NAME OF DRUG

ACTION

INDICATION

SIDE EFFECT ADVERSE REACTION Side effect: >Flushing >Headache >Palpitations >Dizziness >Fatigue. >Peripheral edema >Nausea >Vomiting

NURSING REPONSIBILITIES

GENERIC NAME: Felodipine

BRAND NAME: Plendil CLASSIFICATIO N: Cardio/ Antihypertensives/ Calcium Antagonists DOSAGE: Adults PO . 5mg OD

Action: >Felodipine is known as a calcium channel blocker. By blocking calcium, this medication relaxes and widens blood vessels so blood can flow more easily.

>Advise patient that dose of medication may be adjusted to obtain max benefit. >Advise patient to take once daily regularly with food or on an empty stomach. Caution patient Contraindication: to swallow tablets whole >Pregnancy. Unstable angina, and not to crush, chew, significant aortic stenosis, w/in 1 cut, or break. month of myocardial infarction. Rarely: >Inform patient that drug Hypersensitivity. >Tachycardia controls, but does not cure, >Palpitations hypertension or angina and >Syncope Precaution : to continue taking as >Hypotension. Eldery. Impaired >Rash prescribed even when BP hepatic function. Withdraw if >Pruritus. is not elevated or angina ischaemic pain occurs or existing pain worsens shortly after Adverse Reaction: symptoms are not present. >Caution patient not to initiating treatment or if Cardiovascular change or stop taking the cardiogenic shock develops. dose unless advised by Grapefruit juice should be Palpitation (at least health care provider. avoided since it may cause an 1.5%). >Instruct patient to increase in felodipine plasma continue taking other BP concentrations. CNS medications as prescribed by health care provider. Asthenia, dizziness, >Instruct patient who also headache, has angina to notify health paresthesia (at least care provider if frequency Indication: >Treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.

1.5%). Dermatologic Flushing, rash (at least 1.5%). EENT Rhinorrhea, sneezing (at least 1.5%). GI Constipation, dyspepsia, nausea (at least 1.5%). Respiratory Cough, upper respiratory infection (at least 1.5%). Miscellaneous Peripheral edema, warm sensation (at least 1.5%).

or severity of chest pain, or need for sublingual nitroglycerin appears to be increasing. >Instruct patient in BP and pulse measurement skills. >Advise hypertensive patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. >Also advise patient to take record of BP and pulse to each follow-up visit. >Instruct patient to lie or sit down if experiencing dizziness or lightheadedness while standing. >Advise patient to notify health care provider if any of the following occur: frequent episodes of dizziness when arising, swelling of lower legs or ankles, persistent fatigue, any other unusual or unexplained symptoms or signs. >Advise patient that medication can cause gum

swelling but that good dental hygiene reduces the risk and severity. >Emphasize to hypertensive patient the importance of other modalities on BP: weight control, regular exercise, smoking cessation, and moderate intake of alcohol and salt.

GENERIC

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NURSING

NAME: Allopurinol BRAND NAME: Llanol

>Reduces uric acid production by inhibiting biochemical reactions preceding its formation.

Gout Preparations Analgesics Uricosurics DOSAGE: PO 100mg 1 tab BID

>Prevention of attack of gouty arthritis and nephropathy. >Treatment of secondary hyperuricemia which may occur during treatment of tumors or leukemia. >Prevention of recurrent calcium oxalate calculi Special precaution: >Discontinue immediately at the first appearance of rash or any sign that may indicate an allergic reaction. Severe hypersensitivity reactions such as exfoliative, urticarial and purpuric lesions as well as Stevens-Johnson syndrome and/or generalized vasculitis have been reported following appearance of rash. Patients under treatment for hypertension or cardiac insufficiency, such as with diuretics or ACE inhibitors; reversible clinical hepatotoxicity. Contraindication: Hypersensitivity to Drug.

> Gastrointestinal disturbances >skin reactions (e.g., pruritic maculopapular rash) > alterations in liver function test results.

REPONSIBILITIES: >monitor serum uric acid levels to evaluate drugs effectiveness >monitor fluid intake and output; daily urine output of at least 2 liters and maintenance of neutral or slightly alkaline urine are desirable >periodically monitor CBC and hepatic and renal function, especially at start of therapy, as ordered >If renal insufficiency occurs at any time during treatment, be prepared to reduce dosage, as ordered. >Optimal benefits may require 2-6 weeks of therapy. Because acute gouty attacks occur during this time, concurrent use of colchicines may be prescribed prophylactically. >To minimize GI

Adverse Reaction: >Dermatologic: Rash >Endocrine & metabolic: Gout (acute) >Gastrointestinal: Diarrhea, nausea >Hepatic: Alkaline phosphatase increased, liver enzymes increased

disturbance, tell patient to take with or immediately after meals. >Encourage the patient to drink plenty of fluids while taking this drug unless otherwise contraindicated. >Drug may cause drowsiness, tell patient not to drive or perform hazardous tasks requiring mental alertness until CNS effects of the drug are known. >If the patient is taking allopurinol for treatment of recurrent calcium oxalate stones, advise him to also reduce his dietary intake of animal protein, sodium, refined sugars, oxalate-rich foods, and calcium. >Tell patient to discontinue at first sign of rash, which may precede severe hypersensitivity or other adverse reaction.

Rash is more common in patient taking diuretics and in those with renal disorders. Tell the patient to report all adverse reactions.

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NAME: Trimetazidine BRAND NAME: Vastarel MR CLASSIFICATIO N: Anti-Anginal DOSAGE: PO 35mg BID 1 tab in morning and evening.

>Trimetazidine is an anti-ischemic (antianginal) metabolic agent, which improves myocardial glucose utilization through inhibition of fatty acid metabolism. > By preserving the energy metabolism in cells exposed to hypoxia or ischemia, trimetazidine prevents a decrease in intracellular adenosine triphosphate levels, thereby ensuring the proper functioning of ionic pumps and transmembranous sodium-potassium flow whilst maintaining cellular homeostasis. It also inhibits oxidation of fatty acid in blood vessels. > increases coronary flow reserve, thereby delaying the onset of ischemia associated with exercise, limits rapid swings in blood pressure

>Preventive treatment for angina pectoris episodes. >Treatment of vertigo and tinnitus as well as visual disorders with a circulatory origin.

>Nausea >vomiting >GI disorders >Fever >Rash >Respiratory illness >Anemia.

Precaution: >This drug is not a curative treatment for angina attacks, nor is it indicated as an initial treatment for unstable angina, or myocardial infarction. In the event of an angina attack, the coronaropathy should be reevaluated and an adaptation of the treatment considered (drug treatment and possibly revascularisation). Contraindication: >Do not take Vastarel MR if you are allergic to any of the constituents. This drug is generally not recommended during breast feeding

>Assess location, duration and intensity of anginal pain >Monitor BP and PR before and after administering the drug >Notify prescribing signs of heart failure such as swelling of the hands and feet or shortness of breath >Instruct to avoid strenuous or hazardous activities requiring alertness to prevent risks of falls and injury > Tablets should be taken at mealtimes with a full glass of water.

without any significant variations in heart rate, >significantly decreases the frequency of angina attacks, and leads to a significant decrease in the use of nitrates. > It improves left ventricular function in diabetic patients with coronary heart disease.

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NURSING RESPONSIBILITIES

furosemide Brand Name: Lasix Classification: Electrolytic and water balance agent Loop diuretic Dose, Route, IV 20g

Rapid-acting potent sulfonamide loop diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow.

>Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis. CONTRAINDICATIONS >History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation.

>Low blood pressure, >Dehydration and electrolyte depletion.

>Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. >Monitor BP during periods of diuresis and through period of dosage adjustment. >Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. >Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. >Monitor for S&S of hypokalemia.

Adverse Reaction: >CV: Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse. >Metabolic: Hypovolemia, dehydration, hyponatremia hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia.

>GI: Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis, jaundice. >Urogenital: Allergic interstitial nephritis, irreversible renal failure, urinary frequency. >Hematologic: Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis (rare). Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision.

>Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions. >Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia. >Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents. Patient & Family Education >Consult physician regarding allowable salt and fluid intake.

Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis). Body as a Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site.

>Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or prevent potassium depletion. >Learn S&S of hypokalemia. Report muscle cramps or weakness to physician. >Make position changes slowly because high doses of antihypertensive drugs taken concurrently may produce episodes of dizziness or imbalance. >Avoid replacing fluid losses with large amounts of water. >Avoid prolonged exposure to direct sun. >Do not breast feed while taking this drug.

Nursing Responsibilities: Generic Name: Action: Indication: Side Effect/ >Patients who have

Ketorolac Brand Name: Toradol Classification: Nonsteroidal antiinflammatory agents, nonopioid analagesics Dose, Route, IV 30mg q8 2 doses

>Inhibits prostaglandin synthesis, producing peripherally mediated analgesia. >Also has antipyretic and anti-inflammatory properties. >Therapeutic effect:Decreased pain

>Short term management of pain (not to exceed 5 days total for all routes combined) Contraindication: >Hypersensitivity >Cross-sensitivity with other NSAIDs may existPre- or perioperative use >Known alcohol intolerance Use cautiously in: 1) History of GI bleeding 2) Renal impair-ment (dosage reduction may be required) 3) Cardiovascular disease.

Anverse reaction CNS: 1) drowsiness 2) abnormal thinking 3) dizziness 4) euphoria 5) headache RESP: 1) asthma 2) dyspnea CV: 1) edema 2) pallor 3) vasodilation GI: 1) GI Bleeding 2) abnormal taste 3) diarrhea 4) dry mouth 5) dyspepsia 6) GI pain 7) nausea GU: 1) oliguria 2) renal toxicity 3) urinary frequency

asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. >Assess for rhinitis, asthma, and urticaria.

> Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration.

> Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. >Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional.

>Advise patient to consult

DERM: 1) pruritis 2) purpura 3) sweating 4) urticaria HEMAT: 1) prolonged bleeding time > LOCAL: 1) injection site pain - NEURO: 1) paresthesia - MISC: 1) allergic reaction, anaphylaxis

if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur.

>Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

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Nursing Responsibilities: >Lab tests: Perform C&S tests prior to therapy. Monitor periodically liver

Meropenem Brand Name: Merrem Classification: antiinfective; carbapenem antibiotic Dose, Route, IV q12

>Meropenem exerts its action by penetrating bacterial cells readily and interfering with the synthesis of vital cell wall components, which leads to cell death. >Meropenem is bactericidal except against Listeria monocytogenes where it is bacteriostatic. It inhibits bacterial wall synthesis like other betalactam antibiotics.

>used in the treatment of infections of the abdomen, such as appendicitis and peritonitis, bacterial meningitis (infection of the lining of the brain), and skin infections. >used to treat a wide variety of bacterial infections. This medication is known as a carbapenem-type antibiotic. It works by stopping the growth of bacteria. Precaution: Before using meropenem, tell your doctor or pharmacist if you are allergic to it; or to penicillins or cephalosporins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (e.g., seizures, head injury, tumor), kidney disease, stomach/intestinal diseases (e.g., colitis).Kidney function declines as you grow older. This medication is removed by the

Adverse reaction >allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives) >seizures >severe or watery diarrhea; >skin rash; >unusual tiredness or weakness; or >unusual bleeding or bruising. Less serious side effect: >nausea or vomiting; >diarrhea or constipation >headache

and kidney function. >Determine history of hypersensitivity reactions to other beta-lactams, cephalosporins, penicillins, or other drugs. >Discontinue drug and immediately report S&S of hypersensitivity. >Report S&S of superinfection or pseudomembranous colitis. >Monitor for seizures especially in older adults and those with renal insufficiency. Patient & Family Education >Learn S&S of hypersensitivity, superinfection, and pseudomembranous colitis; report any of these to physician promptly. >Do not breast feed while

kidneys. Therefore, elderly people may be at greater risk for side effects while using this drug.Tell your doctor if you are pregnant before using this medication.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

>soreness, redness, or mild swelling at the injection site.

using this drug.

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Nursing Responsibilities: >Monitor BR closely. Determine positional changes (supine, sitting,

CLONIDINE HYDROCHLORID E Brand Name: Catapres Classification: cardiovascular agent; centralacting antihypertensive; analgesic Dose, Route, PRN:q6 If BP is > or = 150/100 Sublingual

>Centrally acting antiadrenergic derivative. Stimulates alpha2-adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys.

>Step 2 drug in stepped-care approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain. Contraindication: >Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa, scleroderma, SLE

CV: Hypotension (epidural), postural hypotension (mild), peripheral edema, ECG changes, tachycardia, bradycardia, flushing, rapid increase in BP with abrupt withdrawal. GI: Dry mouth, constipation, abdominal pain, pseudo-obstruction of large bowel, altered taste, nausea, vomiting, hepatitis, hyperbilirubinemia, weight gain (sodium retention). CNS: Drowsiness, sedation, dizziness, headache, fatigue, weakness, sluggishness, dyspnea, vivid dreams, nightmares, insomnia, behavior changes, agitation,

standing). >With epidural administration, frequently monitor BP and HR. Hypotension is a common side effect that may require intervention. >Monitor BP closely whenever a drug is added to or withdrawn from therapeutic regimen. >Monitor I&O during period of dosage adjustment. Report change in I&O ratio or change in voiding pattern. >Determine weight daily. Patients not receiving a concomitant diuretic agent may gain weight, particularly during first 3 or 4 d of therapy, because of marked sodium and water retention. >Supervise closely patients with history of mental depression, as they may be subject to further

hallucination, nervousness, restlessness, anxiety, mental depression. Skin: Rash, pruritus, thinning of hair, exacerbation of psoriasis; with transdermal patch: hyperpigmentation, recurrent herpes simplex, skin irritation, contact dermatitis, mild erythema. Special Senses: Dry eyes. Urogenital: Impotence, loss of libido.

depressive episodes.

Nursing Responsibilities: Side effect: Nausea >Assess for level of pain relief and administer prn dose as needed but not to

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Tramadol Brand Name: Dolcet Classification: Analgesics/ Opiates & Antagonists Dose, Route PO 1 tab TID

>exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heatregulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.

used in treating moderate to severe pain. The drug has a wide range of applications, including treatment for restless leg syndrome and fibromyalgia. Precaution: >Epilepsy, history of seizures, or recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infection); history of anaphylactoid reactions to codeine and other opioids; patients at risk for respiratory depression; increased intracranial pressure or head injury; patients receiving CNS depressants; opioid-dependent patients; chronic heavy alcohol abusers; patients taking MAO inhibitors or SSRI; impaired renal function. May impair driving or operating machinery. Contraindication: Hypersensitivity. Acute intoxication with alcohol, hypnotics, narcotics, centrallyacting analgesics, opioids or psychotropic drugs. Severe hepatic impairment; pregnancy, lactation.

Dizziness somnolence. Adverse Reaction: CNS and GI disturbances. Nausea, Dizziness Fatigue Constipation dry mouth.

exceed the recommended total daily dose. >Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression. >Discontinue drug and notify physician if S&S of hypersensitivity occur. >Assess bowel and bladder function; report urinary frequency or retention. >Use seizure precautions for patients who have a history of seizures or who are concurrently using drugs that lower the seizure threshold. >Monitor ambulation and take appropriate safety precautions.

Patient & Family Education

>Exercise caution with potentially hazardous activities until response to drug is known. >Understand potential adverse effects and report problems with bowel and bladder function, CNS impairment, and any other bothersome adverse effects to physician. >Do not breast feed while taking this drug.

Nursing Responsibilities: Allergic disorders Side effect: GENERIC Action: Indication: coagulation defects

NAME: Etoricoxib BRAND NAME: Arcoxia

non-steroidal antiinflammatory drug (NSAID). DOSAGE AND ROUTE: PO 60mg 1 tab BID

>NSAIDs work by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in producing prostaglandins, in response to injury or certain diseases. These prostaglandins cause pain, swelling and inflammation. Because NSAIDs block the production of these prostaglandins, they are effective at relieving pain and inflammation.

history of cardiac failure acute and chronic treatment of the signs and symptoms of osteoarthritis and rheumatoid arthritis management of ankylosing spondylitis relief of chronic musculoskeletal pain relief of acute pain to treat acute gouty arthritis high blood pressure Contraindication: you have an allergy to Arcoxia or any of the ingredients listed at the end of this leaflet the packaging is torn or shows signs of tampering the expiry date on the pack has passed. If you take this medicine after the expiry date has passed, it may not work. dizziness headache feeling sick (nausea), vomiting heartburn, indigestion, uncomfortable feeling or pain in the stomach diarrhoea hepatic impairment swelling of the legs, ankles or feet left ventricular dysfunction, hypertension or in patients with edema due to other reasons; elderly renal,cardiac

Adverse Reaction: swelling of the face, lips, tongue or throat which may cause difficulty in swallowing or breathing

You have had heart failure, a heart attack, bypass surgery, chest pain (angina), narrow or blocked arteries of the extremities (peripheral arterial disease), a stroke or mini stroke (TIA or transient ischaemic attack). You have high blood pressure that is not well controlled on blood pressure medication. You are having major surgery and have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking. You are having major surgery on you heart or arteries.

(hypersensitivity reactions, anaphylactic/anaph ylactoid reactions including shock) abnormal rhythm of the heart (atrial fibrillation) heart failure palpitations serious kidney problems serious liver problems stomach pain stomach ulcers that may become serious and may bleed, and may occur at any time during use and without warning.