Drug Summary

Hydralazine (Aprezin)
Classification: Anti-hypertensive Mechanism of Action: Direct-Acting vasodilator, it relaxes arteriolar smooth nuscle. Specific Indication: Essential hypertension, severe essential hypertension to lower blood pressure quickly. Side Effects: Headache, Dizziness, hypotension, diarrhea, anorexia DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: MAO inhibitors (isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine).Check the labels on all your medicines (such as cough-and-cold products, diet aids, pain relievers) because they may contain ingredients that could increase your blood pressure or heart rate. Nursing Implications: Before: Assess blood pressure before starting therapy and regular thereafter. Assess patients and familys knowledge of drug therapy. During : Give oral form of drug with meals to increase absorption. Be alert for adverse reactions and drug interaction. After: Tell the patient to limit sodium intake.

Celecoxib (Celebrex)
Classification: Non-steroidal Anti-inflammatory drug Mechanism of Action: Inhibits the enzyme Cox-e. This enzyme is required for the synthesis of prostaglandin has analgesic and anti-inflammatory properties. Specific Indication: For mild and moderate inflammation. Side Effects: Dizziness, headache, insomnia, G.I bleeding, abdominal pain, diarrhea, dyspepsia, flatulence, nausea, G.I toxicity and rashes. Nursing Implications: Before: Assess patient for allergy to NSAIDS. Educate the patient about the medication. During: Tell the patient that this medication can be taken without regards to medication.

After: Observe for prompt signs and symptoms for G.I toxicity, skin rashes, edema, and weight gain occurs.
GENERIC AVAILABLE: No PRESCRIPTION: Yes PREPARATIONS: Capsules: 50, 100, 200, and 400 mg STORAGE: Capsules should be stored between 15-30 C (59-86 F). PRESCRIBED FOR: Celecoxib is used for the relief of pain, fever, swelling, and tenderness caused by osteoarthritis, juvenile arthritis, rheumatoid arthritis, and ankylosing spondylitis. Celecoxib does not prevent the progression of either type of arthritis. It reduces only the symptoms and signs of arthritis. Celecoxib is approved for patients with familial FAP who have not had their colons removed. Celebrex also is also used for the relief of acute pain and the pain of menstrual cramps (primary dysmenorrhea). DOSING: The lowest effective dose should be used for each patient. For the management of osteoarthritis, the dose usually is 100 mg twice daily or 200 mg as a single dose. For rheumatoid arthritis, the dose usually is 100 or 200 mg twice daily. For acute pain or menstrual cramps, the dose is 400 mg as a single dose on the first day followed by an additional 200 mg if needed, then 200 mg twice daily as needed. For FAP, the recommended dose is 400 mg twice daily. DRUG INTERACTIONS: Concomitant use of celecoxib with aspirin or other NSAIDs (for example, ibuprofen, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers. It may be used with low dose aspirin. Fluconazole (Diflucan) increases the concentration of celecoxib in the body by preventing the elimination of celecoxib in the liver. Therefore, treatment with celecoxib should be initiated at the lowest recommended doses in patients who are taking fluconazole.

Cefuroxime (Ambixime)
Classification: Anti-infectives Mechanism of Action: Inhibits cell wall synthesis promoting osmotic instability. Hinders and kills susceptible bacteria, including gram positive organism and enteric gram negative bacilli. Specific Indication: For treatment of different kinds of bacterial infection such as UTI, bronchitis, sinusitis and skin infection. Side Effect: Diarrhea, nausea and vomiting, headaches, migraine and dizziness.
PRESCRIPTION: yes GENERIC AVAILABLE: yes PREPARATIONS:

Tablets: 125 mg, 250 mg, 500 mg. Suspension: 125 mg per 5 ml teaspoon. STORAGE: Tablets should be stored at room temperature in a tightly closed container. The oral suspension should be stored in the refrigerator in a tightly closed container.PRESCRIBED

Nursing Implications: Before: Obtain specimen for culture and sensitivity test. Check the doctors order before giving the medication. During: Advise patient to take oral fluids with food during administration to enhance absorption. After: Tell the patient to report any kind of adverse reactions and if reactions occur monitor the patients hydration.

Mefenamic Acid (Ponstan)

Classification: Non-steroidal Anti-inflammatory drug. Mechanism of Action: Inhibits the enzyme Cox-e. This enzyme is required for the synthesis of prostaglandin has analgesic and anti-inflammatory properties. Specific Indication: Used for the relief of mild to moderate pain in acute and chronic conditions. Side Effects: Dyspepsia, upper-gastro intestinal discomfort, headache, drowsiness, dizziness, nervousness and visual disturbance.
DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.This drug should not be used with the following medications because very serious interactions may occur: cidofovir, ketorolac.If you are currently using either of the medications listed above, tell your doctor or pharmacist before starting mefenamic acid.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: anti-platelet drugs (e.g., cilostazol, clopidogrel), oral bisphosphonates (e.g., alendronate), "blood thinners" (e.g., enoxaparin, heparin, warfarin), corticosteroids (e.g., prednisone), cyclosporine, desmopressin, fluconazole, drugs for high blood pressure (including ACE inhibitors such as captopril, angiotensin II receptor antagonists such as losartan, and beta blockers such as metoprolol), lithium, methotrexate, pemetrexed, probenecid, SSRI antidepressants (e.g., fluoxetine, sertraline), tenofovir, "water pills" (diuretics such as furosemide, hydrochlorothiazide, triamterene).Check all prescription and nonprescription medicine labels carefully for other pain/fever drugs (NSAIDs such as aspirin, celecoxib, ibuprofen). These drugs are similar to this medication, so taking one of these drugs while also taking this medication may increase your risk of side effects. However, if your doctor has prescribed low doses of aspirin to prevent heart attack or stroke (usually at dosages of 81-325 milligrams a day), you should continue to take the aspirin. Daily use of NSAIDs (e.g., ibuprofen) may decrease aspirin's ability to prevent heart attack/stroke. Consult your doctor or pharmacist for more details and to discuss other possible treatments (e.g., acetaminophen) for your pain/fever.This

medication may interfere with certain laboratory tests (e.g., urine bile test), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Nifedipine (Adalat, Procardia, Afeditab, Nifediac)

DRUG CLASS AND MECHANISM: Nifedipine belongs to a class of medications called calcium channel blockers (CCBs) that are used to treat angina (heart pain), high blood pressure, and abnormal heart rhythms. Other drugs in the same class include amlodipine (Norvasc), diltiazem (Cardizem LA, Tiazac), felodipine (Plendil), isradipine (Dynacirc), nicardipine (Cardene), nimodipine (Nimotop), and verapamil (Covera-HS, Veralan PM, Calan). Like other CCBs, nifedipine works by blocking the flow of calcium into the muscle cells surrounding the arteries that supply blood to the heart (coronary arteries) as well as other arteries of the body. Since the inflow of calcium is what causes the muscle cells to contract, blocking the entry of calcium relaxes the muscles and dilates (widens) the arteries. By dilating coronary arteries, nifedipine increases the flow of blood to the heart. This treats and prevents angina which occurs when the flow of blood to the heart is not adequate to supply the heart with enough oxygen necessary to pump blood. Relaxing the muscles surrounding other arteries of the body lowers blood pressure and thereby reduces the pressure against which the heart must pump blood and function. This reduces the demand of the heart for oxygen--another mechanism by which CCBs treat and prevent angina. In addition, nifedipine slows conduction of the electrical current that travels through the heart that causes the muscle of the heart to contract. This effect can be used to correct abnormally rapid heartbeats. PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Capsules:10 and 20 mg. Tablets: 30, 60, and 90 mg STORAGE: Tablets should be stored at room temperature 15-25 C (59-77 F). They should be protected from light, moisture, and humidity. PRESCRIBED FOR: Nifedipine is used for the treatment and prevention of angina resulting from either an increased workload on the heart (as with exercise) or spasm of the coronary arteries. It is used in the treatment of high blood pressure, to treat abnormally fast heart rhythms such as atrial fibrillation, and in the prevention of episodes of rapid heart rhythm originating from the atria of the heart. It also is used to dilate blood vessels that go into spasm such as those causing Raynaud's phenomenon, a painful condition of the hands caused by spasm of the arteries supplying blood to the hands. Non-FDA approved uses include anal fissures (applied to the fissures), prevention of migraine headaches in adults, ureteral stones (as secondary therapy) and wound healing (applied to the skin). DOSING: The usual dose for nifedipine capsules is 10 to 20 mg three times daily. It is

important to swallow capsules whole. For extended release tablets, the usual dose is 30 or 60 mg once daily. The tablets should be swallowed whole and not bitten or cut in half. Nifedipine can be taken with or without food. DRUG INTERACTIONS: In rare instances, congestive heart failure has been associated with nifedipine, usually in patients already on a beta blocker, for example, propranolol (Inderal), metoprolol (Lopressor), etc. Excessive lowering of blood pressure (hypotension) during initiation of nifedipine treatment can occur, especially in patients already taking another blood pressure lowering drug. Generally, nifedipine is avoided in children. Nifedipine decreases the elimination of digoxin (Lanoxin) by the kidneys which can increase digoxin blood levels in the blood and give rise to digoxin toxicity. It is important, therefore, to monitor blood levels of digoxin in order to avoid toxicity. Nifedipine interferes with the breakdown of tacrolimus (Prograf) by the liver, which in turn causes elevated blood levels of tacrolimus and may increase the risk of toxicity from tacrolimus. Nifedipine reduces the blood levels of quinidine (Quinaglute, Quinidex, Quinora) which may reduce the effectiveness of quinidine. Conversely, blood levels of nifedipine are increased by quinidine and may lead to side effects from nifedipine. Cimetidine (Tagamet) interferes with breakdown by the liver of nifedipine and increases nifedipine blood levels. Therefore, cautious dosing is necessary when both medications are administered concurrently. Nifedipine should not be taken with grapefruit juice since grapefruit juice (one glass, approximately 200 ml) inhibits the breakdown of nifedipine by the liver and increases the levels of nifedipine in the blood. SIDE EFFECTS: Side effects of nifedipine are generally mild, and reversible. Most side effects are expected consequences of the dilation of the arteries. The most common side effects include headache, dizziness, flushing, and edema (swelling) of the lower extremities. Less common side effects include dizziness, nausea and constipation.

Amlodipine besylate (Norvasc)

DRUG CLASS AND MECHANISM: Amlodipine belongs to a class of medications called calcium channel blockers. These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. By relaxing coronary arteries, amlodipine is useful in preventing chest pain (angina) resulting from coronary artery spasm. Relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart as it pumps blood to the body. Reducing heart burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina in patients with coronary artery disease. PRESCRIPTION: yes GENERIC AVAILABLE: yes PREPARATIONS: Tablets ( 2.5mg, 5mg, 10mg.) STORAGE: Amlodipine should be stored at room temperature in a tight, light resistant container. PRESCRIBED FOR:

Chest pain or heart pain (angina) occurs because of insufficient oxygen delivered to the heart muscles. Insufficient oxygen may be a result of coronary artery blockage or spasm, or because of physical exertion which increases heart oxygen demand in a patient with coronary artery narrowing. Amlodipine is used for the treatment and prevention of angina resulting from coronary spasm as well as from exertion. Amlodipine is also used in the treatment of high blood pressure. DOSING: Amlodipine can be taken with or without food. Amlodipine is metabolized mainly by the liver and dosages may need to be lowered in patients with liver dysfunction. DRUG INTERACTIONS: In patients with severe coronary artery disease, amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting amlodipine, or at the time of dosage increase. Excessive lowering of blood pressure during initiation of amlodipine treatment can occur, especially in patients already taking another blood pressure lowering medication. In rare instances, congestive heart failure has been associated with amlodipine, usually in patients already on a beta blocker. PREGNANCY: Generally, amlodipine is avoided in pregnancy, and by nursing mothers and children. NURSING MOTHERS: Generally, amlodipine is avoided in pregnancy, and by nursing mothers and children. SIDE EFFECTS: Side effects of amlodipine are generally mild and reversible. The two most common side effects are headache and edema (swelling) of the lower extremities. Less common side effects include dizziness, flushing, fatigue, nausea, and palpitations.

METHYLDOPA (Aldomet)
USES: This medication is used alone or with other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks and kidney problems. Methyldopa blocks certain natural chemicals (e.g., epinephrine, norepinephrine) that can raise your blood pressure. SIDE EFFECTS: Dizziness, drowsiness, headache, nasal congestion, and weakness may occur, especially when you start this medication and when your dose is increased. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.In rare cases, this medication may increase your level of a certain natural substance made by the body (prolactin). For females, this increase in prolactin may result in unwanted breast milk, missing/stopped periods, or difficulty becoming pregnant. For males, it may result in decreased sexual ability, inability to produce sperm, or enlarged breasts. If you develop these symptoms, tell your doctor immediately.Tell your doctor immediately if any of these rare but very serious side effects occur: swelling of ankles/feet, unexpected or rapid weight gain, unusual bruising or bleeding, involuntary movements, joint/muscle aches, mental/mood changes (e.g., confusion, depression), signs of infection (e.g., fever, persistent sore throat).Seek immediate medical attention if any of these rare but very serious side effects occur: chest pain,

slow/fast/irregular heartbeat.This drug may infrequently cause serious (rarely fatal) liver disease. DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first.Avoid taking MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) within 2 weeks before, during and after taking methyldopa. In some cases a serious, possibly fatal drug interaction may occur. If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting methyldopa.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: entacapone, levodopa, lithium, iron products, other blood pressure medications (e.g., beta blockers such as propranolol, calcium channel blockers such as nifedipine, ACE inhibitors such as lisinopril, diuretics such as furosemide).

Spironolactone(Aldactone)
DRUG CLASS AND MECHANISM: One of the main functions of the kidneys is to retain salt (sodium chloride) and water in the body. In patients with heart failure and cirrhosis, increased levels of a hormone produced by the adrenal glands, called aldosterone, causes salt and fluid to be retained by the kidneys. (At the same time, it also causes the kidneys to eliminate potassium.) The body becomes overloaded with salt and water, and this worsens the heart failure. Spironolactone inhibits the action of aldosterone thereby causing the kidneys to excrete salt and fluid in the urine while retaining potassium. Therefore, spironolactone is classified as a potassium-sparing diuretic, a drug that promotes the output of urine (diuretic) while allowing the kidneys to hold onto potassium. The FDA approved spironolactone in October 1985. PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets 25, 50, and 100 mg STORAGE: Spironolactone should be stored at room temperature, below 25 C (77 F). PRESCRIBED FOR: Spironolactone removes excess fluid from the body in congestive heart failure, cirrhosis of the liver, and kidney disease. It can also be used in combination with other drugs to treat elevated blood pressure and for treating diuretic-induced low potassium (hypokalemia). Spironolactone also is used to counteract the effects of excessive adrenal aldosterone production (hyperaldosteronism). Aldosterone overproduction can occur from a tumor in the adrenal gland or enlarged adrenal glands (hyperplasia of the adrenal glands). DOSING: Spironolactone may be taken with or without food. The dosage range is 25-400 mg daily in single or divided doses. DRUG INTERACTIONS: Spironolactone can lower blood sodium levels while raising blood potassium levels. Excessively high blood potassium levels can lead to potentially life-threatening

abnormalities in the rhythm of the heart. Therefore, spironolactone usually is not administered with other agents that can raise blood potassium levels, such as potassium supplements, angiotensin converting enzyme (ACE) inhibitors [for example, enalapril (Vasotec)], indomethacin (Indocin), or other potassium-sparing diuretics. Spironolactone can cause elevation of blood digoxin (Lanoxin) to toxic levels, requiring adjustment of the digoxin dosage. PREGNANCY: There are no adequate studies in pregnant women. Spironolactone may be harmful if used for treating gestational hypertension (high blood pressure during pregnancy). NURSING MOTHERS: An active metabolite of spironolactone is secreted in breast-milk. To avoid adverse effects in the newborn, mothers should avoid breastfeeding while taking spironolactone. SIDE EFFECTS: Side effects of spironolactone include headache, diarrhea, cramps, drowsiness, rash, nausea, vomiting, impotence, irregular menstrual periods, and irregular hair growth. Fluid and electrolytes imbalance (for example, low sodium, low magnesium, and high potassium) may occur, so patients should be monitored carefully. Enlargement of the breasts (gynecomastia) may also occur and is related to dose and duration of therapy. It usually reverses upon discontinuation of spironolactone.

Nicardipine (Cardene, Cardene SR)

DRUG CLASS AND MECHANISM: Nicardipine belongs to a class of blood pressure reducing medications called calcium channel blockers (CCBs). Other medications in this class include diltiazem (Cardizem), amlodipine (Norvasc), felodipine (Plendil), verapamil (Calan, Isoptin), clevidipine (Cleviprex), and nifedipine (Adalat, Procardia). These medications block the movement of calcium into the smooth muscle cells surrounding the arteries of the body. Since calcium promotes contraction of muscle, blocking calcium entry into the muscle cells relaxes the arterial muscles and causes the arteries to become larger. This lowers blood pressure, which reduces the work that the heart must do to pump blood to the body. Reducing the work of the heart lessens the heart muscle's demand for oxygen and thereby helps prevent angina (heart pain) in patients with coronary artery disease. Unlike verapamil or diltiazem, nicardipine has little effect on heart muscle or on electrical conduction within the heart. T PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Capsules: 20 and 30 mg. Capsules (sustained release): 30, 45, and 60 mg. Injection: 0.1, 0.2, and 2.5 mg/ml.

STORAGE: Nicardipine should be stored at room temperature, 15 to 30 C (59 to 86 F), and protected from light. PRESCRIBED FOR: Oral nicardipine is used alone or in combination with other drugs for the treatment of high blood pressure. Conventional capsules (not sustained release) also are used for the treatment of angina (heart pain). Nicardipine injections are used for short-term treatment of blood pressure when oral medications are not possible or desirable. DOSING: The recommended dose of nicardipine is 20-40 mg three times daily with conventional capsules or 30-60 mg twice daily with sustained release capsules. Intravenous infusion rates can range between 0.1 and 15 mg/hr. DRUG INTERACTIONS: Rifampin, phenobarbital, phenytoin, oxcarbazepine (suspension oral Trileptal; oral Trileptal) and carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol) may reduce blood levels of nicardipine by increasing its metabolism in the liver. Therapy should be monitored and drug doses should be adjusted accordingly. Co-administration of nicardipine and cyclosporine results in increased cyclosporine blood levels. Cyclosporine blood levels should be monitored and its dosage reduced when taking nicardipine. PREGNANCY: There are no adequate studies of nicardipine in pregnant women; Nicardipine has been used to treat the high blood pressure of preeclampsia during the third trimester of pregnancy. SIDE EFFECTS: Side effects of nicardipine include an increased heart rate due to the drop in blood pressure. Other side effects include swelling of the feet (edema), dizziness, headaches, flushing, palpitations, and nausea. Nicardipine sometimes can cause an increase in the frequency and duration of angina.