Clopidogrel

Name of Drug Mechanism of Action Indication Contraindication Side Effects & Adverse Nursing Responsibilities
Effects
Generic Name: Inhibits the binding of To reduce rate of MI  Contraindicated in CNS: confusion, fatal  Monitor patient for
clopidogrel bisulfate ADP to its platelet and stroke in patients patients intracranial bleeding, signs of thrombotic
receptor, impeding ADP with unstable hypersensitive to hallucinations, thrombocytopenic
mediated activation and angina/nonST- drug or its headache. purpura (low
Brand Name: subsequent platelet elevation MI components, in CV: hypotension, platelet count,
Plavix aggregation, and (NSTEMI),including those with a history hemorrhage at any site. neuro symptoms,
irreversibly modifies the those managed of hypersensitivity EENT: epitaxis, rhinitis, renal dysfunction,
Route & Dosage: platelet ADP receptor. medically and those or hematologic taste disorder. fever).
300mg P.O. loading managed with reaction to other GI: hemorrhage,  Monitor for signs
dose, then 75mg P.O. coronary thienopyridines, abdominal pain, and symptoms of
once daily for 7 days revascularization; to and in those with constipation, diarrhea, bleeding (urine,
reduce rate of MI and pathologic bleeding dyspepsia, gastritis, stool, hematoma,
Therapeutic Class: stroke in patients with (such as peptic ulcers. epistaxis,
Antiplatelet drugs acute ST-elevation MI ulcer or intracranial GU: UTI, hematuria. petechiae). May
(STEMI) who are to be hemorrhage). Hematologic: cause elevation of
Pharmacologic Class: managed medically.  Hypersensitivity thrombotic serum liver
Platelet aggregation reactions, including thrombocytopenic enzymes–establish
inhibitors rash, angioedema, purpura. baseline enzymes
and hematologic Musculoskeletal: and bilirubin levels.
reactions, have arthralgia, myalgia,
been reported. arthritis.
 Consider Respiratory:
discontinuing drug bronchospasm,
5 days before interstitial pneumonitis, Patient Teaching
elective surgery, respiratory tract
including elective bleeding.  Advise patient that
CABG. Platelet Skin: rash, pruritus, it may take longer
aggregation won't bruising, eczema, than usual to stop
return to normal erythema multiforme, bleeding and to
for at least 5 days urticaria, Stevens refrain from
 after drug has been Johnson syndrome, toxic activities in which
stopped. epidermal necrolysis trauma and
 Premature Others: flulike bleeding may
interruption of syndrome, angioedema occur. Encourage
therapy may result anaphylaxis, serum patient to wear
instent thrombosis sickness. seat belt when in a
with subsequent car.
fatal or nonfatal MI.  Instruct patient to
Duration of notify prescriber if
therapy, in general, unusual bleeding
is determined by or bruising occurs.
type of stent placed  Tell patient to
(bare metal or drug inform all health
luting) and whether care providers,
an AC event was including dentists,
ongoing at the time before undergoing
of placement. procedures or
 Use cautiously in starting new drug
patients at risk for therapy, about
increased bleeding taking drug.
from trauma,  Inform patient that
surgery, or other drug may be taken
pathologic without regard to
conditions and in meals.
those with renal or
hepatic
impairment.

Isosorbide mononitrate

Name of Drug Mechanism of Action Indication Contraindication Side Effects & Adverse Nursing Responsibilities
Effects
Generic Name: Acts as a donor of nitric Isosorbide  Contraindicated CNS: headache,  Give sublingual
Isosorbide oxide (NO). NO causes a mononitrate is with allergy to dizziness, preparations under
mononitrate relaxation of vascular indicated for the nitrates, severe lightheadedness or the tongue or in
smooth muscle via the prevention and anemia, head fainting. the buccal pouch;
Brand Name: stimulation of guanylyl management of trauma, cerebral CV: irregular heart rates discourage the
Imdur, Monoket, and cyclase and the angina pectoris due hemorrhage, GI: nausea, vomiting, patient from
ISMO. subsequent increase of to coronary artery hypertrophic constipation, dry mouth, swallowing.
intracellular cyclic disease. The onset of cardiomyopathy, diarrhea  Create a nitrate-
Route & Dosage: guanosine action of oral narrow-angle Musculoskeletal: pain or free period to
60mg P.O. once daily monophosphate (cGMP) isosorbide glaucoma, stiffness in joints or minimize
for 3 days concentration. mononitrate is not postdural muscles. tolerance.
sufficiently rapid to hypotension Respiratory: chest pain,
Therapeutic Class: be useful in aborting  Use cautiously with and shortness of breath. Patient Teaching
Vasodilators an acute anginal pregnancy, Skin: skin warmth or
Nitrates, Angina episode. lactation, acute MI, redness, hot flashes,  Place sublingual
CHF. tingling under your skin. tablets under your
Pharmacologic Class: tongue or in your
Vasodilators cheek; do not
chew or swallow
the tablet. Take
the isosorbide
before chest pain
begins, when
activities or
situation may
precipitate an
attack. Take oral
isosorbide
dinitrate on an
empty stomach, 1
hour before or 2
hours after meals;
do not chew or
crush sustained-
release
 preparations; do
not take isosorbide
mononitrate to
relieve acute
anginal episodes.
 You may
experience these
side effects:
Dizziness,
lightheadedness
(may be transient;
use care to change
positions slowly);
headache (lie
down in a cool
environment, rest;
over-the-counter
preparations may
not help; take drug
with meals);
flushing of the
neck or face
(reversible).
 Report blurred
vision, persistent
or severe
headache, rash,
more frequent or
more severe
angina attacks,
fainting.

L carneitine 330mg
 Name of Drug Mechanism of Action Indication Contraindication Side Effects & Adverse Nursing Responsibilities
Effects
Generic Name: Levocarnitine can be For treatment of The patient should not CNS: headache, dizziness  Store at room
levocarnitine synthesised within the primary systemic take this medicine if the CV: irregular heart rates temperature
fumarate body from the amino carnitine deficiency, a patient is allergic to any GI: nausea, vomiting, between 59-86
acids lysine or genetic impairment of ingredient of the product. constipation, dry mouth, degrees F (15-30
methionine. Vitamin C normal biosynthesis or diarrhea degrees C) away
Brand Name: (ascorbic acid) is utilization of Musculoskeletal: muscle from light and
Carnitine, Carnitor essential to the synthesis levocarnitine from weakness moisture.
of carnitine. dietary sources, or for Respiratory: chest pain,  Monitor predialysis
Route & Dosage: Levocarnitine is a carrier the treatment of and shortness of breath. (trough) plasma
200 mg/mL (2.5 mL, 5 molecule in the transport secondary carnitine Skin: pruritic rash carnitine levels.
mL) I.V. of long chain fatty acids deficiency resulting  Monitor blood
Solution, 100 mg/mL across the inner from an inborn error of chemistry, vital
(118 mL) P.O. mitochondrial metabolism such as signs, and plasma
membrane. It also glutaric aciduria II, carnitine levels
Therapeutic Class: exports acyl groups from methyl malonic (maintain between
Amino Acids and subcellular organelles aciduria, propionic 35-60mol/L)
Derivatives and from cells to urine acidemia, and medium  Apply pressure to
Supplements before they accumulate chain fatty acylCoA the area where the
Metabolic Agents, to toxic concentrations. dehydrogenase catheter was
Carnitine Deficiency Only the L isomer of deficiency. Used inserted for at least
carnitine (sometimes therapeutically to 15 minutes.
Pharmacologic Class: called vitamin BT) affects stimulate gastric and  Monitor serum
Supplemental Dietary lipid metabolism. pancreatic secretions triglycerides, fatty
Agents Levocarnitine is handled and in the treatment acids, and carnitine
by several proteins in of levels
different pathways hyperlipoproteinemias.
including carnitine Parenteral
transporters, carnitine levocarnitine is
translocases, carnitine indicated for the
acetyltransferases and prevention and
carnitine treatment of carnitine
palmitoyltransferases. deficiency in patients
 with end-stage renal
disease.

Glimefiride

Name of Drug Mechanism of Action Indication Contraindication Side Effects & Adverse Nursing Responsibilities
Effects
Generic Name: Lowers glucose level by Adjust to diet and  Contraindicated in CNS: dizziness, asthenia,  Monitor urine or
glimepiride stimulating release of exercise to lower patients headache. serum glucose
insulin from functioning glucose level in hypersensitive to ENT: changes in levels frequently to
pancreatic beta cells, patients with type 2 drug and in those accommodation. determine
Brand Name: and may lead to diabetes. with diabetic Gl: nausea. effectiveness of
Amaryl increased sensitivity of ketoacidosis, which Metabolic: drug and dosage
peripheral tissues to should be treated hypoglycemia, dilutional being used.
Route & Dosage: insulin. with insulin. byponatremia.  WARNING:
1 or 2 mg P.O. once  Contraindicated as Respiratory: flulike Transfer to insulin
daily; usual sole therapy for symptoms. therapy during
maintenance dose is 1 type 1 diabetes. periods of high
to 4 mg P.O. once  Contraindicated in stress (eg,
daily patients with infections, surgery,
sulfonamide trauma).
Therapeutic Class: allergy.  Use IV glucose if
Antidiabetics  Use cautiously in severe
debilitated or hypoglycemia
Pharmacologic Class: malnourished occurs as a result
Sulfonylureas patients and in of overdose.
those with adrenal,  Arrange for
pituitary, or renal consultation with
insufficiency; these dietitian to
patients are more establish weight-
susceptible to the loss program and
hypoglycemic dietary control.
action of glucose- Arrange for thorough
lowering drugs. diabetic teaching program,
including disease, dietary
control, exercise, signs and
symptoms of hypoglycemia
and hyperglycemia,
avoidance of infection,
hygiene.

Patient Teaching

 Take a missed dose

as soon as possible
unless it is almost
time for next dose;
NEVER take two
doses at the same
time.
 Avoid drinking
alcohol or using
OTC drugs without
informing
physician.
 Use sunscreen and
avoid sunlamps.
 Learn about
adverse reactions
and drug
interactions.
 Do not breast feed
while taking this
drug.
 Eicosapentaenoic acid

Name of Drug Mechanism of Action Indication Contraindication Side Effects & Adverse Nursing Responsibilities
Effects
Generic Name: Fish oil reduces the rate Fish Oil suggested Fish oil might increase the CV: heart burn  Monitor for S&S of
Fish Oil of VLDL synthesis in the uses include risk of bleeding in people GI: nausea, vomiting, hypersensitivity in
liver. Reduced NEFA treatment for bipolar with liver scarring due to constipation, diarrhea, those with known
Brand Name: delivery to the liver is a disorder, coronary liver disease. Diabetes: stomach pain allergy to fish.
DHA, likely locus of action for heart disease, Taking high doses of fish Musculoskeletal:  Monitor diabetics
docosahexaenoic acid fish oils. Fish oil dysmenorrhea, oil might make it more Joint paint for loss of glycemic
(DHA), counteracts the lipolytic hyperlipidemia, HTN, difficult to control blood control.
eicosapentaenoic acid release of NEFA from hypertriglyceridemia, sugar levels.  Lab tests: Baseline
(EPA), EPA (fish oils), adipose tissue by Raynaud's syndrome, and periodic lipid
fish oils, marine oils, suppressing rheumatoid arthritis, profile.
menhaden oil, N3 inflammation. Fish oil stroke prevention, to  Note: Poor
fatty acids, omega 3 increases FA uptake and decrease risk of therapeutic
PUFA, β-oxidation in adipose, prostate cancer response after 2
polyunsaturated fatty heart and skeletal (dietary fish), mo is an indication
acids, PUFA, W3 fatty muscle. rheumatoid arthritis, to discontinue
acids, shark liver oil psoriasis, and other drug.
chronic inflammatory  Monitor blood
Route & Dosage: conditions. levels of
4 g P.O. once daily anticoagulants with
concurrent
Therapeutic Class: therapy.
antilipemic or lipid-
regulating agents. Patient Teaching

Pharmacologic Class:  Do not breast feed

Lipid-lowering agent while taking this
drug without
consulting
physician.
 Diazepam 5mg 1 tab at 1 pm

Name of Drug Mechanism of Action Indication Contraindication Side Effects & Adverse Nursing Responsibilities
Effects
Generic Name: A benzodiazepine that diazepam is a useful  Contraindicated in CNS: drowsiness,  Periodically
diazePAM potentiates the effects of adjunct for the relief patients dysarthria, slurred monitor LFTs, CBC,
GABA, depresses the of skeletal muscle hypersensitive to speech, tremor, and renal function
CNS, and suppresses the spasm due to reflex drug and in infants transient amnesia, in patients
Brand Name: spread of seizure spasm to local younger than age 6 fatigue, ataxia, receiving repeated
Diastat, Diastat activity. pathologies, such as months (oral form). headache, insomnia, or prolonged
AcuDial, Diazepam inflammation of the  Diazepam (oral paradoxical anxiety, therapy.
Intensol, Valium muscle and joints or form) is hallucinations, minor  Monitor HR, BP,
secondary to trauma; contraindicated in changes in EEG patterns, and mental status
Route & Dosage: spasticity caused by patients with pain, vertigo, confusion, changes. Patients
2 to 10 mg P.O. b.i.d. upper motor neuron myasthenia gravis, depression. are at an increased
to q.i.d. as an adjunct. disorders, such as severe respiratory CV: CV collapse, risk for falls.
Or, 5 to 10 mg I.V. or cerebral palsy and insufficiency, bradycardia,  Alert: Use of drug
I.M. initially; then 5 to paraplegia; athetosis severe hepatic hypotension. may lead to abuse
10 mg I.V. or I.M. and the rare "stiff insufficiency, or ENT: diplopia, blurred and addiction.
again in 3 to 4 hours man syndrome". sleep apnea vision, nystagmus. Don't withdraw
syndrome. GI: nausea, constipation, drug abruptly after
Therapeutic Class:  Diazepam is diarrhea with rectal long-term use
Anxiolytics contraindicated in form, dry mouth. because
patients with acute GU: incontinence, urine withdrawal
Pharmacologic Class: angle-closure retention. symptoms may
Benzodiazepines glaucoma. Hematologic: occur; taper
 Use cautiously in neutropenia. gradually.
patients Hepatic: jaundice.  Look alike-sound
experiencing shock, Respiratory: respiratory alike: Don't
coma, or acute depression, confuse diazepam
alcohol intoxication apnea, hiccups. with diazoxide or
(parenteral form). Skin: rash, phlebitis at Ditropan. Don't
 Use cautiously in injection site. confuse Valium
elderly and Other: altered libido, with Valcyte.
 debilitated patients physical or psychological Patient Teaching
and in patients with dependence.  Warn patient to
hepatic or renal report all adverse
impairement, reactions and to
depression, history avoid activities that
of substance abuse, require alertness.
impaired gag reflex,
or chronic angle
glaucoma (who are
receiving
appropriate
therapy) and in
those at risk for
falls.
 Some injectable
forms may contain
propylene glycol;
large amounts are
potentially toxic
and have been
associated with
hyperosmolality,
lactic acidosis,
seizures, and
respiratory
depression.

Diphenhydramine 25mg 1 cap at 1 pm

Name of Drug Mechanism of Action Indication Contraindication Side Effects & Adverse Nursing Responsibilities
Effects
Generic Name: Competes with Rhinitis, allergy  Contraindicated in CNS: drowsiness,  Stop drug 4 days
diphenhydrAMINE histamine for H1- symptoms, motion patients sedation, sleepiness, before diagnostic
hydrochloride receptor sites. Prevents, sickness, Parkinson hypersensitive to dizziness, skin testing.
but doesn’t reverse, disease drug and other incoordination, seizures,  Injection form is
Brand Name: histamine-mediated similar confu- for I.V.or I.M.
Aler-Cap, Banophen, responses, particularly antihistamines, in sion, insomnia, administration
Benadryl, Children’s those of the bronchial newborns, and in headache, vertigo, only.
Benadryl Allergy, tubes, GI tract, uterus, premature fatigue, restlessness,  Dizziness,
Diphenhist, PediaCare and blood vessels. neonates. tremor, nervousness. excessive sedation,
Childrens Allergy,  Use cautiously in CV: palpitations, syncope, toxicity,
Silphen Cough, Simply patients with hypotension, paradoxical
Allergy, Sominex, TH angleclosure tachycardia. stimulation, and
Allergy Relief, TH glaucoma, EENT: diplopia, blurred hypotension are
Childrens Allergy, stenosing peptic vision, nasal congestion, more likely to
TheraFlu ulcer, symptomatic tinnitus. occur in elderly
MultiSymptom, Total prostatic GI: dry mouth, nausea, patients.
Allergy, Triaminic hyperplasia, epigastric distress,  Look alike-sound
MultiSymptom, bladder neck vomiting, diarrhea, alike: Don't
Unisom SleepMelts obstruction, constipation, anorexia. confuse
pyloroduodenal GU: dysuria, urine diphenhydramine
Route & Dosage: obstruction, or retention, urinary with
25 to 50 mg P.O. asthma. frequency, early menses. dimenhydrinate.
every 4 to 6 hours. Hematologic: Don't confuse
Maximum, 300 mg  Avoid use in thrombocytopenia, Benadryl with
P.O. daily. Or, 10 to 50 patients taking agranulocytosis, Bentyl or
mg I.V. or deep I.M. MAO inhibitors. hemolytic anemia. benazepril.
Maximum I.V. or I.M.  Use with caution in Respiratory: thickening
dosage, 400 mg daily. patients with of bronchial secretions. Patient Teaching
prostatic Skin: urticaria,
Therapeutic Class: hyperplasia, photosensitivity, rash.  Warn patient not
Antihistamines asthma, COPD, Other: anaphylactic to take this drug
increased IOP, shock. with any other
Pharmacologic Class: hyperthyroidism, products that
Ethanolamines CV disease, and contain
HTN. diphenhydramine
 Children younger (including topical
 than age 12 should therapy) because
use drug only as of increased
directed by adverse reactions.
prescriber.  Instruct patient to
 Dialyzable drug: take drug 30
Unlikely. & minutes before
Overdose S&S: Dry travel to prevent
mouth, fixed or motion sickness,
dilated pupils,  Tell patient to take
flushing, GI diphenhydramine
symptoms. with food or milk
to reduce GI
distress.
 Warn patient to
avoid alcohol and
hazardous
activities that
require alertness
until CNS effects of
drug are unknown.
 Tell patient to
notify prescriber if
tolerance develops
because a different
antihistamine may
need to be
prescribed.
 Drug is in many
OTC sleep and cold
products. Advise
patient to consult
prescriber before
using these
products.
 Warn patient of
possible
photosensitivity
reactions. Advise
use of a sunblock.