University of the Philippines The Health Sciences Center COLLEGE OF NURSING Sotejo Hall, Pedro Gil Street, Manila

Drug Study DRUG ORDER (Generic name, Dosage, Route, Frequency, etc.) Aspirin 80mg/tab 1 tab p lunch PO OD

PHARMACOLOGIC ACTION OF DRUG

INDICATIONS AND CONTRAINDICATIONS

ADVERSE EFFECTS OF THE DRUG

DESIRED ACTION ON THE CLIENT

NURSING RESPONSIBILITIES /PRECAUTIONS

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. Antiinflammatory effects are mediated by a decrease in prostaglandin synthesis. It also decreases platelet aggregation.

Indications: For pain on integumentary structures, myalgia, neuralgia, headache, dysmenorrhea, gout. Arthritis, SLE, acute rheumatic fever Contraindications: Hypersensitivity to salicylates, severe anemia, history of blood coagulation defects, vitamin K deficiency, 1 week before and after surgery, pregnancy in the last trimester

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

Prevent blood coagulation due to hypertension (narrow blood vessels may cause blood to aggregate)

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

Precautions: Do not use in children with chicken pox or flu symptoms Lactation Mild diabetes, erosive gastritis, bleeding tendencies, liver or kidney disease.

Clopidogrel 75mg/tab 1 tab OD

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

Indications Treatment of patients at risk for ischemic events history of MI, ischemic stroke, peripheral artery disease Treatment of patients with acute coronary syndrome Contraindications Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation.

CNS: Headache, dizziness, weakness, syncope, flushing CV: Hypertension, edema Dermatologic: Rash, pruritus GI: Nausea, GI distress, constipation, diarrhea, GI bleed Other: Increased bleeding risk

Prevent platelet aggregation

Assess for symptoms of stroke, MI during treatment Monitor liver function studies: AST, ALT, bilirubin, creatinine if patient is on longterm therapy Monitor blood studies: CBC,Hgb, Hct, protime, cholesterol if the patient is on longterm therapy; thrombocytopenia and neutropenia may occur.

Hydrochlorothiaz ide 12.5 mg 1 tab OD PO

Inhibits reabsorption of sodium and chloride in distal renal tubule, increasing the excretion of sodium, chloride, and water by the kidney.

Indications Adjunctive therapy in edema associated with CHF, cirrhosis, corticosteroid, and estrogen therapy; renal dysfunction Hypertension as sole therapy or in combination with other antihypertensives Unlabeled uses: Calcium nephrolithiasis alone or with amiloride or allopurinol to prevent recurrences in

CNS: Dizziness, vertigo, paresthesias, weakness, headache, drowsiness, fatigue CV: Orthostatic hypotension, venous thrombosis, volume depletion, cardiac arrhythmias, chest pain Dermatologic: Photosensitivity, rash, purpura, exfoliative dermatitis, hives, alopecia GI: Nausea, anorexia, diarrhea, constipation, jaundice, hepatitis, pancreatitis GU: Polyuria, nocturia,

Decrease blood pressure

vomiting, dry mouth,

Precautions: bleeding disorders, recent surgery, hepatic impairment, pregnancy Assess improvement in CVP q8h Check for rashes and temperature elevation daily Assess for confusion Monitor manifestations of hypokalemia: acidic urine, reduced urine, osmolality, nocturia, hypotension, tachycardia, weak pulse, weakness,

hypercalciuric or normal calciuric patients; diabetes insipidus, especially nephrogenic diabetes insipidus; osteoporosis Contraindications Contraindicated with allergy to thiazides, sulfonamides; fluid or electrolyte imbalance; renal disease (can lead to azotemia); liver disease (risk of hepatic coma); anuria.

impotence, loss of libido Hematologic: Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia, neutropenia Other: Muscle cramps and muscle spasms, fever, gouty attacks, flushing, weight loss, rhinorrhea, electrolyte imbalances, hyperglycemia

Isosorbide mononitrate 60mg/tab 1 tab OD at HS PO

Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial

Indications Dinitrate: Treatment and prevention of angina pectoris Mononitrate:

CNS: Headache,

apprehension, restlessness, weakness,

vertigo, dizziness, faintness

Relief of angina pectoris

altered LOC Monitor for manifestations of hypomagnesemia: agitation, muscle twitching, paresthesias, hyperactive reflexes, 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 Precautions: gout (risk of attack); SLE; glucose tolerance abnormalities, diabetes mellitus; hyperparathyroidis m; manicdepressive disorder (aggravated by hypercalcemia); pregnancy; lactation, elevated triglyceride levels. Assess for pain: duration, time started, activity Fcbeing performed,

Isosorbide dinitrate 5 mg PRN for chest pain

BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

Prevention of angina pectoris Contraindications Contraindicated with allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, narrow-angle glaucoma, postdural hypotension

CV: Tachycardia, retrosternal

Dermatologic: Rash, exfoliative dermatitis, cutaneous vasodilation with flushing GI: Nausea, vomiting, incontinence of urine and feces, abdominal pain, diarrhea GU: Dysuria, impotence, urinary frequency Other: Muscle twitching, pallor, perspiration, cold sweat, arthralgia, bronchitis

discomfort, palpitations, hypotension, syncope, collapse, orthostatic hypotension, angina, rebound hypertension, atrial fibrillation, postdural hypertension

character, intensity Assess orthostatic hypotension, blood pressure at baseline and during treatment

Precautions: pregnancy, lactation, acute MI, CHF, postural hypotension, severe renal, hepatic disease