Generic Name:

Citicoline

Brand Name: Nicholin, Somazine, 5-Cytidine diphosphate choline, CDPC, CDP Choline, CDP-Choline, Citicholine, Citicolina, Cytidine 5-Diphosphocholine, Cytidine 5-diphosphocholine, Cytidine (5) diphosphocholine Classification: Neurotonics, Nootropics Mechanism of Action Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.It is usually known that phospholipid, especially lecithin, decreases following decline in brain activity with cerebral trauma. Citicoline, which is a co-enzyme, accelerates the biosynthesis of lecithin in the body. This medication enhances the action of the brain stem ciliary body especially the ascending ciliary body activating system, which is closely related to consciousness, but does not exert effort on the extrapyramidal system. Citicoline increases cerebral blood flow and oxygen consumption of the brain and improves cerebral circulation and metabolism. Scientific research demonstrates that Citicoline consumption promotes brain metabolism by enhancing the synthesis of acetyl-choline, restoring phospholipid content in the brain and affecting neuron membrane excitability and osmosis (by its effect on the ATP-dependent sodium and potassium pump). When taken orally, its two main components, Cytidine and Choline are absorbed into the bloodstream. Citicoline is also believed to protect nerve cells when in low oxygen conditions. Citicoline may be used for nutritional support in cerebral vascular disease, head trauma, stroke, and cognitive disorders. It also is used by those who have age related mental decline, such as Alzheimers and Parkinsons. Indication

Parkinsons disease Head injury Cerebral vascular disease Alzheimers disease

Cerebral surgery or acute cerebral disturbance Disturbance of consciousness following brain surgery Special Precautions Patients with acute, severe & progressive disturbance of consciousness Administration with hemostatics Intracranial pressure relieving drugs or use measures to keep body temp low. Side Effects Citicoline seems to be safe when taken short-term (up to 90 days). The safety of long-term use is not known. Most people who take citicoline dont experience problematic side effects. However, these are the common side effects reported by some patients:

Body temperature elevation Restlessness Headaches Nausea and vomiting Diarrhea Low or high blood pressure Tachycardia Sleeping troubles or insomnia Blurred vision Chest pains

Nursing Management

Citicoline may be taken with or without food. Take it with or between meals. The supplement should not be taken in the late afternoon or at night because it can cause difficulty sleeping. Women who are pregnant or trying to become pregnant should consult with their doctor before taking the supplements. Not enough is known about the use of Citicoline during pregnancy and breast-feeding. Stay on the safe side and avoid use. Special attention should be paid for administration in the neonate, premature and children. Contact the physician immediately if allergic reaction such as hives, rash, or itching, swellingin your face or hands, mouth or throat, chest tightness or trouble breathing are experienced. Citicoline therapy should be started within 24 hours of a stroke. The physician will prescribe the correct dosage and the length of time it should be taken for a medical condition. Generic Name : simvastatin Therapeutic actions 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, LDL-cholesterol and triglycerides and increases HDLcholesterol levels. Indications 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 Adverse effects 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. Contraindications Acute liver disease or unexplained persistent elevations of serum transaminases. Pregnancy, lactation. Porphyria. Nursing considerations Assessment History: Allergy to simvastatin, fungal byproducts; impaired hepatic function; pregnancy; lactation Physical: Orientation, affect; liver evaluation, abdominal examination; lipid studies, LFTs Interventions 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.

Generic Name:Lactulose Brand Name:Cephulac, Chronulac ,Movelax,Lilac Classifications:gastrointestinal agent; hyperosmotic laxative Pregnancy Category:C Availability 10 g/15 mL solution, syrup Actions Reduces blood ammonia; appears to involve metabolism of lactose to organic acids by resident intestinal bacteria. Therapeutic effects Acidifies colon contents, which retards diffusion of nonionic ammonia (NH3) from colon to blood while promoting its migration from blood to colon. In the acidic colon, NH3 is converted to nonabsorbable ammonium ions (NH4) and is then expelled in feces by laxative action. Decreased blood ammonia in a patient with hepatic encephalopathy is marked by improved EEG patterns and mental state (clearing of confusion, apathy, and irritation). Osmotic effect of organic acids causes laxative action, which moves water from plasma to intestines, softens stools, and stimulates peristalsis by pressure from water content of stool. Uses Prevention and treatment of portal-systemic encephalopathy (PSE), including stages of hepatic precoma and coma, and by prescription for relief of chronic constipation.

GENERIC NAME: losartan BRAND NAME: Cozaar

DRUG CLASS AND MECHANISM: Losartan is an oral medication that belongs to a class of drugs called angiotensin receptor blockers (ARBs). Other ARBs include irbesartan (Avapro), valsartan (Diovan), andcandesartan (Atacand). Angiotensin formed in the blood by the action ofangiotensin converting enzyme (ACE) is a powerful chemical that attaches to angiotensin receptors found in many tissues but primarily on smooth muscle cells of blood vessels. Angiotensin's attachment to the receptors causes the muscle cells to contract and the blood vessels to narrow (vasoconstrict) which leads to an increase in blood pressure (hypertension). Losartan (more specifically, the chemical formed when the liver converts the inactive losartan into its active form) blocks the angiotensin receptor. By blocking the action of angiotensin, losartan relaxes muscle cells and dilates blood vessels thereby reducing blood pressure. Losartan was approved by the FDA in April 1995. DRUG INTERACTIONS: Losartan may increase levels of blood potassium (hyperkalemia), which can lead to serious heart problems (arrhythmias). Therefore, concomitant use of other drugs or substances that increase blood-such as potassium-sparing diuretics (for example, spironolactone[Aldactone], triamterene, and amiloride), potassium supplements, or salt substitutes containing potassium may lead to dangerous increases in serum potassium.

Combining losartan or other ARBs with nonsteroidal anti-inflammatory drugs(NSAIDs) in patients who are elderly, fluid-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible. The antihypertensive effect of losartan may be reduced by aspirin and other NSAIDs such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin, Indocin-SR), andnaproxen (Anaprox, Naprelan, Naprosyn, Aleve). PREGNANCY: When used in the second or third trimester of pregnancy , ARBs can cause injury and even death to the fetus. Losartan should not be used during pregnancy. When pregnancy is first detected, losartan should be stopped.