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GENERIC NAME/ TRADE NAME Irbesartan / Avapro CLASSIFICATION Angiotensin II receptor antagonist (ARB), Antihypertensive THERAPEUTIC ACTION Selectively

blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the renin-angiotensin system as well as the release of aldosterone, leading to decreased blood pressure. DOSAGE Tablets: 75mg, 150mg, 300mg. INDICATION Treatment of hypertension as monotherapy or in combination with other antihypertensives Slowing of the progression of kidney disease in patients with hypertension and type 2 diabetes CONTRAINDICATION Contraindicated with hypersensitivity to irbesartan, pregnancy (use during the second or third trimester can cause injury or even death to the fetus), lactation. Use cautiously with hepatic or renal dysfunction, hypovolemia. SIDE EFFECTS Headache, dizziness, syncope, muscle weakness Hypotension, orthostatic hypotension Rash, inflammation, urticaria, pruritus, alopecia, dry skin Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain URI symptoms, cough, sinus disorders Cancer in preclinical studies, back pain, fever, gout, fatigue NURSING RESPONSIBILITIES Administer without regard to meals. Ensure that patient is not pregnant before beginning therapy; suggest the use of barrier birth control while using irbesartan; fetal injury and deaths have been reported. Find an alternative method of feeding the baby if giving drug to a nursing mother. Depression of the renin-angiotensin system in infants is potentially very dangerous. Alert surgeon and mark patient's chart with notice that irbesartan is being taken. The blockage of the renin-angiotensin system following surgery can produce problems. Hypotension may be reversed with volume expansion. Monitor patient closely in any situation that may lead to a decrease in blood pressure secondary to reduction in fluid volume (excessive perspiration, dehydration, vomiting, diarrhea); excessive hypotension can occur.

GENERIC NAME/ TRADE NAME Amlodipine / Norvasc CLASSIFICATION cardiovascular agent; calcium channel blocker; antihypertensive agent Therapeutic Action
Amlodipine inhibits calcium movement across cell membranes of cardiac and vascular smooth muscle. It dilates coronary arteries, peripheral arteries and arterioles. Amlodipine decreases total peripheral vascular resistance by vasodilation.

DOSAGE Hypertension PO: ADULTS: Initially 5 mg/day as single dose. Maximum: 10 mg per day. PO: SMALL-FRAME, FRAGILE, ELDERLY: Initially 2.5 mg/day as single dose.

Angina (Chronic, Stable, or Vasospastic) PO: ADULTS: 5-20 mg. ELDERLY, HEPATIC, INSUFFICIENCY: 5 mg. Dosage in Liver Impairment PO: ADULTS, ELDERLY: Initially, 2.5 mg per day. INDICATION Amlodipine is used to manage hypertension, chronic stable angina, and vasospastic angina. It may be used alone or with other anti-hypertensives or anti-anginals. CONTRAINDICATION Allergy to amlodipine -Hepatic or renal impairment -Sick sinus syndrome -Heart block -Sick sinus syndrome -Lactation SIDE EFFECTS
Peripheral edema Headache Flushing Dizziness Palpitations Nausea Unusual tiredness or weakness Chest pain Bradycardia Orthostatic Hypotension Excessive peripheral vasodilation Marked hypotension Reflex tachycardia

Assess blood pressure. Assess apical pulse.

Assess baseline renal and liver function.

Assess for peripheral edema behind medial malleolus. Assess skin for flushing. Question for headache and weakness. May be given without regards to food. Grapefruit juice may increase drug concentration. Do not abruptly discontinue medication. Compliance with therapy regimen is essential to control hypertension. Avoid tasks that require alertness or motor skills until response to drug is established. Avoid concomitant ingestion of grapefruit.


Antihyperlipidemic, HMG-CoA reductase inhibitor Pregnancy Category X

Therapeutic Action
Simvastatin is a prodrug metabolised in the liver to form the active -hydroxyacid derivative. This inhibits the conversion of HMG-CoA to mevalonic acid by blocking HMG-CoA reductase, an early and rate-limiting step in cholesterol biosynthesis. It reduces total cholesterol, LDLcholesterol and triglycerides and increases HDL-cholesterol levels.

DOSAGE Adults:
Initially, 20 mg PO; up to 80 mg PO daily in the evening. Usual range, 580 mg/day. Maximum dose, 80 mg/day. Adjust at 4-wk intervals.

Familial hypercholesterolemia: 40 mg/day PO in the evening, or 80 mg/day divided into doses of 20 mg, 20 mg, and 40 mg in the

Combination therapy: Do not combine with other statins; if used with fibrates or niacin, do not exceed 10 mg/day; regular dose if
combined with bile acid sequestrants. Combined with cyclosporine, start with 5 mg/day; do not exceed 20 mg/day. Combination with amiodarone or verapamil, dose should not exceed 10 mg/day.

Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) 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 hypercholesterolemia Treatment of patients with isolated hypertriglyceridemia Treatment of type III hyperlipoproteinemia Treatment of adolescents 1017 yr with heterozygous familial hypercholesterolemia

Acute liver disease or unexplained persistent elevations of serum transaminases. Pregnancy, lactation. Porphyria.

Headache, nausea, flatulence, heartburn, abdominal pain, diarrhea/constipation, dysgeusia; myopathy features like myalgia and muscle weakness; serum transaminases and CPK elevations; hypersensitivity; lens opacities; blurring of vision; dizziness; sexual dysfunction; insomnia; depression and upper respiratory symptoms.

Potentially Fatal: Severe rhabdomyolysis with acute renal failure. NURSING REAPONSIBILITIES
History: Allergy to simvastatin, fungal byproducts; impaired hepatic function; pregnancy; lactation Physical: Orientation, affect; liver evaluation, abdominal examination; lipid studies, LFTs

Ensure that patient has tried a cholesterol-lowering diet regimen for 36 mo before beginning therapy. Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM. Advise patient that this drug cannot be taken during pregnancy; advise patient to use barrier contraceptives. Arrange for regular follow-up during long-term therapy. Consider reducing dose if cholesterol falls below target.

Teaching points
Take drug in the evening. Do not drink grapefruit juice while using this drug. Have periodic blood tests. This drug cannot be taken during pregnancy; using barrier contraceptives is recommended. You may experience these side effects: Nausea (eat frequent small meals); headache, muscle and joint aches and pains (may lessen); sensitivity to light (use a suncreen and wear protective clothing).

Report severe GI upset, changes in vision, unusual bleeding or bruising, dark urine or light-colored stools, fever, muscle pain, or soreness.