Generic Name: Cefazolin Brand Name: Ancef Dosage: 250 mg CLASSIFICATIONS Therapeutic: Anti-infectives Pharmacologic: First generation cephalosphorins

ACTIONS Bind to bacterial cell wall membrane, causing cell death. Active against many gram-positive cocci including: Streptococcus pneumoniae, Group A beta-hemolytic streptococci; Penicillinas-producing staphylococci. INDICATION Treatment of: Skin & skin structure infections; pneumonia; urinary tract infections; bone & joint infections CONTRA INDICATIONS Contraindicated in: Hypersensitivity to cephalosphorins. Serious hypersensitivity to penicillin. Use Cautiously in: Renal impair- ment History of GI disease, especially colitis Geriatric patients (consider age-related decrease in body mass, renal/hepatic/ cardiac function, concurrent medications and chronic disease states) Pregnancy or Lactation SIDE EFFECTS/ ADVERSE EFFECTS CNS: Seizures (high doses) GI: Pseudomembranous colitis, diarrhea, nausea, vomiting, cramps GU: Interstitial nephritis DERM: Rashes, urticaria HEMAT: Blood dyscrasias, hemolytic anemia LOCAL: Pain at IM site, phlebitis at IV site MISC: Allergic reactions including Anaphylaxis and Serum sickness, superinfection NURSING CONSIDERATIONS Assess patient for infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosphorins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. Observe patient for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction. Monitor site for thrombophlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis. Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and

diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise not to treat diarrhea without consulting healthcare professional. GENERIC NAME: Ranitidine BRAND NAME: Zantac CLASSIFICATION Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists DOSAGE 20 mg IV q8h MECHANISM OF ACTION Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori. INDICATION Treatment and prevention of heartburn, acid indigestion, and sour stomach. CONTRA INDICATIONS Contraindicated in: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impair- ment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation SIDE EFFECTS/ ADVERSE EFFECTS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis NURSING IMPLICATIONS/RESPONSIBILITIES Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly.

 Inform patient that medication may temporarily cause stools and tongue to appear gray black.

Treatment of asymptomatic left ventricular dysfunction (LVD) Unlabeled use: Diabetic nephropathy Adverse effects Initial hypotension may be severe and prolonged. Dizziness, headache, fatigue, persistent dry cough, abnormal taste, lassitude, rash, neutropenia, renal impairment or failure. Potentially Fatal: Angioedema. Contraindications Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy. Nursing considerations Assessment History: Allergy to enalapril, impaired renal function, salt or volume depletion, lactation, pregnancy Physical: Skin color, lesions, turgor; T; orientation, reflexes, affect, peripheral sensation; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC, and differential Interventions WARNING: Alert surgeon, and mark patient's chart with notice that enalapril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion. Be aware that use of this drug in second and third trimesters can cause serious injury or death to the fetus; advise contraceptive use. Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril. Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur. Arrange for reduced dosage in patients with impaired renal function. WARNING: Monitor patient carefully because peak effect may not be seen for 4 hr. Do not administer second dose until BP has been checked. Teaching points Do not stop taking the medication without consulting your health care provider. Be careful in any situation that may lead to a drop in blood pressure (diarrhea, sweating, vomiting, dehydration). Avoid over-the-counter medications, especially cough, cold, and allergy medications that may interact with this drug. You may experience these side effects: GI upset, loss of appetite, change in taste perception (will pass with time); mouth sores (frequent mouth care may help); rash; fast heart rate; dizziness, light-headedness (usually passes in a few days; change position slowly, limit activities to those not requiring alertness and precision). Use of contraception is advised while taking the drug. 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. GENERIC NAME: metoprolol BRAND NAMES: Lopressor, Toprol XL DRUG CLASS AND MECHANISM: Metoprolol is a beta-adrenergic blocking agent that is used for treating high blood pressure, heart pain, abnormal rhythms of the heart, and some neurologic conditions. Examples of beta-adrenergic blockers include

Generic Name : enalapril maleate Brand Name: Vasotec , enalaprilat , Vasotec I.V. Classification: Antihypertensive, ACE inhibitor Pregnancy Category D

Hypertension: Patients not taking diuretics: Initial dose is 5 mg/day PO. Adjust dosage based on patient response. Usual range is 1040 mg/day as a single dose or in two divided doses. Patients taking diuretics: Discontinue diuretic for 23 days if possible. If it is not possible to discontinue diuretic, give initial dose of 2.5 mg, and monitor for excessive hypotension. Converting to oral therapy from IV therapy: 5 mg daily with subsequent doses based on patient response. CHF: 2.5 mg PO daily or bid in conjunction with diuretics and digitalis. Maintenance dose is 520 mg/day given in two divided doses. Maximum daily dose is 40 mg.

Parenteral Give IV only. 1.25 mg q 6 hr given IV over 5 min. A response is usually seen within 15 min, but peak effects may not occur for 4 hr. Hypertension: Converting to IV therapy from oral therapy: 1.25 mg q 6 hr; monitor patient response. Patients taking diuretics: 0.625 mg IV over 5 min. If adequate response is not seen after 1 hr, repeat the 0.625-mg dose. Give additional doses of 1.25 mg q 6 hr. PEDIATRIC PATIENTS 1 MO16 YR Oral Hypertension: Initial dose is 0.08 mg/kg PO once daily; maximum dose is 5 mg. GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT Oral Excretion is reduced in renal failure; use smaller initial dose, and adjust upward to a maximum of 40 mg/day PO. For patients on dialysis, use 2.5 mg on dialysis days.

Therapeutic actions Enalapril is de-esterified into the active enalaprilat resulting in potent inhibition of ACE thus leading to reduced levels of angiotensin II and aldosterone. Clinically, BP is reduced, salt and water retention is corrected. Ventricular hypertrophy is reversed. Renal blood flow is increased but in patients with renal impairment there may be oliguria or acute renal failure. Indications Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics Treatment of acute and chronic CHF

propanolol (Inderal), atenolol (Tenormin), andtimolol (Blocadren). Metoprolol blocks the action of the sympathetic nervous system, a portion of the involuntary nervous system, by blocking beta receptors on sympathetic nerves. Since the sympathetic nervous system is responsible for increasing the rate with which the heart beats, by blocking the action of these nerves metoprolol reduces the heart rate and is useful in treating abnormally rapid heart rhythms. Metoprolol also reduces the force of contraction of heart muscle and thereby lowers blood pressure. By reducing the heart rate and the force of muscle contraction, metoprolol reduces the need for oxygen by heart muscle. Since heart pain (angina pectoris) occurs when oxygen demand of the heart muscle exceeds the supply of oxygen, metoprolol, by reducing the demand for oxygen, is helpful in treating heart pain. The FDA approved metoprolol in August 1978. PREPARATIONS: Tablets: 25, 50, and 100 mg. Tablets (extended release): 25, 50, 100, and 200 mg. Injection: 1 mg/ml PRESCRIBED FOR: Metoprolol is prescribed for patients with high blood pressure (hypertension). It is also used to treat chest pain (angina pectoris) related to coronary artery disease. Metoprolol is also useful in slowing and regulating certain types of abnormally rapid heart rates (tachycardias). Other uses for metoprolol include the prevention of migraine headache and the treatment of certain types of tremors (familial or hereditary essential tremors). Assessment & Drug Effects Take apical pulse and BP before administering drug. Report to physician significant changes in rate, rhythm, or quality of pulse or variations in BP prior to administration. Monitor BP, HR, and ECG carefully during IV administration. Expect maximal effect on BP after 1 wk of therapy. Take several BP readings close to the end of a 12 h dosing interval to evaluate adequacy of dosage for patients with hypertension, particularly in patients on twice daily doses. Some patients require doses 3 times a day to maintain satisfactory control. Observe hypertensive patients with CHF closely for impending heart failure: Dyspnea on exertion, orthopnea, night cough, edema, distended neck veins. Lab tests: Obtain baseline and periodic evaluations of blood cell counts, blood glucose, liver and kidney function. Monitor I&O, daily weight; auscultate daily for pulmonary rales. Withdraw drug if patient presents symptoms of mental depression because it can progress to catatonia. Possible symptoms of depression: disinterest in people, surroundings, food, personal hygiene; withdrawal, apathy, sadness, difficulty in concentrating, insomnia. Monitor patients with thyrotoxicosis closely since drug masks signs of hyperthyroidism (see Appendix F). Abrupt withdrawal may precipitate thyroid storm. Patient & Family Education Learn how to take radial pulse before each dose. Report to physician if pulse is slower than base rate (e.g., 60 bpm) or becomes irregular. Consult physician for parameters. Reduce insomnia or increased dreaming by avoiding late evening doses. Monitor blood glucose (diabetics) for loss of glycemic control. Drug may mask some symptoms of hypoglycemia (e.g., BP and HR changes) and prolong hypoglycemia. Be alert to other possible signs of hypoglycemia not affected by metoprolol and report to physician if present: Sweating, fatigue, hunger, inability to concentrate. Protect extremities from cold and do not smoke. Report cold, painful, or tender feet or hands or other symptoms of Raynauds

disease (intermittent pallor, cyanosis or redness, paresthesias). Physician may prescribe a vasodilator. Report immediately to physician the onset of problems with vision. Learn measures to relieve dry mouth; rinse mouth frequently with water, increase noncalorie liquid intake if inadequate, suck sugarless gum or hard candy. Relieve eye dryness by using sterile artificial tears available OTC. Do not drive or engage in potentially hazardous activities until response to drug is known. Do not alter established dosage regimen; compliance is very important. Reduce dosage reduced gradually over a period of 12 wk when drug is discontinued. Sudden withdrawal can result in increase in anginal attacks and MI in patients with angina pectoris and thyroid storm in patients with hyperthyroidism. Do not breast feed while taking this drug without consulting physician. A heart attack, known in medicine as an acute myocardial infarction (AMI or MI), occurs when the blood supply to part of the heart is interrupted. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstablecollection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period, can cause damage and/or death (infarction) of heart muscle tissue (myocardium). The post contains the pathophysiologic processes that occur during an Acute Myocardial Infarction A basal ganglia hemorrhage is bleeding from blood vessels in an area of the brain responsible for body movements, sensation, speech and personality. Most often, an artery in the basal ganglia bursts after being damaged due to the effects of high blood pressure. This type of event in the brain is sometimes referred to as a stroke. The area of the basal ganglia is the part of the brain most frequently affected by hemorrhages. A brain hemorrhage causes blood to accumulate inside the brain, compressing and damaging brain tissue. While the main cause of bleeding into the basal ganglia is high blood pressure, other causes ofbasal ganglia hemorrhage include rupture of an aneurysm, or weak spot, in a blood vessel wall and bursting of an abnormal mass of arteries and veins joined together, known as an arteriovenous malformation. Injuries, tumors, infections, and blood abnormalities can also cause bleeding in the basal ganglia. Older people are at greater risk of experiencing a basalganglia hemorrhage, and the risk doubles every ten years from the age of 55.