NAME Pritor

DOSAG E 40mg PO

CLASSIFICATION Angiotensin II antagonist used as an antihypertensive.

INDICATION This drug is used to treat hypertension, either alone or in combination with other drugs.

CONTRAINDICATION Biliary obstructive disorders, severe hepatic impairment. Fructose intolerance. Pregnancy (2nd & 3rd trimesters) & lactation.

SIDE EFFECTS CNS: dizziness, headache, fatigue CV: chest pain, peripheral edema, hypertension EENT: sinusitis, pharyngitis GI: nausea, vomiting, diarrhea, dyspepsia, abdominal pain GU: urinary tract infection Musculoskeleta l: myalgia, back and leg pain Respiratory: cough, upper respiratory infection Other: pain, flu or flulike symptoms

NURSING RESPONSIBILITIES Drugs that react on the renin angiotensin system can cause fetal and n e o n a t a l morbidity and death when given to pregnant women. These problems havent been detected when exposure has been limited to the first trimester. Use cautiously in patients with biliary obstruction disorders or Renal and hepatic insufficiency and in those with and activated Renin angiotensin system such as volume or salt depleted patients Monitor patient for hypotension after starting drug. Place patient supine

i f hypotension occurs, and give I.V. normal saline is needed. Most of the antihypertensive effect occurs within 2 weeks. Maximal blood pressure reduction is usually reached after 4 weeks. Diuretics may be added if blood pressure isnt controlled by drug alone. For patients whose renal function may depend on the activity of the r e n i n - angiotensinaldosterone system (such those with severe heart failure), treatment with A C E inhibitors and angiotensin receptor antagonists has cause oliguria o r progressive

azotemia and (rarely) acute renal failure. Drug isnt removed by hemodialysis. Patients undergoing dialysis may develop orthostatic hypotension. Closely monitor blood pressure. Assess condition before therapy and reassess regularly thereafter to monitor drugs effectiveness Monitor for any adverse GI reactions, nausea, vomiting, diarrhea Assess for adverse reactions For patient with hepatic encelopathy, regularly assess mental condition Monitor I & O

Lactulose

30cc at bed time

Gastrointestinal agent, hyperosmotic laxative

Patient who require a low lactose diet. Constipation, Galactosemia salmonellosis. Tre deficiency .Intestinal atment of hepatic obstruction encephalopathy

Abdominal discomfort associated with flatulence and intestinal cramps. Nausea, vomiting, diarrhea on prolonged use.

monitor for Increase glucose level in diabetic patients Relief of pain including muscular, rheumatic, traumatic, dental, post-op and postpartum pain, headache, migraine, fever, dysmenorrheal Pregnancy &lactation, hypersensitivity, active ulceration or chronic inflammation of either upper or lower GIT, blood disorders, poor platelet function, kidney or liver impairment, children < 14 yrs GI discomfort, diarrhea or constipation, gas pain, nausea, vomiting, drowsiness

Analgesic Mefenamic acid 500mg PRN q6

Assess patients pain before therapy Monitor for possible drug induced adverse reactions Advice patient not to take drug for more than 7 days

Cardiovascular Beta-blockers Metoclopromide (plasil) 10mg IV

Gastrointestinal motility, nausea, vomiting of central and peripheral origin associated with surgery

GI hemorrhage, epileptics, hypersensitivity, lactation, patients with breast cancer

Restlessness,d rowsiness,fatig ue,insomnia,he adache,dizzines s,nausea

Advice patient to report immediately persistence or failure to relieve pain Give 30 minutes before meals and at bed time Assess mental status during treatment Tell patient to avoid driving and other hazardous activities

Enteral Nutrition Isocal 5scoops q5

Nutritionally complete and well-balanced to provide the total dietary needs of most tube-fed patients. High calorie nutrition with less sodium content, suitable for people with sodium restrictions.

Contraindicated with: Pregnancy, lactation, children 1 year below and geriatrics

for at least 2 hrs Aspiration pneumonitis may occur with enteral tube feedings, and is more common in the elderly. Advice patient to avoid alcohol and other CNS depressant that enhance sedating properties of this drug

Celecoxib

Central nervous system agent, analgesic, NSAID,

Celecoxib is used for the relief of signs and symptoms of Arthritis Celecoxib should not (Osteoarthritis be given to patients and Rheumatoid Arthritis) in adults. who have

Celecoxib is contraindicated in patients with known hypersensitivity to celecoxib.

Particular attention should be given to water supply for comatose and Gastrointestinal unconscious patients disturbances m and others who ay also be a cannot express the complication of usual sensations of feeding tube thirst. use, with or without Additional water is pneumonitis. important also when renal concentrating ability is impaired, when there is extensive breakdown of tissue protein, or when water requirements are high, Diarrhea, as in fever. Dyspepsia, Headache, Upper respiratory tract infections, Assess patients

200mg 1 cap BID RTC

cyclooxygenase-2 inhibitor, antipyretic

It is also used for the treatment of acute pain and menstrual pain. Celecoxib is also used to reduce the number of adenomatous colorectal polyps in familial adenomatous polyposis.

demonstrated allergictype reactions to sulfonamides. Celecoxib should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients Celecoxib is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surger

Abdominal pain, Flatulence, Nausea, Back pain, Peripheral edema, Dizziness, Rash

range of motion, degree of swelling, and pain in affected joints before and periodically throughout therapy. Assess patient for allergy to sulfonamides, aspirin, or NSAIDS. Patients with these allergies should not receive celecoxib. May be administered without regard to meals. Instruct patient to take celecoxib exactly as directed. Do not take more than prescribed dose. Increasing doses does not appear to increase effectiveness.

Advise patient to notify health care professional promptly if signs or symptoms of GI toxicity (abdominal pain, black stools), skin rash, unexplained weight gain, edema occurs. Patient should discontinue celecoxib and notify health care professional if signs and symptoms of hepatotoxicity (nausea, fatigue, lethargy, pruritus, jaundice, upper right quadrant tenderness, flu-like symptoms) occur. Shock. Gynecomastia, galactorrhea, hysterorrhea; anorexia, catharsis,

AntiInflammatories

Dompenyl

Symptomatic relief of acute nausea & v omiting. Treatment of nausea & vomiting caused by levodopa or

Intolerance. GI bleeding, perforation, prolactinoma.

Watch out for the signs and symptoms of the side effects

10mg 1 tab NGT

bromocriptine administration in Parkinson's disease.

constipation, celialgia, dipsia, vomiting. Extrapyramidal, circulatory & dermatologic effects.

Assess your patient (inspect, palpate, percuss and auscultate)

Inhibitor of Prevention of adenosine vascular ischemic diphosphate (ADP) events in patients with symptomatic athe rosclerosis Clopidrogel Acute coronary

In patients with hypersensitivity to drug or its components and in those with pathologic bleeding (peptic ulcer or intracranial hemorrhage)

The tolerability of clopidogrel is similar to that of aspirin. Platelet aggregation Diarrhea, rash, wont return to normal or itching occur for at least 5 days

75mg 1tab Od

syndrome without ST-segment elevation (NSTEMI), ST elevation MI (STEMI)

HMG-CoA reductase inhibitors, commonly called "statins." Simvastatin 40mg 1tab PO

To reduce risk of death from disease and CV events in patients at high-risk for coronary events

Contraindicated with allergy to simvastatin, fungal by products, pregnancy, lactation

s in approximately 1 in 20 persons taking clopidogrel. Abdominal pain also occurs in about 1 in 20 persons, but it is less frequent than with aspirin. Abdominal pain, diarrhea, indigestion, and a general feeling of weakness. Rare side effects include joint pain, memory loss, and muscle cramps. Cholestatic hepatitis, hepatic cirrhosis, rhabdomyolysis and myositis have been

after the drug has been stopped Watch out for: drug can cause fatal thrombotic thrombocytopenic purpura May be taken without regard to meals. Instruct the patient to notify prescriber if unusual bleeding will occur Assess nutrition. Fat, protein, carbohydrates Monitor bowel pattern daily Monitor triglycerides, cholesterol baseline throughout treatment Past liver disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances,

reported in patients receiving the drug chronically Antivertigo Drugs Betahistine (HCl) is primarily indicated in conditions like Hearing loss, Menieres disease, Tinnitus, Vertigo. 16mg PO TID Betahistine is contraindicated for people with peptic ulcers or tumours of the adrenal gland, such as pheochromocytoma People with bronchial asthma should be closely monitored. Headache. Low level of gastric side effects. Nausea can be a side effect, but the patient is generally already experiencing nausea due to the vertigo so it goes largely unnoticed. Decreased appetite, leading to weight loss Dizziness, headache, swelling of the ankles, feet or

elderly, renal disease

Betahistine

Avoid contact of oral solution or injection with skin Raise bed rails, institute safety measures, supervise ambulation

Calcium Channel Blocker

Management of chronic stable angina, angina du e to coronary artery spasm;

Patients w/ sick sinus syndrome or 2nd/3rd degree AV block except in the presence of a functioning ventricular pacemaker.

Monitor blood

Angiozen 60mg TID

alone or in combination, for the treatment of HTN.

Hypotension (<90 mmHg systolic), acute MI, pulmonary congestion. Lactation.

hand

pressure and heart rate when starting therapy and during dosage adjustments If systolic blood pressure is below 90mmHg or heart rate is below 60 bpm, withhold the medication and notify the physician. Advise patient to do hazardous activity