Amlodipine GENERIC NAME: amlodipine besylate BRAND NAME: Norvasc DRUG CLASS AND MECHANISM: Amlodipine belongs to a class

of medications 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. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. By relaxing coronary arteries, amlodipine is useful in preventing chest pain (angina) resulting from coronary artery spasm. Relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart as it pumps blood to the body. Reducing heart burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina in patients with coronary artery disease. PRESCRIPTION: yes GENERIC AVAILABLE: yes PREPARATIONS: Tablets ( 2.5mg, 5mg, 10mg.) STORAGE: Amlodipine should be stored at room temperature in a tight, light resistant container. PRESCRIBED FOR: Chest pain or heart pain (angina) occurs because of insufficient oxygen delivered to the heart muscles. Insufficient oxygen may be a result of coronary artery blockage or spasm, or because of physical exertion which increases heart oxygen demand in a patient with coronary artery narrowing. Amlodipine is used for the treatment and prevention of angina resulting from coronary spasm as well as from exertion. Amlodipine is also used in the treatment of high blood pressure. DOSING: Amlodipine can be taken with or without food. Amlodipine is metabolized mainly by the liver and dosages may need to be lowered in patients with liver dysfunction. DRUG INTERACTIONS: In patients with severe coronary artery disease, amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting amlodipine, or at the time of dosage increase. Excessive lowering of blood pressure during initiation of amlodipine treatment can occur, especially in patients already taking another blood pressure lowering medication. In rare instances, congestive heart failure has been associated with amlodipine, usually in patients already on a beta blocker.

PREGNANCY: Generally, amlodipine is avoided in pregnancy, and by nursing mothers and children. NURSING MOTHERS: Generally, amlodipine is avoided in pregnancy, and by nursing mothers and children. SIDE EFFECTS: Side effects of amlodipine are generally mild and reversible. The two most common side effects are headache and edema (swelling) of the lower extremities. Less common side effects include dizziness, flushing, fatigue, nausea, and palpitations.

Atenolol Drug Study

Brand Names: Apo-Atenolol, Novo-Atenolol, Tenormin Classification: Therapeutic: antianginals, antihypertensives. Pharmacologic: beta blockers Indications Management of hypertension. Management of angina pectoris. Prevention of Myocardial Infarction (MI). Mechanism of Action Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)-receptor sites. Therapeutic Effects: Decreased blood pressure and heart rate. Decreased frequency of attacks of angina pectoris. Prevention ofMyocardial Infarction. Contraindications/Precautions Contraindicated in: Uncompensated CHF; Pulmonary edema; Cardiogenic shock; Bradycardia or heart block. Use Cautiously in: Renal impairment (dosage reduction recommended if CCr .35 ml/min); Hepatic impairment; Geriatric patients (increased sensitivity to beta blockers; initial dosage reduction recommended); Pulmonary disease (including asthma; beta selectivity may be lost at higher doses); Diabetes mellitus (may mask signs of hypoglycemia); Thyrotoxicosis (may mask symptoms); Patients with a history of severe allergic reactions (intensity of reactions may be increased); OB: Crosses the placenta and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression; Lactation, Pedi: Safety not established.

Adverse Reactions/Side Effects CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia,memory loss, mental status changes, nervousness, night mares. EENT: blurred vision, stuffy nose. Resp: bronchospasm, wheezing. CV: BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction. function abnormalities, nausea, vomiting. GU: GI:

constipation, diarrhea, liver erectile dysfunction, decreased libido, urinary frequency. Derm: rashes. Endo: hyperglycemia, hypoglycemia. MS: arthralgia, back pain, joint pain. Misc: druginduced lupus syndrome. Route/Dosage PO (Adults): Antianginal50 mg once daily; may be increased after 1 wk to 100 mg/day (up to 200 mg/day). Antihypertensive2550 mg once daily; may be increased after 2 wk to 50100 mg once daily. MI50 mg (given 10 min after last IV dose), then 50 mg 12 hr later, then 100 mg/day as a single dose or in 2 divided doses for 69 days or until hospital discharge. Nursing Management 1. Instruct patient to take atenolol as directed at the same time each day, even if feeling well; do not skip or double up onmissed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may cause life-threatening arrhythmias, hypertension, or myocardial ischemia. 2. Advise patient tomake sure enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency. 3. Teach patient and family how to check pulse and blood pressure. Instruct them to check pulse daily and blood pressure biweekly and to report significant changes. 4. May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known. 5. Advise patients to change positions slowly to minimize orthostatic hypotension. 6. Caution patient that atenolol may increase sensitivity to cold. 7. Instruct patient to consult health care professional before taking any OTCmedications, especially cold preparations, concurrently with this medication. 8. Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication does not block sweating as a sign of hypoglycemia. 9. Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs. 10. Instruct patient to inform health care professional of medication regimen before treatment or surgery.

Calmoseptine ointment
Generic Name: menthol/zinc oxide (MEN-thol/zink OX-ide) Brand Name: Calmoseptine Calmoseptine ointment is used for: Preventing and treating minor skin irritations (eg, caused by cuts, scrapes, minor burns, perspiration, itching, wound drainage). Calmoseptine ointment is an analgesic, antiseptic, antipruritic, and skin protectant combination. It works by temporarily relieving itching and pain. It also decreases moisture in the affected area. Do NOT use Calmoseptine ointment if: you are allergic to any ingredient in Calmoseptine ointment you are treating a deep wound or puncture wound Contact your doctor or health care provider right away if any of these apply to you. Before using Calmoseptine ointment: Some medical conditions may interact with Calmoseptine ointment. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances

Some MEDICINES MAY INTERACT with Calmoseptine ointment. However, no specific interactions with Calmoseptine ointment are known at this time. Ask your health care provider if Calmoseptine ointment may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. How to use Calmoseptine ointment: Use Calmoseptine ointment as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Gently wash the affected area. Pat dry or allow to air dry.

Apply a thin layer of Calmoseptine ointment to the affected area as directed by your doctor or the package labeling. Rub in gently. Wash your hands right away after using Calmoseptine ointment, unless your hands are part of the treated area. If you miss a dose of Calmoseptine ointment and you are using it regularly, use it as soon as you remember. Continue to use it as directed by your doctor or on the package label.

Ask your health care provider any questions you may have about how to use Calmoseptine ointment. Important safety information: Calmoseptine ointment is for external use only. Do not get it in your eyes, nose, or mouth. If you get it in any of these areas, rinse at once with cool water. If your symptoms do not get better within 7 days or if they get worse, check with your doctor.

Do not use Calmoseptine ointment to treat deep wounds or puncture wounds. If you may have taken Calmoseptine ointment by mouth, contact your poison control center or emergency room right away. PREGNANCY and BREAST-FEEDING: If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Calmoseptine ointment while you are pregnant. It is not known if Calmoseptine ointment is found in breast milk after topical use. If you are or will be breastfeeding while you use Calmoseptine ointment, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Calmoseptine ointment: All medicines may cause side effects, but many people have no, or minor side effects. No COMMON side effects have been reported with this product. Seek medical attention right away if any of these SEVERE side effects occur: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue). This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. Proper storage of Calmoseptine ointment:

Store Calmoseptine ointment at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Calmoseptine ointment out of the reach of children and away from pets. General information: If you have any questions about Calmoseptine ointment, please talk with your doctor, pharmacist, or other health care provider. Calmoseptine ointment is to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take Calmoseptine ointment or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Calmoseptine ointment. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Calmoseptine ointment. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using Calmoseptine ointment.

Iberet
Generic Name: Multivitamins with Iron Brand Name: Iberet Folic 500 Classification: Vitamins & Minerals, Antianemics Mode of Action: Iron is needed to produce hemoglobin (Hb). In the case of iron deficiency, smaller red blood cell with lower Hb content is formed, which may lead to hypochromic microcytic anemia.Vitamin C helps body metabolism.Vitamin B-complex play an important role as co-enzyme in protein metabolism.Folic Acid: Deficiency in folic acid as well as in vitamin B12 will affect hematopoiesis.

Indication: Prevention and treatment of iron-deficiency anemia, especially when associated with an increased need for water-soluble vitamins.Prevention and treatment of iron deficiency anemia, especially when associated with increased need for or depletion of the watersoluble B-complex and vitamin C (nutritional microcytic anemia.Iron deficiency anemia, megaloblastic anemia with vitamin C and vitamin B-complex deficiency, particularly during pregnancy. Contraindication: Iberet Folic-500: Patients hypersensitive to one of the components of Iberet Folic-500; pernicious anemia. Side effects: Gastric intolerance to iron in the controlled-release Gradumet vehicle is rare. Should it occur, the filmtab may be taken after a meal, although this reduces iron absorption.Nausea, vomiting, constipation or diarrhoea, abdominal pain. Drug to Drug Interaction: Magnesium trisilicate and antacid which contains carbonate will inhibit the absorption of iron. Ferrous sulfate affects tetracycline absorption. Levodopa (anti-Parkinson) may produce reversed effect due to pyridoxine. Administration with milk or egg may inhibit the absorption of iron. Nursing Responsibilities: 1. take only once a day. 2. Do not crush, chew, or break this medication. Doing so can destroy the long action of the drug and may increase side effects. 3. Report if experiences side effects. 4. instruct patient to follow treatment regimen 5. Increase water intake.

Diphenhydramine
Generic name: diphenhydramine

Brand name: Benadryl Preparations: PO 25-50 mg q4-6 hr, 50mg 20-30 mins before bedtime CLASSIFICATION: Antiparkinsonian drug ACTION: Antagonizes the effect of histamine at H1 receptor sites; does not bind or inactivate histamine INDICATION / USES: parkinsonism or drug-induced extrapyramidal effects COMMON ADVERSE EFFECTS: CNS: headache, fatigue, anxiety, tremors, vertigo, confusion, depression, seizures, hallucinations CV: tachycardia, palpitations, orthostaic hypotension, heart failure EENT: blurred vision GI: dry mouth, nausea, vomiting, constipation, flatulence GU: urinary hesitancy or frequency, urine retention Hematologic: leukopenia Skin: photosensitivity, dermatitis CONTRA-INDICATIONS: cardiac disease or hypertension glaucoma gastric or duodenal ulcers NURSING CONSIDERATIONS: Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness. Tell the client to take the medication with food to decrease GI upset. Explain to the client that arising quickly form a lying or sitting position may cause orthostatic hypotension. When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored. Adverse effects of these drugs occur more commonly in elderly clients. Explain to the client that use of these drugs in warm weather may increase the likelihood of heatstroke.

Paracetamol
Generic Name: Paracetamol, Acetaminophen Brand Name: Biogesic, Panadol, Tylenol Classification: Non-narcotic analgesic, Antipyretic Uses: 1. Control of pain due to headache, earache, dysmenorrhea, arthralgia, myalgia, musculoskeletal pain, arthritis, immunizations, teething, tonsillectomy 2. O reduce fever in viral and bacterial infections 3. As a substitute for aspirin in upper GI disease, bleeding disorders clients in anticoagulant therapy and gouty arthritis Actions: 1. Decreases fever by a hypothalamic effect leading to sweating and vasodilation 2. Inhibits pyrogen effect on the hypothalamic-heat-regulating centers 3. Inhibits CNS prostaglandin synthesis with minimal effects on peripheral prostaglandin synthesis 4. Does not cause ulceration of the GI tract and causes no anticoagulant action. Contraindications: 1. Renal Insufficiency 2. Anemia Special Concerns: 1. Liver toxicity (hepatocyte necrosis) may occur with doses not far beyond labeled dosing. 2. If 3 or more alcoholic drinks per day is consumed, consult a physician prior use. Side-Effects:

1. Minimal GI upset. 2. Methemoglobinemia 3. Hemolytic Anemia 4. Neutropenia 5. Thrombocytopenia 6. Pancytopenia 7. Leukopenia 8. Urticaria 9. CNS stimulation 10. Hypoglycemic coma 11. Jaundice 12. Glissitis 13. Drowsiness 14. Liver Damage Dosage: Per Orem: 325-650mg q4h up to a maximum of 1 gram q6h. Suppositories: 650mg q4h not to exceed 4 grams a day for up to 10 days. Nursing Considerations: 1. Do not exceed 4gm/24hr. in adults and 75mg/kg/day in children. 2. Do not take for >5days for pain in children, 10 days for pain in adults, or more than 3 days for fever in adults. 3. Extended-Release tablets are not to be chewed. 4. Monitor CBC, liver and renal functions. 5. Assess for fecal occult blood and nephritis. 6. Avoid using OTC drugs with Acetaminophen. 7. Take with food or milk to minimize GI upset. 8. Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity.

9. Report paleness, weakness and heart beat skips 10. Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools. 11. Phenmacetin may cause urine to become dark brown or wine-colored. 12. Report pain that persists for more than 3-5 days 13. Avoid alcohol. 14. This drug is not for regular use with any form of liver disease.

Furosemide
Brand Name: Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN) Pregnancy Category C Drug class: Loop diuretic

Therapeutic actions Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.

Indications

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

Contraindications Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation.

Adverse effects Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice Polyuria, nocturia, glycosuria, urinary bladder spasm Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances Muscle cramps and muscle spasms

Drug Interactions: Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte imbalance) Increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin Decreased absorption of furosemide with phenytoin

 Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other NSAIDs Decreased GI absorption with charcoal

Nursing considerations CLINICAL ALERT! Name confusion has occurred between furosemide and torsemide; use extreme caution. Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds. Give early in the day so that increased urination will not disturb sleep. Avoid IV use if oral use is at all possible. Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. Discard diluted solution after 24 hr. Refrigerate oral solution. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver function. Arrange for potassium-rich diet or supplemental potassium as needed.