DRUG STUDY Generic Name/ Trade Name sodium chloride Dosage/ Frequency Indication Contraindication Side Effects Nursing

Responsibilities

1 Tab TID 8am 1pm 6pm

prophylaxis of heat prostration or muscle cramps; chloride deficiency due to dieresis or salt restrictions; prevention or treatment of extracellular volume depletion

congestive heart failure, severely impaired renal function, hypernatremia, fluid retention

hypernatremia, hypopotassemia, acidosis. Fluid and solute overload leading to dilution of serum electrolyte level, CHF, overhydration, acute pulmonary edema

a. Monitor electrolytes, ECG, liver and renal function studies b. Note level of consciousness c. Assess the heart and lung sounds d. Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, and edema e. Monitor VS and I&O f. Assess urine specific gravity and serum sodium levels

Enalapril Maleate

5 mg/ tab 1 tab OD

Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics Treatment of acute and chronic CHF Treatment of asymptomatic left ventricular dysfunction (LVD) Unlabeled use: Diabetic nephropathy

Contraindicated with allergy to enalapril. Use cautiously with impaired renal function; salt or volume depletion (hypotension may occur); lactation, pregnancy.

CNS: Headache, dizziness, fatigue, insomnia, paresthesias CV: Syncope, chest pain, palpitations, hypotension in salt- or volume-depleted patients GI: Gastric irritation, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, elevated liver enzymes GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency, impotence Hematologic: Decreased hematocrit and hemoglobin Other: Cough, muscle cramps, hyperhidrosis

Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril. Monitor patient carefully because peak effect may not be seen for 4 hr. Do not administer second dose until BP has been checked.

Aspirin

80 g 1 Tab OD 1PM

Mild to moderate pain Fever Inflammatory conditionsrheumatic fever, rheumatoid arthritis, osteoarthritis Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris MI prophylaxis Unlabeled use: Prophylaxis against cataract formation with long-term use

Allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency (increased risk of bleeding) Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye's syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial hemorrhage, stillbirths, neonatal death); lactation.

Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulmonary edema, seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure (dose related 2025 g in adults, 4 g in children) Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps, asthma, rhinitis) GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, hepatotoxicity Hematologic: Occult blood loss, hemostatic defects Hypersensitivity: Anaphylactoid reactions to anaphylactic shock Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, lassitude (dose related)

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 crush, and ensure that patient does not chew sustained-release preparations. Do not use aspirin that has a strong vinegar-like odor. Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting.

Isosorbide mononitrate

30 g OD 8AM

Isosorbide mononitrate is used to prevent chest pain in patients with a heart condition known as angina.

Immediate Release Tablets: Allergic reactions to organic nitrates are extremely rare, but they do occur. Isosorbide mononitrate is contraindicated in patients who are allergic to it. Extended Release Tablets: Isosorbide mononitrate extended release tablets are contraindicated in patients who have shown hypersensitivity or idiosyncratic reactions to other nitrates or nitrites.

This can cause dizziness and lightheadedness when standing quickly and during the first days of therapy. This medication can cause headache which also indicates the drug is working. These headaches are relieved with aspirin or acetaminophen. For this drug to be most effective it should be taken as prescribed, separating doses by 7 hours. Missed doses should not be doubled up.

Patients should be told that the antianginal efficacy of Isosorbide Mononitrate Extended-Release Tablets can be maintained by carefully following the prescribed schedule of dosing. For most patients, this can be accomplished by taking the dose on arising.
In patients who get these headaches, the headaches are a marker of the activity of the drug. Patients should resist the temptation to avoid headaches by altering the schedule of their treatment with Isosorbide Mononitrate,