VII.

Drug Study: DRUG NAME Losartan Potassium Drug Class: Antihypertensive ARB MECHANISM OF ACTION Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands; this action block the vasoconstriction effect of the reninangiotensin system as well as the release of aldosterone leading to decreased BP. INDICATION Treatment of hypertension, alone or in combination with other antihypertensive. DOSAGE 50 mg tab OD in AM via NGT. SIDE EFFECTS Dizziness, headache, nauseas, vomiting, diarrhea, symptoms of upper respiratory tract infection, cough. CONTRAINDICATION Contraindicated with hypersensitivity to losartan, pregnancy (use during the second or third trimester can cause injury or even death to fetus), lactation. NURSING INTERVENTIONS Administer without regards to meal. Ensure that the patient is not pregnant before beginning therapy; suggest the use of barrier birth control while using losartan; fetal injury and deaths have been reported. Find an alternative method of feeding the baby if given to a nursing mother. Depression of reninangiotensin system in infant us potentially very dangerous. Alert surgeon and mark the patients chart with notice that losartan is being taken. The blockage of renin-angiotensin system following

Reduction of risk of CVA in patients with hypertension and left ventricular hypertrophy.

surgery can produce problems. Hypotension may be reversed with volume expansion. Monitor patient closely in any situation that may lead to decreased in BP secondary to reduction in fluid volume excessive perspiration, dehydration, vomiting, diarrhea excessive hypotension can occur.

DRUG NAME Amlodipine besylate Drug Class: Antianginal Antihypertensive Calcium Channel Blocker

MECHANISM OF ACTION Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane

INDICATION Essential hypertension, alone or in combination with other antihypertensives.

DOSAGE 10 mg tab OD at HS via NGT

SIDE EFFECTS Nausea, vomiting, headache.

CONTRAINDICATION Contraindicated with allergy to losartan, impaired hepatic or renal function, sick sinus syndrome, heart block, lactation.

NURSING INTERVENTIONS Monitor patients carefully (BP, cardiac rhythm, and output) while adjusting drug to therapeutic dose; use special caution if patient has heart failure.

calcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of cardiac impulse, depression of myocardial contractility, and dilatation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac oxygen consumption, and in patients with vasospastic angina, increased delivery of oxygen to cardiac cells.

Monitor BP very carefully if patient is also in nitrates. Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long term therapy. Administer drug without regards to meal. Report irregular heartbeat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

DRUG NAME Simvastatin Drug class: Antihyperlipidemic HMG-CoA Reductase Inhibitor

MECHANISM OF ACTION Inhibits HMG-CoA Reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

INDICATION

DOSAGE

Adjunct to diet in 40 mg tab OD at the treatment of HS via NGT. elevated total cholesterol and LDL cholesterol with primary hypercholesterolem ia in those unresponsive to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures. To reduce the risk of coronary disease, mortality and CV events, including CVA, TIA, MI and reduction in need for bypass surgery and angioplasty in patients with coronary heart disease and hypercholesterolem ia.

SIDE EFFECTS Nausea, headache, muscle and joint aches and pains, sensitivity to light.

CONTRAINDICATION Contraindicated with allergy to simvastatin, fungal byproducts; active liver disease or unexplained, persistent elevation of serum transaminases; pregnancy, lactation.

NURSING INTERVENTIONS Take drug in the evening. Highest rate of cholesterol synthesis are between midnight and 5 am. Do not drink grape juice while using this drug. Advise patient to have periodic blood test. Advise patient that this drug cannot be taken during pregnancy; using barrier contraception, is recommended.

DRUG NAME Mannitol Drug class: Diagnostic agent Osmotic diuretics Urinary irrigant

MECHANISM OF ACTION Elevates the osmolarity of the glomerular filtrate, thereby hindering the reabsorption of water and leading to a loss of water, sodium, chloride; creates an osmotic gradient in the eye between plasma and ocular fluids, thereby reducing IOP; creates an osmotic effect, leading to decreased swelling in posttransurethral prostatic resection.

INDICATION Prevention and treatment of the oliguric phase of renal failure. Reduction of intracranial pressure and treatment of cerebral edema; of elevated IOP when the pressure cannot be lowered by other means. Promotion of urinary excretion of toxic substances. Diagnostic use: Measurement of GFR.

DOSAGE 175cc every 4 hours

SIDE EFFECTS Increased urination; GI upset; dry mouth; headache, blurred vision.

CONTRAINDICATION Contraindicated with anuria due to severe renal disease.

NURSING INTERVENTIONS Do not give electrolyte free mannitol with blood. If blood must be given, add atleast 20mEq of sodium chloride to each liter of mannitol solution. Do not expose solutions to low temperatures; crystallization may occur. If crystals are seen, warm the bottle in a hot water bath, then cool to body temperature before administering. Make sure the infusion set contains a filter if giving concentrated mannitol. Monitor serum electrolytes

periodically with prolonged therapy.

DRUG NAME Citicholine Drug class: CNS Stimulant, Peripheral Vasodilators, Cerebral Activators

MECHANISM OF ACTION Citicoline increases blood flow and O2 consumption in the brain. It is also involved in the biosynthesis action.

SIDE EFFECTS Citicoline is 500mg IV every 8 Fleeting and indicated in CVD hours discrete in acute recovery hypotension phase in severe s/sx effect, of cerebrovascular increased insufficiency and parasympathe in-cranial tic effects, traumatism and low blood their sequellae. pressure Citicoline in CVA, stimulates brain Itching or function. hives, swelling in face or hands, chest tightness, tingling in mouth and throat

INDICATION

DOSAGE

CONTRAINDICATION Any allergy or hypersensitivity to the drug Hypertonia of the parasympathetic nervous system

NURSING INTERVENTIONS Take Citicoline as prescribed Take Citicoline on time Monitor patients neurologic status Note if there are signs of slurring of speech Note for adverse reactions Titer medication when discontinuing Teach patient on how to take the drug Arrange for regular

follow-ups

DRUG NAME Lactulose Drug class: Ammonia reduction drug Laxative

MECHANISM OF ACTION Lactulose is a synthetic sugar used in the treatment of constipation and liver disease. It consists of the monosaccharides fructose and galactose. In the colon, lactulose is broken down primarily to lactic acid, and also to small amounts of formic and acetic acids, by the action of via evolved-beta galactosidase from colonic bacteria, which results in an increase in osmotic pressure and slight acidification of the

INDICATION Treatment of constipation. Prevention and treatment of portalsystemic encephalopathy.

DOSAGE 30 cc OD at HS

SIDE EFFECTS Abdominal fullness, flatulence, belching.

CONTRAINDICATION Contraindicated with allergy to lactulose, lowgalactose diet.

NURSING INTERVENTIONS Do not freeze laxative form. Extremely dark or cloudy syrup may be unsafe; do not use. Give laxative syrup orally with fruit juice, water, or milk to increase palatability. Administer retention enema using a rectal balloon catheter. Do not use cleansing enemas containing soapsuds or other alkaline drugs that counteract the effects of lactulose. Do not administer other laxatives while using lactulose.

colonic contents. This in turn causes an increase in stool water content and softens the stool. In treating heptic diseases (hepatic encephalopathy) it is thought that lactulose draws out ammonia from the body in the same way that it draws out water into the colon.

Monitor serum ammonia levels.

DRUG NAME Omeprazole Drug class: Antisecretory drug Proton pump inhibitor

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

INDICATION

DOSAGE

First-line therapy in 40 mg IV OD treatment of heartburn or symptoms of gastro esophageal reflux disease (GERD) Short-term treatment of active benign gastric ulcer

SIDE EFFECTS Dizziness, headache, nausea, vomiting, diarrhea, symptoms of URI, cough.

CONTRAINDICATION Contraindicated with hypersensitivity to omeprazole or its components.

NURSING INTERVENTIONS Administer before meals. Caution patient to swallow capsules whole- not to open, chew, or crush them. If using oral suspension, empty packet into a small cup containing 2 tbsp of water. Stir and have patient drink

cells; blocks the final step of acid production.

GERD, severe erosive esophagitis, poorly responsive symptomatic GERD

immediately; fill cup with water and have patient drink this water. Do not use any other diluent. Administer antacids with, if needed.