DRUG ANALYSIS Drug Name trimetazidine (Vastarel MR) Drug Classification: Anti-ischemic metabolic agent Dosage 35mg 1 tab

TID PO Mechanism Of Action improves myocardial glucose utilization through stopping of fatty acid metabolism by limitation of intracellular acidosis, correction of disturbances of transmembrane ion exchanges, and prevention of excessive production of free radicals Indication patients with heart failure Contraindication Contraindicated with hypersensitivity to trimetazidine Use cautiously with heart failure and pregnancy Side Effects Others: fever, rash, abscess GI: nausea Nursing Responsibilities Assess for hypersensitivity to trimetazidine, with heart failure and pregnancy Administer drug after patient has eaten with a full glass of water Encourage patient to continue efforts at smoking cessation Provide safety measures if lethargy occurs

Drug Name phenytoin (Dilantin) Drug Classification: Antiarrhythmic

Dosage 100mg TID PO

Mechanism Of Action Effective in treating cardiac arrhythmias, especially those induced by cardiac glycosides

Indication Unlabeled uses: Antiarrhythmic, particulary in arrhythmias induced by cardiac glycosides

Contraindication Contraindicated with hypersensitivity to sinus bradycardia, pregnancy Use cautiously with hypotension, sever myocardial insufficiency, DM ,hyperglycemia

Side Effects CNS: Dizziness CV: hypotension GI: nausea and vomiting

Nursing Responsibilities Administer IV slowly to prevent hypotension and venous irritation Continually monitor patients cardiac rhythm and check BP frequently and regularly during IV infusion Give oral drug with or without food. Give with food if patient complains of GI upset Do not discontinue the drug abruptly Monitor blood or urine sugar regularly Report rash, severe nausea and vomiting, drowsiness, slurred speech, confusion, joint pain, sore throat, unexplained fever, unusual bleeding, persistent headache, malaise, yellow discoloration of the skin or eyes

Drug Name

Dosage

Mechanism Of

Indication

Contraindication

Side Effects

Nursing Responsibilities

montelukast sodium Drug Classification: Antiasthmatic Leukotriene receptor antagonist

10 mg OD PO

Action Selectively and competitively blocks the receptor that inhibits leukotriene formation, thus blocking many of the signs and symptoms of asthma

Chronic treatment of asthma

Contraindicated with hypersensitivity to montelukast or any of its components; acute asthma attacks; status asthmaticus Use cautiously with pregnancy and lactation.

CNS: headache, dizziness GI: nausea, diarrhea, abdominal pain, dental pain, liver impairment Respiratory: Influenza, cold, nasal congestion Other: generalized pain, fever, rash, fatigue

Administer in the evening without regard to food. Ensure that drug is taken continually for optimal effect. Use caution when doing activities that require alertness. Eat frequent small meals. Take drug with food. Analgesics may be available for headache. Report fever, acute asthma attacks, flulike symptoms, lethargy. Do not administer for acute asthma attack or acute bronchospasm; this drug is not a bronchodilator, and routine emergency procedures should be followed during acute attacks.

Drug Name lansoprazole Drug Classification: Antisecretory drug Proton pump inhibitor

Dosage 30 mg OD PO

Mechanism Of Action Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production

Indication Reduction in occurrence of gastric ulcers

Contraindication Contraindicated with hypersensitivity to lanzoprazole or any of its components. Use cautiously with pregnancy, lactation.

Side Effects CNS: headache, dizziness, insomnia, anxiety, paresthesias, dream abnormalities Dermatologic: rash, inflammation, urticaria, pruritus, alopecia, dry skin, acne GI: diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth Respiratory: URI symptoms, cough

Nursing Responsibilities Administer before meals. Caution patient to swallow capsules whole, not to chew or crush. Avoid performing hazardous tasks.

Drug Name sertraline hydrochloride (Zoloft)

Dosage 50 mg HS PO

Mechanism Of Action Act as an antidepressant by inhibiting CNS neuronal uptake of

Indication Treatment of major depressive disorder

Contraindication Contraindicated with hypersensitivity to sertraline.

Side Effects CNS: headache, nervousness, drowsiness, anxiety, tremor, dizziness, insomnia,

Nursing Responsibilities Use lower doses in elderly patients and with renal impairment

Drug Classification: Antidepressant SSRI

serotonin; blocks uptake of serotonin with little effect on norepinephrine, muscarinic, histaminergic, and alpha-adrenergic or dopaminergic receptors.

Use cautiously with impaired hepatic or renal function, lactation, pregnancy

vision changes, fatigue Dermatologic: sweating GI: nausea, vomiting, diarrhea, dry mouth GU: painful menstruation Respiratory: rhinitis

N/V: eat frequent small meals Dry mouth: suck sugarless lozenges; perform frequent mouth care Excessive sweating: monitor temperature, avoid overheating Report rash, mania, seizures, edema, depression, thoughts of suicide.

Drug Name levatiracetam (Keppra) Drug Classification: Antiepileptic

Mechanism Of Action 250 mg OD Mechanism of PO action not well understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block posttetanic potentiation.

Dosage

Indication Adjunctive therapy for bipolar disease

Contraindication Contraindicated with hypersensitivity to levatiracetam. Use cautiously with lactation, pregnancy, renal impairment.

Side Effects CNS: dizziness, headache, somnolence, ataxia

Nursing Responsibilities Give drug with food to prevent GI upset. If CNS, vision, or coordination changes occur, establish safety precautions (use side rails, accompany patient when ambulating) Do not stop drug abruptly. Risk for seizure precipitation; withdraw gradually. GI upset: take this drug with food or milk and eating frequent small meals Fatigue: periodic rest periods may be helpful Report severe headache, sleepwalking, rash, severe vomiting, chills, fever, difficulty breathing.

Drug Name epoetin alfa (EPO) Drug Classification: Recombinant human erythropoietin

Dosage 4000 U 2x/week SQ

Mechanism Of Action A natural glycoprotein produced in the kidneys, which stimulates red blood cell production in the bone marrow.

Indication Treatment of anemia associated with chronic renal failure

Contraindication Contraindicated with uncontrolled hypertension, hypersensitivity to mammalian-derived products or to albumin human; contains benzyl alcohol, which can be fatal in premature infants. Use cautiously with

Side Effects CNS: headache, arthralgia, fatigue, asthenia, dizziness CV: hypertension, edema, chest pain GI: nausea,

Nursing Responsibilities Confirm chronic, renal nature of anemia; not intended as a treatment of severe anemia or substitute for emergency transfusion. Patients with chronic renal failure on hemodialysis should receive the drug IV, not by subcutaneous injection, to decrease the risk of developing antierythropoietin anti-bodies. Do not give with any other drug

pregnancy, lactation, sickle cell anemia, myelodysplastic syndromes, porphyria, hypercoagulable disorders.

vomiting, diarrhea

solution. Monitor access lines for signs of clotting Monitor Hgb levels; target range is 1012 g/dL; do not exceed 12 g/dL

Drug Name methylprednisolone (Medrol) Drug Classification: Corticosteroid Glucocorticoid Hormone

Dosage 16 mg OD PO

Mechanism Of Indication Action Enters target Status cells and binds asthmaticus to intracellular corticosteroids receptors, initiating many complex reactions that are responsible for its antiinflammatory and immunosuppress ive effects.

Contraindication Contraindicated with infections, especially TB, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation Administration of live vaccines is contraindicated in patients receiving immunosuppressive doses. Use cautiously with kidney or liver disease, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, heart failure, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus, pregnancy

Side Effects CNS: vertigo, headache Electrolyte imbalance: sodium and fluid retention GI: increased appetite, weight gain Other: immunosuppression, aggravation or masking of infections; impaired wound healing

Nursing Responsibilities Give daily dose before 9 am to mimic normal peak corticosteroid blood levels. Monitor glucose levels with prolonged therapy; dietary adjustments may be needed. Taper doses when discontinuing high dose or long-term therapy to allow adrenal recovery. Do not give live-virus vaccines with immunosuppressive doses of corticosteroids. Avoid exposure to infections: proper hand washing. Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of disorder.

Drug Name divalproex sodium (Epival) Drug Classification: Antiepileptic

Dosage 250 mg HS PO

Mechanism Of Action Mechanism of action not understood; antiepileptic activity may be related to the metabolism of the inhibitory neurotransmitter, GABA; divalproex

Indication Acute treatment of manic episodes associated with bipolar disorder

Contraindication Contraindicated with hypersensitivity to valproic acid, hepatic disease, or significant hepatic impairment Lactation

Side Effects CNS: sedation GI: nausea, vomiting, indigestion

Nursing Responsibilities Give drug with food if GI upset occurs. Do not discontinue drug abruptly or change dosage, except on advice of doctor. Avoid alcohol and sleepinducing OTC drugs This may interfere with urine

sodium is a compound containing equal proportions of valproic aid and sodium valproate

tests for ketones for DM. Drowsiness: take at bed time GI upset: take with food or milk, eat frequent small meals

Drug Name citicoline Drug Classification: Brain Supplement

Dosage 1g OD PO

Mechanism Of Action Protects cholinergic neurons and enhances brain acetylcholine synthesis for membrane repair and regeneration Citicoline seems to increase a brain chemical called phosphatidylcholine. Citicoline is also believed to protect nerve cells when in low oxygen conditions.

Indication Indicated to memory loss, stroke recovery. Citicoline may be used for nutritional support in cerebral vascular disease, head trauma, stroke, and cognitive disorders. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.

Contraindication Citicoline is contraindicated in conditions like unconciousness, brain surgery, pregnancy,breast feeding.

Side Effects Elevated body temperature, restlessness, and difficulty sleeping if the supplement is taken in the evening.

Nursing Responsibilities Administer citicoline in the morning. Implement safety measures including adequate lighting, use of side rails and assistance of ambulation to protect patient from injury.

Drug Name ambroxol hydrochrloride (Mucosolvan) Drug Classification: active mucolytic agent

Dosage 75 mg 1 tab OD PO

Mechanism Of Action The breakdown of acid mucopolysaccharide fibers makes the sputum thinner and less viscous and therefore more easily removed by coughing.

Indication chronic inflammatory pulmonary conditions, bronchiectasis, bronchitis with bronchospasm asthma

Contraindication There are no absolute contraindications but in patients with gastric ulceration relative caution should be observed. Avoid use during the first trimester of pregnancy.

Side Effects Occasional gastrointestinal side effects such as nausea and vomiting may occur but these are normally mild.

Nursing Responsibilities GI upset: take this drug with food or milk and eating frequent small meals N/V: eat frequent small meals

Drug Name

Dosage

Mechanism Of Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Calcitriol (Rocaltrol) Drug Classification: Synthetic Vitamin D analog Vitamin D3

0.25 mg 1 tab OD PO

active in the regulation of the absorption of ca lcium from the gastrointestinal tract and its utilization in the body

indicated in the management of hypocalcemia and the resultant metabolic bone disease in patients undergoing chronic renal dialysis. In these patients, Calcitriol administration enhances calcium absorption, reduces serum alkaline phosphatase levels, and may reduce elevated parathyroid hormone levels

should not be given to patients with hypercalcemia or evidence of vitamin D toxicity. patients with known hypersensitivity to calcitriol lactation

weakness, headache, drowsiness; nausea, vomiting, stomach pain, constipation; loss of appetite; dry mouth, increased thirst; metallic taste in the mouth; polyuria fast, slow, or uneven heart rate; changes in behavior; muscle pain, bone pain, muscle weakness, loss of height;

GI upset: take this drug with food or milk and eating frequent small meals N/V: eat frequent small meals Increase roughage in the diet Drowsiness: take at bed time Implement safety measures including adequate lighting, use of side rails and assistance of ambulation to protect patient from injury.

Drug Name nitroglycerin/ nitrate patch Drug Classification: Antianginal

Dosage OACW Q24o

Mechanism Of Action Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decrease myocardial oxygen consumption

Indication Prophylaxis of angina, reduction of cardiac workload in acute myocardial infarction

Contraindication Contraindicated with allergy to nitrates Use cautiously with hepatic and renal disease Increase ICP

Side Effects Dizziness, lightheadedness, or orthostatic hypotension flushing of face and neck headache weakness irritation at site of patch, rash Nausea, vomiting. Tachycardia

Nursing Responsibilities Assist patient in doing activities of daily living and promotes safety measures by keeping side rails up Assist patient in changing body position, slowly. Provide cool and comfortable environment. N/V: eat frequent small meals

Drug Name levodropropizine (Levopront) Drug Classification: Cough

Dosage 2 tsp BID

Mechanism Of Action Levodropropizine is a cough suppressant that exerts peripheral action in nonproductive

Indication Symptomatic treatment of cough

Contraindication Patients with excessive discharge of mucus, with limited mucociliary function, severe liver dysfunction. Pregnancy, lactation. Children <24

Side Effects Nausea, vomiting, heartburn, diarrhea fatigue, weakness, drowsiness, dizziness, headache palpitations

Nursing Responsibilities Should be taken on an empty stomach (Take between meals.) N/V: eat frequent small meals Assist patient in doing activities of daily living and

suppressant

cough.

month. Precaution to serious renal insufficiency, diabetes.

promotes safety measures by keeping side rails up

Drug Name sultamicillin Drug Classification: Penicillin Antibacterial Antiinfective

Dosage 375 mg/cap q8o

Mechanism Of Action Sultamicillin inhibits lactamases in penicillin-resistant microorganisms and it acts against sensitive organisms during the stage of active multiplication by inhibiting biosynthesis of cell wall mucopeptide.

Indication Respiratory tract infection

Contraindication Hypersensitivity to any component of the drug.

Side Effects Diarrhea nausea, vomiting rashes, pruritus blood dyscrasias superinfections dizziness dyspnea

Nursing Responsibilities N/V: eat frequent small meals Assist patient in doing activities of daily living and promotes safety measures by keeping side rails up Monitor input and output. Monitor respiratory rate.

Drug Name calcium carbonate (Caltrate Plus) Drug Classification: Antacid Electrolyte

Dosage 1 tab Q6o

Mechanism Of Action Calcium carbonate can neutralize gastric acid rapidly and effectively. Helps maintain functional integrity of the nervous and muscular systems; helps maintain cardiac function, blood coagulation.

Indication

Contraindication

Side Effects Constipation, flatulence; hypercalcemia; metabolic alkalosis; milk-alkali syndrome, tissue-calcification. Gastric hypersecretion and acid rebound (with prolonged use).

Nursing Responsibilities May be taken with or without food. (Take w/ meals for better absorption. Avoid taking w/ large amount of fiber-rich food.) Tell patient to avoid foods that are irritating to the stomach such as spicy foods.

Hyperphosphatemia Patients with Ca renal in chronic renal calculi or history of renal failure calculi; hypercalcemia; hypophosphatemia. Use cautiously with renal impairment, pregnancy, lactation

Drug Name cilostazol Drug Classification:

Dosage 100 mg 1 tab OD PO

Mechanism Of Action

Indication to reduce leg pain caused by poor circulation

Contraindication Heart failure; known predisposition to bleeding; history of ventricular arrhythmias; QT interval

Side Effects Headache, dizziness Palpitations diarrhea, abnormal stools

Nursing Responsibilities Stress proper handwashing to patient. N/V: eat frequent small meals Assist patient in doing

Reversibly inhibits platelet aggregation induced by a variety of stimuli including ADP,

Platelet Aggregation Inhibitor Phosphodiesterase Inhibitor Antiplatelet Anticoagulant

(intermittent thrombin, collagen, claudication). shear stress, epinephrine, and arachidonic acid by inhibiting cAMP phosphodiesterase III; produces vascular dilation in vascular beds with a specificity for femoral beds; seems to have no effect on renal arteries

prolongation; severe renal impairment; moderate to severe hepatic impairment. Use cautiously with congestive heart disease. Concurrent therapy with clopidogrel has not been studied for safety or efficacy. Pregnancy and lactation.

pain infection peripheral edema, nausea, vomiting cardiac arrhythmias, chest pain rhinitis, pharyngitis ecchymosis and skin rash.

activities of daily living and promotes safety measures by keeping side rails up Monitor input and output. Watch out for bleeding tendencies. Apply pressure to puncture sites.

Drug Name Domperidone (Motilium) Drug Classification: GIT Regulators, Antiflatulents & AntiInflammatories Antivertigo Drugs

Dosage 10 mg 1 tab TID PO

Mechanism Of Action Domperidone is a peripheral dopaminereceptor blocker. It increases oesophageal peristalsis, lower oesophageal sphincter pressure, gastric motility and peristalsis, thus facilitating gastric emptying and decreasing small bowel transit time.

Indication Acute treatment of nausea and vomiting

Contraindication Hypersensitivity. GI hemorrhage, obstruction and perforation, patients with prolactin releasing pituitary hormone, chronic admin or routine prophylaxis of postoperative nausea and vomiting.

Side Effects Drowsiness, extrapyramidal reactions galactorrhea, gynecomastia constipation or diarrhea lassitude decreased libido skin rash, itch.

Nursing Responsibilities Monitor intake and output. Ask patient not to scratch itchy part and rashes. Maintain short nails. Assist patient in doing activities of daily living and promotes safety measures by keeping side rails up Monitor electrolyte balance for diarrhea.

Drug Name Insulin glargine (Lantus) Drug Classification: Antidiabetic Hormone

Dosage 10U SQ OD

Mechanism Of Action The primary activity of insulin, including insulin glargine, is regulation of glucose metabolism. Insulin and its analogs lower blood glucose levels by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin inhibits lipolysis in the adipocyte, inhibits proteolysis, and enhances protein synthesis.

Indication Treatment of adult patient with type 2 diabetes mellitus who require basal insulin control of hyperglycemia

Contraindication Lantus is contraindicated in patients hypersensitive to insulin glargine or the excipients.

Side Effects Allergic reactions Injection site reaction, lipodystrophy pruritus, rash dry mouth hypoglycemia

Nursing Responsibilities Provide mouth hygiene. Provide ice chips. Advise patient not to scratch pruritic skin and apply topical lotions to reduce pruritus. Advise patient not to massage injection site to avoid lipodystrophy

Drug Name Amlodipine (Norvasc) Drug Classification: Antihypertensive Calcium Channel Blocker

Dosage 5mg OD PO

Mechanism Of Action Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane calcium flow, which results in depression of impulse formation in specialized cardiac pacemaker muscles, slowing the conduction of the cardiac impulse, depression of myocardial contractility and dilation of coronary arteries and arterioles

Indication Essential hypertension

Contraindication Contraindicated with allergies to amlodipine, impaired hepatic or renal function, heart block Use cautiously with heart failure

Side Effects CNS: fatigue, lethargy

Nursing Responsibilities Administer drug with food or meals if GI upset occurs Monitor patient carefully Monitor cardiac rhythm regularly Report irregular heartbeat, shortness of breath, swelling of hands or feet, dizziness