DRUG ANALYSIS DRUG ACTION INDICATION CONTRAINDICATION EFFECTS NURSING CONSIDERATIONS -Assess nutrition -assess liver function tests

prior to therapy -administer drug with the evening meal because taking this enhances absorption and increases cholesterol biosynthesis. -teach patient about proper dietary management of cholesterol and triglycerides. -tell patient to notify physician when adverse reactions occu.r

Simvastatin

Inhibits HMG COA reductase enzyme, which reduces cholesterol synthesis. This enzyme is needed for cholesterol production.

To reduce low density lipoprotein in cholesterol, apolipoprate in beta and triglycerides. To increase high density lipoprotein cholesterol in the treatment of hyperlipideamias.

Hypersensitivity to HMGCoA reductase inhibitors. Liver diseases. Pregnancy and nursing period.

-back pain -constipation -diarrhea -flushing (dizziness, itching, redness, tingling, warmth) -headache -nausea -runny or stuffy nose -stomach upset

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NURSING CONSIDERATIONS -Take metoprolol exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. -Take metoprolol at the same time every day. -Metoprolol should be taken with food or just after a meal. A Toprol XL tablet can be divided in half if your doctor has told you to do so. The half tablet should be swallowed whole, without chewing or crushing. Chewing or crushing the pill could cause too much of the drug to be released at one time. Do not skip doses or stop taking metoprolol without

Metropolol

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.

Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.

y y y y

y y y y y y

congestive heart failure; low blood pressure; pheochromocytom a; problems with circulation (such as Raynaud's syndrome); asthma, bronchitis, emphysema; diabetes; depression; liver or kidney disease; a thyroid disorder; or severe allergies.

chest pain, pounding heartbeats or fluttering in your chest; feeling lightheaded, fainting; feeling short of breath, even with mild exertion; swelling of your hands or feet; nausea, upper stomach pain, itching, loss of appetite, dark urine, claycolored stools, jaundice (yellowing

of the skin or eyes); easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin; wheezing, trouble breathing; depression, confusion, memory problems, hallucinati ons; or

first talking to your doctor. Stopping suddenly may make your condition worse. -Your blood pressure will need to be checked often. Visit your doctor regularly.

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y

Citicoline

Citicholine increases blood flow and O2 consumption in the brain. It is also involved in the biosysntehsis action.

. Citicholine is indicated in CVD in acute recovery phase in severe s/sx of cerebrovascular insufficiency and in-cranial traumatism and their sequellae. Citicholine in CVA, stimulates brain function.

Any allergy or hypersensitivity to the drug Hypertonia of the parasympathetic nervous system Use cautiously for pregnancy and lactation Conscious use for patient with renal and hepatic damage

Fleeting and discrete hypotensio n effect, increased parasympat hetic affects, low blood pressure Itching or hives, swelling in face or hands, chest tightness, tingling in mouth and throat

Take Citicholine as prescribed Take Citicholine on time Monitor patients neurologic status Note if there are signs of slurring of speech Note for adverse reactions Titer medication when discontinuin g Teach patient on how to take the drug

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NURSING CONSIDERATIONS Assess for symptoms of stroke, MI during treatment Monitor liver function studies: AST, ALT, bilirubin, creatinine if patient is on long-term therapy Monitor blood studies: CBC,Hgb, Hct, protime, cholesterol if the patient is on long-term therapy; thrombocytopeni a and neutropenia may occur. Precautions: bleeding disorders, recent surgery, hepatic impairment, pregnancy

Clopidogrel

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

Treatment of patients at risk for ischemic events history of MI, ischemic stroke, peripheral artery disease Treatment of patients with acute coronary syndrome

Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation.

CNS:Hea dache, dizziness,weakness , syncope, flushing CV: Hypertension, edema Dermatologic: Ras h, pruritus GI: Nausea, GI distress, constipation, diarrhea, GI bleed Other:Increased bleeding risk

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NURSING CONSIDERATIONS 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

Aspirin

Exhibits antipyretic, antiinflammatory 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.

For pain on integumentary structures, myalgia, neuralgia, headache, dysmenorrhea, gout. Arthritis, SLE, acute rheumatic feve

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:Bronc hosp asm, asthmalike symptoms, anaphylaxis, skin rashes, urticaria Hematologic: prolongation of bleeding time, thrombocytopenia, leucopenia, Other: Thirst, fever, dimness of vision

Mild diabetes, erosive gastritis, bleeding tendencies, liver or kidney disease.

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NURSING CONSIDERATIONS 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

Zantac (Ranitidine)

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.

Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Hypersensitivity, Crosssensitivity 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

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 promptly. LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

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