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GENERIC NAME Trimetazidine BRAND NAME Vastarel INDICATION This drug is recommended in longterm treatment of coronary insufficiency; angina pectoris. ACTION Trimetazidine is a cellular acting anti-ischaemic agent. It has 3 main properties by which it acts as a cytoprotective agent. It inhibits the anaerobic glycolysis and fatty acid metabolism, thus allowing only aerobic glycolysis. This action helps to restore the energy balance in the cell. It inhibits acidosis and free radical accumulation in the cell. All these action help the cell to restore the normal ionic and metabolic balance. SIDE-EFFECTS

Rare causes of GI


and vomiting Fever Rash Respiratory illness anemia

NURSING MANAGEMENT Use cautiously in patients with heart failure or hypertension and in elderly patients

GENERIC NAME Isosorbide Dinitrate BRAND NAME Isoket INDICATION Coronary heart disease: treatment and prevention of angina pectoris attack. Maintenance therapy after myocardial infarction. Fresh myocardial infarction, with left ventricle failure of other origins with impending or full-blown pulmonary edema. Longterm treatment of chronic congestive heart failure (either alone or in addition to cardiac glycosides and diuretics. ACTION Isosorbide Dinitrate is a smooth muscle relaxant. It particularly effective on vascular and bronchial smooth muscle. Its systemic cardiovascular effects are mainly due to a decrease in venous return (pooling of blood in the peripheral venous system). Consequently, ventricular enddiastolic pressure and volume are diminished, thus reducing cardiac work and, implicitly, myocardial oxygen requirements. The arterial vessels are dilated as well, though to a lesser degree. This results in a slight drop in aortic and systemic blood pressure relieving the myocardium of a part of its afterload. This nitrate- induced changes account for both the anti-anginal effects of Isosorbide Dinitrate and for its beneficial effects in the treatment of congestive heart failure. SIDE-EFFECTS In sensitive persons nitrate headaches may develop which may, however, be minimized by starting with low, gradually increasing doses. To overcome headache, therapy should not be stopped but rather continued on adequate dose level, as this side effect usually subsides within several days of regular intake. If headaches are very strong, an analgesic compound based on acetylsalicyclic acid is recommended. NURSING MANAGEMENT Monitor ECG and vital signs closely, especially blood pressure. Monitor arterial blood gas valuesand methemoglobin levels. Teach patient to take oral drug 30 minutes before or 1 to 2 hours after a meal. Inform patient that drug may cause headache. Advise him to treat headache as usual and not to alter drug schedule. If headache persists, tell him to contact prescriber. Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from sudden blood pressure decrease. As appropriate, review all other significant adverse reactions.

Amoxicillin Trihydrate
GENERIC NAME Amoxicillin Trihydrate BRAND NAME INDICATION ACTION This drug acts by inhibiting the synthesis of bacterial cell walls. It inhibits crosslinkage between the linear peptidoglycan polymer chains that make up a major component of the cell walls of both Gram-positive and Gram-negative bacteria. It has two ionizable groups in the physiological range (the amino group in alpha-position to the amide carbonyl group and the carboxyl group). SIDE-EFFECTS NURSING MANAGEMENT

Infections due to
susceptible strains of Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Neisseria gonorrhoeae, Streptococcus pneumoniae, Enterococcus faecalis, streptococci, non penicillinaseproducing staphylococci Helicobacter pylori infection in combination with other agents Postexposure prophylaxis against Bacillus anthracis Unlabeleduse: Chlamydia trachomatis in pregnancy

CNS: Lethargy, hallucinations,

seizures GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Other: Superinfectionsoral and rectal moniliasis, vaginitis

Culture infected area prior

to treatment; reculture area if response is not as expected. Give in oral preparations only; amoxicillin is not affected by food. Continue therapy for at least 2 days after signs of infection have disappeared; continuation for 10 full days is recommended. Use corticosteroids, antihistamines for skin reactions. Take this drug around-theclock. Take the full course of therapy; do not stop because you feel better. This antibiotic is specific for this problem and should not be used to self-treat other infections.

GENERIC NAME Cefuroxime Sodium BRAND NAME Harox INDICATION It is effective for the treatment of penicillinaseproducing Neisseria gonorrhoea (PPNG).Effectively treats bone and joint infections, bronchitis, meningitis, gonorrhea, otitis media, pharyngitis/tonsillitis, sinusitis, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections, and is used for surgical prophylaxis, reducing or eliminating infection. ACTION Inhibits bacterial cell wall synthesis by binding to one or more of protein-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) white cell wall assembly is arrested. SIDE-EFFECTS Diarrhea Nausea Antibiotic associated colitis Rash Pruritis Urticaria Increased serum creatinine and BUN Decreased creatinine clearance Thrombophlebitis (IV site) Pain Burning Cellulitis (IM site) Superinfections Positive Coombs test NURSING MANAGEMENT Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Inspect IM and IV injection sites frequently for signs of phlebitis. Report onset of loose stools or diarrhea. Although pseudomembranous colitis. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

GENERIC NAME Ipratropium Salbutamol BRAND NAME Duavent INDICATION Management of reversible bronchospasm associated with obstructive airway disease (e.g., bronchial asthma. For use in patients with COPD on a regular inhaled bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator. ACTION Ipratropium bromide: Ipratropium bromide is a quaternary ammonium compound with anticholinergic (parasympatholytic) properties. Similar to atropine, it is a nonselective competitive antagonist of muscarinic receptors present in airways and other organs. Ipratropium bromide relaxes smooth muscles of bronchi and bronchioles by blocking acetylcholine-induced stimulation of guanyl cyclase, thus reducing formation of cyclic guanosine monophosphate (cGMP), a mediator of bronchoconstriction. Ipratropium generally exhibits greater antimuscarinic activity of bronchial smooth muscle than on secretory (eg, salivary, gastric) glands. Ipratropium bromide is a potent bronchodilator, particularly in large bronchial airways; however, some evidence suggests that it also has bronchodilator activity in small airways. Bronchodilation results from relaxation of smooth muscles of the bronchial tree. SIDE-EFFECTS Headache Pain Influenza Chest pain Nausea and vomiting Bronchitis Dyspnea Coughing Pneumonia Bronchospasm Pharyngitis Sinusitis and rhinitis Fatigue and dizziness HPN Nervousness Paresthesia Tremor Dysphonia Insomnia Diarrhea and dyspepsia Dry mouth Arrhythmia Palpitation Tachycardia Arthralgia Angina Increased sputum Taste perversion NURSING MANAGEMENT Drugs should be given only if the potential benefit justifies the potential risk to the fetus. Position patient on high back rest position. Do back tapping after you nebulizer the patient. Do not give a food immediately it can cause vomiting

GENERIC NAME Hyoscine-NButylbromide BRAND NAME Sorbisine INDICATION Used in treatment of spasm and hypermotility of the Gastrointestinal tract, biliary and renal colic; spasmodic dysmennorhea; gastric and duodenal ulcer. ACTION Hyoscine works by relaxing the muscle that is found in the walls of the stomach, intestines, bowel, bile duct and urinary tract. This type of muscle is called smooth muscle or involuntary muscle. It normally contracts and relaxes in response to natural body chemicals called neurotransmitters. The contractions are caused by a neurotransmitter called acetylcholine. These contractions are not under our conscious control and we are not normally aware of them. However, if the muscles go into spasm this can cause pain. Hyoscine stops the spasms in the smooth muscle by preventing acetylcholine from acting on the muscle. It does this by blocking the receptors on the muscle cells that the acetylcholine would normally act on. By preventing acetylcholine from acting on the muscle in the GI and GU tracts, hyoscine reduces the muscle contractions. SIDE-EFFECTS Flushing, postural hypotension, tachycardia, fibrillation. Rarely psychotic reactions. Dizziness, drowsiness, fatigue, headache, memory loss. Dry skin, erythema, increased sensitivity to light, rash. Bloatedness, constipation, dry throat, dysphagia, nausea, vomiting, xerostomia. Dysuria, urinary retention. Tremor, weakness. Impaired accommodation, blurred vision, Dry nose. Decreased diaphoresis, heat intolerance. NURSING MANAGEMENT Assess for eye pain Monitor Output ration Assess for parkinsonism and EPS Assess for urinary hesitancy Assess for constipation Assess for tolerance over long term therapy

GENERIC NAME Phenylpropanolamine HCL+Brompheniramine Maleate BRAND NAME Pediatapp INDICATION Treatment of nasal congestion. Symptomatic relief of allergic conditions, mainly rhinitis & conjunctivitis. ACTION Phenylpropanolamine acts directly on alpha- and, to a lesser degree, beta-adrenergic receptors in the mucosa of the respiratory tract. Stimulation of alpha-adrenergic receptors produces vasoconstriction, reduces tissue hyperemia, edema, and nasal congestion, and increases nasal airway patency. PPA indirectly stimulates beta-receptors, producing tachycardia and a positive inotropic effect. SIDE-EFFECTS

CNS depression
including slight drowsiness to deep sleep, lassitude, dizziness, in coordination. Headache, psychomotor impairment and antimuscarinic effects. Rarely, rashes and hypersensitivity reactions; blood disorders, convulsions, sweating, myalgia, extra pyramidal effects, tremor, confusion, tinnitus, hypotension, hair loss. Potentially Fatal: Palpitations, arrhythmias, blood disorders, and liver dysfunction may occur

NURSING MANAGEMENT Check for allergic reactions>monitor the patient for any adverse effect Assess if the client is suffering from DM, epilepsy, glaucoma, heart or blood vessel disease, hiatal hernia, high blood pressure, myasthenia gravis, obstructed bladder or intestinal tract, peptic ulcer, enlarged prostate gland, or thyroid disease If any of the above mentioned diseases is present, tell the physician about this. Advise the client to drink at least eight glasses of water. Advise the client to avoid excessive work and exercise in hot weather.

GENERIC NAME Montelukast Sodium Levocetrizine diHCL BRAND NAME Co-altria INDICATION Relief of symptoms associated w/ seasonal & perennial allergic rhinitis. ACTION Montelukast is a Leukotriene Receptor Antagonist. Montelukast competitively and selectively inhibits the actions of leukotriene D4 (LTD4) at the cysteinyl leukotriene type-1 (CysLT1) receptor without any agonist activity. The cysteinyl leukotrienes, such as LTD4, are products of arachidonic acid metabolism and are released from various cells, including mast cells and eosinophils SIDE-EFFECTS Asthenia/fatigue Fever abdominal pain Trauma Dyspepsia infectious gastroenteritis dental pain Dizziness Headache nasal congestion Cough Influenza Rash increased ALT & AST Pyuria Somnolence dry mouth NURSING MANAGEMENT


Treatment essential hypertension.


Amlodipine belongs to a class of drugs called calcium channel blockers. These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Valsartan is an oral drug that belongs to a class of drugs called angiotensin receptor blockers (ARBs) . Angiotensin, formed in the blood by the action of angiotensin converting enzyme (ACE) on a chemical in blood called angiotensinogen. Angiotensin is a powerful chemical that attaches to angiotensin receptors found in many tissues but primarily on smooth muscle cells surrounding blood vessels. Angiotensin's attachment to the receptors causes the blood vessels to narrow (constrict) which leads to an increase in blood pressure (hypertension). Valsartan blocks the angiotensin receptor.

Nasopharyngitis, influenza Hypersensitivity Visual disturbance Anxiety Headache, dizziness, somnolence, dizziness postural, paraesthesia Vertigo, tinnitus Tachycardia, palpitations, syncope Orthostatic hypotension Cough, pharyngolaryngeal pain Diarrhea, nausea, abdominal pain, constipation, dry mouth Rash, erythema, hyperhidrosis, exanthema, pruritus

Monitor BP for
therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are achieved 69 h following oral doses. Monitor for S&S of dose-related peripheral or facial edema that may not be accompanied by weight gain; rarely, severe edema may cause discontinuation of drug. Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when additional antihypertensives or diuretics are added.

Ekosart Plus
GENERIC NAME Losartan potassium + hydrochloroth iazide BRAND NAME Ekosart Plus INDICATION -treatment for HPN -use in patients with renal impairment and hemodialysis patients -used in patients with intravascular volume depletion -used in patients with hepatic impairment ACTION Angiotensin II [formed from angiotensin I in a reaction catalyzed by angiotensin converting enzyme (ACE, kininase II)], is a potent vasoconstrictor, the primary vasoactive hormone of the reninangiotensin system and an important component in the pathophysiology of hypertension. It also stimulates aldosterone secretion by the adrenal cortex. Losartan and its principal active metabolite block the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor found in many tissues (e.g., vascular smooth muscle, adrenal gland). SIDE-EFFECTS NURSING MANAGEMENT

Hypotension Orthostatic hypotension Asthenia/fatigue Hypesthesia Dizziness Cellulitis Cataract Nasal congestion Diarrhea Gastritis Dyspepsia UTI Anemia Hepatitis Anaphylactic reactions Angioedema Vasculitis Hypoglycemia Hyperkalemia Weight gain Hyponatremia Sinusitis

Assess improvement in CVP q8h Check for rashes and temperature

elevation daily

Assess for confusion Monitor manifestations of

hypokalemia: acidic urine, r educed urine, osmolality, nocturia hypotension, tachycardia, weak pulse, weakness, altered LOC Monitor for manifestations of hypomagnesemia: agitation,muscletwitching,par esthesias,hyperactivereflexes, dysphagia,tetany, nausea, vomiting, diarrhea Monitor for manifestations of hyponatremia: increased BP ,cold, clammy skin, hypovolemia, abdominal cramps, lethargy Assess fluid volume status Monitor electrolytes.

GENERIC NAME Clopidogrel BRAND NAME Plogrel INDICATION ACTION Clopidogrel is an irreversible inhibitor of platelet aggregation. It acts by irreversibly modifying the platelet adenosine 5'-diphosphate (ADP) receptor, thus selectively inhibiting the binding of ADP to its platelet receptor and the subsequent activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. Consequently, platelets exposed to clopidogrel are affected for the remainder of their lifespan. Biotransformation of clopidogrel to its active metabolite is necessary to produce inhibition of platelet aggregation. SIDE-EFFECTS

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

Headache Dizziness Weakness Syncope Flushing Hypertension Edema Rash Pruritus Nausea GI distress Constipation diarrhea, GI bleed Increased bleeding risk

NURSING MANAGEMENT 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; thrombocytopenia and neutropenia may occur.

GENERIC NAME Aspirin BRAND NAME Scheeprin INDICATION Treatment and prophylaxis of cardiovascular diseases (angina pectoris or myocardial infarction) and acute ischemic stroke; prevention of thromboembolism and adjunct treatment for peripheral arterial thromboembolism; and in preventing thrombotic complications associated with procedures such an angioplasty and coronary bypass grafting. 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. Anti-inflammatory effects are mediated by a decrease in prostaglandin synthesis. It also decreases platelet aggregation. SIDE-EFFECTS

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

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