsiness
0.01 mcg/kg/min (0.1 (cGMP) and smooth  Nausea/
Cardio-myopathy  Paresthesia
mL/kg/h) (max: 0.03 muscle cell relaxation. Constrictive Vomiting  Tremor
mcg/kg/min). Monitor cGMP acts as a Pericarditis/Cardiac MS: EENT:
blood pressure “second messenger” to  Back Pain
closely. If
Tamponade or other  Amblyopia
dilate veins and conditions which cardiac EENT:
hypotension occurs, Respiratory:
arteries. output is dependent on  Vision Changes
the dose should be  Apnea
venous return.  Cough
reduced or Therapeutic Effects: Patients with:
discontinued. The Dose-dependent  Hemoptysis
 HF where renal function CV:
infusion can reduction in pulmonary
is dependent on activity  Hypotension
subsequently be capillary wedge
of the RAAS (may cause
restarted at a dose pressure (PCWP) and  Arrhythmias
azotemia)
that is reduced by systemic arterial  Bradycardia
 Cardiogenic shock
30% (with no bolus pressure in patients  Ventricular Tachycardia
(should not be used as
administration) after with heart failure with
primary therapy)  Ventricular Extrasystoles
stabilization of resultant decrease in
OB, Lactation, Pedi:  Angina
hemodynamics. dyspnea.
 Pregnancy  Tachycardia
 Lactation  Atrial Fibrillation
Pharmacokinetics
 Children  AV Node Conduction
A: IV administration
(safety not established) Abnormalities
results in complete
Geri: May have  sensitivity GI:
bioavailability.
to effects.  Abdominal pain
D: Unknown.
M & E: Cleared from  Nausea/Vomiting
circulation by binding GU:
to cell surface   serum creatinine
clearance receptors  Renal failure
resulting in cellular Skin:
internalization and  Itching
proteolysis, proteolytic  Rash
breakdown by  Sweating
endopeptidases, and Hematologic:
renal filtration.  Anemia
Half-life: 18 min. Local:
Onset: 15 min.  Injection site reactions
Duration: >60 h MS:
depending on dose.  Back pain
 Leg cramps
Other:
 Allergic reactions
 Fever
Assessment: between administration of Nesiritide and other medications. Do not administer through a central
 Monitor the pt’s BP, PCWP, HR, and ECG throughout therapy. If systolic BP is heparin-coated catheter because it binds to heparin. Concomitant administration of a heparin
<90 mmHg report immediately to the physician. infusion through a separate catheter is acceptable.
 Obtain pt’s baseline assessment (hypotension parameters) before initiating the IV Administration:
therapy.  pH: 4.0–6.0.
 Reduce the dose or discontinue administration if hypotension occurs. Reinitiate  Direct IV: Diluent: Reconstitute 1.5mg vial by adding 5 mL of diluent removed from a pre-filled
therapy infusion only after HR is normalized. 250mL plastic IV bag containing D5W, 0.9% NaCl, D5/0.45% NaCl, or D5/0.2% NaCl. Do not shake;
Potential Nursing Diagnoses: rock gently so all surfaces including stopper are in contact with diluent to ensure complete
 Decreased cardiac output (Indications) reconstitution. Withdraw entire content of reconstituted vial and add back to 250mL plastic IV bag.
 Activity intolerance (Indications) Invert IV bag several times to ensure complete mixing of solution. Infusion stable for 24hrs. After
 Excess fluid volume (Indications) preparation of infusion bag, withdraw bolus volume from infusion bag. Calculation: bolus volume
Implementation: in mL 0.33 x pt weight in kg. Concentration: 6 mcg/mL. Rate: Administer bolus over 60 secs
 High Alert: IV vasoactive medications have an  potential for causing harm. through a port in the IV tubing.
Ask your partner or another nurse to independently check the original order, Patient/Family Teaching:
dose calculations, and infusion pump settings. Administer only in settings where  Explain the purpose of medication to pt/SO before administering.
BP can be closely monitored.  If signs and symptoms persist, report immediately to physician.
 Prime the IV tubing with an infusion of 25 mL prior to connecting to the patient’s Evaluation/Desired Outcomes:
vascular access port and prior to administering bolus or infusion. Flush catheter  Improvement in dyspnea and reduction in mean PCWP in patients with decompensated HF.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Nitrostat Generic Name: Nitroglycerin SL Drug Classification: Nitrates
Dosage, Route & Frequency Adverse

Drug-Drug & Drug-Food Side Effects
Drug Action Indications Contraindications Reactions (By
Recommended Prescribed Interactions (By System)
System)
Angina Dilates coronary DRUG:  Angina Pectoris  Hypersensitivity to CNS: CNS:
Adult: Sublingual 1– arteries, improves May  risk of Orthostatic  HF nitroglycerin  Headache  Dizziness
2 sprays (0.4–0.8 mg) collateral blood flow to Hypotension:  Acute MI  Allergy to adhesives  Dizziness  Headache
or a 0.3–0.6-mg ischemic areas within  Alcohol  Perioperative (transdermal)  Weakness  Apprehension
tablet q3–5min as myocardium. IV form  Other Antihypertensives Hypertension   ICP Skin:  Restlessness
needed (max: 3 produces peripheral (e.g., Amlodipine,  Induction of  Severe Anemia  Transient  Weakness
doses in 15 min) vasodilation. Lisinopril, Valsartan) Intraoperative  Concurrent Use Of flushing of EENT:
PO 1.3–9 mg q8–12h  Vasodilators Hypotension Sildenafil, Tadalafil, face/neck  Blurred Vision
IV Start with 5 Therapeutic Effect: Cause hypotension when Rectiv: Moderate to CV:
Vardenafil (PDE5 CV:
mcg/min and titrate Decreases myocardial  Orthostatic
concurrent use of: Severe pain inhibitors)  Hypotension
q3–5min until desired oxygen demand.
 Sildenafil associated with IV: Hypotension  Tachycardia
response Reduces left ventricular
 Tadalafil Chronic Anal  Restrictive Sublingual:  Syncope
Transdermal Apply preload, afterload.
 Vardenafil (PDE5 Fissure. Cardiomyopathy GI: GI:
once q24h or leave Unlabeled Use:  Pericardial Tamponade  Burning and
on for 10–12 h, then Pharmacokinetics A: inhibitors)  Abdominal
Readily absorbed after HERBAL: Short-term mgt for:  Constrictive Pericarditis tingling Pain
remove and have a o Pulmonary
oral administration. May  hypertension: Sublingual, Rectal: sensation at  Nausea/Vomiti
10–12 h nitrate free Hypertension
Absorption is slower but  Ephedra   Intracranial Pressure oral point of ng
interval o Esophageal dissolution
Topical Apply 1.5–5 more complete with  Ginger  Severe Anemia Skin:
macrocrystals  Ginseng Spastic disorders Pay more attention to pts with:  GI upset  Contact
cm (½–2 in) of o Uterine Ointment:
ointment q4–6h (Macrodantin).  Licorice  Blood Volume Depletion Dermatitis
Cause hypotension: Relaxation  Severe Hypotension Skin: Other:
Child: IV 0.25–0.5 D: Crosses placenta;
enters breast milk.  Black cohosh  Sympathomime (systolic B/P less than 90  Erythema  Alcohol
mcg/kg/min, titrate by
Protein-binding: 40%  Goldenseal
tic Vasopressor mm Hg)  Pruritus Intoxication
0.5–1 mcg/kg/min Extravasation
M & E: Partially  Hawthorne  Bradycardia (less than 50 Transdermal: (large IV doses
q3–5 min
metabolized by the liver; FOOD: None known. beats/min)  Contact only)
30–50% excreted LAB VALUES:  Inferior Wall MI dermatitis  Cross-
unchanged by the May  serum Methemoglobin  Suspected Right Tolerance
kidneys. and urine Catecholamine Ventricular Involvement  Flushing
Half-life: 20 min ( in concentrations.  Tolerance
renal impairment)
Assessment:  If headache occurs during therapy, take medication with meals.
 If pt experiences/verbalizes anginal pain record its onset, type (sharp, dull, squeezing),  Consult physician first when changing brands.
radiation, location, intensity and duration; precipitating factors (exertion, emotional stress).  Keep container away from heat or moisture.
 Assess the pt’s BP and HR before administration.  Expel from mouth if there is a remaining amount of SL tablet after pain is completely
 Pt’s EKG must be monitored continuously when administering IV. relieved.
 Obtain pt’s full medication history, and check for any contraindications.  Do not use within 48hrs with PDE5 inhibitors; may cause acute hypotensive episode.
Potential Nursing Diagnoses: Evaluation/Desired Outcomes:
 Acute pain (Indications)  Decrease in frequency and severity of anginal attacks.
 Ineffective tissue perfusion (Indications)  Increase in activity tolerance. During long-term therapy, tolerance may be minimized by
Implementation: intermittent administration in 12–14hr or 10–12hr off intervals.
 Tablet should be held under tongue and pt must avoid eating, drinking (esp. alcohol), or  Controlled hypotension during surgical procedures.
smoking until it fully dissolves.  Treatment of HF associated with acute MI.
Patient/Family Teaching:
 Advise SO to assist pt from lying to standing slowly.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Inderal Generic Name: Propranolol Drug Classification: Beta Blockers (Non-Selective)
Dosage, Route & Frequency Drug-Drug &

Side Effects
Drug Action Drug-Food Indications Contraindications Adverse Reactions (By System)
Recommended Prescribed (By System)
Interactions
Hypertension Blocks beta1 -, DRUG:  Cardiac Arrhythmias  Hypersensitivity to GU: CNS:
Adult: beta2 –adrenergic Diuretics (e.g.,  MI Propranolol   sexual  Fatigue/Weakness
PO 40 mg B.I.D., receptors. furosemide, HCTZ),  Tachyarrhythmias  Bronchial Asthma function  Anxiety
usually need 160–480 other associated with  Severe Sinus CNS:  Dizziness
mg/d in divided doses Therapeutic antihypertensives Digitalis Intoxication, Bradycardia  Drowsiness  Drowsiness
InnoPran XL dose 80 Effect:  heart rate; (e.g., amlodipine, anesthesia, and  Cardiogenic Shock  Difficulty  Insomnia
mg q hs, may  to 120  B/P, myocardial lisinopril, valsartan) Thyrotoxicosis  Sick Sinus Sleeping  Memory Loss
mg hs contractility, and may  hypotensive  Hypertrophic Syndrome  Depression  Mental Depression
Child: myocardial oxygen effect.  Heart block greater  Anxiety
Subaortic Stenosis  Mental Status Changes
PO 1 mg/kg/d in 2 demand. May mask   Altered Taste
Angina Pectoris due than first-degree  Nervousness
divided doses (1–5 symptoms of to Coronary  Paresthesia
Pharmacokinetics
(unless pt has  Nightmares
mg/kg/d) hypoglycemia, Atherosclerosis functional  Unusual
Neonate: A: Well absorbed prolong  Paresthesia
 Pheochromocytoma pacemaker) Fatigue/ EENT:
PO 0.25 mg/kg q6–8h but undergoes hypoglycemic effect  Hereditary essential  Uncompensated HF Weakness  Blurred Vision
(max: 5 mg/kg/d) extensive first-pass of insulin, oral
hepatic
tremor  Premature infants CV:  Dry eyes
IV 0.01 mg/kg slow IV hypoglycemics 
metabolism. Hypertension alone, with corrected age  Bradycardia  Nasal Stuffiness
push over 10 min q6– (e.g., glipizide, but generally with a younger than 5wks
D: Moderate CNS Skin: Respiratory:
8h prn (max: 0.15 metformin).
penetration. thiazide or other  Infants weighing  Sensation of  Bronchospasm
mg/kg q6–8h) Digoxin may  risk antihypertensives <2kg
Crosses the coldness in  Wheezing
for bradycardia. 
Angina placenta; enters Anxiety States  Asthma extremities CV:
NSAIDs (e.g.,
Adult: breast milk.  Migraine  History of  Pruritus  Arrhythmias
ibuprofen,
Prophylaxis Bronchospasm GI:
PO 10–20 mg B.I.D. or Protein Binding: ketorolac, and  Bradycardia
93%.  Essential tremors  Bradycardia (<80  Diarrhea
T.I.D., may need 160– naproxen) may   HF
M & E: Almost  Schizophrenia bpm)  Constipation
320 mg/d in divided antihypertensive  Pulmonary Edema
doses completely  Tardive Dyskinesia  BP <50/30 mmHg  Nausea/
effect.  Orthostatic Hypotension
metabolized by the  Acute Panic  Pheochromocytoma Vomiting
HERBAL:  Peripheral Vasoconstriction
Arrhythmias liver (primarily for Ephedra, ginger, symptoms Patients with: EENT:
GI:
Adult: CYP2D6  Recurrent GI  Diabetes  Nasal
licorice, ginseng,  Constipation
PO 10–30 mg T.I.D. or isoenzyme) (the bleeding in Cirrhotic  Renal/Hepatic congestion
and yohimbe may  Diarrhea
Q.I.D. CYP2D6 enzyme worsen pts impairment  Dry eyes
 Nausea
IV 0.5–3 mg q4h prn system exhibits hypertension.  Aggression/Rage  Raynaud’s disease
Child: GU:
genetic  Hyperthyroidism
PO 1–4 mg/kg/d in 4 polymorphism; 7% Licorice may   Myasthenia gravis  Erectile Dysfunction
divided doses (max: of population may water retention.  Psychiatric disease   Libido.
16 mg/kg/d) be poor Garlic, periwinkle  Bronchospastic Skin:
IV 10–20 mcg/kg/min metabolizers and have disease  Erythema Multiforme
over 10 min may have antihypertensive  Elderly  Exfoliative Dermatitis
significantly  effects.  History of severe  Stevens-Johnson Syndrome
Acute MI propranolol FOOD: None anaphylaxis to  Toxic Epidermal Necrolysis
Adult: concentrations and known. LAB allergens  Itching
PO 180–240 mg/d in a  risk of adverse VALUES:
 Rash
divided doses effects). May  serum Endocrine:
Half-life: 3.4–6hr. antinuclear
Migraine Prophylaxis  Hyperglycemia
antibody (ANA)
Adult: titer, serum BUN,  Hypoglycemia ( in children)
PO 80 mg/d in divided LDH, lipoprotein, MS:
doses, may need 160– alkaline  Arthralgia
240 mg/d phosphatase,  Back pain
potassium, uric  Muscle Cramps
acid, ALT, AST,  Myopathy
triglycerides. Other:
 Anaphylaxis
 Drug-induced Lupus Syndrome
Assessment:  Direct IV: Diluent: Administer undiluted or dilute each 1mg in 10 mL of D5W for injection.
 Obtain pt’s full medical history to check for any contraindications. Concentration: Undiluted: 1mg/mL. Diluted in 10 mL of D5W: 0.1mg/mL. Rate: Administer at 0.5mg/
Propranolol can cause bronchiolar constriction even in normal pts. min for adults to avoid hypotension and cardiac arrest; max: 1mg/min. Pedi: Administer over 10 min.
 Monitor pt’s HR, RR, BP and circulation to extremities carefully throughout  Intermittent Infusion: Diluent: May be diluted in 50 mL of 0.9% NaCl, D5W, D5/0.45% NaCl, D5/ 0.9%
period of dosage adjustment. Consult physician for acceptable parameters. NaCl, or lactated Ringer’s injection. Concentration: Depends on dose. Rate: Infuse over 10–15 min.
 Monitor pt’s intake & output ratio and daily weight to detect signs of fluid Patient/Family Teaching:
retention and prevent pt from developing HF.  Continue taking medication, although pt verbalizes being cured.
 Fasting for >12hrs may induce hypoglycemic effects.  Pt must comply with the therapy regimen to control hypertension, arrhythmia, and anginal pain.
 If pt verbalizes coldness, pain, or tenderness in feet or hands, examine  Advise SO to assist pt from lying to standing slowly.
carefully for signs of impaired circulation.  Avoid tasks that require great amount of effort until response to drug is known.
Potential Nursing Diagnoses:  Report excessively slow pulse rate (<50bpm), peripheral numbness, and dizziness.
 Decreased cardiac output (Side Effects)  Consult physician first before using nasal decongestants and OTC cold preparations (stimulants).
 Noncompliance (Patient/Family Teaching)  Do not allow pt to eat food with salt or drink alcohol.
Implementation:
 High Alert: IV vasoactive medications are inherently dangerous. Before Evaluation/Desired Outcomes:
administering intravenously, ask your partner or another nurse to  Decrease in BP.
independently check the original order, dose calculations, and infusion  Control of arrhythmias without appearance of detrimental side effects.
pump settings. Oral and parenteral doses are not interchangeable. IV dose  Reduction in frequency of anginal attacks.
is 1/10 of the oral dose. Change to oral therapy as soon as possible.  Increase in activity tolerance.
 Do not confuse Inderal with Adderall.  Prevention of MI.
 PO: Assess pt’s HR before administering. If 50 bpm or if arrhythmia occurs,  Prevention of vascular headaches.
discontinue medication and report immediately to the physician.  Management of thyrotoxicosis.
 Administer medication with meals or directly PC to enhance absorption.  Management of Pheochromocytoma.
 Propranolol tablets may be crushed or mixed with food.  Decrease in tremors.
 Mix propranolol oral solution with liquid or semisolid food such as water,  Management of hypertrophic cardiomyopathy.
juices, applesauce, and puddings. Rinse glass with more liquid or have pt  Decrease in symptoms associated with PTSD.
eat all of the applesauce or pudding to make sure exact dose is taken.
IV Administration:
 pH: 2.8–4.0.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Tenormin Generic Name: Atenolol Drug Classification: Beta Blockers (Selective)
Dosage, Route & Frequency Drug-Drug & Drug- Side Effects

Drug Action Indications Contraindications Adverse Reactions (By System)
Recommended Prescribed Food Interactions (By System)
Hypertension, Blocks beta1 - DRUG:  Hypertension  Hypersensitivity to CV: CNS:
Angina adrenergic Diuretics (e.g.,  Stable Angina Atenolol  Hypotension  Fatigue/Weakness
Adult: receptors in cardiac furosemide, HCTZ), Pectoris  Cardiogenic Shock manifested as  Anxiety
PO 25–50 mg/d, may tissue. other  MI  Uncompensated cold  Depression
 to 100 mg/d antihypertensives  Antiarrhythmic HF extremities  Dizziness
Therapeutic (e.g., amlodipine,  Second- or Third- GI:
Child:  Mitral Valve  Drowsiness
PO 0.8–1.5 mg/kg/d Effect: lisinopril, valsartan)  Constipation
Prolapse degree Heart  Insomnia
(max: 2 mg/kg/d) Slows sinus node may  hypotensive  Pheochromocytoma Block (except with  Diarrhea  Memory loss/ status changes
heart rate, effect.  Nausea
 Thyrotoxicosis functioning  Nervousness
MI decreasing cardiac Sympathomimetics,  Flatulence
output, B/P.  Vascular Headache pacemaker)  Nightmares
Adult: xanthines may Prophylaxis  Sinus Bradycardia Other: EENT:
PO 10 min after Decreases mutually inhibit  Sinus Node  Diaphoresis  Blurred Vision
second IV dose, start myocardial oxygen effects. Dysfunction CNS:  Stuffy Nose
50 mg/d demand. May mask symptoms  Pulmonary Edema  Dizziness Respiratory:
IV 5 mg q5min times of hypoglycemia,  Pregnancy  Fatigue
2 doses, then switch Pharmacokinetics prolong  Bronchospasm
A: 50–60% Patients with/that are:  Headache  Wheezing
to PO hypoglycemic effect
absorbed after oral  Elderly  Insomnia CV:
of insulin, oral
administration.  Renal Impairment  Depression  Bradycardia
antidiabetic
D: Minimal medications (e.g.,  Peripheral  Confusion  HF
penetration of CNS. glyburide). Vascular Disease (esp. in the  Pulmonary edema
Crosses the NSAIDs may   Diabetes elderly)  Hypotension
placenta and enters antihypertensive  Thyroid Disease  Altered Taste  Peripheral vasoconstriction
breast milk. effect.  Bronchospastic GU: GI:
M & E: 40–50% HERBAL: Disease  Urinary  Constipation
excreted Ephedra, ginseng,  Compensated HF Frequency  Diarrhea
unchanged by the and yohimbe may  Myasthenia Gravis   Libido   liver enzymes
kidneys; remainder  Psychiatric Skin:
worsen hypertension.  Nausea/vomiting
excreted in feces
Garlic may  Disease  Rash GU: Erectile Dysfunction
as unabsorbed  History of MS:
drug.
antihypertensive   Libido
effect. Anaphylaxis to  Arthralgia  Urinary Frequency
Half-life: 6–9 hr. Allergens  Myalgia
FOOD: None known. Skin:
LAB VALUES: May  Concurrent use  Rashes
 serum ANA titer, with Digoxin,
serum BUN, Verapamil, or Endocrine:
creatinine, Diltiazem.  Hyperglycemia
potassium, uric acid,  Hypoglycemia
lipoprotein, MS:
triglycerides.  Arthralgia
 Back pain
 Joint pain
Other:
 Drug-induced Lupus Syndrome
Assessment:  Pt must comply with the therapy regimen to control hypertension and angina.
 Pregnant or lactating pts must avoid taking atenolol their infant may be at risk  Advise SO to assist pt from lying to standing slowly.
for hypoglycemia.  Avoid tasks that require great amount of effort until response to drug is known.
 Monitor pt’s HR, BP, RR, and peripheral circulation throughout dosage  Advise diabetic pts to monitor blood glucose levels carefully (may mask signs of hypoglycemia).
adjustment period. Consult physician for acceptable parameters.  Report dizziness, depression, confusion, rash, and unusual bruising/bleeding to physician.
Potential Nursing Diagnoses:  Outpatients should monitor BP and HR before taking the medication and follow correct technique.
 Decreased cardiac output (Side Effects)  Do not allow pt to eat food with salt or drink alcohol.
 Noncompliance (Patient/Family Teaching) Evaluation/Desired Outcomes:
Implementation:  Decrease in BP.
 PO: Check HR before administering drug. If 50bpm or if arrhythmia occurs,  Reduction in frequency of angina.
discontinue medication and report to physician immediately.  Increase in activity tolerance.
Patient/Family Teaching:  Prevention of MI.
 Continue taking medication, although pt verbalizes being cured.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Norvasc Generic Name: Amlodipine Drug Classification: Calcium-Channel Blocker

Drug-Drug & Drug-Food Side Effects
Recommended Prescribed Interactions (By System)
System)
Hypertension Inhibits calcium movement DRUG:  Mild to  Hypersensitivity CV: CNS:
Adult: across cardiac and vascular May  level of simvastatin. Moderate to Amlodipine  Peripheral  Dizziness
PO 5–10 mg once smooth muscle cell membranes. Azole antifungals, cyclosporine, Hypertension Patients with: Edema  Fatigue
daily protease inhibitors (e.g., and Angina  Hepatic  Palpitations CV:
Geriatric: Start Therapeutic Effect: Dilates darunavir, ritonavir) may  impairment  Chest Pain  Peripheral
with 2.5 mg, adjust coronary arteries, peripheral concentration  Severe Aortic  Bradycardia Edema
dose at intervals of arteries/arterioles. Decreases Carbamazepine, rifampin may  Stenosis  Orthostatic  Angina
not less than 2wks total peripheral vascular level/effect.  Hypertrophic Hypotension  Bradycardia
resistance and B/P by HERBAL: Cardiomyopathy  Flushing  Hypotension
Hepatic vasodilation. St. John’s wort may  with Outflow CNS:  Palpitations
Impairment  Headache
Pharmacokinetics
concentration. Tract Obstruction  Flushing
Start with 2.5 mg,
A: Well absorbed after oral
Ephedra, yohimbe may worsen  Dizziness GI:
adjust dose at hypertension.
administration (64–90%).  Unusual  Gingival
intervals of not less Garlic may  antihypertensive
D: Probably crosses the Fatigue/ Hyperplasia
than 2wks effect.
placenta. Weakness  Nausea
FOOD: (Asthenia)
Protein Binding: 95–98%.
Grapefruit products may  GI:
M & E: Mostly metabolized by
the liver.
concentration, hypotensive  Nausea
effects.
Half-life: 30–50 hr ( in geriatric
LAB VALUES: May  hepatic
patients and patients with
enzyme levels.
hepatic impairment).
Assessment:  PO: May be administered without regard to meals.
 Monitor pt’s BP for therapeutic effectiveness. BP reduction is greatest after peak levels of Amlodipine Patient/Family Teaching:
are achieved 6–9hrs following oral doses.  Continue taking medication, although pt verbalizes being cured.
 Monitor for signs and symptoms of dose-related peripheral/facial edema that is not accompanied by  Pt must comply with the therapy regimen to control hypertension.
weight gain; discontinue drug if there is severe edema.  Avoid tasks that require great amount of effort until response to drug is known.
 Monitor pt’s BP with postural changes. Report postural hypotension. Monitor more frequently when  Restrict pt from grapefruit products.
adding additional antihypertensives or diuretics. Evaluation/Desired Outcomes:
 Monitor pt’s HR; dose-related palpitations may occur.  Decrease in BP.
Potential Nursing Diagnoses:  Decrease in frequency and severity of anginal attacks.
 Ineffective tissue perfusion (Indications)  Decrease in need for nitrate therapy.
 Acute pain (Indications)  Increase in activity tolerance and sense of well-being.
Implementation:
 Amlodipine is not the same with Amiloride. Do not confuse Norvasc with Navane.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Pronestyl Generic Name: Procainamide Drug Classification: Sodium Channel Blocker IA
Arrhythmias Depresses excitability of DRUG:  Prophylactically  Myasthenia Gravis CV: CNS:
Adult: myocardium to electrical Other to maintain  Hypersensitivity to  Hypotension  Dizziness
PO 1 g followed by stimulation, reduces antiarrhythmics  Normal Sinus Procainamide/  Proarrhythmia  Psychosis
250–500 mg q3h or conduction velocity in atria, therapeutic and toxic Rhythm following Procaine Other: CV:
500 mg–1 g q6h ventricles, and His-Purkinje effects. conversion of  Blood Dyscrasias  Fever  Severe Hypotension
sustained release system.  duration of Anticholinergic Atrial Flutter or  Complete AV  SLE  Pericarditis
IM 0.5–1 g q4–6h refractory period, especially Agents compound Fibrillation by Block Hematologic:  Ventricular Fibrillation
until able to take in the atria. anticholinergic other methods.  Second- and  Agranulocytosis  AV Block
PO effects.  Prevent Third- degree AV CNS:  Tachycardia
IV 100 mg q5min at Therapeutic Effects: Antihypertensives  Recurrence of Block unassisted  Headaches  Flushing
a rate of 25–50 Produces slight change in hypotensive effects. Paroxysmal by pacemaker  Confusion GI:
mg/min until contractility of cardiac muscle Cimetidine may  Atrial Fibrillation Patient who has:  Disorientation  Bitter taste
arrhythmia is and cardiac output; procainamide and and Tachycardia  Undergone GI:  Nausea
controlled or 1 g suppresses automaticity of NAPA levels with   Paroxysmal AV Electrical  Gl symptoms
given, then 2–6 His-Purkinje ventricular  Vomiting
in toxicity. Junctional conversion to
mg/min muscle. Produces peripheral  Diarrhea
Rhythm Sinus Rhythm
Child: vasodilation and  Anorexia
 Ventricular  Hypotension
PO 40–60 mg/kg/d hypotension, especially with Hematologic:
Tachycardia  Cardiac  Agranulocytosis with
divided q4–6h IV use.  Ventricular and Enlargement repeated use
IV 3–6 mg/kg q 10–
Pharmacokinetics
Atrial Premature  CHF  Thrombocytopenia
30 min (max: 100 Contractions
mg/dose), then A: 75–95% absorbed from GI  MI Other:
 Cardiac  Coronary
0.02–0.08 tract.
Arrhythmias  Fever
mg/kg/min Peak: 15–60 min IM; 30–60 Occlusion  SLE-like Syndrome
Associated with  Ventricular
min PO. MS:
Surgery and Dysrhythmia from
Duration: 3 h; 8 h with  Muscle & Joint Pain
Anaesthesia Digitalis
sustained release.  Angioneurotic Edema
D: Distributed to CSF, liver,  Malignant Intoxication
Hyperthermia  Myalgia
spleen, kidney, brain, and  Hepatic or Renal
 Polyarthralgias
heart; crosses placenta; Insufficiency
Respiratory:
distributed into breast milk.  Electrolyte
 Pleuritic Pain
M: Metabolized in liver Imbalance
 Pleural Effusion
to NAPA, an active  Bronchial Asthma
Skin:
metabolite.  History of SLE
E: Excreted in urine.  Safety during  Maculopapular rash
Half-Life: 3 h procainamide, pregnancy  Pruritus
6 h NAPA. (category C) or  Erythema
lactation is not  Rash
established.
Assessment:  Titrate the dose to the smallest amount enough to manage arrhythmia to  risk for drug toxicity.
 Check pt’s HR before each dose during period of adjustment to the oral route.  Provide comfort and safety measures to pt to help him/her tolerate drug effects.
 Monitor pt's ECG and BP continuously during IV drug administration.  Keep emergency drugs and equipment near bedside to promote immediate treatment in cases
 Withhold IV drug temporarily when arrhythmia occurs, adverse effects are present, of severe toxicity.
QRS complex is excessively widened >50%, PR interval is prolonged, or BP drops IV Administration:
15 mmHg or more.  Use IV route for emergency situations.
 Report to physician when pt verbalizes chest pain, dyspnea, and anxiety.  PREPARE: Direct: When given direct IV, dilute each 100mg with 5–10 mL of D5W or sterile
 Therapeutic Procainamide blood levels are reached in approximately 24hrs if water for injection. IV Infusion: When given by IV infusion, add 1g of procainamide to 250–500
kidney function is normal. mL of D5W solution to yield 4mg/mL in 250 mL or 2mg/mL in 500mL.
Potential Nursing Diagnosis:  ADMINISTER: Direct: Usual rate 20mg/min. Faster rates (up to 50 mg/min) should be used with
 Decreased cardiac output related to cardiac effects of the drug caution. IV Infusion: 2–6mg/min.
 Ineffective tissue perfusion related to decreased blood circulation Patient/Family Teaching:
 Altered sensory perception related to CNS drug effects  Explain the purpose of the medication to both pt and SO.
 Risk for injury related to weakness and dizziness  Monitor pt’s weight and notify physician if there is an increase gain accompanied by local edema.
Implementation:  Monitor HR and notify physician if it changes in rate or quality.
 PO: Give first PO dose at least 4hrs after last IV dose. Administer on an empty  Do not double the dose because a previous dose was missed. Take drug at evenly spaced
stomach, 1hr AC or 2hrs PC, with full glass of water to enhance absorption. If gastric intervals around the clock unless otherwise prescribed.
distress occur, administer with food. If patient is unable to swallow the drug, crush Evaluation/Desired Outcomes:
immediate-release tablet. Has a wax matrix appears in stool.  Normalization of cardiac output and rhythm without severe side effects.
 IM: Assess Procainamide blood levels if more than three IM injections are required.  Pt must be able to name the drug, its indication, and adverse effects.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Mexitil Generic Name: Mexiletine Hydrochloride Drug Classification: Sodium Channel Blocker IB
Dosage, Route & Frequency Drug-Drug & Drug-Food Side Effects Adverse Reactions (By
Recommended Prescribed Interactions (By System) System)
Ventricular Shortens action potential DRUG:  Acute and  Severe Left CNS: CNS:
Arrhythmias refractory period duration and Phenytoin, Chronic Ventricular  Drowsiness  Dizziness
Adult: PO 200– improves resting potential. phenobarbital, rifampin Ventricular Failure  Agitation  Tremor
300 mg q8h may  mexiletine levels Arrhythmias  Cardiogenic  Seizures  Nervousness
(max: 1200 mg/d) Therapeutic Effects: Cimetidine, fluvoxamine  Prevention of Shock  Paresthesia  Incoordination
Child: PO 1.4–5 Has little or no effect on atrial may  mexiletine levels. Recurrent  Severe MS:  Headache
mg/kg q8h tissue and produces modest  Muscle twitching
May Cardiac Arrests Bradyarrhythmias  Blurred vision
suppression of sinus node  theophylline levels.  Suppression of  Pre-existing CV:  Paresthesias
automatically and AV nodal May  proarrhythmic PVCs due to Second- or Third-  Proarrhythmia  Numbness
conduction. Prolongs the His- effects of dofetilide. Ventricular degree Heart GI: CV:
to-ventricular interval (HQ) FOOD: Tachyarrhythmias Block  Nausea/Vomiting  Exacerbated
only if patient has pre-existing Unlabelled Uses:  Pregnancy
conduction disturbance.
Take with food to reduce  Hepatitis arrhythmias
irritation.  Wolff-Parkinson-  Lactation Hematologic:  Palpitations
Pharmacokinetics
White Syndrome  Concurrent  Blood Dyscrasias  Chest pain
 Supraventricular administration of Other:  Syncope
A: Well absorbed
Arrhythmias. drugs which alter  Fever
(bioavailability 90%) from the  Hypotension
GI tract. urinary pH GI:
D: 5 to 7 L/kg Patients with:  Nausea/Vomiting
Protein binding:  Sinus Node  Heartburn
Conduction
50-60%  Diarrhea
M: Primarily hepatic (85%) via Irregularities
 Constipation
CYP2D6 and CYP1A2  Intraventricular
 Dry Mouth
(primarily CYP2D6). Conduction
Abnormalities  Abdominal Pain
2-hydroxymexiletine and p- GU:
hydroxymexiletine.  Hypotension
 Impotence
E: Approximately 10% is  Severe CHF
 Urinary retention
excreted unchanged by the  Liver Dysfunction.
Skin:
kidney. The urinary excretion
 Rash
of N-methylmexiletine in man
MS:
is less than 0.5%.
Half-life: 10-12hrs  Arthralgia
Other:
 Dyspnea
 Edema
 Fever
 Malaise
 Hiccups
Assessment: be swallowed whole. Do not crush, break, or chew tablets or open capsules, unless
 Monitor pt’s ECG, HR, and BP frequently throughout IV administration and periodically instructed.
throughout oral administration. Patient/Family Teaching:
Potential Nursing Diagnoses:  Instruct patient to take oral doses around the clock, as directed, even if feeling better.
 Decreased cardiac output (Indications).  Instruct patient or family member on how to take HR. Advise pt to report changes in HR or
 Deficient knowledge, related to disease process and medication regimen. rhythm to physician.
Implementation:  Consult physician before taking OTC medications.
 Assess HR before administration of oral doses. Discontinue medication and notify  Emphasize the importance and encourage pt to have follow-up exams to monitor progress.
physician if heart rate is 50bpm. Evaluation/Desired Outcomes:
 Give oral doses with a full glass of water. Most sustained-release preparations should  Resolution of cardiac arrhythmias without detrimental side effects.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Tambocor Generic Name: Flecainide Drug Classification: Sodium Channel Blocker IC

Side Effects
Drug Action Drug-Drug & Drug-Food Interactions Indications Contraindications Reactions (By
Recommended Prescribed (By System)
System)
Life-threatening Slows conduction in DRUG:  Life-threatening  Hypersensitivity CNS: CNS:
Ventricular cardiac tissue by  risk of arrhythmias with other Ventricular  Cardiogenic shock  Dizziness  Dizziness
Arrhythmias altering transport of antiarrhythmics, including calcium Arrhythmias Use Cautiously in:  Tremors  Anxiety
Adult: PO 100 ions across cell channel blockers. Unlabelled Uses:  HF (dosage  may CV:  Fatigue
mg q12h, may  membranes. Disopyramide, beta blockers, or  Atrial tachycardia be required)  Bradycardia  Headache
by 50 mg B.I.D. verapamil may have  myocardial and other  Pre-existing sinus  Heart Block  Mental
Therapeutic
q4d (max: 400 depressant effects; combination use Arrhythmias node dysfunction  HF depression
mg/d) Effects: should be undertaken cautiously. unresponsive to  2nd- or 3rd- degree  Proarrhythmia  Tremor
Child: PO 1–3 Suppression of Amiodarone doubles serum flecainide standard agents heart block (without  Flushing EENT:
mg/kg/d in 3 arrhythmias.  Wolff-Parkinson-
levels ( flecainide dose by 50%). a pacemaker) GI:  Blurred Vision
divided doses serum digoxin levels by a small amount White syndrome  Renal impairment  Gl upset  Visual
Pharmacokinetics
(max: 8 mg/kg/d) (15–25%).  Recurrent (dosage  required  Metallic Taste Disturbances
A: Well absorbed
Concurrent beta blocker therapy may Ventricular Hematologic: CV:
from the GI tract if CCr <35 mL/ min)
cause  levels of beta blocker and Tachycardias OB: Teratogenic in  Neutropenia  Arrhythmias
following oral
flecainide. animal studies; use only EENT:  Chest Pain
administration.
Alkalinizing agents promote if potential benefit  Blurred Vision  HF
D: Widely
distributed. reabsorption,  blood levels, and may justifies potential risk to GI:
M & E: Mostly cause toxicity. fetus.  Anorexia
metabolized by Acidifying agents  renal elimination and Lactation: Usually  Constipation
liver; 30% excreted may  effectiveness of flecainide (urine compatible with breast  Drug-induced
unchanged by pH 5). feeding (AAP). hepatitis
kidneys. FOOD:  Nausea/
Half-life: 11–14 hr. Foods that  urine pH to >7 result in  Vomiting
levels (strict vegetarian diet).  Stomach pain
Foods or beverages that  urine pH to Skin:
<5  renal elimination and may   Rash
effectiveness of flecainide (acidic
juices).
Assessment:  Therapy should be initiated in a hospital setting to monitor for  in arrhythmias.
 Pre-existing hypokalemia or hyperkalemia before treatment must be corrected.
 Dose adjustments should be at least 4 days interval because of its long half-life.
 Monitor pt’s ECG because of the possibility of drug-induced arrhythmias.  PO: May be given with meals if GI irritation becomes a problem.
 Obtain pt’s baseline assessment to serve as basis for changes in intervals. Patient/Family Teaching:
 Monitor pt’s plasma level.  Instruct patient to take oral doses around the clock, as directed, even if feeling better.
 Effective trough plasma levels are between 0.7–1mcg/mL. When trough levels exceed 1  If visual disturbances occur report to physician.
mcg/mL there will be an  probability of adverse reactions.  Consult physician before breastfeeding.
 Attempt to reduce dose catiously after arrhythmia is controlled. Evaluation/Desired Outcomes:
Potential Nursing Diagnoses:  Decrease in frequency of life-threatening ventricular arrhythmias.
 Decreased cardiac output (Adverse Reactions)  Decrease in supraventricular tachyarrhythmias.
Implementation:
 Do not confuse Tambocor with Pamelor.
 Previous antiarrhythmic therapy (except lidocaine) should be withdrawn 2–4 half-lives
before starting Flecainide.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Betapace Generic Name: Sotalol Hydrochloride Drug Classification: Class II Beta-Adrenergic Blocker

Drug-Drug & Drug- Side Effects
System)
Ventricular Prolongs cardiac DRUG:  Life-threatening  Hypersensitivity to Sotalol GU: CV:
Arrhythmias action potential, Calcium channel Ventricular  Cardiogenic Shock  Diminished  Bradycardia
(Betapace) effective refractory blockers (e.g., Arrhythmias  Congenital or Acquired long QT Sexual  HF
Adult: PO Initial dose of period, QT interval. diltiazem, verapamil) (Sustained syndrome Function  Hypotension
80 mg B.I.D. or 160 mg Decreases heart may  effect on AV Ventricular  Second- or Third-degree Heart CNS:  Bronchospasm
Q.D. taken prior to rate, AV node conduction, B/P. Tachycardia) Block (unless functioning  Drowsiness  Hypoglycemia
meals, may  every 3–4 conduction;  AV May mask symptoms  Maintenance of pacemaker is present)  Insomnia  Prolonged QT
d in 40–160 mg node refractoriness. of hypoglycemia, normal sinus rhythm  Sinus Bradycardia  Asthenia Interval
increments (most prolong hypoglycemic in pts with Atrial  Uncontrolled HF  Depression  Torsades De
patients respond to Therapeutic effects of insulin, oral Fibrillation/Flutter  Bronchial Asthma or related  Anxiety Pointes
240–320 mg/d in 2 or 3 Effect: Produces hypoglycemics (e.g., Unlabelled Uses: Bronchospastic conditions  Paresthesia  Ventricular
divided doses, doses antiarrhythmic glipizide, metformin).  Hypertension  QT interval >450msec of fingers, Tachycardia
>640 mg/d have not activity. QT prolonging  Angina  CrCl <40 mL/min toes, and  Premature
been studied) medications (e.g.,
Pharmacokinetics  Serum Potassium <4 mEq/L scalp Ventricular
amiodarone, CV:
Renal Impairment A: Well absorbed ciprofloxacin,  Sick Sinus Syndrome Complexes
Patients with:  Cold
Clcr >60 mL/min: q12h; following oral haloperidol,
30–60 mL/min: q24h; administration ketoconazole,  Ventricular Tachycardia hands/feet
 Ventricular Fibrillation GI:
10–30 mL/min: q36– (bioavailability 90– ondansetron).
 Cardiomegaly  Diarrhea
48h; <10 mL/min: 100%). HERBAL:
D: Crosses the  Compensated HF  Constipation
Individualize carefully Ephedra may worsen
placenta; enters arrhythmias.  Diabetes Mellitus  Nausea/
Atrial breast milk. FOOD: None known.  QT interval prolongation Vomiting
Fibrillation/flutter M & E: Elimination LAB VALUES:  Hypokalemia  Altered taste
 Hypomagnesemia EENT:
(Betapace AF) is mostly renal. May  serum BUN,
Adult: PO Initial dose of Half-life: 12hr ( in glucose, alkaline  Renal Impairment  Nasal
80 mg b.i.d., may  congestion
renal impairment). phosphatase, LDH,  Post MI
 Dry eyes
every 3–4 d (max: 240 lipoprotein, ALT, AST,  Peripheral Vascular Disease
mg/d in 1–2 divided triglycerides,  Raynaud’s Syndrome
doses) potassium, uric acid. Skin:
 Myasthenia Gravis
 Pruritus
 Psychiatric Disease
Renal Impairment  Bronchospastic Disease
Clcr >60 mL/min: q12h;
40–60 mL/min: q24h;  Concurrent use of digoxin,
<40 mL/min verapamil, diltiazem
contraindicated  History of Severe Anaphylaxis to
Allergens
Assessment:  Within 2hrs before administration, avoid administering antacids containing aluminum or magnesium.
 Pt must be on continuous cardiac monitoring upon initiation of therapy.  For pts unable to swallow pills, pharmacist can convert tablets to a solution.
 Do not administer without consulting physician if pulse is <60bpm. Patient/Family Teaching:
 Assess creatinine clearance before administering.  Be aware of risk for hypotension and syncope, esp. with concurrent treatment with catecholamine-
 Obtain pt’s complete medical history. depleting drugs (e.g., reserpine, guanethidine).
Potential Nursing Diagnoses:  Monitor HR daily and report marked bradycardia (<60 or other established parameter) to physician.
 Decreased cardiac output (Side Effects)  Type 2 diabetics are at  risk for hyperglycemia.
 Noncompliance (Patient/Family Teaching)  Do not abruptly discontinue drug because of the risk of exacerbation of angina, arrhythmias, and
Implementation: possible myocardial infarction.
 Do not confuse Sotalol with Sudafed (pseudoephedrine).  Do not breastfeed while taking this drug.
 Therapy should be initiated in a hospital setting to monitor for  in arrhythmias. Evaluation/Desired Outcomes:
 PO: Check HR before administering. If 50bpm or if arrhythmia occurs,  Control of arrhythmias without appearance of detrimental side effects.
discontinue medication and report to physician.
 Give medication with an empty stomach, 1hr AC or 2hrs PC. Give with food,
especially milk or milk products, reduces absorption.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Cordarone Generic Name: Amiodarone Drug Classification: Class III Drug that Prolongs Repolarization
Arrhythmias Prolongs duration of DRUG:  Prophylaxis  Hypersensitivity EENT: CNS:
Adult: myocardial cell Sofosbuvir may cause  Life-Threatening to amiodarone &  Corneal  Confusion
PO Loading action potential and severe bradycardia. Ventricular iodine Microdeposits  Disorientation
Dose 800–1600 mg/d refractory period by May  thioridazine Arrhythmias  Bradycardia  Asymptomatic  Hallucinations
in 1–2 doses for 1– acting directly on all concentration and  Supraventricular induced Syncope Corneal  Dizziness
3wks cardiac tissue. produce additive Arrhythmias  Second- and Deposits  Fatigue
PO Maintenance Decreases AV and prolongation of QT particularly with Third-degree AV  Visual  Malaise
Dose 400–600 mg/d in sinus node function. interval. May  cardiac Atrial Fibrillation Block Disturbances  Headache
1–2 doses effects with other Unlabelled Uses:  Severe Sinus  Halo Vision  Insomnia
IV Loading Dose 15 Therapeutic Effect: antiarrhythmics. May   Nonexertional Node GI:
Suppresses  Ataxia
mg over 10 min effect of beta blockers Angina Dysfunction  Constipation
followed by 360mg arrhythmias.  Involuntary Movement
(e.g., carvedilol, labetalol,  Conversion of  Causing Marked   Appetite  Paresthesia
over next 6hrs metoprolol), oral Atrial Fibrillation Sinus  Nausea/Vomiti
IV Maintenance Pharmacokinetics  Peripheral Neuropathy
anticoagulants (e.g., to normal Sinus Bradycardia ng
Dose 540mg over A: Slowly and  Poor Coordination
warfarin). rhythm  Cardiogenic  Bitter or
18hrs (0.5 mg/min), variably absorbed  Tremor
May  concentration,  Paroxysmal Shock Metallic taste
may continue at 0.5 from the GI tract (35– EENT:
toxicity of aripiprazole, Supraventricular Patient’s with: CNS:
mg/min 65%). IV  Corneal Microdeposits
colchicine, digoxin, and Tachycardia  Prolong QT  Headache
Convert IV to administration results  Abnormal sense of Smell
in complete
phenytoin.  Ventricular Rate interval  Paresthesia
PO Duration of May  risk of simvastatin  Dry eyes
bioavailability. control due to  Thyroid disease  Photosensitivity
infusion <1wk use  Optic Neuritis
D: Distributed to and toxicity, myopathy, and Accessory  Electrolyte  Dizziness
800–1600 mg PO, 1– rhabdomyolysis. Pathway imbalance  Optic Neuropathy
3wk use 600–800 mg accumulates slowly  Blurred vision  Photophobia
in body tissues. HERBAL: Conduction in  Hepatic disease
PO, >3wk use 400 mg MS:
Reaches high levels St. John’s wort may  Pre-Excited Atrial  Hypotension  Muscular
Respiratory:
PO effect. Arrhythmia after  ARDS
Child: in fat, muscle, liver,  Left Ventricular incoordination
Ephedra may worsen Defibrillation Dysfunction  Pulmonary Fibrosis
PO Loading lungs, and spleen. CV:
arrhythmia.  Epinephrine in  Pulmonary  Pulmonary Toxicity
Dose 10–15 mg/kg/d Crosses the placenta  Hypotension
Herbals with hypotensive Cardiac Arrest CV:
or 600–800 mg/1.73 and enters breast disease  Bradycardia
milk. properties may   Taking Warfarin  CHF
m2/d, in 1–2 divided  Facial Flushing
Protein Binding: levels/effects of  Surgical pts  Worsening of Arrhythmias
doses for 4–14 d cycle Other:
96% bound to amiodarone.  Bradycardia
or until adequate  Fever
control of arrhythmia plasma proteins. FOOD:  Hypotension
GU:
GI:
  libido
PO Maintenance M & E: Metabolized Grapefruit products may Skin:  Anorexia
Dose 5 mg/kg/d or by the liver, excreted alter effect. Avoid use  Blue-Gray  Constipation
200–400 mg/1.73 m2/d into bile. Minimal during therapy. coloring of skin  Nausea/Vomiting
once daily, may be renal excretion. One LAB VALUES: (face, arms,  Abdominal pain
able to reduce to 2–5 metabolite has May  serum ALT, AST, and neck)  Abnormal sense of Taste
mg/kg/d 5 d per week antiarrhythmic alkaline phosphatase,  Rash   liver enzymes
activity. ANA titer. GU:
Half-life: 13–107 May cause changes in   libido
days EKG, thyroid function test  Epididymitis
results. Skin:
Therapeutic serum
 Toxic Epidermal Necrolysis
level: 0.5–2.5 mcg/mL;
 Photosensitivity
toxic serum level not
established.  Blue Discoloration
Endocrine:
 Hypothyroidism
 Hyperthyroidism
Assessment:  Infusions exceeding 2hr must be given in glass or polyolefin bottles to prevent adsorption.
 Obtain and monitor the pt’s baseline serum ALT, AST, alkaline phosphatase, EKG, However, polyvinyl chloride (PVC) tubing must be used during administration because
pulmonary function tests, and CXR in pts with pulmonary disease. concentrations and infusion rate recommendations have been based on PVC tubing.
 Assess pt’s BP and HR immediately before drug is given (if pulse is <60/min or  Direct IV: Diluent: Give undiluted. May also be diluted in 20–30mL of D5W or 0.9% NaCl.
systolic BP is <90 mmHg, discontinue medication and notify physician). Concentration: 50mg/mL. Rate: Administer IV push.
Potential Nursing Diagnoses:  Intermittent Infusion: Diluent: Dilute 150mg of amiodarone in 100mL of D5W. Infusion stable
 Decreased cardiac output (Indications) for 2hr in PVC bag, or use pre-mixed bags. Concentration: 1.5mg/mL. Rate: Infuse over 10
 Impaired gas exchange (Side Effects) min. Do not administer IV push.
Implementation:  Continuous Infusion: Diluent: Dilute 900mg (18mL) in 500mL of D5W. Infusion stable for 24hr
 High Alert: IV vasoactive medications are inherently dangerous; fatalities have in glass or polyolefin bottle. Concentration: 1.8mg/mL. Concentration may range from 1–6
occurred from medication errors involving amiodarone. Before administering, ask mg/mL (concentrations >2 mg/ mL must be administered via central venous catheter). Rate:
your partner or another nurse to check the original order, dose calculations, and Infuse at a rate of 1mg/min for the first 6hrs, then  infusion rate to 0.5mg/min and continue until
infusion pump settings. Pts should be hospitalized and monitored closely during IV oral therapy is initiated.
therapy and initiation of oral therapy. IV therapy should be given only by physicians Patient/Family Teaching:
experienced in treating life-threatening arrhythmias.  Do not let pt be exosed from the sunlight for too long.
 Do not confuse amiodarone with amantadine.  When drug is withhold, bluish skin discoloration gradually disappears.
 Hypokalemia and hypomagnesemia may  effectiveness or cause arrhythmias;  If shortness of breath and cough occur, report immediately.
correct before therapy.  Outpatients should monitor HR before taking medication.
 Monitor pt’s VS closely when converting from IV to oral, esp. in geriatric pts.  Continue taking medication, although pt verbalizes being cured.
 PO: May be given with meals and in divided doses if GI intolerance occurs or if daily  Pt must comply with the therapy regimen to control arrythmias.
dose exceeds 1000mg.  Advise pt to avoid eating food that has salt and avoid drinking alcohol.
IV Administration:  Restrict pt from grapefruit products.
 pH: 4.1. Evaluation/Desired Outcomes:
 IV: Administer via volumetric pump; drop size may be reduced, causing altered  Cessation of life-threatening ventricular arrhythmias.
dosing with drop counter infusion sets.  Adverse effects may take up to 4mos to resolve.
 Give medication through in-line filter.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Cardizem Generic Name: Diltiazem Drug Classification: Class IV Calcium Channel Blocker
Angina Inhibits calcium DRUG:  Vasospastic PO: CNS: CNS:
Adult: PO 30 mg movement across Beta blockers (e.g., angina  Acute MI  Peripheral  Abnormal Dreams
Q.I.D., may increase cardiac, vascular carvedilol, metoprolol), (Prinzmetal's  Pulmonary Edema  Anxiety
q1–2d as required smooth-muscle cell digoxin may have additive variant or at rest Congestion  Dizziness  Confusion
(usual range: 180– membranes (causes effect on prolonging AV angina)  Hypersensitivity to  Light-  Dizziness
360 mg/d in divided dilation of coronary conduction.  chronic stable Diltiazem Headedness  Drowsiness
doses) arteries, peripheral May  concentration, risk of (classic effort-  Second- or Third-  Headache  Headache
arteries, arterioles). toxicity with associated) degree AV Block  Drowsiness  Nervousness
Hypertension carbamazepine, Angina  Severe Hypotension
Therapeutic Effect:
CV:  Psychiatric
Adult: PO 60–120 benzodiazepines.  Essential (<90 mmHg, systolic)  Bradycardia Disturbances
mg sustained- Relaxes coronary May  serum digoxin Hypertension  Sick Sinus Syndrome MS:  Weakness
release B.I.D. (usual vascular smooth concentration. IV form: IV:  Asthenia  Paresthesia
range: 240–360 muscle, increases Rifampin may   Atrial Fibrillation  Hypersensitivity to GI:  Tremor
mg/d) or 120–540 myocardial oxygen concentration/effects.  Atrial Flutter
delivery in pts with
Diltiazem  Nausea EENT:
mg of CD or LA once May  concentration of  Supraventricular
vasospastic angina,  Sick Sinus Syndrome  Abdominal  Blurred Vision
daily statins and risk of
decreases heart rate.
Tachycardia  Second- or Third- Discomfort  Disturbed Equilibrium
myopathy/rhabdomyolysis. Unlabelled Uses: degree Block  Constipation
Atrial Fibrillation  Epistaxis
HERBAL:  Prevention of  Cardiogenic Shock Skin:
Adult: IV 0.25 mg/kg Pharmacokinetics
Ephedra may worsen  Tinnitus
IV bolus over 2 min, A: Well absorbed, but reinfarction in  Atrial  Flushing Respiratory:
arrhythmias, hypertension. non-Q-wave MI
if inadequate rapidly metabolized Fibrillation/Flutter  Rash  Cough
after oral Garlic may  associated with Other:
response, may antihypertensive effect.  Dyspnea
repeat in 15 min with administration. Accessory Bypass  EKG changes CV:
D: Unknown. Ginseng, yohimbe may tract GU:
0.35 mg/kg, followed worsen hypertension.  Arrhythmias
by a continuous Protein Binding: 70–  Severe Hypotension  Micturition  HF
80%. St. John’s wort may   Ventricular Disorder
infusion of 5–10 concentration.  Peripheral Edema
M & E: Mostly Tachycardia (Polyuria,
mg/h (max: 15 mg/h FOOD:  Bradycardia
for 24 h) metabolized by the Patients with: Nocturia,
None known.  Chest Pain
liver (CYP3A4 enzyme  Renal/hepatic Dysuria,
system). Half-life:  Hypotension
impairment Frequency of
LAB VALUES:  Palpitations
3.5–9 hr.  HF Urination)
EKG: May  PR interval.  Syncope
 concurrent use with
Beta Blocker  Tachycardia
GI:
 Hypertrophic   Liver enzymes
Obstructive  Anorexia
Cardiomyopathy  Constipation
 Diarrhea
 Dry Mouth
 Dysgeusia
 Dyspepsia
 Nausea/Vomiting
GU:
 Dysuria
 Nocturia
 Polyuria
 Sexual Dysfunction
 Urinary Frequency
Skin:
 Stevens-Johnson
Syndrome
 Dermatitis
 Erythema Multiforme
 Flushing
 Sweating
 Photosensitivity
 Pruritus/Urticaria
 Rash
Endocrine:
 Gynecomastia
 Hyperglycemia
Hematologic:
 Anemia
 Leukopenia
 Thrombocytopenia.
Metabolism:
 Weight gain
MS:
 Joint Stiffness
 Muscle Cramps
Other:
 Gingival Hyperplasia
Assessment:  Continuous Infusion: Diluent: Dilute 125 mg in 100 mL, 250 mg in 250 mL, or 250 mg in 500
 Record onset, type (sharp, dull, squeezing), radiation, location, intensity, duration of mL of 0.9% NaCl, D5W, or D5/0.45% NaCl. Infusion is stable for 24hrs at room temperature or
anginal pain, and precipitating factors (exertion, emotional stress). if refrigerated. Concentration: 125 mg/125 mL (1 mg/ mL), 250 mg/300 mL (0.83 mg/mL), 250
 Obtain pt’s baseline renal/hepatic function tests. mg/550 mL (0.45 mg/mL). Check for pt’s heart rate and BP response.
 Assess BP and HR immediately before drug is given. Patient/Family Teaching:
 Obtain baseline EKG in pts with history of arrhythmia.  Continue taking medication, although pt verbalizes being cured.
Potential Nursing Diagnoses:  Pt must comply with the therapy regimen to control anginal pain.
 Acute pain (Indications)  Advise SO to assist pt from lying to standing slowly.
 Decreased cardiac output (Adverse Reactions)  Avoid tasks that require great amount of effort until response to drug is known.
Implementation:  Advise pt to avoid drinking alcohol (may  risk of hypotension or vasodilation).
 PO: May be given without regard to meals. May be given with meals if GI irritation Evaluation/Desired Outcomes:
and swallowing becomes a problem. Do not open, crush, break, or chew sustained  Decrease in BP.
release capsules or tablets. Empty tablets that appear in stool is normal.  Decrease in frequency and severity of anginal attacks.
IV Administration:  Decrease in need for nitrate therapy.
 Direct IV: Diluent: Administer bolus dose undiluted. Concentration: 5mg/mL. Rate:  Increase in activity tolerance and sense of wellbeing.
Administer over 2 min.  Suppression and prevention of tachyarrhythmias.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Esidrix Generic Name: Hydrochlorothiazide Drug Classification: Short-Acting Thiazide Diuretic

Edema Inhibits sodium DRUG:  Edema  Hypersensitivity to CNS: CNS:
Adult: PO 25– reabsorption in Cholestyramine, associated with Hydrochlorothiazide  Headache  Dizziness
200 mg/d in 1–3 distal renal tubules, colestipol may  CHF  Anuria GI:  Drowsiness
divided doses causing excretion absorption, effects.  Hepatic  History of  GI Disturbances  Lethargy
of sodium, Antihypertensives Cirrhosis Hypersensitivity to Skin:  Weakness
Hypertension potassium, (e.g., amlodipine,  Renal Failure Sulfonamides or  Photosensitivity CV:
Adult: PO 12.5– hydrogen ions, clonidine, lisinopril,  Hypertension Thiazide Diuretics GU:  Hypotension
100 mg/d in 1–2 water. valsartan) may  Unlabelled Uses: Patients with:   Urinary EENT:
divided doses hypotensive effect.  Nephrogenic  Severe Frequency (  Acute Angle-Closure Glaucoma.
Child: PO 2.2 Therapeutic May  risk of digoxin Renal/Hepatic
Diabetes with continued GI:
mg/kg/d in 2 Effect: Promotes toxicity associated Insipidus Impairment use)  Anorexia
divided doses diuresis; reduces  Prediabetes or
with  Hypercalciuria  Urine Volume  Cramping
Neonate: PO < B/P. hydrochlorothiazide-  Electrolyte Diabetes  Potassium  Hepatitis
6mos, 2–4 induced  Elderly or
mg/kg/d in 2 Pharmacokinetics Disturbances Depletion  Nausea/Vomiting
hypokalemia. Debilitated
divided doses A: All are rapidly associated with CV:  Pancreatitis
May  risk of lithium Renal Tubular  History of Gout  Orthostatic Skin:
absorbed after oral
administration.
toxicity. Acidosis  Moderate to High Hypotension  Stevens-Johnson Syndrome
HERBAL: Serum Cholesterol
D: All cross the  Photosensitivity
Ephedra, ginseng,  Hypercalcemia
placenta and enter  Rash
breast milk. yohimbe may   Hypokalemia Endocrine:
effect.
M & E: All are  Hyperglycemia
excreted mainly Black cohosh,
F and E:
periwinkle may 
unchanged by the  Hypokalemia
kidneys. antihypertensive
effect.  Dehydration
Half-life: 6–15hr  Hypercalcemia
FOOD: None known.
LAB VALUES:  Hypochloremic Alkalosis
May  serum  Hypomagnesemia
glucose, cholesterol,  Hyponatremia
LDL, bilirubin,  Hypophosphatemia
calcium, creatinine,  Hypovolemia
uric acid,  Hematologic: Thrombocytopenia
triglycerides. Metabolism:
May  urinary  Hypercholesterolemia
calcium, serum  Hyperuricemia
magnesium, MS:
potassium, sodium.  Muscle Cramps
Assessment: IV Administration:
 Check pt’s vital signs, esp. BP for hypotension, before administration.  Intermittent Infusion: Reconstitute chlorothiazide with at least 18 mL of sterile water for injection. Shake to
 Obtain pt’s baseline electrolytes, esp. for hypokalemia. dissolve. Stable for 24hrs at room temperature. Diluent: May be given undiluted/diluted further with D5W or
 Assess for skin turgor, and mucous membranes for hydration status. 0.9% NaCl. Concentration: Up to 28 mg/mL. Rate: Undiluted: direct IV over 3–5 min. Diluted: may run over
 Assess pt for peripheral edema. 30 min.
 Assess pt muscle strength, and mental status. Patient/Family Teaching:
 Note skin temperature, and moisture.  Urination frequency and volume is expected to increase.
 Obtain baseline weight.  Advise SO to assist pt from lying to standing slowly.
 Monitor pt’s intake and output.  Encourage pt to eat high in potassium foods (whole grains, legumes, meat, bananas, apricots, orange juice,
Potential Nursing Diagnoses: potatoes and raisins).
 Excess fluid volume (Indications)  Avoid prolong exposure of the sun.
 Risk for deficient fluid volume (Side Effects) Evaluation/Desired Outcomes:
 Deficient knowledge, related to medication regimen  Decrease in BP.
Implementation:  Increase in urine output.
 Give drug in the morning to prevent disruption of sleep cycle.  Decrease in edema.
 PO: May give with food or milk to reduce GI irritation. Tablets may be
crushed and mixed with fluid to facilitate swallowing.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Hygroton Generic Name: Chlorthalidone Drug Classification: Thiazide-Like Diuretic

Hypertension Increases excretion of DRUG:  Edema  Hypersensitivity CNS: CNS:
Adult: PO 12.5– sodium and water by Cholestyramine, associated with to Sulfonamide Headache  Dizziness
25 mg/d, may inhibiting sodium colestipol may  CHF derivatives GI:  Drowsiness
be increased to reabsorption in the absorption, effects.  Renal  Anuria GI Disturbances  Lethargy
100 mg/d if distal tubule. Promotes Antihypertensives Decompensation  Hypokalemia Skin:  Weakness
needed excretion of chloride, (e.g., amlodipine,  Hepatic Cirrhosis  Pregnancy Photosensitivity. CV:
Child: PO 2 potassium, clonidine, lisinopril,  Corticosteroid  Lactation GU:  Hypotension
mg/kg 3 magnesium, and valsartan) may  and Estrogen  Urinary Frequency ( EENT:
times/wk. bicarbonate. May hypotensive effect. therapy with continued use), Urine  Acute Angle-Closure
produce arteriolar May  risk of lithium  Hypertension Volume, Potassium Glaucoma
Edema dilation. toxicity. Depletion. GI:
Adult: PO 50– HERBAL: CV:  Anorexia
100 mg/d, may Therapeutic Effects: Ephedra, ginseng, Orthostatic Hypotension
Lowering of BP in  Cramping
be increased to yohimbe may  effect.
hypertensive patients  Hepatitis
200 mg/d if Black cohosh,
needed and diuresis with  Nausea/Vomiting
periwinkle may   Pancreatitis
mobilization of edema.
antihypertensive Skin:
Pharmacokinetics A: effect.  Stevens-Johnson Syndrome
FOOD:
All are rapidly  Photosensitivity
None known.
absorbed after oral  Rash
administration. LAB VALUES:
Endocrine:
May  serum glucose,
D: All cross the  Hyperglycemia
placenta and enter cholesterol, LDL,
F and E:
bilirubin, calcium,
breast milk.  Hypokalemia
M & E: All are creatinine, uric acid,
triglycerides.  Dehydration
excreted mainly  Hypercalcemia
unchanged by the May  urinary calcium,
serum magnesium,  Hypochloremic
kidneys.
potassium, sodium.  Alkalosis
Half-life: 35–50hr
 Hypomagnesemia
 Hyponatremia
 Hypophosphatemia
 Hypovolemia
Hematologic:
 Thrombocytopenia
Metabolism:
 Hypercholesterolemia
 Hyperuricemia
MS:
 Muscle Cramps
Assessment:  PO: May give with food or milk to reduce GI irritation. Tablets may be crushed and mixed with fluid to
 Monitor pt’s BP, intake and output, and daily weight and examine feet, legs, facilitate swallowing.
and sacral area for edema daily. IV Administration:
 Assess pt, esp.if taking digoxin, for anorexia, nausea/vomiting, muscle  Intermittent Infusion: Reconstitute chlorothiazide with at least 18 mL of sterile water for injection. Shake
cramps, paresthesia, and confusion. Report to physician if signs of to dissolve. Stable for 24 hr at room temperature. Diluent: May be given undiluted or may be diluted
electrolyte imbalance occur. Pts taking digoxin are at risk of digoxin toxicity further with D5W or 0.9% NaCl. Concentration: Up to 28 mg/mL. Rate: Undiluted: direct IV over 3–5
because of the potassium-depleting effect of the diuretic. min. Diluted: run over 30 min.
 Assess pt for any contraindications. Treat symptomatically; may recur once Patient/Family Teaching:
treatment is stopped.  Urination frequency and volume is expected to increase.
 Hypertension: Monitor pt’s BP before and periodically during therapy.  Advise SO to assist pt from lying to standing slowly.
Potential Nursing Diagnoses:  Encourage pt to eat high in potassium foods (whole grains, legumes, meat, bananas, apricots, orange
 Excess fluid volume (Indications) juice, potatoes and raisins).
 Risk for deficient fluid volume (Side Effects)  Avoid prolong exposure of the sun.
 Deficient knowledge, related to medication regimen Evaluation/Desired Outcomes:
Implementation:  Decrease in BP.
 Give medication in the morning to prevent disruption of sleep cycle.  Increase in urine output.
 Intermittent dose schedule may be used for continued control of edema.  Decrease in edema.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Lasix Generic Name: Furosemide Drug Classification: Loop Diuretic
Edema Action Enhances DRUG:  Edema  Hypersensitivity to CNS: CNS:
Adult: excretion of Amphotericin B, associated with Furosemide  Dizziness  Blurred Vision
PO 20–80 mg in 1 sodium, chloride, nephrotoxic ototoxic CHF  Anuria  Light-headedness  Dizziness
or more divided potassium by direct medications (e.g.,  Cirrhosis of Liver Patients with:  Headache  Headache
doses up to 600 action at ascending lisinopril, IV contrast and Kidney  Hepatic Cirrhosis  Blurred Vision  Vertigo
mg/d if needed limb of loop of dye, and disease  Hepatic Coma  Restlessness  Paresthesia
IV/IM 20–40 mg in Henle. vancomycin) may   Nephrotic  Severe Electrolyte  Fatigue EENT:
1 or more divided risk of nephrotoxicity, Syndrome Depletion GU:  Hearing Loss
doses up to 600 Therapeutic ototoxicity.  Hypertension  Prediabetes/Diabetes   Urinary  Tinnitus
mg/d Effect: Produces May  risk of lithium  Hypercalcemia  Systemic Lupus Frequency/Volume CV:
Child: PO 2 mg/kg, diuresis, lowers toxicity.  Severe Cerebral Erythematosus  Bladder Spasm  Hypotension
may be increased B/P. Other medications Edema  Prostatic GI: GI:
by 1–2 mg/kg q6– causing hypokalemia 
Pharmacokinetics Meningitis Hyperplasia/Urinary  Nausea  Anorexia
8h (max: 6 (e.g., HCTZ,
A: 60–67% Stricture  Dyspepsia  Constipation
mg/kg/dose) laxatives) may  risk
IV/IM 1 mg/kg, may absorbed after oral  Abdominal Cramps  Diarrhea
of hypokalemia.
be increased by 1 administration (pin  Diarrhea  Dry Mouth
HERBAL:
mg/kg q2h if acute HF and in
Ephedra, ginseng,  Constipation  Dyspepsia
needed renal failure); also
yohimbe may worsen  Electrolyte   Liver enzymes
Neonate: PO 1–4 absorbed from IM
hypertension. Disturbances  Nausea/ Vomiting
mg/kg q12–24h sites.
Garlic may   Flank Pain  Pancreatitis
IV/IM 1–2 mg/kg D: Crosses Skin: GU:
antihypertensive
q12–24h placenta, enters
effect.  Paresthesia   BUN
breast milk. Protein  Photosensitivity  Excessive Urination
FOOD:
Hypertension Binding: 91–99%.  Rash  Nephrocalcinosis
None known.
Adult: PO 10–40 M & E: Minimally  Diaphoresis Skin:
LAB VALUES:
metabolized by
mg B.I.D. (max: May  serum  Erythema Multiforme
liver, some
480 mg/d) glucose, BUN, uric  Stevens-Johnson Syndrome
nonhepatic
metabolism, some acid.  Toxic Epidermal Necrolysis
renal excretion as May  serum  Photosensitivity
unchanged drug. calcium, chloride,  Pruritis
Half-life: 30–60min magnesium,  Rash
potassium, sodium.  Urticaria
( in renal Endo:
impairment).  Hypercholesterolemia
 Hyperglycemia
 Hypertriglyceridemia
 Hyperuricemia
F and E:
 Dehydration
 Hypocalcemia
 Hypochloremia
 Hypokalemia
 Hypomagnesemia
 Hyponatremia
 Hypovolemia
 Metabolic Alkalosis
Hematologic:
 Aplastic Anemia
 Agranulocytosis
 Hemolytic Anemia
 Leukopenia
 Thrombocytopenia.
MS:
 Muscle Cramps.
Other:
 Fever
Assessment  PO: Can taken with food or milk to reduce gastric irritation. Tablets may be crushed if patient has difficulty
 Monitor pts receiving parenteral drug closely; carefully monitor BP & VS. swallowing.
 Monitor pt’s BP during periods of diuresis and through period of dosage  Do not give if medication is discolored solution or tablets.
adjustment. IV Administration:
 Observe older adults more closely during period of brisk diuresis. Sudden  Direct IV: Diluent: Administer undiluted. Concentration: 10 mg/mL. Rate: Administer at a rate of 20
alteration in F & E balance will have adverse reactions. Report symptoms mg/min. Pedi: Administer at a maximum rate of 0.5–1 mg/ kg/min (for doses 120mg) with infusion not
to physician immediately. exceeding 10 min.
 Monitor pt’s intake and output ratio and pattern. Report if there’s an  Intermittent Infusion: Diluent: Dilute larger doses in 50 mL of D5W, D10W, D20W, D5/0.9% NaCl,
unusual change in output. Excessive diuresis can result in dehydration D5/LR, 0.9% NaCl, 3% NaCl, or LR. Infusion stable for 24hrs at room temperature. Do not refrigerate.
and hypovolemia, circulatory collapse, and hypotension. Assess pt’s Protect from light. Concentration: 1mg/ mL. Rate: Give at a rate not to exceed 4 mg/ min (for doses 120
weight daily. mg) in adults to prevent ototoxicity. Pedi: not to exceed 1 mg/kg/min with infusion not exceeding 10 min.
 Monitor pt’s urine and blood glucose levels carefully in diabetics and pts Use an infusion pump to ensure accurate dose is received by pt.
with decompensated hepatic cirrhosis, drug may cause hyperglycemia. Patient/Family Teaching:
 Severe dehydration is most likely to occur in elderly, those with chronic  Urination frequency and volume is expected to increase.
cardiac disease on prolonged salt restriction, or those receiving  Encourage pt to eat high in potassium foods (whole grains, legumes, meat, bananas, apricots, orange
sympatholytic agents. juice, potatoes and raisins).
Potential Nursing Diagnoses:  Avoid prolong exposure of the sun.
 Excess fluid volume (Indications) Evaluation/Desired Outcomes:
 Deficient fluid volume (Side Effects)  Decrease in edema.
Implementation:
 Do not confuse Lasix with Luvox.  Decrease in abdominal girth and weight.
 If administering B.I.D., give last dose not later than 5 PM to reduce  Increase in urinary output.
disruption of sleep cycle.  Decrease in BP.
 IV route is preferred than IM route.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Osmitrol Generic Name: Mannitol Drug Classification: Osmotic Diuretic
Dosage, Route & Frequency Drug-Drug &

Side Effects Adverse Reactions (By
Drug Action Drug-Food Indications Contraindications
Recommended Prescribed (By System) System)
Interactions
Acute Kidney Failure Action Elevates osmotic DRUG:  Promote diuresis  Hypersensitivity to GI: CNS:
Adult: pressure of glomerular None significant. in prevention and mannitol  Dry mouth  Confusion
IV Test Dose 0.2 g/kg or 12.5 g filtrate, inhibiting tubular HERBAL: treatment of  Severe dehydration  Thirst  Headache
as a 15–20% solution over 3–5 reabsorption of water Yohimbe may  oliguric phase of  Active intracranial  Nausea/ EENT:
min and electrolytes, effects. acute kidney bleeding Vomiting  Blurred Vision
Positive Response 30–50 mL resulting in increased FOOD: failure following  Severe pulmonary CNS:  Rhinitis
of urine over next 2–3h, may urine output. Reduces None known. cardiovascular edema  Blurred vision CV:
repeat test dose 1 time. If still intracranial pressure by LAB VALUES: surgery  Congestion  Headache  Transient Volume
negative, do not use. decreasing blood May  serum  Severe traumatic  Severe renal  Dizziness Expansion
Treatment 50–100 g as 15– viscosity, thereby phosphate, injury disease (anuria) GU:  Chest Pain
20% solution over 90min to increasing cerebral potassium.  Surgery in  Progressive HF   Urinary  HF
several hours blood flow/oxygen May  serum presence of  Patients with: Frequency/  Pulmonary Edema
Child: IV Test Dose 200 mg/kg transport. sodium, serum severe jaundice  Concurrent Volume  Tachycardia
(max: 12.5 g) over 3–5min osmolality.  Hemolytic MS:
Therapeutic Effect: nephrotoxic agents GI:
Positive Response Urine flow transfusion
Produces diuresis;  Conditions  Arm Pain  Nausea/ Vomiting
of 1 mL/kg/h for 1–2h reaction
reduces intraocular increasing  Backache  Thirst
Maintenance 0.25–0.5 g/kg q4–  Reduce elevated
pressure (IOP), sensitivity to Skin: GU:
6h intraocular (IOP)
intracranial pressure bronchoconstriction  Urticaria  Renal Failure
and intracranial 
Edema, Ascites (ICP), cerebral edema. Sepsis CV:  Urinary Retention
pressure (ICP)  Preexisting renal  Hypotension
Adult: IV 100 g as a 10–20% F and E:
 Measure GFR  Hypertension
solution over 2–6h Pharmacokinetics disease  Dehydration
 Promote   Tachycardia
A: IV administration Hypernatremia  Hyperkalemia
excretion of toxic  Fever
Elevated IOP or ICP produces complete  Hypernatremia
substances
Adult: IV 1.5–2 mg/kg as a 15– bioavailability. Some  Angina-like  Hypokalemia
absorption may follow  Relieve
25% solution over 30–60min
symptoms of
Chest Pain  Hyponatremia
use as a GU irrigant. Local:
D: Confined to the pulmonary edema
Acute Chemical Toxicity
 Irrigating solution  Phlebitis at IV site.
Adult: IV 100–200 g depending extracellular space;
does not usually cross in transurethral
on urine output
the blood-brain barrier prostatic reaction
or eye. to minimize
Measurement of GFR
Adult: IV 100 mL of 20%
solution diluted with 180 mL M & E: Excreted by the hemolytic effects
NaCl injection infused at a rate kidneys; minimal liver of water
of 20 mL/min metabolism.
Half-life: 100 min.
Assessment:  Oliguria: Administration rate should be titrated to produce a urine output of 30–50 mL/hr.
 Obtain pt’s baseline BP and HR. Administer child’s dose over 2–6hr. Increased Intracranial Pressure: Infuse dose over 30–
 Assess pt’s skin turgor, mucous membranes, mental status, and muscle strength. 60 min in adults and children.
 Obtain pt’s baseline weight, and lab results.  Intraocular Pressure: Administer dose over 30 min. When used preoperatively, administer
 Assess pt’s intake and output. 60–90 min before operation.
Potential Nursing Diagnoses: Patient/Family Teaching:
 Excess fluid volume (Indications)  Report immediately to the physician if side effects occur.
 Risk for deficient fluid volume (Side Effects)  If family members observe confusion or disorientation of pt, this must be reported
Implementation: immediately.
 Carefully observe infusion site frequently for infiltration. Extravasation may cause tissue  Do not breastfeed while using this drug.
irritation and necrosis. Evaluation/Desired Outcomes:
 Do not give electrolyte-free mannitol solution with blood. If blood must be given  Urine output of at least 30–50 mL/hr or an increase in urine output in accordance with
simultaneously with mannitol, add at least 20 mEq/L NaCl to each L of mannitol. parameters set by physician.
 IV: Administer by IV infusion undiluted. If solution contains crystals, warm bottle in hot  Reduction in intracranial pressure.
water and shake vigorously. Do not give solution in which crystals remain undissolved.  Reduction of intraocular pressure.
Cool to body temperature.  Excretion of certain toxic substances.
 Test Dose: Administer over 3– 5 min to produce a urine output of 30– 50 mL/hr. If urine  Irrigation during transurethral prostate resection
flow does not , administer 2nd test dose. If urine output is not at least 30–50 mL/hr for
2– 3hr after 2nd test dose, patient should be re-assessed.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Diamox Generic Name: Acetazolamide Drug Classification: Carbonic Anhydrase Inhibitor
Dosage, Route & Frequency Drug-Drug & Drug- Side Effects Adverse Reactions
Recommended Prescribed Food Interactions (By System) (By System)
Glaucoma Inhibition of carbonic DRUG:  Seizures  Hypersensitivity CNS: CNS:
Adult: PO 250 mg 1–4 anhydrase in the eye results Renal excretion  Absence or Petit or cross-  Dizziness  Depression
times/d, 500 mg in decreased secretion of of Amphetamines, Mal sensitivity with  Lightheaded-Ness  Fatigue/Weakness
sustained release aqueous humor. Inhibition of Ephedrine, Flecai-  Generalized Sulfonamides  Blurred Vision  Drowsiness
B.I.D. IM/IV 500 mg, renal carbonic anhydrase, nide, Quinidine, Tonic-Clonic may occur  Drowsiness EENT:
may repeat in 2–4 h resulting in self-limiting Procainamide, (grand mal) &  Hepatic disease  Headache  Transient
Child: PO 8–30 mg/kg/d urinary excretion of sodium, Tricyclic Focal or insufficiency  Tingling Feeling Nearsightedness
in 3 doses IM/IV 5–10 potassium, bicarbonate, and antidepressants may  Reduction of  Concurrent use  Confusion GI:
mg/kg q6h water. CNS inhibition of be , thereby Intraocular with Ophthalmic  Tiredness  Anorexia
carbonic anhydrase and enhancing or Pressure in Carbonic  Metallic Taste
GU:
Epilepsy resultant diuresis may  prolonging their Open-Angle Anhydrase  Nausea/Vomiting
 amount of urine
Adult/Child: PO 8–30 abnormal neuronal firing. effects. inhibitors
Glaucoma GI:  Melena
mg/kg/d in 1–4 doses Alkaline diuresis prevents Renal excretion  Secondary (brinzolamide,  Dry mouth GU:
precipitation of uric acid or of lithium is . Glaucoma dorzolamide) is  Crystalluria
Edema cysteine in the urinary tract.  Loss of appetite
Excretion  Preoperative: not
 Changes in  Renal Calculi
Adult: PO 250–375 mg of phenobarbital may Acute Closed- recommended
Therapeutic Effects: the sense of taste  Skin: Stevens-
every AM (5 mg/kg) be . Amphotericin Angle Glaucoma OB: Avoid during first
Child: PO/IM/IV 5 Lowering of intraocular  Stomach upset Johnson
B and Corticoste-  Drug-induced trimester of
 Nausea/vomiting Syndrome
mg/kg or 150 pressure. Control of some roids may  pregnancy.
Edema Edema  Rashes
mg/m2/every AM types of seizures. Prevention potassium loss. Patients with:  Diarrhea
due to CHF  Paresthesias
and treatment of acute  Chronic EENT:
Digitalis  Acute High-
High Altitude Sickness altitude sickness. Diuresis Glycosides may Respiratory  Tinnitus Endocrine:
Altitude Sickness.  Hyperglycemia
Adult: PO 250 mg q8– and subsequent mobilization predispose persons disease
Unlabelled Uses: F and E:
12h or 500 mg of excess fluid. Prevention of with hypokalemia  Electrolyte
uric acid or cystine renal  Prevent Uric Acid  Hyperchloremic
sustained release q12– to digitalis toxicity; abnormalities
24h, starting 24–48 h calculi.  Cystine Renal Acidosis
puts patients on high Calculi  Gout
before climb and  Hypokalemia
doses  Acute  Renal disease
continuing for 48 h at Pharmacokinetics
of Salicylates at   Growth
A: Dose dependent; erratic Pancreatitis (dosage 
high altitude risk Retardation
with doses 10 m g/kg/day.  Premenstrual necessary for
Hematologic:
for Salicylate toxicity. Syndrome (PMS) CCr 50 mL/min)
Treatment D: Crosses the placenta and  Aplastic Anemia
blood-brain barrier; enters  Metabolic  Diabetes mellitus
Hydrocephalus  Hemolytic Anemia
Neonate/Infant: PO/IV breast milk. Alkalosis  Leukopenia
20 mg/kg/d in divided Protein Binding: 95%. Metabolism:
doses q8–12h (max: M & E: Excreted mostly  Hypokalemic OB:  Weight Loss
100 mg/kg/d) unchanged in urine. Hyperkalemic Use with caution  Hyperuricemia
Half-life: 2.4–5.8 hr.  Familial Periodic during 2nd or 3rd Other:
Renal Impairment Paralysis trimester of  Anaphylaxis
Clcr10–50 mL/min:  To  Secretion of pregnancy.
dose q12h; <10 mL/min: Phenobarbital or Lactation:
use not recommended Lithium Safety not
 Hydrocephalus established.
 Observe pt for signs of hypokalemia.  pH: 9.2.
 Assess pt for any hypersensitivities to drug.  Direct IV: Reconstitute 500 mg of acetazolamide in at least 5 mL of sterile water for injection.
 Intraocular Pressure: Assess pt for eye discomfort or  in visual acuity. Use reconstituted solution within 24hrs. Concentration: 100 mg/mL. Rate: Not to exceed
 Seizures: Monitor pt’s neurologic status when receiving acetazolamide. Initiate 500 mg/min.
precautions.  Intermittent Infusion: Diluent: Further dilute in 50–100 mL of D5W, D10W, 0.45% NaCl,
 Altitude Sickness: Monitor pt for  in severity of symptoms which are the side effects. 0.9% NaCl, LR, or combinations of dextrose and saline or dextrose and LR solution.
Report to physician immediately if it worsen or if patient becomes more dyspneic and Concentration: 5–10 mg/mL. Rate: Infuse over 15–30 min.
rales or crackles develop. Patient/Family Teaching:
 Edema: Monitor pt’s intake and output ratios and weight daily throughout therapy.  Encourage pt to drink plenty of fluids, unless contraindicated, to reduce risk of kidney stones.
Potential Nursing Diagnoses:  Report to physician if any side effects occur during therapy.
 Disturbed sensory perception (visual) (Indications)  Encourage pt to eat high in potassium foods and take potassium supplement when taking
Implementation: this drug in high doses or for prolonged periods.
 Do not confuse acetazolamide with acetohexamide. Do not confuse Diamox with  Consult physician before breastfeeding.
Diabinese. Evaluation/Desired Outcomes:
 Encourage pt to drink plenty of fluids (2000–3000 mL/day), unless contraindicated, to  Decrease in intraocular pressure when used for glaucoma. If therapy is not effective or
prevent crystalluria and stone formation. patient is unable to tolerate one carbonic anhydrase inhibitor, using another may be effective
 A potassium supplement without chloride should be given concurrently with and more tolerable.
acetazolamide.  Decrease in the frequency of seizures.
 PO: Give with food to reduce GI irritation. Tablets may be crushed and mixed with fruit-  Reduction of edema.
flavored syrup or juice to reduce bitterness for pts with difficulty swallowing. Extended-  Prevention of altitude sickness.
release capsules may be opened and sprinkled on soft food.  Prevention of uric acid or cystine stones in the urinary tract.
 IM: Extremely painful; not preferred.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Aldactone Generic Name: Spironolactone Drug Classification: Androgen Receptor Blocker
Edema Adult: PO 25–200 Interferes with DRUG: Clinical conditions  Hypersensitivity F & E: CNS:
mg/d in divided doses, sodium ACE inhibitors (e.g., associated with to  Hyperkalemia  Dizziness
continued for at least 5 d reabsorption by captopril, lisinopril), Augmented Aldosterone Spironolactone  Dehydration  Clumsiness
(dose adjusted to optimal competitively angiotensin receptor production:  Acute Renal  Hyponatremia  Headache
response; if no response, a inhibiting action of blockers (e.g.,  Essential insufficiency CNS: CV:
thiazide or loop diuretic aldosterone in valsartan), potassium- Hypertension  significant  Lethargy  Arrhythmias
may be added) distal tubule, containing  Refractory Edema impairment of  Headache GU:
Child: PO 3.3 mg/kg/d in promoting sodium medications, due to CHF Renal Excretory  Ataxia  Erectile
single or divided doses, and water potassium  Hepatic Cirrhosis function  Drowsiness Dysfunction
continued for at least 5 d excretion, supplements may   Nephrotic Syndrome  Anuria  Confusion Skin:
(dose adjusted to optimal increasing risk of hyperkalemia.  Idiopathic Edema  Hyperkalemia  Stevens-
GI:
response) potassium May  half-life of  May be used to  Addison’s  Nausea/Vomiting Johnson
Neonate: PO 1–3 mg/kg/d retention. digoxin.
divided q12–24h
potentiate actions of disease  Anorexia Syndrome
NSAIDs (e.g., other Diuretics and  concomitant use  Toxic Epidermal
Therapeutic  Abdominal Cramps
ibuprofen, ketorolac, Antihypertensive with Eplerenone Necrolysis
Effect: Produces  Diarrhea
Hypertension and naproxen) may  agents or for its Patients with: Endocrine:
Adult: PO 25–100 mg/d in diuresis, lowers antihypertensive  Fever
B/P.
Potassium-Sparing  Dehydration Male:  Breast
single or divided doses, effect. effect.  Hyponatremia  Gynecomastia Tenderness
continued for at least 2 wk HERBAL:  Primary
Pharmacokinetics  concurrent use of  Impotence  Gynecomastia
(dose adjusted to optimal Avoid natural licorice
response) A: >90% absorbed Aldosteronism Supplemental   Libido  Irregular Menses
(possesses Unlabelled Uses:
D: all cross the Potassium Female:  Voice Deepening
mineralocorticoid  Hirsutism in Women
Primary Aldosteronism: placenta and enter  Elderly  Menstrual Irregularities F and E:
activity).
Diagnosis breast milk. with Polycystic  Mild Renal (Amenorrhea,  Hyperkalemia
FOOD: Ovary Syndrome or
Adult: PO Short Test: 400 Protein Binding: Impairment Postmenopausal  Hyponatremia
Food  absorption. Idiopathic Hirsutism
mg/d for 4 d; long test: 400 >90%.  Declining Renal Bleeding) Hematologic:
LAB VALUES:  Adjunct in treatment
mg/d for 3–4 wk M & E: converted Function  Breast Tenderness  Agranulocytosis
May  urinary calcium of Myasthenia
by the liver to its  ACE Inhibitors or Skin: MS:
excretion, serum BUN, Gravis
Primary Aldosteronism: active diuretic Angiotensin  Rash  Muscle Cramps
compound glucose, creatinine,  Familial Periodic
Treatment Receptor  Urticaria Other:
magnesium, Paralysis
Adult: PO 100–400 mg/d in (canrenone)
potassium, uric acid.
Blockers. Endocrine:  Allergic
Half-life: 78–84 Reactions
divided doses May  serum sodium.  Hirsutism
min
Assessment:  Avoid replacing fluid losses with large amounts of free water (can result in dilutional
 Weigh pt; initiate strict I&O. hyponatremia).
 Evaluate hydration status by assessing mucous membranes, and skin turgor.  Weigh 2–3 times each week. Report gains/loss of 5 lb.
 Obtain baseline serum electrolytes, renal/hepatic function, and urinalysis.  Do not drive or engage in potentially hazardous activities until response to the drug is known.
 Assess for edema; note location, and extent.  Avoid excessive intake of high-potassium foods and salt substitutes.
 Check baseline VS, note HR/regularity.  Do not breast feed while taking this drug.
Potential Nursing Diagnoses: Evaluation/Desired Outcomes:
 Excess fluid volume (Indications)  Increase in diuresis and decrease in edema while maintaining serum potassium level in an
Implementation: acceptable range.
 Do not confuse amiloride with amlodipine.  Decrease in BP.
 PO: Administer in AM to avoid interrupting sleep pattern. Administer with food or  Prevention of hypokalemia in patients taking diuretics.
milk to reduce gastric irritation and to  bioavailability.  Treatment of hyperaldosteronism.
 Report signs of hyponatremia or hyperkalemia, most likely to occur in pts with
severe cirrhosis.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Catapres Generic Name: Clonidine Hydrochloride Drug Classification: Drugs for Gestational Hypertension
Hypertension Stimulates alpha2-adrenergic DRUG:  Hypertension  Hypersensitivity GI: CNS:
Adult: PO 0.1 mg B.I.D. receptors, reducing Discontinuation of (alone or with to clonidine  Dry mouth  Drowsiness
or T.I.D., may  by 0.1– sympathetic CNS response. concurrent beta- diuretic or other  Epidural: pts with CNS:  Depression
0.2 mg/d until desired Epidural: Prevents pain blocker (e.g., antihypertensive bleeding diathesis  Drowsiness  Dizziness
response is achieved signal transmission to brain carvedilol, agents) or infection at the  Dizziness  Hallucinations
(max: 2.4 mg/d) and produces analgesia at metoprolol) therapy  Epidural: Severe injection site  Sedation  Nervousness
Transdermal 0.1 mg pre- and post-alpha- may  risk of Pain  pts receiving  Constipation  Nightmares
patch once q7d, may  adrenergic receptors in clonidine-withdrawal Unlabelled Uses: anticoagulation  Tablets  Paresthesia
by 0.1 mg q1–2 wk. spinal cord. hypertensive crisis.  Prophylaxis for therapy  Injection EENT:
Geriatric: PO Start with ADHD: Mechanism of action Tricyclic Migraine Patients with:  Depression  Dry Eyes
0.1 mg once daily unknown. antidepressants  Dysmenorrhea  Depression  Pedal edema CV:
Child: PO 5–10 (e.g., amitriptyline,  Menopausal  Elderly  loss of appetite  AV block
Therapeutic Effect: doxepin, and
mcg/kg/d divided q8– Flushing  Severe coronary  decreased sexual  Bradycardia
Reduces peripheral nortriptyline) may 
12h, may increase to 5–  Diarrhea insufficiency function  Hypotension (
25 mcg/kg/d divided q6h resistance; decreases B/P, effect (may require  Paroxysmal  Recent MI  itching eyes with epidural)
(max: 0.9 mg/d) heart rate. Produces increased dose of
analgesia.
Localized  Cerebrovascular  nausea/vomiting  Palpitations
clonidine). Hyperhidrosis disease
Severe Pain Digoxin, diltiazem, nervous GI:
Pharmacokinetics  Alcohol  Chronic renal Skin:  Side Effects
Adult: Epidural Start metoprolol,  Smoking impairment
infusion at 30 mcg/h and A: Well absorbed from the GI
verapamil may  risk
Pruritus  Dry Mouth
tract and skin. Enters  Opiate  Preexisting Redness/darkening of  Constipation
titrate to response. Use of serious
systemic circulation following Benzodiazepine bradycardia skin
rates >40 mcg/h with bradycardia.  Nausea/Vomiting
epidural use. Some  withdrawal  Sinus node Nightmares GU:
caution HERBAL:
Child: Epidural Start absorption follows sublingual  Pheochromocyto dysfunction Vivid Dreams  Erectile
Gotu kola, kava
infusion at 0.5 mcg/kg/h administration. D: Widely ma  Conduction Feeling Of Coldness In dysfunction
kava, SAMe, St.
distributed; enters CNS.  Gilles De La disturbances Distal Extremities (esp.
and titrate to response John’s wort, valerian Skin:
Crosses the placenta readily; Tourette  Concurrent use the digits)  Rash
may  CNS
enters breast milk in high Syndrome with digoxin,
ADDH depression.  Sweating
Child: PO 5 mcg/kg/d in concentrations.  Children: ADDH diltiazem,
Ephedra, ginseng,
M & E: metoprolol,
4 divided doses
Mostly metabolized by the yohimbe may  verapamil.
F and E:
(average dose, 0.15–0.2 antihypertensive  Sodium retention
mg/d) liver; 40–60% eliminated
unchanged in urine. effect.
Transdermal 0.2–0.3 FOOD: None known.
mg/d q5–7d
Half-life: Neonates, 44. 72hr LAB VALUES: None Metabolicism:
Children—8–12; Adults significant.  Weight gain
Plasma—12–16hr ( in renal withdrawal
impairment); phenomenon.
CNS—1.3 hr.
Assessment:  Transdermal: Transdermal system should be applied once every 7 days. May be applied
 Obtain BP immediately before each dose is administered, in addition to regular to any hairless site; avoid cuts or calluses. Absorption is greater when placed on chest or
monitoring. upper arm and decreased when placed on thigh. Rotate sites. Wash area with soap and
Potential Nursing Diagnoses: water; dry thoroughly before application. Apply firm pressure over patch to ensure contact
 Chronic pain (Indications) with skin, especially around edges. Remove old system and discard. System includes a
 Impaired social interaction (Indications) protective adhesive overlay to be applied over medication patch to ensure adhesion, should
 Risk for injury (Side Effects) medication patch loosen.
Implementation: Patient/Family Teaching:
 Do not confuse Catapres (clonidine) with Cataflam (diclofenac).  Sugarless gum, sips of water may relieve dry mouth.
 Do not confuse clonidine with clonazepam (Klonopin) and clozapine.  Avoid tasks that require alertness, motor skills until response to drug is established.
 Do not substitute between clonidine products on an mg-per-mg basis, because of  To reduce hypotensive effect, rise slowly from lying to standing.
differing pharmacokinetic profiles.  Skipping doses or voluntarily discontinuing drug may produce severe rebound
 In the perioperative setting, continue clonidine up to 4hr prior to surgery and resume as hypertension.
soon as possible thereafter. Do not interrupt transdermal clonidine during surgery.  Avoid alcohol.
Monitor BP carefully.  If patch loosens during 7-day application period, secure with adhesive cover.
 PO: Administer last dose of the day at bedtime. May be taken without regard for food. Evaluation/Desired Outcomes:
 Swallow extended-release tablets whole; do not crush, break, or chew.  Decrease in BP.
 Epidural: Dilute 500 mcg/mL with 0.9% NaCl for a concentration of 100 mcg/mL. Do not  Decrease in severity of pain.
administer solutions that are discolored or contain a precipitate. Discard unused portion.  Decrease in the signs and symptoms of opioid withdrawal.
 Improved attention span and social interactions in ADHD.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Minipress Generic Name: Prazosin Drug Classification: Drugs for Gestational Hypertension
Hypertension Dilates both arteries DRUG:  Mild to moderate  Hypersensitivity CNS: CNS:
Adult: PO Start and veins by blocking Additive hypotension hypertension Patients with:  Dizziness  Dizziness
with 1 mg h.s., postsynaptic alpha1- with acute ingestion of Unlabeled Use:  Renal insufficiency (  Drowsiness  Headache
then 1 mg B.I.D. adrenergic receptors. alcohol, other  Management of sensitivity to effects;  Headache  Weakness
or T.I.D., may Decreases antihypertensives, or urinary outflow Dosepmay be  Weakness  Drowsiness
increase to 20 contractions in smooth nitrates. obstruction in pts required)  Fainting  Mental depression
mg/d in divided muscle of prostatic Antihypertensive with benign OB, Lactation, Pedi:  Vertigo  Syncope
doses capsule. effects may be  by prostatic  Safety not established  Depression EENT:
Child: PO Start NSAIDs. hyperplasia  Blurred Vision
Therapeutic Effects:  Nervousness
with 5 mcg/kg 
Lowering of BP.
Angina Pectoris  Numbness & Tingling  Intraoperative
q6h, gradually 
increase to 25 Decreased cardiac
When adding  Hallucinations Floppy Iris
preload and afterload. Diuretics ( dose of  Falling asleep whenever Syndrome
mcg/kg q6h
Decreased symptoms Prazosin) Relaxing CV:
(max: 15 mg or
of prostatic  Undergoing Cataract  Malaise  First-dose
0.4 mg/kg/d)
hyperplasia (urinary surgery ( risk of  Insomnia Orthostatic
urgency, urinary Intraoperative Floppy GI: Hypotension
hesitancy, nocturia). Iris Syndrome).  Nausea/ Vomiting  Palpitations
 Abdominal  Angina
Pharmacokinetics Discomfort/Pain  Edema
A: 60% absorbed  Diarrhea GI:
following oral  Constipation  Abdominal
administration.  Dry Mouth Cramps
D: Widely distributed.  White Lesions in the  Diarrhea
Protein Binding: Mouth  Dry Mouth
97%.
 Abnormal Liver Function  Nausea/Vomiting
M & E: Extensively GU:
 Pancreatitis
metabolized by the  Erectile
CV:
liver. Minimal (5–10%) Dysfunction
 Strong Irregular Heart
renal excretion of  Priapism
Beat
unchanged drug.
Half-life: 2–3 hr  Shortness Of Breath
 Fast Heart Rate
 Low Blood Pressure
 Slow Heart Rate
 Chest Pain
 Swelling
Other:
 Fever
Skin:
 Rash
 Flushing
 Allergic Reaction
GU:
 Urinary Frequency
 Urinary Incontinence
EENT:
 Blurred Vision
 Reddened Whites Of The
Eye
 Fluid buildup under the
Retina
 Cataracts
 Eye Pain
 Small Pupil
 Nosebleed
 Nasal Congestion
 Tinnitus
Endocrine:
 Hair Loss
 Gynecomastia
F & E:
 Sweating
Immune:
 Positive Autoimmune
Disease Test (Ana Titer)
MS:
 Joint Pain
Assessment  Advise pt to weigh self twice weekly and assess feet and ankles for fluid retention.
 Be alert for first-dose signs of adverse reactions. Monitor blood pressure. If  Advise pt to avoid driving or other activities requiring alertness until response to the medication is
it falls precipitously with first dose, notify physician promptly. known.
 Full therapeutic effect may not be achieved until 4–6 wk. of therapy  Caution pt to avoid sudden changes in position to decrease orthostatic hypotension. Alcohol, CNS
Potential Nursing Diagnoses: depressants, standing for long periods, hot showers, and exercising in hot weather.
 Risk for injury (Side Effects)  Instruct pt to notify health care professional of medication regimen before any surgery.
 Noncompliance (Patient/Family Teaching)  Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
Implementation:  Hypertension: Emphasize the importance of continuing to take this medication as directed, even if
feeling well. Medication controls but does not cure hypertension.
 May be used in combination with diuretics or beta blockers to reduce sodium  Instruct patient and family on proper technique for BP monitoring. Advise them to check BP at least
and water retention. If these are added to prazosin therapy, reduce dose of weekly and to report significant changes.
prazosin initially and titrate to effect. Evaluation/Desired Outcomes:
 PO: Administer daily dose at bedtime. If necessary, dose may be increased  Decrease in BP without appearance of side effects.
to twice daily.  Decrease in symptoms of prostatic hyperplasia.
 Instruct pt to take medication at the same time each day. Take missed doses
as soon as remembered. If not remembered until next day, omit; do not
double doses.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Trandate Generic Name: Labetalol Drug Classification: Drugs for Gestational Hypertension
Hypertension Blocks alpha1 -, beta1 DRUG: Mild, moderate,  Hypersensitivity to CNS: CNS:
Adult: -, and beta2 - (large May  effects of beta2 - and severe Labetalol  Drowsiness  Fatigue/weakness
PO 100 mg b.i.d., doses) adrenergic adrenergic agonists (e.g., hypertension  Bronchial Asthma  Dizziness  Anxiety
may gradually receptor sites. arformoterol, salmeterol), (alone or in  history of Obstructive  Excessive Fatigue  Depression
increase to 200– theophylline. combination with Airway disease  Weakness  Dizziness
400 mg b.i.d. Therapeutic Effect: other anti-  Cardiogenic Shock
Beta blockers (e.g., carvedilol,  Transient Scalp  Drowsiness
(max: 1200–2400 Slows sinus heart metoprolol), calcium channel hypertensive  Uncompensated HF Tingling  Insomnia
mg/d). rate;  peripheral blockers (e.g., diltiazem, agents, especially  Second- or Third-degree  Insomnia  Memory Loss
IV 20 mg slowly vascular resistance, verapamil), digoxin may  risk thiazide diuretics) heart block  Depression  Mental Status
over 2 min, with and BP. of bradycardia.  Severe Bradycardia  Anxiety Changes
40–80 mg q10min HERBAL:
Pharmacokinetics  Severe, prolonged  Paresthesia  Nightmares
if needed up to Ephedra, ginseng, yohimbe
300 mg total or 2 A: Well absorbed but Hypotension Other:  Paresthesia
may worsen hypertension.
rapidly undergoes Patients with:  Dyspnea EENT:
mg/min Garlic may  antihypertensive  Compensated HF
continuous extensive first-pass CV:  Blurred Vision
effect.  Severe Anaphylaxis to
infusion (max: hepatic metabolism,  Peripheral Edema  Dry Eyes
Licorice may cause water
300 mg total resulting in 25% allergens GI:  Intraoperative
retention,  serum sodium,  Myasthenia Gravis
dose) bioavailability.  Constipation Floppy Iris
and  serum potassium.  Psychiatric disease
Geriatric: D: Some CNS  Diarrhea Syndrome
FOOD: None known.
PO Start with 100 penetration; crosses  Hepatic Impairment  Nausea/Vomiting  Nasal Stuffiness
LAB VALUES:
mg daily the placenta.  Pheochromocytoma  Abdominal Respiratory:
May serum antinuclear
IV 20 mg slowly Protein Binding:  Diabetes Discomfort  Bronchospasm
antibody titer (ANA), BUN,
over 2 min, with 50%.  concurrent use with  Altered taste  Wheezing
M & E: Undergoes LDH, alkaline phosphatase,
40–80 mg q10min digoxin, verapamil, or EENT: CV:
bilirubin, creatinine, potassium,
if needed up to extensive hepatic
triglycerides, lipoprotein, uric
diltiazem  Nasal Congestion  Arrhythmias
300 mg total or 2 metabolism.
acid, ALT, AST.  Arterial obstruction  Dry Eyes  Bradycardia
mg/min Half-life: 3–8hr  Elderly GU:  CHF
continuous  Peripheral Vascular  Diminished Sexual  Pulmonary Edema
infusion (max: disease Function  Orthostatic
300 mg total  Raynaud’s disease  Increased Urination Hypotension
dose) GI:
 Constipation
 Diarrhea
 Nausea
GU:
 Erectile
Dysfunction
  Libido
Skin:
 Itching
 Rashes
Endocrine:
 Hyperglycemia
 Hypoglycemia
MS:
 Arthralgia
 Back Pain
 Muscle Cramps
 Assess baseline renal function, LFT.  Direct IV: Diluent: Administer undiluted. Concentration: 5 mg/mL. Rate: Administer slowly
 Assess B/P, apical pulse immediately before drug administration. over 2 min.
 Question history of bradycardia, HF, second- or third-degree heart block,  Continuous Infusion: Diluent: Add 200 mg of labetalol to 160 mL of diluent. May also be
myasthenia gravis. administered as undiluted drug. Compatible diluents include D5W, 0.9% NaCl, D5/0.9% NaCl,
Potential Nursing Diagnoses: and LR. Concentration: Diluted: 1 mg/mL; Undiluted: 5 mg/mL. Rate: Administer at a rate of 2
 Decreased cardiac output (Side Effects) mg/min. Titrate for desired response. Infuse via infusion pump to ensure accurate dose.
 Noncompliance (Patient/Family Teaching) Patient/Family Teaching:
Implementation:  Do not discontinue drug except upon advice of physician (abrupt discontinuation may precipitate
 High Alert: IV vasoactive medications are inherently dangerous. Before heart failure).
administering intravenously, have second practitioner independently check original  Slowly go from lying to standing.
order, dosage calculations, and infusion pump settings.  Compliance with therapy regimen is essential to control hypertension, arrhythmias.
 Do not confuse labetalol with Lamictal.  Avoid tasks that require alertness, motor skills until response to drug is established.
 Discontinuation of concurrent clonidine should take place gradually, with beta  Report shortness of breath, excessive fatigue, weight gain, prolonged dizziness, and headache.
blocker discontinued first. Then, after several days, discontinue clonidine.  Do not use nasal decongestants, OTC cold preparations (stimulants) without physician approval.
 PO: Take apical pulse prior to administering. If 50 bpm or if arrhythmia occurs,  Limit alcohol.
withhold medication and notify health care professional. Evaluation/Desired Outcomes:
 Administer with meals or directly after eating to enhance absorption.  Decrease in BP.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Apresoline Generic Name: Hydralazine Hydrochloride Drug Classification: Drugs for Gestational Hypertension
Hypertension Direct vasodilating effects on DRUG:  Moderate to  Hypersensitivity CNS: CNS:
Adult: PO 10–50 arterioles. Diuretics (e.g., Severe to Hydralazine  Headache  Dizziness
mg Q.I.D. IM 10– furosemide, HCTZ), Hypertension  Coronary Artery GI:  Drowsiness
50 mg q4– Therapeutic Effect: Decreases other  Early Malignant disease  Anorexia  Headache
6h IV 10–20 mg BP, systemic vascular resistance. antihypertensives Hypertension  Mitral Valvular  Nausea/Vomiting  Peripheral
q4–6h (e.g., amLODIPine,  Resistant Rheumatic Heart  Diarrhea Neuropathy
Geriatric: PO Sta Pharmacokinetics cloNIDine, lisinopril,
A: Rapidly absorbed following oral
Hypertension that disease  Constipation CV:
rt with 10 mg 2–3 valsartan) may  persists after Patients with:  Ileus Edema  Tachycardia
administration; well absorbed from
times/d hypotensive effect. Sympathectomy.  Advanced Renal CV:  Angina
Child: PO 3–7.5 IM sites. HERBAL:
D: Widely distributed. Crosses the
Unlabelled Uses: Impairment  Palpitations  Arrhythmias
mg/kg/d in 4 Ephedra, ginseng,  Acute CHF  Cerebrovascular  Tachycardia  Edema
divided placenta; enters breast milk in yohimbe may  Unexplained Accident  Angina Pectoris  Orthostatic
doses IV/IM 1.7– minimal concentrations. worsen
M&E: Mostly metabolized by the
pulmonary  Suspected  Paresthesia Hypotension
3.5 mg/kg/d in 4 hypertension. hypertension Coronary Artery
GI mucosa and liver by N-  Dizziness GI:
divided doses Garlic may 
acetyltransferase (rate of disease  Muscle Cramps  Diarrhea
antihypertensive  Positive ANA
acetylation is genetically  Anxiety  Nausea/Vomiting
effect. Titer
determined [slow acetylators have Skin: Skin:
FOOD: Any foods  Pulmonary
 hydralazine levels and  risk of  Rash  Rash
may  absorption. Hypertension
toxicity; fast acetylators have  LAB VALUES: May  Urticaria F and E:
hydralazine levels and   Pruritus  Sodium Retention
produce positive
response]). direct Coombs’ test.  Flushing MS:
Half-life: 2–8 hr. Other:  Arthralgias
 Fever  Arthritis
 Chills Other:
MS:  Drug-Induced
 Arthralgia Lupus Syndrome.
EENT:
 Nasal Congestion
 Conjunctivitis
 Obtain BP, pulse immediately before each dose, in addition to regular monitoring.  pH: 3.4–4.0.
Potential Nursing Diagnoses:  Direct IV: Diluent: Administer undiluted. Use solution as quickly as possible after drawing
 Ineffective tissue perfusion (Indications) through needle into syringe. Concentration: 20 mg/mL. Rate: Administer over at least 1 min.
 Noncompliance (Patient/Family Teaching) Pedi: Administer at a rate of 0.2 mg/kg/min in children. Monitor BP and pulse in all patients
Implementation: frequently after injection.
 Do not confuse hydralazine with hydroxyzine. Patient/Family Teaching:
 IM or IV route should be used only when drug cannot be given orally.  To reduce hypotensive effect, go from lying to standing slowly.
 May be administered concurrently with diuretics or beta blockers to permit lower  Report muscle/joint aches, fever (lupus-like reaction), flu-like symptoms.
doses and minimize side effects.  Limit alcohol use.
 PO: Administer with meals consistently to enhance absorption. Evaluation/Desired Outcomes:
 Pharmacist may prepare oral solution from hydralazine injection for patients with  Decrease in BP without appearance of side effects.
difficulty swallowing.  Decreased afterload in patients with HF.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Zestril Generic Name: Lisinopril Drug Classification: ACE Inhibitor
Hypertension Competitive inhibitor DRUG:  Hypertension,  Hypersensitivity to CV: CNS:
Adult: PO 10 mg of angiotensin- Diuretics (e.g., furosemide, alone or lisinopril other ACE  Hypotension  Headache
once/d, may converting enzyme HCTZ) may  hypotensive concomitantly with inhibitors CNS:  Dizziness
increase up to (ACE) (prevents effects. other classes of  History of angioedema  Headache  Fatigue
20–40 mg 1–2 conversion of May  concentration, risk of antihypertensive from treatment with  Fatigue  Drowsiness
times/d (max: 80 angiotensin I to toxicity of lithium. agents ACE inhibitors,  Dizziness  Insomnia
mg/d) angiotensin II, a NSAIDs (e.g., ibuprofen,  CHF idiopathic or hereditary F&E:  Vertigo
Child: PO 6–16 potent ketorolac, naproxen) may   To improve MI angioedema.  Hyperkalemia CV:
y, Start at 0.07 vasoconstrictor; may effects. survival Concomitant use with Respiratory:  Hypotension
mg/kg (max 5 mg) inhibit angiotensin II Potassium-sparing diuretics aliskiren in pts with  Cough  Chest pain
once/d (max: 40 at local vascular, (e.g., spironolactone, diabetes.  Edema
mg/d) renal sites). triamterene), potassium Patients with:
 Tachycardia
Geriatric: PO Initi Decreases plasma supplements may cause  Renal impairment GI:
al 2.5–5 mg/d, angiotensin II, hyperkalemia.  unstented  Nausea/vomiting
may increase by increases plasma May  hypoglycemic effect unilateral/bilateral renal
2.5–5 mg/d every renin activity,  Diarrhea
of oral hypoglycemic artery stenosis
1–2 wk (max: 40 decreases  Anorexia
agents (e.g., glyburide,  volume depletion
mg/d). aldosterone  Constipation
metformin).  ischemic heart disease
secretion.  Intestinal angioedema
HERBAL:  Cerebrovascular
Heart Failure Ephedra, ginseng, licorice,  Taste disturbances
disease
Adult: PO 5–40 Therapeutic Effect:  Abdominal pain
Reduces blood
and yohimbe may worsen  severe aortic stenosis
mg/d hypertension. GU:
 hypertrophic
pressure. Black cohosh, periwinkle  Erectile dysfunction
cardiomyopathy
may  antihypertensive  Proteinuria
Pharmacokinetics  HF
effect.  Renal dysfunction
A: 25% absorbed  systolic B/P less than
FOOD: None known. 100  Renal failure
after oral
LAB VALUES: Hematologic:
administration (much  dialysis, hyponatremia
May  serum BUN, alkaline  Neutropenia
variability).  before, during, or
D: Minimal phosphatase, bilirubin, immediately after major  Agranulocytosis
penetration of CNS. creatinine, potassium, ALT, surgery Skin:
M & E: 100% AST.  Concomitant use of  Flushing
eliminated by the May  serum sodium. potassium  Pruritis
kidneys. supplements.  Rashes
Half-life: 12hr ( in May cause positive ANA Respiratory:
renal impairment) titer.  Dyspnea
 Cough
Skin:
 Rash
Metabolic:
 Azotemia
 Hyperkalemia
 increased BUN &
creatinine
Endocrine:
 Hyperuricemia
MS:
 Back pain
 Muscle cramps
 Myalgia
Other:
 Angioedema
 Fever
Assessment:  PO: For patients with difficulty swallowing tablets, pharmacist may compound oral suspension;
 Place patient in supine position and notify physician if sudden and severe stable at room temperature for 4 wk. Shake suspension before each use.
hypotension occurs within the first 1–5 h after initial drug dose. Patient/ Family Teaching:
 Measure BP just prior to dosing to determine whether satisfactory control is  Discontinue drug and contact physician immediately for severe hypersensitivity reaction (e.g.,
being maintained for 24 h. If the antihypertensive effect is diminished in less than hoarseness, swelling of the face, mouth, hands, or feet, or sudden trouble breathing).
24 h, an increase in dosage may be necessary.  To reduce hypotensive effect, go from lying to standing slowly.
Potential Nursing Diagnoses:  Limit alcohol intake.
 Decreased cardiac output (Indications, Side Effects)  Report vomiting, diarrhea, diaphoresis, swelling of face/lips/tongue, difficulty in breathing, persistent
 Noncompliance (Patient/Family Teaching) cough.
Implementation:  Limit salt intake.
 Do not confuse Zestril with Zegerid, Zetia, or Zyprexa.  Maintain adequate hydration.
 Correct volume depletion, if possible, before initiation of therapy.  Report decreased urinary output, dark-colored urine, swelling of the hands and feet.
 PO: Precipitous drop in BP during first 1–3hr after first dose may require volume  Immediately report allergic reactions, esp. life-threatening swelling of the face or tongue.
expansion with normal saline but is not normally considered an indication for Evaluation/Desired Outcomes:
stopping therapy. Discontinuing diuretic therapy or cautiously increasing salt  Decrease in BP without appearance of excessive side effects.
intake 2–3 days before initiation may  risk of hypotension. Monitor closely for  Decrease in signs and symptoms of HF (some drugs may also improve survival).
at least 1 hr after BP has stabilized. Resume diuretics if BP is not controlled.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Diovan Generic Name: Valsartan Drug Classification: Angiotensin II Receptor Blocker
Hypertension Directly antagonizes DRUG:  Hypertension  Hypersensitivity to CNS: CNS:
Adult: PO 80 angiotensin II NSAIDs (e.g., ibuprofen,  Heart Failure Valsartan  Insomnia  Dizziness
mg q.d. (max: receptors. Blocks ketorolac, and  Concomitant use with  Fatigue  Anxiety
320 mg q.d.) vasoconstrictor, naproxen) may  Aliskiren in pts with  Dizziness  Depression
aldosterone-secreting antihypertensive effects. Diabetes  Headache  Fatigue/ Weakness
Heart Failure effects of angiotensin Potassium-sparing Patients with: CV:  Headache
Adult: PO Start II, inhibiting binding of drugs (e.g.,  Concurrent use of  Heartburn  Insomnia
with 40 mg angiotensin II to AT1 spironolactone, Potassium-Sparing  Edema CV:
B.I.D. and titrate receptors. triamterene), potassium Diuretics or GI:  Hypotension
up to 160 mg supplements may  Potassium  Abdominal pain  Chest pain
B.I.D. Therapeutic Effect: serum potassium. Supplements
Produces vasodilation,  Diarrhea  Edema
Diuretics (e.g.,  Mild to Severe  Nausea/Vomiting  Tachycardia
decreases peripheral furosemide, HCTZ) may Hepatic Impairment
resistance, decreases MS: Skin:
produce additive  Unstented  Arthralgia  Rashes
B/P. hypotensive effects. Bilateral/Unilateral EENT:
HERBAL: Renal Artery
Pharmacokinetics Ginger, ginseng, licorice  Nasal Congestion
Stenosis
Absorption: 10–35%  Pharyngitis
may worsen  Renal Impairment
absorbed following hypertension.  Rhinitis
 Significant
oral administration. Black cohosh, periwinkle  Sinusitis
Distribution: cross Aortic/Mitral
may  antihypertensive GI:
Stenosis
the placenta
effects.  Abdominal Pain
Protein Binding:  Elderly
FOOD: None known.  Diarrhea
>90% protein bound.  Drug-Induced Hepatitis
LAB VALUES:
Metabolism and  Dyspepsia
May  serum bilirubin,
Excretion: Minor
ALT, AST, BUN,  Nausea/Vomiting
metabolism by the GU:
creatinine, potassium.
liver; 13% excreted in
May  Hgb, Hct, and  Impaired Renal Function
urine, 83% in feces.
WBC. F and E:
Half-life: 6hr
 Hyperkalemia
MS:
 Arthralgia
 Back Pain
 Myalgia
Other:
 Angioedema
Assessment  PO: May be administered without regard to meals.
 Monitor BP periodically; take trough readings, just prior to the next Patient/Family Teaching:
scheduled dose, when possible.  Females of childbearing potential must use effective contraception during treatment.
 Lab tests: Monitor liver function tests, BUN and creatinine, serum  Inform physician as soon as possible if pregnancy occurs.
potassium, and CBC with differential, periodically.  Report any sign of infection (sore throat, fever).
Potential Nursing Diagnoses:  Do not stop taking medication.
 Risk for injury (Adverse Reactions) Evaluation/Desired Outcomes:
 Noncompliance (Patient/Family Teaching)  Decrease in BP without appearance of excessive side effects.
Implementation:  Decreased hospitalizations in patients with HF.
 Do not confuse Diovan with Zyban.  Decreased risk of cardiovascular death in patients A with left ventricular systolic dysfunction after MI.
 Correct volume depletion, if possible, prior to initiation of therapy.
Sources:
PHARMACOLOGY
DRUG STUDY
Brand Name: Tekturna Generic Name: Aliskiren Drug Classification: Direct Renin Inhibitor
Hypertension PO: Inhibition of renin DRUG: Hypertension  Hypersensitivity to GI: Respiratory:
Adults, Elderly: results in decreased Cyclosporine, itraconazole (alone or with Aliskiren  Diarrhea in women  Cough
150 mg/day. May  formation of may  concentration/effect. other agents).  Concurrent use with (elderly, older than 65 CV:
to 300 mg/day. angiotensin II, a HERBAL: ACE inhibitor or yrs.)  Hypotension
Renal Impairment powerful Ephedra, ginseng, yohimbe Angiotensin II  Gastroesophageal GI:
Mild to Moderate vasoconstrictor. may worsen hypertension. Receptor Blockers in Reflux  Abdominal Pain
Impairment: Garlic, black cohosh may  pts with diabetes Respiratory:  Diarrhea ( in
No dose Therapeutic Effects: antihypertensive effect. Patients with:  Cough females and
adjustment. Decreased BP. FOOD:  Severe renal Skin: elderly)
Severe High-fat meals substantially impairment  Rash  Dyspepsia
Pharmacokinetics
impairment: Use  absorption.  History of angioedema  Reflux
A: Poorly absorbed
caution. Grapefruit products may  Dialysis Other:
Hepatic (bioavailability 2.5%).
D: Unknown.
reduce antihypertensive  Nephrotic syndrome  Angioedema
Impairment No effects. Separate by 4 hrs.  Renovascular
dose adjustment. M & E: 2% excreted
LAB VALUES: hypertension
unchanged in urine,
May  serum BUN,  Concurrent use with P-
remainder is probably
creatinine, uric acid, glycoprotein inhibitors
metabolized (CYP3A4
creatinine kinase, potassium. (e.g., cyclosporine).
enzyme system).
Half-life: 24 hr. May  Hgb, Hct.
Assessment:  PO: Administer at the same time each day without regard to meals.
 Monitor BP and pulse frequently during initial dose adjustment and periodically during Patient/Family Teaching:
therapy.  Report swelling of face/lips/tongue, difficulty breathing.
 Notify health care professional of significant changes. If an excessive fall in BP  Avoid strenuous exercise during hot weather (risk of dehydration, hypotension).
occurs, place patient in a supine position and administer IV 0.9% NaCl, if necessary.  Do not chew, crush, dissolve, or divide film-coated tablets.
 Monitor frequency of prescription refills to determine adherence. Evaluation/Desired Outcomes:
Potential Nursing Diagnoses:  Decrease in BP without appearance of side effects. Antihypertensive effect is 90% attained by
 Noncompliance (Patient/Family Teaching) 2 wk.
Implementation:
 Correct volume or sodium depletion prior to initiating therapy.
Sources:
Mindanao State University – Iligan Institute of Technology Student: Grace Pikit Bacsan Section: J
PHARMACOLOGY
Drug Study
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Mindanao State University – Iligan Institute of Technology

Brand Name: Nitrostat Generic Name: Nitroglycerin SL Drug Classification: Nitrates

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