Brand Name: Versant XR Generic Name: felodipine Dosage: 5mg OD (6:00AM) Classification: Cardiovascular drugs, calcium- channel blocker

Indication Treatment of hypertension. Contraindication Hypersensitivity to felodip ine. Uncompensat ed hea rt failure. A cute myo card ial infarction. Unstable angina pectoris. Mechanism of Action Felodipine is a vascular-selective dihydropyridine calciumchannel blocker that produces a sustained 24-hr reduction in systolic and diastolic pressure inpatients with all degrees of primary hypertension with no direct effect on cardiac contractility and conduction. It lowers arterial blood pressure by decreasing systemic vascular resistance. Felodipine improves coronary blood flow and myocardial oxygen supply by dilating the epicardial arteries and arterioles. Adverse Reaction Peripheral edema Hypotension Myocardial infarction Arrhythmias Angina Tachycardia Headache Dizziness Insomnia Nausea and vomiting Abdominal discomfort Dry mouth Thirst Flatulence Shortness of breath Nursing Management Check first the doctors order regarding to the drug to be administered. Rationale: The doctors order provides instruction on the dose and frequency of the drug. Observed 12 rights in administering medications. Rationale: Before giving the medicine, the nurse must be aware of the guidelines (12 rights) to avoid mistakes and protect the patient. Monitor cardiac status: BP, pulse, respiration, ECGRat ionale: To check fo r any changes of the clients BP because administering this without monitoring the BP may cause hypotension. Caution patient to avoid hazardous activities until stabilized on drug, and dizziness is no longer a problem. Rationale: Because one of the advers e react ions is dizziness. If this will occur the patient is risk for injury. Instruct pat ient t o limit caffeine consumption; to avoid a lcoho l and O TC drugs unless directed by the physician. R a t i o n a l e : T h e c o m m o n s i d e e f f e c t s o f c a f f e i n e a r e d i z z i n e s s , irritab ility , nausea, nervousness and fo r P s ych iatric side effects have included confusion. Therefore having caffeine consumption during drug therapy will alter the effect of the drug. Teach patient to change positions slowly. Rationale: To prevent orthostatic hypotension. Rationale This drug is given to our patient since he has always high blood pressure 160/70m m H g . U p o n c h e c k i n g o n patients vital signs record. With this drug it will help to decrease the patients BP by

inhibiting influx of calcium ions thus d e c r e a s i n g t h e contractility of the cardiac muscles.

Generic name: vitamins B1 + B6 + B12 Brand name: Neurobion tablet Formulation: Each coated tablet contains: Thiamine mononitrate (Vitamin B1) = 100mg, Pyridoxine hydrochloride (Vitamin B6) = 200mg, Cyanocobalamin (Vitamin B12) = 200mcg Indications: Neuritis and neuralgia, especially cervical syndrome, shoulder-arm syndrome, lumbalgia, sciatica, facial paresis. Alcoholic polyneuropathy, Diabetic neuropathy, including impotence due to autonomic neuropathy. Metabolic and neuropathic changes due to pregnancy and oral contraceptives. Drug-induced neuropathies. Supplemental therapy following major surgery or debilitating illness. Dosage and administration: Unless otherwise prescribed by the physician, one to two tablets 3 times daily to treat moderate case or to provide interval and follow-up therapy for a course of injections. Storage condition: Store at a temperature not exceeding 25 degrees Celsius. Availability: Box of 100 coated tablets in blister strips of 10s Manufactured by: PT, Merck Tbl. Jl. T.B. Simatupang No. 8 Pasar Rebo, Jakarta 13760, Indonesia Under license of Merck KGaA, Darmstadt, Germany PHARMACOLOGICAL CLASSIFICATION: A.22.1.4 - Vitamins: Others INDICATIONS: NEUROBION tablets are indicated where a deficiency of the relevant vitamins exists. CONTRA-INDICATIONS: NEUROBION should not be used in patients on Levodopa therapy. Hypersensitivity to any of the above ingredients. DOSAGE AND DIRECTIONS FOR USE: NEUROBION tablets may be administered in a dosage of 1 daily. SIDE-EFFECTS AND SPECIAL PRECAUTIONS: Cyanocobalamin should not be given before a diagnosis has been fully established because of the possibility of masking symptoms of subacute degeneration of the spinal cord. Cyanocobalamin is not a suitable form of Vitamin B12 for the treatment of optic neuropathies associated with raised plasma concentrations of cyanocobalamin. KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT: Treatment is symptomatic and supportive. IDENTIFICATION:

White, shiny, round coated tablets, steeply convexed on both sides.

Severe renal impairment (CrCl less than 30 mL/min or approximate serum creatinine levels of more than 3 mg/dL in men and more than 2.5 mg/dL in women)

Sitagliptin Phosphate Pronunciation: SYE-ta-GLIP-tin FOS-fate Class: Antidiabetic agent Trade Names Januvia - Tablets, oral 25 mg - Tablets, oral 50 mg - Tablets, oral 100 mg Pharmacology Sitagliptin is a dipeptidyl peptidase-4 inhibitor that is thought to act in type 2 diabetes by slowing the inactivation of incretin hormones. Pharmacokinetics Absorption Sitagliptin is rapidly absorbed, with a 100 mg dose reaching a C
max

PO 25 mg once daily. ESRD requiring hemodialysis or peritoneal dialysis PO 25 mg once daily. Administer without regard to the timing of hemodialysis. General Advice

Instruct patients to take with or without food. Instruct patients to swallow the tablet whole and not to split, crush, or chew before swallowing. When used in combination with an insulin secretagogue (eg, sulfonylurea) or with insulin, a lower dose of the insulin secretagogue or insulin may be required to reduce the risk of hypoglycemia.

Drug Interactions Cyclosporine Sitagliptin plasma concentrations may be increased modestly (approximately 68%), which is not expected to be clinically important. Digoxin Digoxin plasma concentrations may be increased slightly (approximately 18%); no dosage adjustment is recommended. Insulin, sulfonylureas (eg, tolbutamide) A lower dose of the insulin or sulfonylurea may be needed to reduce the risk of hypoglycemia. Adverse Reactions GI Diarrhea (3%); abdominal pain (2%); nausea (1%); acute pancreatitis including fatal and nonfatal hemorrhagic and necrotizing pancreatitis, constipation, hepatic enzyme elevations, vomiting (postmarketing). Genitourinary Increased serum creatinine; worsening renal function including acute renal failure sometimes requiring dialysis (postmarketing). Hypersensitivity Hypersensitivity reactions, including anaphylaxis, angioedema, cutaneous vasculitis, exfoliative skin conditions (including Stevens-Johnson syndrome), rash, and urticaria (postmarketing). Respiratory Nasopharyngitis, upper respiratory tract infection (5%).Precautions

of 950 nM in 1 to 4 h; AUC was 8.52 mcM. The

bioavailability is approximately 87%. Elderly Elderly patients had an approximate 19% higher plasma concentration; no dosage adjustment is required. Children Studies characterizing the pharmacokinetics of sitagliptin in children have not been performed. Indications and Usage Adjunct to diet and exercise to improve glycemic control in adult patients with type 2 diabetes mellitus as monotherapy or as combination therapy. Contraindications History of a serious hypersensitivity reaction to sitagliptin. Dosage and Administration Adults PO 100 mg once daily. Renal Function Impairment Adults Moderate renal impairment (CrCl 30 to less than 50 mL/min or approximate serum creatinine levels of more than 1.7 up to 3 mg/dL in men and more than 1.5 up to 2.5 mg/dL in women) PO 50 mg once daily.

testing, recognition and management of Monitor Periodically monitor blood glucose and HbA
1c

hypoglycemia and hyperglycemia, and assessment for diabetes complications. During periods of stress, . Assess renal such as fever, trauma, infection, or surgery, medication requirements may change; advise patients to seek medical advice promptly.

function prior to initiation of therapy and periodically thereafter. Observe patients carefully for signs and symptoms of pancreatitis. Pregnancy Category B . Lactation Undetermined. Children Safety and efficacy not established. Elderly Use with caution. Hypersensitivity Use with caution in patients with a history of angioedema. Serious hypersensitivity reactions, including anaphylaxis, angioedema, and exfoliative skin conditions, including Stevens-Johnson syndrome, have occurred. Renal Function Use caution to ensure the correct dose of sitagliptin is prescribed for patients with moderate to severe renal impairment and in patients with ESRD requiring hemodialysis or peritoneal dialysis. Pancreatitis Acute pancreatitis, both fatal and nonfatal hemorrhagic or necrotizing pancreatitis, has been reported. Type 1 diabetes/diabetic ketoacidosis Do not use sitagliptin in these settings. Overdosage Symptoms Mean increases in QTc interval of 8 msec, which were not considered clinically important, were observed at a dose of 800 mg. There is no experience with doses more than 800 mg. Patient Information

Inform patients that acute pancreatitis has been reported during postmarketing use of sitagliptin. Inform patients that persistent, severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting, is the hallmark symptom of acute pancreatitis. Instruct patients to promptly discontinue sitagliptin and contact their health care provider if persistent abdominal pain occurs.

Inform patients that the incidence of hypoglycemia is increased when sitagliptin is added to a sulfonylurea or insulin, and that a lower dose of the sulfonylurea or insulin may be required to reduce the risk of hypoglycemia.

Inform patients that allergic reactions have been reported during postmarketing use of sitagliptin. If symptoms of allergic reactions, including rash, hives, and swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing, occur, advise patients to stop taking sitagliptin and seek medical advice promptly.

Inform patients that the tablets must be swallowed whole and never split, crushed, or chewed.

Junuvia (sitagliptin phosphate) Side Effects Adverse events associated with the use of Januvia may include, but are not limited to, the following:

Upper Respiratory Tract Infection Nasopharyngitis Headache.

Mechanism of Action Januvia is an an orally-active inhibitor of the dipeptidyl peptidase-4 (DPP-4) enzyme. The DPP-4 enzyme inactivates incretin hormones, which are involved in the physiologic regulation of glucose homeostasis. Januvia slows the inactivation of incretin hormones and thus increases and prolongs their action. By inhibiting DPP-4, Januvia increases and prolongs active incretin levels. This in turn increases insulin release and decreases glucagon levels in the circulation in a glucose-dependent manner JANUVIA is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. 100 mg once daily

Advise patients to read the Medication Guide before starting therapy and to read it again with each refill. Inform patients of the potential risks and benefits of sitagliptin and of alternative modes of therapy. Also inform patients about the importance of adherence to dietary instructions, regular physical activity, periodic blood glucose monitoring and HbA
1c