DRUGS Date Ordered: August 7 Generic Name: Spironolactone Brand Name: Aldactone Classification : Potassiumsparing Diuretic Dosage: 50mg

tab OD

INDICATIO NS Managemen t of essential hypertensio n

ACTION Antagoniz es aldosteron e in the distal tubules; increasing sodium and water excretion

SIDE EFFECT/ ADVERSE EFFECT Agranulocytosis, headache, drowsiness, lethargy, GI disturbances, ataxia, drug fever

NURSING CONSIDERATION

PATIENT TEACHING

Obtain patient history, including history and instruct to take any known hypersensitivity. medication early to prevent need to urinate at night Monitor for manifestations of hyperkalemia: fatigue, muscle weakness, arrhythmia, hypotension, paresthesias, confusion, dyspnea. Monitor for manifestations of hyponatremia: BP, cold, clammy skin, hypo or hypervolemia, anorexia, nausea, vomiting, diarrhea, abdl pain, lethargy, increased ICP, confusion, headache, seizure, coma, fatigue, tremor, hyperreflexia. Assess fluid volume status: input-output ratio & record, crackles in lung, color, quality & specific gravity of urine, skin turgor, adequacy of pulses, moist mucous membranes should be reported. instruct patient to take with food or milk if GI symptoms of nausea & anorexia occur advice not to take OTC drugs without physicians approval

emphasize to patient to continue medication even if feeling better Inform that this drug controls symptoms but does not cure the condition

DRUGS

INDICATI ONS Treatment of HPN

ACTION

Date Ordered: August 7 Generic Name: Telmisartan Brand Name: Pritor Classificatio n: Antihypertensi ve (angiotensin II antagonist) Dosage: 40 mg 1 tab OD

Blocks the vasoconstrictive & aldosteronesecreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the ATI receptor in many tissues

SIDE EFFECT/ ADVERSE EFFECT Diarrhea & angioedema, sinusitis, pharyngitis, URTI, back pain

NURSING CONSIDERATION

PATIENT TEACHING

assess for heart failure instruct patient to comply with because renal function depend dosage schedule even if feeling on RAAS, use of ACE inhibitors better & angiotensin-receptor antagonist maybe related to oliguria or progressive azothemia tell patient that drug may cause obtain baseline renal & liver light-headedness, dizziness or status before therapy: BUN fainting. Inform patient also CREA, AST, ALT, bilirubin about transient hypotension & necessary precautions assess for obstructive jaundice because drug level may elevate due to inability to excrete drug. Drug is not removed by hemodialysis. Closely monitor BP & pulse ( rate, rhythm, quality) teach patient the importance of diet control, exercise, stress reduction in the management of HPN

DRUGS Date Ordered: August 7 Generic Name: Furosemide Brand Name: Lasix Classificatio n: Loop diuretic Dosage: 40 mg IV BID

INDICATIO NS Hypertensi on

ACTION Inhibits sodium and chloride reabsorption at proximal tubules, distal tubules and ascending loop of Henley leading to excretion of water together with sodium, chloride and potassium. Diuretic, antihypertensiv e

SIDE EFFECT/ ADVERSE EFFECT Orthostatic hypotension; thrombophlebitis , vertigo, headache, dizziness, paresthesia, restlessness, fever, photosensitivity, urticaria, pruritus, blurred vision

NURSING CONSIDERATION monitor peripheral edema, breath sounds, BP, fluid intake and output. Electrolytes: potassium, sodium, calcium, magnesium, glucose, uric acid and BUN monitor for renal, cardiac, neurologic, GI, pulmonary, manifestations of hypokalemia: acidic urine, reduced urine osmolality, nocturia, polyuria, polydipsia; hypotension

PATIENT TEACHING teach patient to take medication early in the day to prevent nocturia and to continue taking medication even if feeling better, this drug controls symptoms but does not cure the condition instruct the patient to take with food or milk if GI symptoms of nausea and anorexia occurs

advice patient to rise slowly from sitting or reclining positions because assess fluid volume status: orthostatic hypotension may urine: color, quality and specific occur gravity, input-output ratio, weight, skin turgor instruct patient to lie down if dizziness occurs

DRUGS Date Ordered: August 7 Generic Name: Budesonide Brand Name: Budecort Classificatio n: Drug for asthma/COPD (inhaled steroid) Dosage: 250 mg 1 neb BID

INDICATIO NS Used for managemen t of bronchial asthma

ACTION Exerts a local antiinflammatory effect by depression of does not migration of polymorphonucl ear leukocytes & fibroblasts; reversal of increased capillary permeability & lysosomal stabilization. It does not suppress hypothalamus & pituitary function

SIDE EFFECT/ ADVERSE EFFECT Nasal irritation; burning; stinging; sneezing, pharyngitis. Dry mouth, indigestion, increased cough, wheezing, dyspnea

NURSING CONSIDERATION assess respiratory status: rate, rhythm, increase in bronchial secretions, wheezing & chest tightness. Provide at least 2L/day of fluids to decrease viscosity of secretions check for oral candidiasis

PATIENT TEACHING instruct patient how to use nasal inhaler herself inform patient that use of oral inhaler results in improvement of asthma control in 10 to 24 hours, maximum benefit in 1 to 2 weeks or longer teach patient physician of nasal bleeding to notify pharyngitis,

be alert of bronchospasm. If it occurs stop treatment instruct patient not to exceed and give bronchodilators recommended dose; adrenal suppression may occur carefully assess presence of viral infections, teach patient to carry/wear corticosteroid use can mask emergency ID identifying infections steroid use regularly assess intraocular instruct patient to prevent pressure, discontinue use if exposure to infections, increase is noted especially viral

DRUGS Date Ordered: August 7 Generic Name: Clopidrogel BRAND NAME: plavix CLASSIFICA TION: anti-platelet drug DOSAGE: 50mg tab od

INDICATIO N Treatment of patients at risk for ischemic events history of MI, ischemic stroke, peripheral artery disease Treatment of patients with acute coronary syndrome

ACTION inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

SIDE EFFECTS/ ADVERSE EFFECT CNS:Headache, dizziness,weakness, syncope, flushing CV: Hypertension, edema Dermatologic:Ras h, pruritus GI: Nausea, GI distress, constipation, diarrhea, GI bleed Other:Increased bleeding risk

NURSING CONSIDERATION Assess for symptoms of stroke, MI during treatment Monitor liver function studies: AST, ALT, bilirubin, creatinine if patient is on long-term therapy Monitor blood studies: CBC,Hgb, Hct, protime, cholesterol if the patient is on long-term therapy; thrombocytopeni a and neutropenia may occur.

PATIENT TEACHINGS Take daily as prescribed. May be taken with meals. Instruct patient report signs of side effect.

DRUGS DATE ORDERED: August 7 GENERIC NAME: Ceftazidime BRAND NAME: CLASSIFICA TION: Antibiotic cephalospori n DOSAGE: 1gm tiv q8 anst (-)

INDICATIO N Serious UTI and lower respiratory tract infection and CNS infection

ACTION Inhibits synthesis of bacterial cell wall, causing cell death

SIDE EFFECTS/ ADVERSE EFFECT CNS: headache, dizziness, GI: nausea, vomiting, anorexia, abdominal pain, liver toxicity Hematologic: decreased WBC, decreased paltelets, decreased Hct

NURSING PATIENT TEACHINGS CONSIDERATION Ask patient if he is has Avoid alcohol while taking this drug allergies to penicillin and for 3 days after because severe and cephalospirin reaction often occur. For IM administration, inspect deep into a Instruct client to inform NOD for any large muscle signs of advesrse reaction. If large doses are given, therapy is prolonged or patient is at high risk, monitor for sing and symptoms of super infection. Check IV site for patency prior giving the IV med Monitor blood count

DRUGS

INDICATIO N To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD) Quick relief for bronchospas m For the prevention of exerciseinduced bronchospas m

ACTION

Date Ordered: August 7 Generic Name: ventolin BRAND NAME: salbutamol CLASSIFICA TION: Bronchodilat or DOSAGE: q4

It relieves nasal congestion and reversible bronchospas m by relaxing the smooth muscles of the bronchioles.

SIDE EFFECTS/ ADVERSE EFFECT Nervousness Restlessness Tremor Headache Insomnia Chest pain Palpitations Angina Arrhythmias Hypertension Nausea and vomiting Hyperglycemia Hypokalemia

NURSING CONSIDERATION

PATIENT TEACHINGS

Use cautiously in patients with Teach patient to use the inhaler correctly: cardiovascular disorders. Shake it, clear the throat, expel as much air as possible from the lungs, inhale deeply Inhaler may be used 15 while releasing the drug from the inhaler, minutes before exercise to hold breath for several seconds. prevent exercise-induced bronchospasm. Instruct the client to gargle with tap water after nebulization to avoid drying of mucous membrane.

DRUGS Date Ordered: August 7 Generic Name: Trimetazidine CLASSIFICA TION: Anti-Anginal Drugs DOSAGE: 35mg 1tab bid

INDICATION Long treatment of coronary insufficiency , angina pectoris.

ACTION It inhibits the anaerobic glycolysis and fatty acid metabolism, thus allowing only aerobic glycolysis. This action helps to restore the energy balance in the cell. It inhibits acidosis and free radical accumulation in the cell. All these action help the cell to restore the normal ionic and metabolic balance.

SIDE EFFECTS/ ADVERSE EFFECT GI: vomiting, nausea

NURSING CONSIDERATION Use cautiously in patients with heart failure or hypertension and in elderly patients

PATIENT TEACHINGS Teach the client to avoid from standing immediately once seated. Always provide safety environment to the client.