Drug Study

Drug Name Clopidogrel 75mg/tab 1 tab OD Classification: antiplatelet agent

Action Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

Indication Treatment of patients at risk for ischemic eventshistory of MI, ischemic stroke, peripheral artery disease Treatment of patients with acute coronary syndrome

Contraindication Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation.

Side Effect CNS: Headache, dizziness, weakness, syncope, flushing CV: Hypertension, edema Dermatologic: Rash, pruritus GI: Nausea, GI distress, constipation, diarrhea, GI bleed Other: Increased bleeding risk

Nursing Responsibility Assess for symptoms of stroke, MI during treatment Monitor liver function studies: AST, ALT, bilirubin, creatinine if patient is on long-term therapy Monitor blood studies: CBC,Hgb, Hct, protime, cholesterol if the patient is on long-term therapy; thrombocytopeni a and neutropenia may occur. Precautions: bleeding disorders, recent surgery, hepatic impairment, pregnancy

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Drug Name Aspirin 80mg/tab 1 tab p lunch PO OD Classification: Antipyretic Analgesic (nonopioid) Antiinflammatory Antirheumatic Antiplatelet Salicylate NSAID

Action Exhibits antipyretic, anti-inflammatory and analgesic effects. The antipyretic effect is due to an action on the hypothalamus, resulting in heat loss by vasodilation of peripheral blood vessels. Antiinflammatory effects are mediated by a decrease in prostaglandin synthesis. It also decreases platelet aggregation.

Indication For pain on integumentary structures, myalgia, neuralgia, headache, dysmenorrhea, gout. Arthritis, SLE, acute rheumatic fever

Contraindication Hypersensitivity to salicylates, severe anemia, history of blood coagulation defects, vitamin K deficiency, 1 week before and after surgery, pregnancy in the last trimester

Side Effect GI: dyspepsia, heartburn, anorexia, nausea, epigastric discomfort, potentiation of peptic ulcer Allergic: Bronchospasm, asthma-like symptoms, anaphylaxis, skin rashes, urticaria Hematologic: prolongation of bleeding time, thrombocytopenia, leucopenia, Other: Thirst, fever, dimness of vision

Nursing Responsibility Assess for pain: type, location and pattern Note for asthma Monitor renal, LFTs and CBC Determine history of peptic ulcers or bleeding tendencies.

Precautions: Do not use in children with chicken pox or flu symptoms Lactation Mild diabetes, erosive gastritis, bleeding tendencies, liver or kidney disease.

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Drug Name Isosorbide mononitrate 60mg/tab 1 tab OD at HS PO

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

Indication Dinitrate: Treatment and prevention of angina pectoris Mononitrate: Prevention of angina pectoris

Contraindication

Side Effect CNS: Headache, apprehension, restlessness, weakness, vertigo, dizziness, faintness CV: Tachycardia, retrosternal discomfort, palpitations, orthostatic hypotension, angina, rebound hypertension, atrial fibrillation, postdural hypertension Dermatologic: Rash, exfoliative dermatitis, cutaneous vasodilation with flushing GI: Nausea, vomiting, incontinence of urine and feces, abdominal pain, diarrhea GU: Dysuria, impotence, urinary frequency Other: Muscle twitching, pallor, perspiration, cold sweat, arthralgia, bronchitis

Nursing Responsibility Assess for pain: duration, time started, activity being performed, character, intensity Assess orthostatic hypotension, blood pressure at baseline and during treatment

Isosorbide dinitrate 5 mg PRN for chest pain

Contraindicated with allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, narrow-angle glaucoma, postdural hypotension

Classification: Antianginal agent

Precautions: pregnancy, lactation, acute MI, CHF, postural hypotension, severe renal, hepatic disease

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Drug Name Captopril Classification: Antihypertensiv e Angiotensinconverting enzyme (ACE) inhibitor

Action Blocks ACE from converting angioten sin I to angiotensin II, a powerful vasoconstrictor, leading to decreased blood pressure, decreased aldostero ne secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.

Indication Treatment of hypertension alone or in combination with thiazide-type diuretics Treatment of CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis Treatment of diabetic nephropathy Treatment of left ventricular dysfunction after MI Unlabeled uses: management of hypertensive crises; treatment of rheumatoid arthritis; diagnosis of anatomic renal artery stenosis, hypertension related to scleroderma rena l crisis; diagnosis of primary aldosteronis m, idiopathic edema; Bartter's sy ndrome; Raynaud's syndrome

Contraindication Allergy to captopril; impaired renal function; CHF; salt/volume depletion, lactation, pregnancy.

Side Effect CV: Tachycardia, angina pectoris, MI, CHF, hypotension in salt/volume depleted patients Dermatologic: Rash, pruritus, pemphigoid -like reaction, scalded mouth sensation, exfoliative dermatitis, GI: Gastric irritation, aphthous u lcers, peptic ulcers, dysgeusia, ch olestatic jaundice, h epatocellular injury, anorexia, constipation GU: Proteinuria, ren al insufficiency, renal failure, polyuria, olig uria, urinary frequency Hematologic: Neutro penia, agranulocytosi s, thrombocytopenia, hemolytic anemia, pancytopeni a Other: Cough, malais e, dry mouth, lymphadenopathy

Nursing Responsibility Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting your health care provider. Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if lightheadedness or dizziness occurs, consult your health care provider. Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.

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Drug Name METOPROLOL Classfication: Antianginals Antihypertensiv es

Action Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus

Indication Hypertension, alone or with other drugs, especially diuretics Treatment of angina pectoris

Contraindication Contraindicated with sinus bradycardia Use cautiously with diabetes or thyrotoxicosis; asthma or COPD; pregnancy.

Side Effect CNS: Dizziness, vertigo, tinnitus, CV: CHF, cardiac arrhythmias, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, GU: Impotence, decreased libido Respiratory: Broncho spasm, dyspnea

Nursing Responsibility Do not stop taking this drug unless instructed to do so by a health care provider. Swallow the ER tablets whole; do not cut, crush, or chew. Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever, sore throat.

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Drug Name Atorvastatin Classification

Action Inhibits HMG coenzyme A, the enzyme that catalyzes the first step in the cholesterol synthesis pathway

Indication

Contraindication Contraindicated with allergy to atorvastatin, Use cautiously with impaired endocrine function.

Side Effect CNS: Headache, ast henia GI: Flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia Respiratory: Sinusitis, pharyngitis Other: arthralgia, m yalgia

Nursing Responsibility Take this drug once a day, at about the same time each day; may be taken with food. Do not drink grapefruit juice while on this drug. Institute appropriate dietary changes that need to be made. Report muscle pain, weakness, tenderness; malaise; fever; changes in color of urine or stool; swelling.

Lipid-lowering agent

secondary prevention of cardiovascular disease in patient with clinically evident CHD

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Drug Name Furosemide Classification: Loop Diuretic Inhibits

Action the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop ofHenle, leading to a sodiumrich diuresis.

Indication Edema associated with CHF, cirrhosis, renal disease (oral, IV) Acute pulmonary edema (IV) Hypertension (oral)

Contraindication Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation. Use cautiously with SLE, gout, diabetes mellitus.

Side Effect CNS: dizziness, headache, vertigo, CV: hypotension, orthostatic hypotension EENT: blurred vision GI: nausea, vomiting, diarrhea, constipation, GU: excessive and frequent urination Hematologic: anemia, purpura, leukopenia, thrombocytopenia, hemolytic anemia Musculoskeletal: muscle pain, muscle cramps Skin: photosensitivity, rash, diaphoresis, urticaria, pruritis

Nursing Responsibility Monitor BP, PR, fluid intake and output and weight. Watch for signs and symptoms ototoxicity. Instruct patient move slowly rising, to dizziness of to

when avoid from

sudden blood pressure decrease.

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Drug Name Omeprazole Classification: Antisecretory Proton pump inhibitor

Action Gastric acid-pump inhibitor: suppresses gastric acid secretion

Indication Short-term treatment of active duodenal ulcer First-line therapy in treatment of heartburn Treatment of pathologic hyperse cretory conditions

Contraindication Contraindicated with hypersensitivity to omeprazole or its components. Use cautiously with pregnancy, lactation.

Side Effect CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesi as, dream abnormalities Dermatologic: Rash, inflammation, urtica ria, pruritus, alopecia, dry skin GI: Diarrhea,

Nursing Responsibility Take the drug before meals. Swallow the capsules whole; do not chew, open, or crush. Report severe headache, worsening of symptoms, fever, chills.

abdominal pain, nausea, vomiting, constipati

on, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis Other: Cancer in preclinical studies, back pain, fever

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Drug Name Piperacillin Sodium Tazobactam Sodium Classification AntibioticExten ded spectrumpenicil lin, betalactamaseinhi bito

Action Piperacillin : Binds tobacterial cell wallmembrane, causing celldeath. Spectrum isextended compared with other penicillins Tazobactam : Inhibitsbetalactamase, anenzyme that candestroy penicillins

Indication Appendicitis andperitonitis Skin and skin structureinfections Gynecologic infections Communityacquiredand nosocomialpneumonia caused bypiperacillinresistant,betalactamaseproducing bacteria

Contraindication Contraindicated in pregnancy, hypersensitivity to piperacillin.

Side Effect CNS: seiz ure ,confusi on, dizziness,headache, insomnia,lethargy. GI:Pseudomembrano colitis, diarrhea ,constipation, druginduced hepatitis,nausea, vomiting. GU:interstitial nephritis. Skin: rashes ( incystic fibrosis patients) ,urticaria. Hemat:bleeding,leuko penia,neutropenia,thr ombocytopenia

Nursing Responsibility Assess patient for infection at beginning of and during therapy Obtain a history before initiating therapy to determine previous us eof and reactions to penicillins or cephalosporins.