SPIRONOLACTONE

Name & class of drug generic and trade name. GENERIC NAME: Aldactone, Novospiroton BRAND NAME: Spironolactone CLASSIFICATION: Electrolyte and water balance agent; potassium sparing diuretic Dose range and routes for adult & geriatric client. PREPARATIONS: PO (25, 50, 100) mg tablets DOSING: Edema 25 200 mg/d in divided doses, continued for atleast 5 daysd Purpose prescribed. Underline reason your client is prescribed drug. THERAPEUTIC EFFECTS: a diuretic agent that promote sodium and chloride excretion without concomitant loss of K+. USES: clinical conditions associated with augmented aldosterone production, as in essential hypertension, refractory edema due to CHF, hepatic cirrhosis, nephritic syndrome and idiopathic edema Major side effects & drug interactions. DRUG INTERACTIONS: combination of spironolactone and acidifying doses of ammonium chloride may produce systemic acidosis. Effects may be antagonized by aspirin and other salicylates. Digoxin should be monitored for decreased effect. Hypokalemia may result with K+ supplements, ACE inhibitors, ARBS. May alter antiocoagulant response in warfarin. Salt subs may increase risk of hyperkalemia SIDE EFFECTS: lethargy, mental confusion, fatigue, N/V, abd cramps, fluid and electrolyte imbalance .IMPLICATIONS: Check blood pressure before initiation of therapy Monitor serum electrolytes Assess for signs for fluid electrolyte imbalance Monitor daily I&O, check for edema Weigh pt under standard conditions, and daily once therapy commences Observe for and report immediately the onset of mental changes TEACHING: Max diuretic effect may not occur until third day of therapy, diuresis may continue 2-3 days after d/c Avoid replacing fluid losses with large amounts of free water Weigh 2 3 times weekly Avoid intake of high potassium foods and salt substitutes

Losartan
Brand Name: Lifezar Generic Name: Losartan Potassium Indications: Hypertension Drug Classification: Antihypertensive Mechanism of Action: As a selective and competitive, non-peptide angiotensin II receptor antagonist, Losartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; Losartan interacts reversibly at the AT1 and AT2 receptors of many tissues and has slow

dissociation kinetics; its affinity for the AT1 receptors is 1000 greater than the At2 receptor. Angiotensin II receptor antagonists may induce a more complete inhibition of the rennin-angiotensin system than ACE inhibitors, they do not affect the response to brdykinin, and are less likely ti be associated with non-renin-angiotensin effects. Losartan increases urinary flow rate and in addition to being natriuretic and kaliuretic, increases excretion of chloride, magnesium, uric acid, calcium and phosphate Dosage: 1 tab once a day, may increase to a maximum of 2 tabs daily Special Precautions: hypotension and electrolyte/ fluid imbalance. Dosage adjustments of antidiabetic agents and insulin may be required, SLE Pregnancy Risk Category: C (first trimester) D ( second trimester) Adverse reaction: dizziness, angioedema, diarrhea, hypersensitivity reaction, hyperuracemia and or gout, increase in cholesterol or TG levels, cough, rarely hepatitis. Contraindications: anuria, hypersensitivity to other sulphonamide-devised drugs. Intravascular volume depletion. Sever renal or hepatic impairment. Pregnancy, lactation Form: tab 30s Nursing Responsibilities: Observe for systemic hypertension and tachycardia especially in patients with CHF, hyponatremia, high dose diuretics ore severe volume depletion. Monitor BP in supine position, electrolytes, urinalysis and CBC.

Trimetazidine
Brand Name: Vastarel MR Generic Name: Trimetazidine Indication: Long treatment of coronary insufficiency, angina pectoris. Drug Classification: Anti-Anginal Drugs Mechanism of Action: acts by directly counteracting all the major metabolic disorders occurring within the ischemic cell. The actions of trimetazidine include limitation of intracellular acidosis, correction of disturbances of transmembrane ion exchanges, and prevention of excessive production of free radicals.decrease myocardial oxygen requirement by decreasing the heart rate, ventricular volume, blood pressure and contractility. In some cases, myocardial oxygen delivery is increased thru reversing coronary arterial spasm. Dosage: 1 tab morning and evening Special Precaution: Pregnancy and Lactation Pregnancy Risk Category: Adverse Reaction: Rare cases of GI disorders. Contraindications: MAOIs (monoamine oxidase inhibitors) Form: 35 mg tablets Nursing Responsibility: use cautiously in patients with heart failure or hypertension and in elderly patients.

DRUG ORDER Furosemide (Lasix) 20 mg/tab; 1 tab OD PO Pharmacologic class: Loop diuretic

PHARMACOL OGIC ACTION Inhibits the reabsorption of sodium chloride from the ascending limb of the loop of Henle, leading to a sodium-rich diuresis. TE: Promotes water and sodium excretion.

INDICATION S Management of hypertension; Edema associated with CHF as a complication of diabetes mellitus.

CONTRAINDICA TIONS Contraindicated with allergy to furosemide, sulfonamides. Use cautiously with diabetes mellitus./ with metabolic disorders.

ADVERSE DESIRED EFFECTS ACTION CNS: dizziness, For diuresis. fever, vertigo, tinnitus CV: arrhythmias, orthostatic hypotension GI: nausea, vomiting, constipation, vomiting GU: frequent urination, nocturia

NURSING RESPONSIBILITIES Arrange to monitor sodium and potassium serum electrolytes. Give early in the day so that increased urination will not disturb sleep. Blood glucose levels may become temporarily elevated in patients with diabetes after starting this drug. Give medications as ordered that will help loosen stools in case of constipation.

Name Of Drug

Dosage

Drug Class

Indication

Contraindication

Adverse Effect

Nursing

Generic : Atorvastatin Calcium Trade name: Lipitor/ Simvastatin

40 mg/ tab 1 tab OD @ HS

Antihyperlipidemic

To reduce the risk of MI, stroke, angina, and revascularizati on procedures in patients with no evidence of CAD with multiple risk factors. Heterozygous familial hypercholester olemia. Adjunct to diet to reduce elevated LDL, total cholesterol, apo B, and triglyceride levels to increase HDL level in patients with primary hypercholester olemia and mixed dyslipidemia.

Contraindicate d in patients hypertensive to the drug and in those with active liver disease or conditions linked with unexplained persistent increases in transaminase levels. Adolescent girl must be at least 1 year postmenarche

Nausea & vomiting, diarrhea, abdominal pain, constipation, dyspepsia & flatulence. Headache, skin rashes, dizziness, blurred vision, insomnia, dysgeusia. Cholestatic jaundice, pruritus, hypoglycemia, hyperglycemia. Anorexia, pancreatitis, alopecia, weight gain, StevensJohnson syndrome. Back & chest pain, muscle cramps, peripheral edema, malaise & fatigue Drug and food interaction: Cyclosporine, fibric acid derivatives, erythromycin, niacin, azole antifungals. Oral antacid containing Mg & Al hydroxide, colestipol,

Responsibilities Monitor patients lipid and liver function levels at baseline and periodically thereafter. Monitor patient for signs of rhabdomyoly is, especially if taking more than one class of lipid lowering drugs. Asses patients and familys knowledge of drug therapy.

Generic & Brand Name Erdosteine Ectrin cap, Ectrin susp , Zertin cap Zertin susp

Classification

Dosage & Route of Administration

Indication Oral As a mucolytic in the treatment of respiratory tract disorders and productive cough

Action

Contraindication

Adverse Reaction Epigastralgia, nausea, vomiting, loose stools, spasmodic colitis, headache.

Nursing Responsibility Tell to avoid driving or other hazardous activities until stabilized on his medication. Avoid alcohol and other CNS depressants so not to enhance sedating property of the drug Advice to avoid smoking, smoke filled environment

Cough & Cold Preparations Adult: 300 mg bid. Mucokinetics/Expectorants Max duration: 10 days.

Erdosteine contains Active peptic ulcer. two sulfhydryl groups, which are freed after metabolic transformation in the liver. The liberated sulfhydryl groups break the disulphide bonds, which hold the glycoprotein fibres of mucus together. This makes the bronchial secretions more fluid and enhances elimination