DRUG SPIRONOLACTONE (Aldacton)

CLASSIFICATION AND INDICATION Potassium-sparing diuretic Aldosterone antagonist Adunctive therapy in edema associated with CHF, nephritic syndrome, hepatic cirrhosis when other therapies are inadequate or inappropriate

DOSE, ROUTE AND FREQUENCY 25 mg/tab 1 tab

MECHANISM OF ACTION Competitively blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium

CONTRAINDICATIONS Contraindicated with allergy to spironolactone, hyperkalemia, renal disease, anuria, amiloride and triamterene use

SIDE EFFECTS CNS: dizziness, headache, drowsiness, fatgue, ataxia, confusion Derm: Rash GI: Cramping, diarrhea, dry mouth and thirst GU: Impotence, irregular menses HEMA: Hyperkalemia, hyponatremia Hypersensitivity: Rash, anaphylaxis, or angioedema METAB: Hypoglycemia, ketoacidosis

NURSING RESPOSIBILITIES Measure and record regular weight to monitor mobilization of edema fluid Avoid giving foods rich in potassium Give daily dose early so that urination does not interfere with sleep Arrange for regular evaluation of serum electrolytes and BUN Give maintenance doses subcutaneously, rotating injection sites regularly to decrease incidence of lypodystrophy Do not give insulin injection concentrated IV; severe anaphylactic reactions can occur Store insulin in a cool place, away from direct sulight. Refrigeration is referred

HUMULIN-N

Anti-diabetic Hormone Treatment of type 2 DM that cannot be controlled by diet or oral drugs Treatment of hyperglycemia with infusion of glucose to produce a shift f potassium into the cells

28 units in AM 8 units in PM SC BID

Insulin s a hormone secreted by beta cells of the pancreas that by receptormediated effects, promotes the storage of the bodys fuels, facilitating the transfer of metabolites and ions (K) through cell membranes and stimulating the synthesis to glycogen through glucose, of fats from lipids and proteins from amino acids

Conntraindicated with allergy to pork products; history of smoking or lung disease Use cautiously with pregnancy

Metformine Hydrochloride

Anti-diabetic Adjunct to diet to lower blood glucose to type 2 DM in patients >10 years old As part of combination therapy with sulfonylurea insulin

500 mg/tab 1 tab BID

Possibly increases peripheral utilization of glucose, decreases hepatic glucose production, and alters intestinal absorption of glucose

Contraindicated with allergy to metformine; CHF; DM complicated by fever, severe infection and trauma Use cautiously with elderly

Endo: Hypoglycemia, Lactic acidosis GI: Anorexia, nausea and vomiting, epigastric discomfort, heartburn Hypersensitivity: Allergic skin reaction, eczema, pruritus

Epoetin Alfa

Recombinant human erythropoietin Treatment of anemia associated with chronic renal failure, including patients on dialysis

5,000 units SC once a week

A natural glycoprotein produced in the kidneys, which stimulates RBC production in bone marrow

Contraindicated with uncontrolled HPN; hypersensitivity to mammalian callderivate products as yo albumin human Use cautiously with pregnancy, lactation

CNS: Headache, arthralgias, dizziness, seizure, CVA, TIA CV: HPN, edema, chest pain GI: nausea, vomiting, diarrhea

Monitor urine or serum glucose frequently to determine effectiveness of drug and dosage Use IV glucose if severe hypoglycemia occurs as a result of overdose Monitor blood for glucose and ketones as prescribed Avoid using alcohol while taking his drug Report fever, sore fever, unusual bleeding or bruising Gently mimx, do not shake, shaking may denature the glycoprotein. Use only one dose per vial Do not give with any other drug solution Monitor access lines for signs of clotting Keep appointments for blood tests needed to determine the effects of the drug on your blood count

 Isosorbide dinitrate Anti-anginal Nitrate Vasodilator Dinitrate: treatment and prevention of angina pectoris 5 mg/tab 1 tab BID Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial 02 consumption Contraindicated with allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, narrow angle, glaucoma, postural hypotension CNS: Headache, apprehension, weakness, vertigo, dizziness, faintness CV: Tachycardia, hypotension, syncope, angina rebound hypertension DERM: nausea, vomiting, abdominal pain, diarrhea GU: dysuria, impotence, urinary frequency

Atorvastatin Calcium

Anti-hyperlipidemia HMG-CoA reductase inhibitor Adjunct to diet in treatment of elevated total cholesterol in patients with primary

10 mg/tab 1 tab OD of HS

Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum

Contraindicated with allergy to atorvastatin, fungal by products active hepatic disease, or unexplained, and persistent elevation of transminase levels, pregnancy, lactation

CNS: Headache, asthenia GI: flatulence, abdominal pain, cramps, constipation, nausea, LIVER FAILURE Respi: Sinusitis, pharyngitis

and to determine dosage Institute seizure precautions Give sublingual preparations under the tongue, or in buccal pouch; discourage to swallow Create nitrate free period to minimize tolerance Take the isosorbide before chest pain begins, when activities, or situation may precipitate an attack Take with empty stomach Report blurred vision, persistent or severe headache rash Administer drug without regard to food, but at the same time each day Take this drug once a drug once a day, at about the same time each day preferably in the evening, may

hypercholesteremia (type IIa and IIb) Adjunct to diet to treat elevated serum triglyceride levels

HDL, increases hepatic LDL, recapture sites,, enchance reuptake and catabolism of LDL; lowers triglceride levels 650 mg/tab 1 tab TID Increases plasma bicarbonate; buffers excess hydrogen ions concentration; raises blood pH; reverses clinical manifestation of acidosis, increases the exertion of free base in the urin, effectively raising the urinary pH Contraindicated with allergy to components of preparations; low serum chloride (secondary to vomiting, continous GI suction) Use cautiously with impaired renal function, CHF edematous or sodium-retaining states

Other: Rhabdolysis with acute TIF, myalgia

Sodium Bicarbonate

Electrolyte Systemic Alkalinizer Antacid Treatment of metabolic acidosis, with measures to control the cause of the acidosis Adjunctive treatment in severe diarrhea with accompanying loss of bicarbonate

GI: Gastric rupture following ingestion Hema: systemic alkalosis (headache, nausea, irritability, weakness, tetany, confusion)

be taken with food Do not drink grapefruit juice while taking this drug Arrange to have periodic blood test while you are taking this drug Monitor ABG, and calculate, base deficit when administering parenteral NaHCO3 Check serum potassium levels before IV administration Have patient chew oral tablets thoroughly before swallowing, and follow them with a full glass of water Monitor cardiac rhythm carefully during IV administration

Carvediolol

Alpha- and betaadrenergic blocker Antihypertensive Treatmet of metabolic acidosis, with measures to control the cause of

6.25 mg 1 tab OD

Competitively blocks alpha, beta and beta 2 adrenergic receptors and has symphatomemitics activity at beta2 receptors. Both alpha and beta blocking

Contraindicated with decompensated CHF, heart block, cardiogenic shock Use cautiously with hepatic impairment peripheral vascular

the acidosis Adjunctive treatment in severe diarrhea with accompanying loss of bicarbonate

Amlodipine besylate

Calcium channel-blocker Antianginal Antihypertensive Angina pectoris due to coronary artery spasm Chronic stable angina, alone or in combination with other drugs Essential hypertension, alone or in combination with other hypertensive Ketoanalogue Essential amino acid Prevention and therapy of damages due to faulty/ deficient protein metabolism in chronic renal insufficiency

600 mg/tab 1 tab TID

actions contribute to BP-lowering effect beta blockade prevents, the reflex tachycardia seen with most alpha-blocking drugs Inhibits the movement of CA ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane calcim flow; which resultsin the depression of impulse, depression o myocardial contractility

disease

Contraindicated with allergy to amlodipine, impaired hepatic/renal function, sick sinus syndrome heart block Use cautiously with heart failure, pregnancy

CNS: Dizziness, lightheadedness, headache, asthemia, fatigue, lethary CV: peripheral edema, arrhythmias DERM: flushing, rash GIT: Nausea, abdominal discomfort

Take with meals if stomach upset occurs Monitor patients carefully (BP, cardiac rhythm and output) Eat small frequent meals during nausea and vomiting, for headache Report side effects Have a rgular followup visit

Ketosteril

600 mg/tab 1 tab TID

Hypercalcemia, distributed aminoacid metabolism

Hypercalcemia

Give medication with food Instruct the patient to swallow whole the drug and do not chew/crush Monitor serum Ca level

Aproven

Irbesartan 300 mg/tab 1 tab OD For the treatment of essential HPN and treatment of renal disease in patient with HTD, and type 2 DM, as part of an antihypertensive drug regimen

Pregnancy, 2nd, 3rd trimester and lactation

Musculoskeletal trauma and flushing

Angimax

Trimetazidine dihydrdochloric acid Treatment of ischemic, heart disease, angina pectoris, sequelae or infarction Loop diuretics Oral; IV; Edmea assocated with CHF, cirrhosis and renal disease

35 mg/tab BID

Use cautiously with co-administration of MAOI. Impaired renal and hepatic function. Pregnancy and lactation

Administer with or without food Special precautions with intravascular volume depletion, venovascular, HTD, renal impairment, kidney transplantation, hyperkalemia, aortic and mitral valve stenosis Administer drug with meals

Furosemide

40 mg IV OD

Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of the loop of Henle. Leading to a sodiumrich diuresis

Contraindictedwith allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); anuriam severe renal failure; hepatic coma; pregnancy and lactation

CNS: dizziness, vertigo, pareathesias, xanthopsia, weakness, headache, drowsiness CV: orthostatic hypotension, volume depletion thrombophlebitis DERM: Photosensitivity, rash, pruritus GI: nausea and vomiting, oral gastric

Administer with food or milk to prevent GI discomfort Give early in the day so thet increased urination will not disturb sleep Do not expose to light, which may discolor the solution Measure and record weight to monitor fluid changes Arrange to monitor

irritation GU: urinary bladder spasm Aspirin Analgesics Mild to moderate pain Fever Reduction of recurrent TIAs or CVA in maleswith history of TIA or CVA in males with history of TIA due to fibrin platelet emboli 80 mg/tab 1 tab OD Inhibits the synthesis of prostaglandins, important mediators of inflammation Antipyretic effects are not fully understood but aspirin probably acts in the thermoregulation of the hypothalamus Contraindicated with allergy to salicylates or NSAIDS; hemophilia bleeding ulcers. Hemmorhagic states, vitamin K deficiency Use cautiously with impairement renal function Acute aspirin toxicity Aspirin intolerance GI: Nausea, dyspepsia, heart burn, epigastric discomfort, anorexia HEMA: occult blood loss, hemostatic defects

serum electrolytes, hydration, liver and renal function Give drug with food or after meals if GI upset occurs Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus Do not use aspirin that has a strong vinegar odor Do not cut, chew, sustained released products Swallow tablets while Use as a temporary measure Do not take this drug within 1 hr of any other drugs Report sweating, flushing, muscle cramps, excessive thirst Maybe taken with food to reduce GI discomfort Preferably administer before hour of sleep

Dulcolax

Laxative (stimulant)

5 ml OD @ bedtime

Lactulose

Laxative (hyperosmolar) Chronic constipation

30 cc OD HS

The laxative effect occurs upon contact with colonic mucosa, where it stimulates the sensory nerve endings that result to increased peristaltic contracting of the large intestine to production soft, well formed stool Produces on osmotic effect colon; resulting distention promotes peristalsis. Also decreases ammonia

Contraindicated in cases of allergy to these drugs, 3rd trimester of pregnancy, acute abdominal pain

Excessive bowel activity, peripheral irritation, abdominal cramps, weakness, dizziness, cathartic dependence

Galactosemia, bowel obstruction, hypersensitivity Lactuse intolerance

Excessive bowel activity perineal irritation, abdominal cramps, weakness, dizziness, cathartic

probably as result of bacterial degradation which lowers the pH of colon contents

dependence Flatulence, diarrhea

Advice to avoid highfiber food o prevent diarrhea Observe 10Rs Instruct the patient to report side-effects