DRUG STUDY

GENERIC NAME: LISINOPRIL

BRAND NAME: PRINIVIL
CLASSIFICATION: ACE INHIBITOR

INDICATION:
 Lisinopril is indicated for the treatment of acute myocardial infarction
 hypertension in patients ≥6 years
 and as an adjunct therapy for heart failure

NURSING RESPONSIBILITIES:
Assessment:
 History: Allergy to lisinopril or enalapril, impaired renal function, CHF, salt or volume depletion,
lactation, pregnancy
 Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel
sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC and differential
Interventions
 Check doctor’s order
 Begin drug within 24 hr of acute MI; ensure that patient is also receiving standard treatment (eg,
aspirin, beta-adrenergic blockers, thrombolytics).
 WARNING: Keep epinephrine readily available in case of angioedema of the face or neck region;
if breathing difficulty occurs, consult physician, and administer epinephrine.
 WARNING: Alert surgeon, and mark patient’s chart with notice that lisinopril is being taken. The
angiotensin II formation subsequent to compensatory renin release during surgery will be
blocked. Hypotension may be reversed with volume expansion.
 Monitor patients on diuretic therapy for excessive hypotension following the first few doses of
lisinopril.
 Monitor patients closely in any situation that may lead to a decrease in BP secondary to
reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because
excessive hypotension may occur.
  Arrange for reduced dosage in patients with impaired renal function.
 BLACK BOX WARNING: Suggest the use of contraceptives; if pregnancy should occur, discontinue
drug as soon as possible.
Teaching points
 Take this drug once a day. It may be taken with meals. Do not stop taking without consulting
your health care provider.
 Be careful with any conditions that may lead to a drop in blood pressure (such as diarrhea,
sweating, vomiting, dehydration). If light-headedness or dizziness occurs, consult your health
care provider.
 Do not take this drug during pregnancy; use of contraceptive measures is advised.
 You may experience these side effects: GI upset, loss of appetite, change in taste perception
(may be transient; take with meals); rash; fast heart rate; dizziness, light-headedness (transient;
change position slowly, and limit activities to those that do not require alertness and precision);
headache, fatigue, sleeplessness.
 Report mouth sores; sore throat; fever; chills; swelling of the hands or feet; irregular heartbeat;
chest pains; swelling of the face, eyes, lips, or tongue; and difficulty breathing.
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METOPROLOL

GENERIC NAME: METOPROLOL TARTRATE

BRAND NAME: METRATE
CLASSIFICATION: BETA-BLOCKER/ ANTIHYPERTENSIVE/ ANTI-ANGINAL

INDICATION:
 Metoprolol is indicated for the treatment of angina, heart failure, myocardial infarction, atrial
fibrillation, atrial flutter and hypertension.
 Some off-label uses of metoprolol include supraventricular tachycardia and thyroid storm.1
 All the indications of metoprolol are part of cardiovascular diseases
Nursing Responsibilities:
 Check doctor’s order
 Before giving the medication check BP
 Monitor BP, ECG, and pulse frequently during dose adjustment and periodically during therapy.
 Monitor frequency of prescription refills to determine compliance.
 Monitor vital signs and ECG every 5–15 min during and for several hrs after parenteral
administration. If heart rate <40 bpm, especially if cardiac output is also decreased, administer
atropine 0.25–0.5 mg IV.
 Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of
HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).

GENERIC NAME: SPIRONOLACTONE

BRAND NAME: SPIROS/ ALDACTONE
CLASSSIFICATION: ALDOSTERONE ANTAGONIST/ Potassium-sparing diuretic

INDICATION:
 Diagnosis and maintenance of primary hyperaldosteronism
 Adjunctive therapy in edema associated with CHF, nephrotic syndrome, hepatic cirrhosis when
other therapies are inadequate or inappropriate
 Treatment of hypokalemia or prevention of hypokalemia in patients who would be at high risk if
hypokalemia occurred: Digitalized patients, patients with cardiac arrhythmias
 Essential hypertension, usually in combination with other drugs

NURSING RESPONSIBILITES:
Assessment
 History: Allergy to spironolactone; hyperkalemia; renal disease; pregnancy, lactation
  Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength; P, baseline ECG, BP;
R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns,
menstrual cycle; CBC, serum electrolytes, renal function tests, urinalysis
Interventions
 Mark calendars of edema outpatients as reminders of alternate day or 3- to 5-day/wk therapy.
 Give daily doses early so that increased urination does not interfere with sleep.
 Make suspension as follows: Tablets may be pulverized and given in cherry syrup for young
children. This suspension is stable for 1 mo if refrigerated.
 Measure and record regular weight to monitor mobilization of edema fluid.
 Avoid giving food rich in potassium.
 Arrange for regular evaluation of serum electrolytes and BUN.
Teaching points
 Record alternate-day therapy on a calendar, or prepare dated envelopes. Take the drug early
because of increased urination.
 Weigh yourself on a regular basis, at the same time and in the same clothing, and record the
weight on your calendar.
 Avoid foods that are rich in potassium (fruits, Sanka); avoid licorice.
 You may experience these side effects: Increased volume and frequency of urination; dizziness,
confusion, feeling faint on arising, drowsiness (avoid rapid position changes, hazardous
activities: such as driving, using alcohol); increased thirst (suck on sugarless lozenges; use
frequent mouth care); changes in menstrual cycle, deepening of the voice, impotence,
enlargement of the breasts can occur (reversible).
 Report weight change of more than 3 pounds in 1 day, swelling in your ankles or fingers,
dizziness, trembling, numbness, fatigue, enlargement of breasts, deepening of voice, impotence,
muscle weakness, or cramps.
GENERIC NAME: furosemide
BRAND NAME: LASIX
CLASSIFICATION: LOOP DIURETICS

INDICATIONS:
 Furosemide is used to reduce extra fluid in the body (edema) caused by conditions such as heart
failure, liver disease, and kidney disease. This can lessen symptoms such as shortness of breath
and swelling in your arms, legs, and abdomen.
 This is also used to treat high blood pressure.

NURSING RESPONSIBILITIES:
CLINICAL ALERT! Name confusion has occurred between furosemide and torsemide; use
extreme caution.

Assessment
 History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion anuria, severe
renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation, pregnancy
 Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses, baseline ECG, BP,
orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds;
urinary output patterns; CBC, serum electrolytes (including calcium), blood sugar, LFTs, renal
function tests, uric acid, urinalysis, weight
Interventions
 BLACK BOX WARNING: Profound diuresis with water and electrolyte depletion can occur; careful
medical supervision is required.
 CHECK DOCTOS ORDER
 CHECK BP BEFORE GIVING THE MEDICATION
 Administer with food or milk to prevent GI upset.
 Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds.
 Give early in the day so that increased urination will not disturb sleep.
 Avoid IV use if oral use is at all possible.
 WARNING: Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
 Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.
 Discard diluted solution after 24 hr.
 Refrigerate oral solution.
 Measure and record weight to monitor fluid changes.
 Arrange to monitor serum electrolytes, hydration, liver and renal function.
 Arrange for potassium-rich diet or supplemental potassium as needed.
 Teaching points
 Record intermittent therapy on a calendar or dated envelopes. When possible, take the drug
early so increased urination will not disturb sleep. Take with food or meals to prevent GI upset.
  Weigh yourself on a regular basis, at the same time and in the same clothing, and record the
weight on your calendar.
 Blood glucose levels may become temporarily elevated in patients with diabetes after starting
this drug.
 You may experience these side effects: Increased volume and frequency of urination; dizziness,
feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, like
driving; and consumption of alcohol); sensitivity to sunlight (use sunglasses, wear protective
clothing, or use a sunscreen); increased thirst (suck on sugarless lozenges; use frequent mouth
care); loss of body potassium (a potassium-rich diet or potassium supplement will be needed).
 Report loss or gain of more than 3 pounds in 1 day, swelling in your ankles or fingers, unusual
bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps.

GENERIC NAME: Albuterol Sulfate

BRAND NAME: AccuNeb, Novo-Salmol (CAN), Proventil, Proventil HFA, Salbutamol (CAN), Ventodisk
(CAN), Ventolin HFA
CLASSIFICATION: Sympathomimetic, Beta2-selective adrenergic agonist, Bronchodilator, Antiasthmatic

INDICATION:
 Relief and prevention of bronchospasm in patients with reversible obstructive airway disease
 Inhalation: Treatment of acute attacks of bronchospasm
 Prevention of exercise-induced bronchospasm
  Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients; seems to lower
potassium concentrations when inhaled by patients on hemodialysis.

NURSING RESPONSIBILITIES:
Assessment
 History: Hypersensitivity to albuterol; tachyarrhythmias, tachycardia caused by digitalis
intoxication; general anesthesia with halogenated hydrocarbons or cyclopropane; unstable
vasomotor system disorders; hypertension; coronary insufficiency, CAD; history of CVA; COPD
patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidism;
history of seizure disorders; psychoneurotic individuals; lactation
 Physical: Weight; skin color, T, turgor; orientation, reflexes, affect; P, BP; R, adventitious sounds;
blood and urine glucose, serum electrolytes, thyroid function tests, ECG

Interventions
 CHECK DOCTORS ORDER
 Use minimal doses for minimal periods; drug tolerance can occur with prolonged use.
 Maintain a beta-adrenergic blocker (cardioselective beta-blocker, such as atenolol, should be
used with respiratory distress) on standby in case cardiac arrhythmias occur.
 Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline;
deliver over 5–15 min by nebulization.
 Do not exceed recommended dosage; administer pressurized inhalation drug forms during
second half of inspiration, because the airways are open wider and the aerosol distribution is
more extensive.
Teaching points
 Do not exceed recommended dosage; adverse effects or loss of effectiveness may result. Read
the instructions that come with respiratory inhalant.
 You may experience these side effects: Dizziness, drowsiness, fatigue, headache (use caution if
driving or performing tasks that require alertness); nausea, vomiting, change in taste (eat
frequent small meals); rapid heart rate, anxiety, sweating, flushing, insomnia.
 Report chest pain, dizziness, insomnia, weakness, tremors or irregular heartbeat, difficulty
breathing, productive cough, failure to respond to usual dosage.
Generic Name: PARACETAMOL
BRAND NAME: IFIMOL
CLASSIFICATION: ANALGESIC/ANTIPYRETYIC

INDICATION:
 Very high fever, only when oral administration is not possible
 Mild pain, only when oral administration is not possible

NURSING RESPONSIBILITIES:
 CHECK DOCTORS ORDER
 ASSESS PATIENT FOR HIGH FEVER/ CHECK TEMPERATURE FOR MORE THAN 38 DEGREE CELCIUS
 Check that the patient is not taking any other medication containing paracetamol.
 Evaluate therapeutic response of drugs