TRADE NAME Telmisartan

GENERIC NAME Micardis

FREQUENCY /ROUTE 40 mg OD

CLASSIFICATION Angiotensin receptor blocker

ACTION

INDICATION

This medication is used to 1.) Hypertension treat high blood 2.)Cardiovascular Risk pressure (hypertension). Reduction Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Telmisartan belongs to a class of drugs called angiotensin receptor blockers. It works by relaxing blood vessels so blood can flow more easily. OTHER This section contains uses of this drug that are not listed in the approved professional labelling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. This drug may also be used to treat heart failure and to help protect the kidneys from damage due to diabetes.

NURSING RESPONSIBILITIES 1.) Stress need to take drug for prescribed duration even if patient feels better before prescription is finished. 2.) Caution patient to avoid hazardous activities until drugs CNS and visual effects are known. 3.) Instruct patient to notify prescriber if visual disturbances occur and to avoid quick changes in viewing near and distant objects. 4.) Tell patient to alert prescriber if feeling of faints,

CONTRAINDICATION Hypersensitivity to telmisartan or any component; hypersensitivity to other A-II receptor antagonists; primary hyperaldosteronism; bilateral renal artery stenosis; pregnancy (2nd and 3rd trimesters),

because drug may alter heart rhythm. 5.) Caution patient to notify prescriber immediately about fatigue, malaise, anorexia, nausea, abdominal tenderness, yellowish skin, or changes in stool appearance. 6.) Instruct patient to take temazepam exactly as prescribed and not to stop or change dosage without condulting prescriber 7.) Explain the risks associated with abrupt cessation, including abdmominal cramps, acute

sense of hearing, confusion, depression, nausea, numbness, perceptual disturbances, photophobia, sweating, and tachycardia, tingling, trembling, and vomiting. 8.) Advise patient to avoid consuming alcohol because it increases drugs sedative effects and the risk of such abnormal behaviours as sleep driving. 9.) Urge patient to notify prescriber immediately about excessive drowsiness, nausea, and known or

suspected pregnancy. 10.) Do not stop taking the drug abruptly.

TRADE NAME Clopidogrel

GENERIC NAME Plavix

FREQUENCY /ROUTE 75 mg OD

CLASSIFICATION Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)

ACTION Inhibits platelet aggregation by blocking ADP receptors on platelets ,preventing clumping of platelets.

INDICATION Reduction of atherosclerotic events (eg, MI, stroke, vascular death) in patients with atherosclerosis documented by recent stroke, recent MI, or established peripheral arterial disease; treatment of acute coronary syndrome (ACS) (unstable angina/nonST-segment elevation MI), including patients managed with coronary revascularization; treatment of ACS in patients with STsegment elevation acute MI.

NURSING RESPONSIBILITIES 1.) Assess for symptoms of stroke, MI during treatment. 2.) Monitor liver function studies: AST, ALT, bilirubin, creatinine if patient is on long-term therapy. 3.) Monitor blood studies: CBC, Hgb, Hct, protime, cholesterol if the patient is on long-term therapy; thrombocytop

CONTRAINDICATION Hypersensitivity. Active pathological bleeding. Administer within 7 days after MI and ischaemic stroke, coagulation disorders.

enia and neutropenia may occur. 4.) Advise patient that each dose may be taken without regard to meals, but to take with food if stomach upset occurs. 5.) Instruct the patient to take the medicine exactly as ordered. 6.) Advise patient that if a dose is missed, to skip that dose and take the next dose at the regularly scheduled time. 7.) Instruct patient not to change the dose or stop taking unless advised by health care provider. 8.) Inform patient that it may take longer than usual to stop bleeding

while taking clopidogrel and to report bleeding or unusual bruising to health care provider immediately. 9.) Advice patient to inform health care providers about use of this drug before undergoing surgical or dental procedures and before any new drug is taken. 10.) Report any untoward clinical manifestations to the physician immediately.

TRADE NAME Amlodipine

GENERIC NAME Norvasc

FREQUENCY /ROUTE 40 mg OD

CLASSIFICATION Calcium channel blocker

ACTION Inhibits calcium ions from entering the slow channels or select voltage sensitive areas of vascular smooth muscle and myocardium during depolarization.

INDICATION Treatment of essential hypertension and angina

NURSING RESPONSIBILITIES 1.) Assess patient for history of allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block, or CHF. 2.) Assess for adverse drug reactions; report irregular heartbeat, swelling of the hands and feet, shortness of breath, pronounced dizziness, and constipation. 3.) Monitor BP and cardiac rhythm. 4.) Monitor heart rate; doserelated palpitations (more common in women) may

CONTRAINDICATION Allergy to amlodipine Hepatic or renal impairment Sick sinus syndrome Heart block Sick sinus syndrome Lactation

5.)

6.)

7.)

8.)

occur. Instruct patient to take drug with meals if abdominal discomfort occurs; advise on eating small, frequent meals for nausea and vomiting. Encourage patient to report significant swelling of face or extremities. Encourage patient to report shortne ss of breath, palpitations, irregular heartbeat, nausea, or constipation to physician. Take care to have support when standing & walking due to possible

dose-related lightheadedness/di zziness. 9.) Do not start any new prescription or nonprescription medicines or supplements, unless you check with your doctor first. 10.) Report immediately any untoward clinical manifestations to the physician immediately.

TRADE NAME Tramadol Hydrochlorid e

GENERIC NAME Ultram

FREQUENCY /ROUTE 50 mg PRN

CLASSIFICATION Analgesics (Opioid)

ACTION Unknown. A centrally acting synthetic analgesic compound not chemically related to opioids. Thought to bind to opioid receptors and inhibit reuptake of norepinephrine and serotonin.

INDICATION To treat moderate to moderately severe pain

NURSING RESPONSIBILITIES 1.) Reassess level of pain at leaser 30 minutes after administration. 2.) Monitor patient closely for evidence of serotonin syndrome, such as agitation, hallucinations, coma, tachycardia, labile blood pressure, hyperthermia, hyperreflexia, incoordination, nausea, vomiting, or diarrhea. Notify prescriber at once because serotonin syndrome may be life-threatening. Be prepared to discontinue drug and provide supportive care. 3.) Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations decrease or rate is below 12

CONTRAINDICATION Contraindicated in patients hypersensitive to drug or other opioids, in breastfeeding women, and in those with acute intoxication from alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs. Serious hypersensitivity reactions can occur, usually after the first dose. Patients with history of anaphylactic reaction to codeine and other opioids may be at increased risk. Use cautiously in patients at risk for seizures or respiratory depression; in patients with increased intracranial pressure or head injury, acute abdominal conditions, or renal or hepatic impairment; or in patients with physical dependence on opioids.

breaths/minute. 4.) Monitor bowel and bladder function. Anticipate need for laxative. 5.) For better analgesic effect, give drugs before onset of intense pain. 6.) Monitor patients at risk for seizures. Drug may reduce seizure threshold. 7.) In the case of an overdose, naloxone may also increase risk of seizures. 8.) Monitor patient for drug dependence. Drug can produce dependence similar to that of codeine or dextropropoxyphe ne and thus has potential for abuse. 9.) Withdrawal symptoms may occur if drug is stopped abruptly. Reduce dosage gradually. 10.) Take drug as prescribed and not

to increase dose or dosage interval unless ordered by prescriber. 11.) For ambulatory patients: Be careful in rising and walking. Avoid driving and other potentially hazardous activities that require mental alertness until drugs CNS effects are known. 12.) Check with prescriber before taking anny OTC drugs as drug interactions may occur. 13.) Avoid giving tramadol to patients with acute abdominal conditions because it may mask evidence and disrupt assessment of the abdomen. 14.) Monitor patient closely for evidence of suicidal thinking or behavior, especially

when therapy starts or dosage changes.