DRUG STUDY

MEDICATI DRUG INDICATION/ MECHANISM DOSING AND ADVERSE NURSING

ON CLASSIFICATIO CONTRAINDICA OF ACTION ADMINISTRATI EFFECTS CONSIDERATI
N TION ON OMS
Plavix Platelet Indication Inhibits the Clopidogrel CNS: headache, Platelet
(clopidogrel) aggregation -to reduce binding of should be given dizziness, aggregation
inhibitor thrombotic adenosine as a single daily fatigue, won’t return to
events in patients disphosphate dose of 75 mg depression, pain normal for at
with (ADP) to its with or without CV: edema, least 5 days after
atherosclerosis platelet food. hypertension drug has been
documented by receptor, EENT: rhinitis, stopped.
recent stroke, MI, impending ADP- Route: PO epistaxis
or peripheral mediated Onset: 2hr GI: hemorrhage, Patient teaching
arterial disease. activation and Peak: Unknown abdominal pain, -Advise patient it
subsequent Duration: 5 days dyspepsia, may take longer
Contraindication platelet gastritis, than usual to
-Hypersensitivity aggregation. constipation, stop bleeding.
-Severe liver Clopidogrel diarrhea, ulcers Tell him to refrain
impairment. irreversibly GU: UTI from activities in
-Peptic ulcer & modifies the Hematologic: which trauma
intracranial platelet aADP purpura and bleeding
hemorrhage. receptor. Muscuskletal: may occur, and
arthralgia encourage him to
Respiratory: wear a seatbelt
bronchitis, in a car.
coughing, -Tell patient to
dyspnea, upper inform all health
respiratory tract care providers,
infection including
Skin: rash, dentists, before
pruritus undergoing
Other: flulike procedures or
syndrome starting new drug
therapy, that he
is taking drug.
 -Inform patient
that drug maybe
taken without
regard to meals.

Imdur Antianginals Indication Not completely 30-60 mg (1/2 CNS: headache, -To prevent
(isosorbide Acute angina known. Thought tab) isosorbide dizziness, tolerance, a
mononitrate) attacks; to to reduce mononitratre weakness nitrate free
prevent situations cardiac oxygen using Imdur PO CV: orthostatic interval of 8-12
that may cause demand by once daily on hypotension, hours per day is
anginal attacks decreasing arising tachycardia, recommended.
preload and palpitations, The regimen for
Contraindications afterload. Drug Route: PO ankle edema, isosorbide
-Hypersensitivity also may Onset: ½-4 hr fainting, flushing mononitrate is
-Severe cerebral increase blood Peak: Unknown EENT: SL intended to
sclerosis flow through the Duration: 6-12 burning minimize nitrate
-hypotension collateral hr GI: nausea, tolerance by
-relief of acute coronary vomiting providing a
attacks vessels. Skin: cutaneous substantial
vasodilation, nitrate-free
Route: PO rash interval.
Onset: ½-4 hr -Monitor BP and
Peak: Unknown intensity and
Duration: 6-12 duration of drug
hr response.
-Drug may cause
headaches,
especially at
beginning of
therapy. Dosage
may be reduced
temporarily, but
tolerance usually
develops. Treat
headache with
aspirin or
acetaminophen.
-
Methemoglobine
mia has been
seen with
nitrates.
Symptoms are
those of impaired
oxygen delivery
despite adequate
cardiac output
and adequate
arterial partial
pressure of
oxygen

Patient teaching
-Caution patient
to take drug
regularly, at
prescribed, and
to keep it
accessible at all
times
-Advise patient
that stopping
drug abruptly
may cause
spasm of the
coronary arteries
with increased
angina symptoms
and potential risk
of heart attack.
-Tell patient to
 minimize
dizziness upon
standing up by
changing to
upright position
slowly. Advise
him to go up and
down stairs
carefully and to
lie down at first
sign of dizziness.
-Caution patient
to avoid alcohol
because it may
worsen low blood
pressure effects

Neobloc Antihyperten Indication Unknown. A 100 mg (1/2 tab) CNS: fatigue, -always check
(metoprolol sive -Hypertension selective beta once a day dizziness, patient’s apical
tartrate) -Early blocker that depression pulse rate before
intervention in selectively Route: PO CV: bradycardia, giving drug. If it’s
acute MI blocks beta1 Onset: 15 min hypotension, slower than 60
-Angina pectoris receptors; Peak: 1 hr heart failure, AV bpm, withhold
decreases Duration: 6-12 block, edema drug and call
Containdication cardiac output, hr GI: nausea, prescriber
-Heart block, peripheral diarrhea immediately.
greater than first resistance, and Respiratory: -in diabetic
degree AV blocks cardiac oxygen dyspnea patients, monitor
II and III, consumption; Skin: Rash glucose level
cardiogenic and depresses closely because
shock, overt renin secretion. drug masks
cardiac failure, common signs
sinus bradycardia and symptoms of
hypoglycemia.
-monitor BP
frequently; drug
masks common
signs and
symptoms of
shock
-beta blockers
may mask
tachycardia
caused by
hyperthyroidism.
In patients with
suspected
thyrotoxicosis,
taper off beta
blocker to avoid
thyroid storm.
-when stopping
therapy, taper
dose over 1-2
weeks.

Patient teaching
-instruct patient
to take drug
exactly as
prescribed and
with meals
-caution patient
to avoid driving
and other tasks
requiring mental
alertness until
response to
therapy has been
established
-advise patient to
inform dentist or
 prescriber about
use of this drug
before
procedures or
surgery
-tell patients to
alert prescriber if
shortness of
breath occurs
Instruct patient
not to stop drug
suddenly but to
notify prescriber
about unpleasant
adverse
reactions. Inform
him that drug
must be
withdrawn
gradually over 1
or 2 weeks.

Coversyl Anithyperten Indication ACE inhibitors - For renally CNS: dizziness, -patients with
(perindopril) sive -essential prevent the insufficient asthenia, sleep history of
ACE hypertension, conversion of patients with disorder, angioedema
inhibitors CHF angiotensin I to creatinine paresthesia, unrelated to ACE
-prevention of angiotensin II, a clearance 30 depression, inhibitor use may
stroke recurrence potent ml/min or somnolence, be at increased
in combination vasoconstrictor. greater, initially nervousness, risk for
with Indapamide Less angiotensin 2 mg PO daily. headache, fever angioedema
in patients with a II decreases - 5 mg PO, once CV: palpitations, during therapy.
history of peripheral daily edema, chest -if angioedema
cerebrovascular arterial pain, abnormal occurs, stop drug
disease resistance, Route: PO CG and observe
-reduction risk of decreasing Onset: Unknown ENT: rhinitis, patient until
CV events in aldosterone Peak: 1 hr sinusitis, ear swelling
patients w/ stable secretion, which Duration: infection, disappears.
coronary artery reduces sodium Unknown pharyngitis, Antihistamines
disease and water tinnitus may relieve
retention and GI: proteinuria, swelling of the
Contraindication lowers blood UTI, male sexual face and lips.
-Hypersensitivity pressure. dysfunction, Swelling of the
-angioedema menstrual tongue, glottis or
-renal impairment disorder throat may cause
-heart failure Musculoskeletal: life threatening
-ischemic heart back pain, airway
disease hypertonia, neck obstruction. Give
-cvd pain, joint pain, prompt
-renal or artery myalgia, treatment, such
stenosis arthritis, arm or as epinephrine
Collagen vascular leg pain. -monitor cbc with
disease (SLE or Respiratory: differential for
scleroderma) cough, URTI agranulocytosis
Skin: rush and neutropenia
Other: viral before therapy,
infection, injury, especiallyin
seasonal allergy renally impaired
patients with
lupus or
scleroderma
-severe
hypotension can
occur when drug
is given with
diuretics. If
possible, stop
diuretic 2 to 3
days before
starting this drug.
If possible use
lower doses of
either drug.
-in patient who is
volume or
sodium depleted
from prolonged
diuretic therapy,
dietary sodium
restriction,
dialysis, diarrhea,
or vomiting,
correct fluid and
sodium deficits
before starting
drug.
-monitor renal
function before
and periodically
throughout
therapy
-monitor
potassium level
closely

Patient teaching
-inform patient
that throat and
facial swelling,
including swelling
of the throat, can
occur during
therapy,
especially with
the first dose.
Advise patient to
stop taking drug
and immediately
report any signs
or symptoms of
swelling of the
face, extremities,
eyes, lips, or
tongue;
hoarseness; or
difficulty in
swallowing or
breathing.
-advise patient to
report promptly
any sign or
symptom of
infection (sore
throat) or
jaundice
(yellowing of
eyes or skin).
-advise patient to
avoid salt
substitutes
containing
potassium unless
instructed
otherwise by
prescriber
-caution patient
that light-
headedness may
occur, especially
during first few
 days of therapy.
Advise patient to
report
lightheadedness
and, if fainting
occurs, to stop
drug and consult
prescriber.
-caution patient
that inadequate
fluid intake or
excessive
perspiration,
diarrhea, or
vomiting can lead
to an excessive
drop in BP.

Lipitor Antilipemics Indication Inhibits HMG- 20 mg once CNS: headache, -use only after
(atorvastatin) -reduction of CoA reductase, daily asthenia, diet and other
elevated total an early (and insomnia nondrug
cholesterol and rate-limiting) Route: PO CV: peripheral therapies prove
LDL cholesterol, step in Onset: Unknown edema ineffective.
apolopoprotein B cholesterol Peak: 1-2 hr EENT: rhinitis, Patient should
and triglycerides biosynthesis. Duration: pharyngitis, follow a standard
in patients with Unknown sinusitis low-cholesterol
primary GI: abdominal diet before and
hypercholesterole pain, dyspepsia, during therapy.
mia, mixed flatulence, -before starting
hyperlipidemia, nausea, treatment,
heterozygous and constipation, assess patient for
homozygous diarrhea underlying
familial GU: UTI causes for
hypercholesterole Musculoskeletal: hypercholesterol
mia. arthritis, emia and obtain
arthralgia, a baseline lipid
Contraindication myalgia profile.
-active liver Respiratory: -obtain periodic
disease or bronchitis liver function test
elevated serum Skin: rash results and lipid
transaminases >3 Other: infection, levels before
times the upper flulike staring treatment
limit of normal syndrome, and at 6 and 12
allergic weeks after
reactions initiation, or after
an increase in
dosage and
periodically
thereafter.
-drug may be
given as single
dose at any time
of day, with or
without food.
-watch for signs
of myositis

Patient teaching
-teach patient
about proper
dietary
management,
weight control,
and exercise.
Explain their
importance in
controlling high
fat levels
-warn patient to
avoid alcohol
-tell patient to
inform prescriber
 of adverse
reactions, such
as muscle pain,
malaise, and
fever
-advise patient
that drug can be
taken at any time
of day, without
regard to meals.
Vessel due Anticoagulan Indication Inhibits Acute cases 1 Cap GI -Assess patients
(sulodexide) t, -vascular coagulation by amp 10-20 days disorders: for signs of
antithromboti pathologies with attacking once daily nausea, bleeding and
cs & thrombotic risk, several sites of followed by 1-2 vomiting, hemorrhage
fibrinolytics transient the coagulation cap bid 30 mins epigastralgia. (bleeding gums;
ischemic attacks system. Its before meals for Amp Pain, burn, nosebleed;
and CVD, effect is 60-90 days. hematoma at unusual bruising;
peripheral dependent on Chronic cases1-2 the site of black, tarry
vascular the presence of cap bid 30 mins injection. stools;
insufficiency, antithrombin III, before meals for hematuria; fall in
diabetic an alpha 2- 60-90 days. hematocrit or
retinopathy, globulin whose blood pressure;
myocardial activity is guaiac- positive
infarction, retinal augmented by stools). Notify
vassal thrombosis heparin. The physician if these
heparin- occur.
Contraindication antithrombin -Monitor patient
- Hypersensitivity complex for
to sulodexide, inactivates hypersensitivity
heparin & factors IXa, Xa, reactions (chills,
heparin- like XIa and XIIa, and fever, urticaria).
products. prevents Report signs to
Diathesis & thrombin physician
hemorrhagic formation. -Subcutaneous:
diseases. Furthermore, the observe injection
complex sites for
 reverses the hematomas,
effect of already ecchymosis, or
formed inflammation.
thrombin. In -Monitor platelet
high count every 2-3
concentrations, days throughout
heparin also therapy. May
inhibits cause mild
thrombocyte thrombocytopeni
aggregation. a, which appears
on the 4th day
and resolves
despite
continued
heparin therapy.

Humulin N Hormone Indication Insulin is a 6 units in AM - -Ensure uniform

[(Human Intermediate- -Treatment of hormone 4 units in PM Hypersensitivit dispersion of
insulin – acting Insulin type 1 (insulin- secreted by the y: Rash, insulin
recombinant dependent) pancrease that, Route: SQ anaphylaxis or suspensions by
DNA origin) diabetes by receptor- Onset: 1-1.5 hr angioedema rolling the vial
Isophane -Treatment of mediated Peak: 4-12 hr -Local: Allergy— gently between
suspension] type 2 (non– effects, Duration: 24 hr local reactions hands; avoid
insulin- promotes the at injection site vigorous shaking.
dependent) storage of the —redness, -Give
diabetes that body's fuels, swelling, itching; maintenance
cannot be facilitating the usually resolves doses SC,
controlled by diet transport of in a few days to rotating injection
or oral agents metabolites and a few weeks; a sites regularly to
-Treatment of ions (potassium) change in type decrease
severe through cell or species incidence of
ketoacidosis or membranes and source of insulin lipodystrophy;
diabetic coma stimulating the may be tried; give regular
(regular insulin synthesis of lipodystrophy; insulin IV or IM in
injection) glycogen from pruritus severe
-Treatment of glucose, of fats -Metabolic: ketoacidosis or
hyperkalemia from lipids, and Hypoglycemia; diabetic coma.
with infusion of proteins from ketoacidosis -Do not give
glucose to amino acids. insulin injection
produce a shift of concentrated IV;
potassium into severe
the cells anaphylactic
-Highly purified reactions can
and human occur.
insulins promoted -Use caution
for short courses when mixing two
of therapy types of insulin;
(surgery, always draw the
intercurrent regular insulin
disease), newly into the syringe
diagnosed first; if mixing
patients, patients with insulin
with poor lispro, draw the
metabolic control, lispro first; use
and patients with mixtures of
gestational regular and NPH
diabetes or regular and
-Insulin injection Lente insulins
concentrated within 5–15 min
indicated for of combining
treatment of them; Lantus
diabetic patients insulin (insulin
with marked glargine) cannot
insulin resistance be mixed in
(requirements of solution with any
> 200 units/day) other drug,
-Glargine including other
(Lantus): insulins.
Treatment of -Double-check, or
adult patients have a colleague
with type 2 check, the
diabetes who dosage drawn up
require basal for pediatric
insulin control of patients, for
hyperglycemia patients
-Treatment of receiving
adults and concentrated
children > 6 yr insulin injection,
who require or patients
baseline insulin receiving very
control small doses;
even small errors
Contraindication in dosage can
-Contraindicated cause serious
with allergy to problems.
pork products -Carefully
(varies with monitor patients
preparations; being switched
human insulin not from one type of
contraindicated insulin to another
with pork allergy). carefully; dosage
-Use cautiously adjustments are
with pregnancy often needed.
(keep patients Human insulins
under close often require
supervision; rigid smaller doses
control is than beef or pork
desired; following insulin; monitor
delivery, cautiously if
requirements patients are
may drop for 24– switched; lispro
72 hr, rising to insulin is given
normal levels 15 min before a
during next 6 meal.
wk); lactation -Store insulin in a
(monitor mother cool place away
carefully; insulin from direct
requirements sunlight.
may decrease Refrigeration is
during lactation). preferred. Do not
freeze insulin.
Insulin prefilled in
glass or plastic
syringes is stable
for 1 wk
refrigerated; this
is a safe way of
ensuring proper
dosage for
patients with
limited vision or
who have
problems with
drawing up
insulin.
-Monitor urine or
serum glucose
levels frequently
to determine
effectiveness of
drug and dosage.
Patients can
learn to adjust
insulin dosage on
a sliding scale
based on test
results.
-Monitor insulin
needs during
times of trauma
or severe stress;
dosage
adjustments may
be needed.
-Keep life support
equipment and
glucose readily
available to deal
with ketoacidosis
or hypoglycemic
reactions.

Patient teaching
-Use the same
type and brand of
syringe; use the
same type and
brand of insulin
to avoid dosage
errors.
-Do not change
the order of
mixing insulins.
Rotate injection
sites regularly
(keep a chart) to
prevent
breakdown at
injection sites.
-Dosage may
vary with
activities, stress,
diet. Monitor
blood or urine
glucose levels,
and consult
physician if
problems arise.
-Store drug in the
refrigerator or in
a cool place out
of direct sunlight;
do not freeze
insulin.
-If refrigeration
isn't possible,
drug is stable at
controlled room
temperature less
than 30° C
(86° F) and out of
direct sunlight for
up to 28 days; do
not freeze insulin.
-Monitor your
urine or blood for
glucose and
ketones as
prescribed.
-Wear a medical
alert tag stating
that you are a
diabetic taking
insulin so that
emergency
medical
personnel will
take proper care
of you.
-Avoid alcohol;
serious reactions
can occur.
-Report fever,
sore throat,
vomiting,
hypoglycemic or
 hyperglycemic
reactions, rash.

Recormon Indication Mimics effects of 5000 units, CNS: headache, -before starting
(epoeitin -treatment of erythropoietin. twice a week seizures, therapy, evaluate
beta) anemia assoc w/ Functions as paresthesia, patient’s iron
chronic renal growth factor, Route: SQ fatigue, status. Patient
failure on or not enhancing RBC Onset: unknown dizziness, should receive
on dialysis and production Peak: 5-24 hr asthenia adequate iron
malignancy on or Duration: CV: supplementation
not on unknown hypertension, beginning no
chemotherapy edema, later than when
increased epoetin
Contraindication clotting of treatment starts
-Folic acid and vit arteriovenous and continuing
b12 deficiencies grafts throughout
-severe Al EENT: therapy. Patient
overload pharyngitis also may need
-Nephrosclerosis GI: nausea, vitamin B12 and
-serum K and vomiting, folic acid
phosphate; stop if diarrhea, -monitor BP
K incr. and BP abdominal pain. before therapy.
incr. Metabolic: Most patients
hyperuricemia, with chronic renal
hyperkalemia, failure have
hyperphosphate hypertension. BP
mia may
Respiratory: Increase,
cough, shortness especially when
of breath hematocrit
Skin: rash, increases in the
infection site early part of
reactions, therapy
urticaria -institute diet
Other: pyrexia restrictions or
drug therapy to
control BP
-monitor
hemoglobin level
twice weekly
until it stabilizes
in the target
range (10 to 12
g/dl for most
patients) and
maintenance
dose is
established, then
continue to
monitor at
regular intervals.
Resume twice
weekly testing
following any
dosage
adjustments
-reduce dosage
in patients who
have an increase
in hemoglobin
level of more
than 1 g/dl in any
2 week period
-monitor blood
counts; elevated
hematocrit may
cause excessive
clotting
-patient may
need additional
heparin to
prevent clotting
during dialysis
treatments
-evaluate patient
who experiences
a loack or loss of
effect for pure
red cell aplasia

Patient teaching
-inform patient
that pain or
discomfort in
limbs (long
bones) and
pelvis, and
coldness and
sweating may
occur after
injection (usually
within 2 hours)
symptoms may
last for 12 hours
and then
disappear
-advise patient to
avoid driving or
operating heavy
machinery at
start of therapy.
There may be a
relationship
between too
rapid increase
hematocrit and
seizures
-tell patient to
 monitor BP at
home and adhere
dietary
restrictions

NaHCO3 Indication Restores 650 mg TID CNS: tetany -to avoid risk of
-metabolic buffering CV: edema alkalosis, obtain
acidosis capacity of the Route: PO GI: gastric blood pH, partial
-systemic or body and Onset: unknown distention, pressure of
urinary neutralizes Peak: unknown belching, arterial oxygen,
alkalinization excess acid. Duration: flatulence partial pressure
-antacid unknown Metabolic: of arterial carbon
-cardiac arrest hypokalemia, dioxide, and
metabolic electrolyte levels.
Contraindication alkalosis, Tell prescribe
-patient with hypernatremia, laboratory results
metabolic or hyperosmolarity -oral products
respiratory with overdose may contain 27%
alkalosis and in Skin: pain, and sodium
those with irritation at
hypocalcemia in injection site Patient teaching
which alkalosis -tell patient not
may produce to take drug with
tetany, milk because
hypertension, doing so may
seizures, or heart cause high levels
failure of calcium in the
-patients losing blood,
chloride because abnormally high
of vomiting or alkalinity in
continuous GI tissues and
suction and in fluids, or kidney
those receiving stones.
diuretics that
produce
hypochloremic
alkalosis. Oral
drug is
contraindicated
for acute
ingestion of
strong mineral
acids
-Use with caution
in patients with
renal
insufficiency,
heart failure, or
other edematous
or sodium-
retaining
condition.