Drug Study

DRUG STUDY MEDICATI ON

DRUG INDICATION/ CLASSIFICATIO CONTRAINDICA N TION Plavix Platelet Indication (clopidogrel) aggregation -to reduce inhibitor thrombotic events in patients with atherosclerosis documented by recent stroke, MI, or peripheral arterial disease.

MECHANISM OF ACTION

Inhibits the binding of adenosine disphosphate (ADP) to its platelet receptor, impending ADPmediated activation and subsequent Contraindication platelet -Hypersensitivity aggregation. -Severe liver Clopidogrel impairment. irreversibly -Peptic ulcer & modifies the intracranial platelet aADP hemorrhage. receptor.

DOSING AND ADMINISTRATI ON Clopidogrel should be given as a single daily dose of 75 mg with or without food. Route: PO Onset: 2hr Peak: Unknown Duration: 5 days

ADVERSE EFFECTS CNS: headache, dizziness, fatigue, depression, pain CV: edema, hypertension EENT: rhinitis, epistaxis GI: hemorrhage, abdominal pain, dyspepsia, gastritis, constipation, diarrhea, ulcers GU: UTI Hematologic: purpura Muscuskletal: arthralgia Respiratory: bronchitis, coughing, dyspnea, upper respiratory tract infection Skin: rash, pruritus Other: flulike syndrome

NURSING CONSIDERATI OMS Platelet aggregation won’t return to normal for at least 5 days after drug has been stopped. Patient teaching -Advise patient it may take longer than usual to stop bleeding. Tell him to refrain from activities in which trauma and bleeding may occur, and encourage him to wear a seatbelt in a car. -Tell patient to inform all health care providers, including dentists, before undergoing procedures or starting new drug therapy, that he is taking drug.

-Inform patient that drug maybe taken without regard to meals.

Imdur (isosorbide mononitrate)

Antianginals

Indication Acute angina attacks; to prevent situations that may cause anginal attacks Contraindications -Hypersensitivity -Severe cerebral sclerosis -hypotension -relief of acute attacks

Not completely known. Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may increase blood flow through the collateral coronary vessels. Route: PO Onset: ½-4 hr Peak: Unknown Duration: 6-12 hr

30-60 mg (1/2 tab) isosorbide mononitratre using Imdur PO once daily on arising Route: PO Onset: ½-4 hr Peak: Unknown Duration: 6-12 hr

CNS: headache, dizziness, weakness CV: orthostatic hypotension, tachycardia, palpitations, ankle edema, fainting, flushing EENT: SL burning GI: nausea, vomiting Skin: cutaneous vasodilation, rash

-To prevent tolerance, a nitrate free interval of 8-12 hours per day is recommended. The regimen for isosorbide mononitrate is intended to minimize nitrate tolerance by providing a substantial nitrate-free interval. -Monitor BP and intensity and duration of drug response. -Drug may cause headaches, especially at beginning of therapy. Dosage may be reduced temporarily, but tolerance usually develops. Treat headache with

aspirin or acetaminophen. Methemoglobine mia has been seen with nitrates. Symptoms are those of impaired oxygen delivery despite adequate cardiac output and adequate arterial partial pressure of oxygen Patient teaching -Caution patient to take drug regularly, at prescribed, and to keep it accessible at all times -Advise patient that stopping drug abruptly may cause spasm of the coronary arteries with increased angina symptoms and potential risk of heart attack. -Tell patient to

minimize dizziness upon standing up by changing to upright position slowly. Advise him to go up and down stairs carefully and to lie down at first sign of dizziness. -Caution patient to avoid alcohol because it may worsen low blood pressure effects Neobloc (metoprolol tartrate)

Antihyperten sive

Indication -Hypertension -Early intervention in acute MI -Angina pectoris Containdication -Heart block, greater than first degree AV blocks II and III, cardiogenic shock, overt cardiac failure, sinus bradycardia

Unknown. A selective beta blocker that selectively blocks beta1 receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses renin secretion.

100 mg (1/2 tab) once a day Route: PO Onset: 15 min Peak: 1 hr Duration: 6-12 hr

CNS: fatigue, dizziness, depression CV: bradycardia, hypotension, heart failure, AV block, edema GI: nausea, diarrhea Respiratory: dyspnea Skin: Rash

-always check patient’s apical pulse rate before giving drug. If it’s slower than 60 bpm, withhold drug and call prescriber immediately. -in diabetic patients, monitor glucose level closely because drug masks common signs and symptoms of hypoglycemia. -monitor BP frequently; drug

masks common signs and symptoms of shock -beta blockers may mask tachycardia caused by hyperthyroidism. In patients with suspected thyrotoxicosis, taper off beta blocker to avoid thyroid storm. -when stopping therapy, taper dose over 1-2 weeks. Patient teaching -instruct patient to take drug exactly as prescribed and with meals -caution patient to avoid driving and other tasks requiring mental alertness until response to therapy has been established -advise patient to inform dentist or

prescriber about use of this drug before procedures or surgery -tell patients to alert prescriber if shortness of breath occurs Instruct patient not to stop drug suddenly but to notify prescriber about unpleasant adverse reactions. Inform him that drug must be withdrawn gradually over 1 or 2 weeks.

Coversyl (perindopril)

Anithyperten sive ACE inhibitors

Indication -essential hypertension, CHF -prevention of stroke recurrence in combination with Indapamide in patients with a history of cerebrovascular

ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial

- For renally insufficient patients with creatinine clearance 30 ml/min or greater, initially 2 mg PO daily. - 5 mg PO, once daily

CNS: dizziness, asthenia, sleep disorder, paresthesia, depression, somnolence, nervousness, headache, fever CV: palpitations, edema, chest pain, abnormal

-patients with history of angioedema unrelated to ACE inhibitor use may be at increased risk for angioedema during therapy. -if angioedema occurs, stop drug

disease -reduction risk of CV events in patients w/ stable coronary artery disease Contraindication -Hypersensitivity -angioedema -renal impairment -heart failure -ischemic heart disease -cvd -renal or artery stenosis Collagen vascular disease (SLE or scleroderma)

resistance, decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure.

Route: PO Onset: Unknown Peak: 1 hr Duration: Unknown

CG ENT: rhinitis, sinusitis, ear infection, pharyngitis, tinnitus GI: proteinuria, UTI, male sexual dysfunction, menstrual disorder Musculoskeletal: back pain, hypertonia, neck pain, joint pain, myalgia, arthritis, arm or leg pain. Respiratory: cough, URTI Skin: rush Other: viral infection, injury, seasonal allergy

and observe patient until swelling disappears. Antihistamines may relieve swelling of the face and lips. Swelling of the tongue, glottis or throat may cause life threatening airway obstruction. Give prompt treatment, such as epinephrine -monitor cbc with differential for agranulocytosis and neutropenia before therapy, especiallyin renally impaired patients with lupus or scleroderma -severe hypotension can occur when drug is given with diuretics. If possible, stop diuretic 2 to 3 days before starting this drug.

If possible use lower doses of either drug. -in patient who is volume or sodium depleted from prolonged diuretic therapy, dietary sodium restriction, dialysis, diarrhea, or vomiting, correct fluid and sodium deficits before starting drug. -monitor renal function before and periodically throughout therapy -monitor potassium level closely

Patient teaching -inform patient that throat and facial swelling, including swelling of the throat, can occur during therapy, especially with

the first dose. Advise patient to stop taking drug and immediately report any signs or symptoms of swelling of the face, extremities, eyes, lips, or tongue; hoarseness; or difficulty in swallowing or breathing. -advise patient to report promptly any sign or symptom of infection (sore throat) or jaundice (yellowing of eyes or skin). -advise patient to avoid salt substitutes containing potassium unless instructed otherwise by prescriber -caution patient that lightheadedness may occur, especially during first few

days of therapy. Advise patient to report lightheadedness and, if fainting occurs, to stop drug and consult prescriber. -caution patient that inadequate fluid intake or excessive perspiration, diarrhea, or vomiting can lead to an excessive drop in BP. Lipitor (atorvastatin)

Antilipemics

Indication -reduction of elevated total cholesterol and LDL cholesterol, apolopoprotein B and triglycerides in patients with primary hypercholesterole mia, mixed hyperlipidemia, heterozygous and homozygous familial hypercholesterole mia.

Inhibits HMGCoA reductase, an early (and rate-limiting) step in cholesterol biosynthesis.

20 mg once daily Route: PO Onset: Unknown Peak: 1-2 hr Duration: Unknown

CNS: headache, asthenia, insomnia CV: peripheral edema EENT: rhinitis, pharyngitis, sinusitis GI: abdominal pain, dyspepsia, flatulence, nausea, constipation, diarrhea GU: UTI Musculoskeletal: arthritis, arthralgia,

-use only after diet and other nondrug therapies prove ineffective. Patient should follow a standard low-cholesterol diet before and during therapy. -before starting treatment, assess patient for underlying causes for hypercholesterol emia and obtain a baseline lipid

Contraindication -active liver disease or elevated serum transaminases >3 times the upper limit of normal

myalgia Respiratory: bronchitis Skin: rash Other: infection, flulike syndrome, allergic reactions

profile. -obtain periodic liver function test results and lipid levels before staring treatment and at 6 and 12 weeks after initiation, or after an increase in dosage and periodically thereafter. -drug may be given as single dose at any time of day, with or without food. -watch for signs of myositis Patient teaching -teach patient about proper dietary management, weight control, and exercise. Explain their importance in controlling high fat levels -warn patient to avoid alcohol -tell patient to inform prescriber

Vessel due (sulodexide)

Anticoagulan t, antithromboti cs & fibrinolytics

Indication -vascular pathologies with thrombotic risk, transient ischemic attacks and CVD, peripheral vascular insufficiency, diabetic retinopathy, myocardial infarction, retinal vassal thrombosis Contraindication - Hypersensitivity to sulodexide, heparin & heparin- like products. Diathesis & hemorrhagic diseases.

Inhibits coagulation by attacking several sites of the coagulation system. Its effect is dependent on the presence of antithrombin III, an alpha 2globulin whose activity is augmented by heparin. The heparinantithrombin complex inactivates factors IXa, Xa, XIa and XIIa, and prevents thrombin formation. Furthermore, the complex

Acute cases 1 amp 10-20 days once daily followed by 1-2 cap bid 30 mins before meals for 60-90 days. Chronic cases1-2 cap bid 30 mins before meals for 60-90 days.

Cap GI disorders: nausea, vomiting, epigastralgia. Amp Pain, burn, hematoma at the site of injection.

of adverse reactions, such as muscle pain, malaise, and fever -advise patient that drug can be taken at any time of day, without regard to meals. -Assess patients for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac- positive stools). Notify physician if these occur. -Monitor patient for hypersensitivity reactions (chills, fever, urticaria). Report signs to physician -Subcutaneous: observe injection sites for

reverses the effect of already formed thrombin. In high concentrations, heparin also inhibits thrombocyte aggregation.

Humulin N [(Human insulin – recombinant DNA origin) Isophane suspension]

Hormone Intermediateacting Insulin

Indication -Treatment of type 1 (insulindependent) diabetes -Treatment of type 2 (non– insulindependent) diabetes that cannot be controlled by diet or oral agents -Treatment of severe ketoacidosis or diabetic coma (regular insulin injection) -Treatment of

Insulin is a hormone secreted by the pancrease that, by receptormediated effects, promotes the storage of the body's fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats

hematomas, ecchymosis, or inflammation. -Monitor platelet count every 2-3 days throughout therapy. May cause mild thrombocytopeni a, which appears on the 4th day and resolves despite continued heparin therapy. 6 units in AM 4 units in PM Route: SQ Onset: 1-1.5 hr Peak: 4-12 hr Duration: 24 hr

Hypersensitivit y: Rash, anaphylaxis or angioedema -Local: Allergy— local reactions at injection site —redness, swelling, itching; usually resolves in a few days to a few weeks; a change in type or species source of insulin may be tried; lipodystrophy; pruritus -Metabolic:

-Ensure uniform dispersion of insulin suspensions by rolling the vial gently between hands; avoid vigorous shaking. -Give maintenance doses SC, rotating injection sites regularly to decrease incidence of lipodystrophy; give regular insulin IV or IM in severe ketoacidosis or

hyperkalemia with infusion of glucose to produce a shift of potassium into the cells -Highly purified and human insulins promoted for short courses of therapy (surgery, intercurrent disease), newly diagnosed patients, patients with poor metabolic control, and patients with gestational diabetes -Insulin injection concentrated indicated for treatment of diabetic patients with marked insulin resistance (requirements of > 200 units/day) -Glargine (Lantus): Treatment of adult patients with type 2 diabetes who

from lipids, and proteins from amino acids.

Hypoglycemia; ketoacidosis

diabetic coma. -Do not give insulin injection concentrated IV; severe anaphylactic reactions can occur. -Use caution when mixing two types of insulin; always draw the regular insulin into the syringe first; if mixing with insulin lispro, draw the lispro first; use mixtures of regular and NPH or regular and Lente insulins within 5–15 min of combining them; Lantus insulin (insulin glargine) cannot be mixed in solution with any other drug, including other insulins. -Double-check, or have a colleague check, the dosage drawn up

require basal insulin control of hyperglycemia -Treatment of adults and children > 6 yr who require baseline insulin control Contraindication -Contraindicated with allergy to pork products (varies with preparations; human insulin not contraindicated with pork allergy). -Use cautiously with pregnancy (keep patients under close supervision; rigid control is desired; following delivery, requirements may drop for 24– 72 hr, rising to normal levels during next 6 wk); lactation (monitor mother carefully; insulin requirements

for pediatric patients, for patients receiving concentrated insulin injection, or patients receiving very small doses; even small errors in dosage can cause serious problems. -Carefully monitor patients being switched from one type of insulin to another carefully; dosage adjustments are often needed. Human insulins often require smaller doses than beef or pork insulin; monitor cautiously if patients are switched; lispro insulin is given 15 min before a meal. -Store insulin in a cool place away from direct sunlight.

may decrease during lactation).

Refrigeration is preferred. Do not freeze insulin. Insulin prefilled in glass or plastic syringes is stable for 1 wk refrigerated; this is a safe way of ensuring proper dosage for patients with limited vision or who have problems with drawing up insulin. -Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage. Patients can learn to adjust insulin dosage on a sliding scale based on test results. -Monitor insulin needs during times of trauma or severe stress; dosage adjustments may be needed.

-Keep life support equipment and glucose readily available to deal with ketoacidosis or hypoglycemic reactions. Patient teaching -Use the same type and brand of syringe; use the same type and brand of insulin to avoid dosage errors. -Do not change the order of mixing insulins. Rotate injection sites regularly (keep a chart) to prevent breakdown at injection sites. -Dosage may vary with activities, stress, diet. Monitor blood or urine glucose levels, and consult physician if problems arise. -Store drug in the refrigerator or in

a cool place out of direct sunlight; do not freeze insulin. -If refrigeration isn't possible, drug is stable at controlled room temperature less than 30° C (86° F) and out of direct sunlight for up to 28 days; do not freeze insulin. -Monitor your urine or blood for glucose and ketones as prescribed. -Wear a medical alert tag stating that you are a diabetic taking insulin so that emergency medical personnel will take proper care of you. -Avoid alcohol; serious reactions can occur. -Report fever, sore throat, vomiting, hypoglycemic or

hyperglycemic reactions, rash. Recormon (epoeitin beta)

Indication -treatment of anemia assoc w/ chronic renal failure on or not on dialysis and malignancy on or not on chemotherapy Contraindication -Folic acid and vit b12 deficiencies -severe Al overload -Nephrosclerosis -serum K and phosphate; stop if K incr. and BP incr.

Mimics effects of erythropoietin. Functions as growth factor, enhancing RBC production

5000 units, twice a week Route: SQ Onset: unknown Peak: 5-24 hr Duration: unknown

CNS: headache, seizures, paresthesia, fatigue, dizziness, asthenia CV: hypertension, edema, increased clotting of arteriovenous grafts EENT: pharyngitis GI: nausea, vomiting, diarrhea, abdominal pain. Metabolic: hyperuricemia, hyperkalemia, hyperphosphate mia Respiratory: cough, shortness of breath Skin: rash, infection site reactions, urticaria Other: pyrexia

-before starting therapy, evaluate patient’s iron status. Patient should receive adequate iron supplementation beginning no later than when epoetin treatment starts and continuing throughout therapy. Patient also may need vitamin B12 and folic acid -monitor BP before therapy. Most patients with chronic renal failure have hypertension. BP may Increase, especially when hematocrit increases in the early part of therapy -institute diet restrictions or drug therapy to

control BP -monitor hemoglobin level twice weekly until it stabilizes in the target range (10 to 12 g/dl for most patients) and maintenance dose is established, then continue to monitor at regular intervals. Resume twice weekly testing following any dosage adjustments -reduce dosage in patients who have an increase in hemoglobin level of more than 1 g/dl in any 2 week period -monitor blood counts; elevated hematocrit may cause excessive clotting -patient may need additional heparin to prevent clotting

during dialysis treatments -evaluate patient who experiences a loack or loss of effect for pure red cell aplasia Patient teaching -inform patient that pain or discomfort in limbs (long bones) and pelvis, and coldness and sweating may occur after injection (usually within 2 hours) symptoms may last for 12 hours and then disappear -advise patient to avoid driving or operating heavy machinery at start of therapy. There may be a relationship between too rapid increase hematocrit and seizures -tell patient to

monitor BP at home and adhere dietary restrictions

NaHCO3

Indication -metabolic acidosis -systemic or urinary alkalinization -antacid -cardiac arrest Contraindication -patient with metabolic or respiratory alkalosis and in those with hypocalcemia in which alkalosis

Restores buffering capacity of the body and neutralizes excess acid.

650 mg TID Route: PO Onset: unknown Peak: unknown Duration: unknown

CNS: tetany CV: edema GI: gastric distention, belching, flatulence Metabolic: hypokalemia, metabolic alkalosis, hypernatremia, hyperosmolarity with overdose Skin: pain, and irritation at injection site

-to avoid risk of alkalosis, obtain blood pH, partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide, and electrolyte levels. Tell prescribe laboratory results -oral products may contain 27% sodium Patient teaching -tell patient not

may produce tetany, hypertension, seizures, or heart failure -patients losing chloride because of vomiting or continuous GI suction and in those receiving diuretics that produce hypochloremic alkalosis. Oral drug is contraindicated for acute ingestion of strong mineral acids -Use with caution in patients with renal insufficiency, heart failure, or other edematous or sodiumretaining condition.

to take drug with milk because doing so may cause high levels of calcium in the blood, abnormally high alkalinity in tissues and fluids, or kidney stones.