NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

irbesartan Avapro angiotensin II 300 mg PO daily
receptor
antagonists
Peak Onset Duration Normal dosage range
3-14 hrs Within 2 hrs 24 hrs 150 mg once daily; may be increased to 300 mg once daily.
Patients receiving diuretics, who are volume depleted, or
who are being hemodialyzed--initiate with 75 mg/day.Type
2 diabetic nephropathy--300 mg once daily
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
Diabetic neuropathy, HTN solutions
N/A

Mechanism of action and indications Nursing Implications (what to focus on)

(Why med ordered)
Blocks vasoconstrictor and aldosterone-producing
effects of angiotensin II at receptor sites, including
vascular smooth muscle and the adrenal glands
Contraindications/warnings/interactions
Hypersensitivity. Use cautiously in: CHF (may result in
azotemia, oliguria, acute renal failure and/or death).
Volume- or salt-depleted patients or patients receiving high
doses of diuretics (correct deficits before initiating therapy
or initiate at lower doses). Black patients (monotherapy
may not be effective). Impaired renal function due to
primary renal disease or CHF (may worsen renal function).
Obstructive biliary disorders or hepatic impairment (lower
initial doses of losartan, temisartan, or valsartan
recommended).
Common side effects
No common side effects. Potential life threatening side
effects: RENAL FAILURE
Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
↑ antihypertensive effects with other
antihypertensives (labetalol) and diuretics (Lasix).
Risk of hypotension ↑ by concurrent diuretics
(Lasix) (use lower initial doses).
Nursing Process- Assessment
(Pre-administration assessment)
Assess blood pressure (lying down,
sitting, standing) and pulse periodically
during therapy. Monitor frequency of
prescription refills to determine
adherence. Assess patient for signs of
angioedema (dyspnea, facial swelling).
May rarely cause angioedema; more
common in patients who have had
angioedema with ACE inhibitors.
Lab value alterations caused by medicine
Monitor serum creatinine and urinary protein in patients
treated for diabetic nephropathy. May rarely cause ↑ in
BUN and serum creatinine. May cause ↑ serum bilirubin.
May occasionally cause hyperkalemia.
Be sure to teach the patient the following about this
medication
Emphasize the importance of continuing to take as
directed, even if feeling well. Take missed doses as soon as
remembered if not almost time for next dose; do not double
doses. Medication controls but does not cure hypertension.
Instruct patient to take medication at the same time each
day. Gradual reduction of dose prior to discontinuation is
suggested. Encourage patient to comply with additional
interventions for hypertension (weight reduction, low-
sodium diet, discontinuation of smoking, moderation of
alcohol consumption, regular exercise, stress management).
Instruct patient and family on proper technique for
monitoring blood pressure. Advise them to check blood
pressure at least weekly and to report significant changes.
Caution patient to avoid sudden changes in position to
decrease orthostatic hypotension. Use of alcohol, standing
for long periods, exercising, and hot weather may increase
orthostatic hypotension. May cause dizziness. Caution
patient to avoid driving or other activities requiring
alertness until response to medication is known. Advise
patient to consult health care professional before taking any
OTC or herbal cough, cold, or allergy remedies or other
medications. Instruct patient to notify health care
professional of medication regimen prior to treatment or
surgery. Emphasize the importance of follow-up exams to
evaluate effectiveness of medication.
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Decrease in blood pressure
Hypotension. Occurrence of without appearance of
unexpected, intolerable side effects. excessive side effects.
Slowed progression of
diabetic nephropathy.
Reduced risk of stroke.