Name Spironolactone 75mg/tab

Classification Aldosterone Antagonist Potassiumsparing diuretic

Action Completely blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium

Indication Diagnosis and maintenance of primary hyperaldosteronism Treatment of hypokalemia or prevention of hypokalemia in patients who would be at high risk if hypokalemia occurred: Digitalized patients, patients with cardiac arrhythmias Essential hypertension, usually in combination with other drugs

Contraindication Contraindicated with allergy to spironolactone, hyperkalemia, renal disease, anuria, amiloride or triamterene use. Use cautiously with pregnancy, lactation

Adverse action CNS: Dizziness, headache, drowsiness, fatigue , ataxia, confusion Dermatologic: Rash,urticaria GI: Cramping, diarrhea, dry mouth, thirst, vomiting. GU: Impotence, irregular menses, amenorrhea, postmenopausal bleeding

Nursing consideration Record alternate-day therapy on a calendar, or prepare dated envelopes. Take the drug early because of increased urination. Weigh yourself on a regular basis, at the same time and in the same clothing, and record the weight on your calendar. Avoid foods that are rich in potassium (fruits,Sanka).

These side effects may occur: Increased volume and frequency of urination; dizziness, confusion, feeling faint on arising, drowsiness (avoid rapid position changes, hazardous activities: driving, using Hematologic: Hyper alcohol); increased thirst (suck on kalemia, sugarless lozenges; use frequent hyponatremia, mouth care); changes in menstrual agranulocytosis cycle, deepening of the voice, impotence, enlargement of the Other: breasts can occur (reversible). Carcinogenic in animals, deepening Report weight change of more than of the voice, 3 lb in one day, swelling in your hirsutism, ankles or fingers, dizziness, gynecomastia trembling, numbness, fatigue, enlargement of breasts, deepening of voice, impotence, muscle weakness or cramps.

Name Propanolol 20 mg/tab Q8

Classification Antianginal, Antiarrythmic, Antihypertensiv e, non selective beta-adrenergic blocker

Action Competitively blocks betaadrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system o n these tissues, the excitability of the heart, cardiac workload and oxygen consumption, an d the release of rennin and lowering BP; has membranestabilizing(local anesthetic) effects that contribute to its antiarrhthmic action; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.

Indication a. Hypertension alone or with other drugs, expecially diuretics. b. Angina pectoris caused by coronary atherosclerosis c. Idiopathic hypertrophic subaortic stenosis to manage associated stress-induced angina, palpitations and syncope. d. Cardiac arrhythmias especially supraventricular tachycardia, and ventricular tachycardias induced by digitalis or catecholamines. e. Prevention if reinfarction in clinically stable patients5-21 days after MI f. Pheochromocytoma, an adjunctive therapy after treatment with an alpha adrenergic blocker to manage the tachycardia before or during surgery or if the pheochromocytoma is inoperable g. Phrophylaxis for migraine headache h. Treatment of essential tremor, familial or hereditary

Contraindication a.Allergy to betablocking agents R: It may induce allergic reactions b. Sinus bradycardia R: It may further contribute to the decreased heart rate of the client c. Pregnancy R: It may cause neonatal bradycardia d. Apnea R: It may further cause relaxation of the respiratory muscles, thus inhibiting respiration

Adverse action Adverse Effects: a. Fever, rashes, pruritus, shortness of breath R: Hypersensitivity reactions to the drug b. Bradycardia, heartfailure R: Reduced cardiac oxygen in the heart. Drug-Drug a. Aminophylline, theophylline R: May act antagonistically reducing the effects of one or both drugs. May reduce theophylline elimination b. Amiodarone, fluconazole, isoniazid R: May increase propranolol level c. Amobarbital, Phenobarbital R: May reduce propranolol effects. Increase beta blocker dose. d. Cemetidine R: May increase pharmacologic effects of beta blocker. e. Epinephrine R: May cause an initial hypertensive episode followed by bradycardia. f. Oral antibiotics R: May alter requirements for these drugs in previously stabilized diabetic patients

Nursing consideration 1.) Monitor the vital signs of the client. 2.) Encourage eat in small frequent feedings if there are episodes of vomiting. 3.) May offer ice chips to reduce nausea. 4.) TSB for fever 5.) Instruct client not to get up on bed immediately to reduce the occurrence of dizziness. 6.) May be given with food if GI upsets occurs 7.) Provide environment conducive for rest