Drug Study

DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING

ACTION RESPONSIBILITIES
Generic Name: Trimetazidine inhibits β- This drug is  Dizziness  Extrasystoles  Monitor blood
Trimetazidine oxidation of fatty acids recommended in long  Headache  Orthostatic pressure and pulse
through inhibition of term treatment of  abdominal pain Hypotension rate before and
long-chain 3-ketoacyl- coronary insufficiency;  Dyspepsia  after giving the
CoA thiolase, which Angina Pectoris  Diarrhea meds. 
enhances glucose  Nausea  Notify prescribing
oxidation. It ensures  Vomiting signs of heart
Brand Name: proper functioning of  Pruritus failure such as
Vastarel ionic pumps and  Rash swelling of hands
transmembrane Na-K  Urticaria and feet or SOB. 
flow by preventing  Asthenia  Advise patient of
decrease in intracellular the adverse effects
ATP levels. of the drug.

Classification: Anti-
angina

Dose, Timing, Route

35 mg 1 tab, PO, BID

 DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
Generic Name: To reduce rate of MI Active metabolite Frequent (15%): granulocytosis, plastic BASELINE ASSESSMENT
Clopidogrel and stroke (with irreversibly blocks Skin disorders. anemia/pancytopenia,  Perform platelet counts
aspirin) in patient’s P2Y12 component of Occasional (8%– thrombotic before drug therapy, every
with non–ST- ADP receptors on 6%): Upper thrombocytopenic 2 days during first week of
segment elevation platelet surface, respiratory tract purpura (TTP) occur treatment, and weekly
acute coronary preventing activation infection, chest pain, rarely. Hepatitis, thereafter until therapeutic
syndrome (ACS), of GPIIb/IIIa receptor flu-like symptoms, hypersensitivity maintenance dose is
Brand Name: acute ST-elevation complex. Inhibits headache, dizziness, reaction, anaphylactoid reached.
Plavix MI (STEMI); patient’s platelet aggregation. arthralgia. reaction have been  Abrupt discontinuation of
with history of recent Rare (5%–3%): reported. drug therapy produces
MI or stroke, or Fatigue, edema, elevated platelet count
established hypertension, within 5 days.
peripheral arterial abdominal pain,
disease (PAD). dyspepsia, diarrhea, INTERVENTION/EVALUATION
nausea, epistaxis,  Monitor platelet count for
dyspnea, rhinitis. evidence of
Drug Class: thrombocytopenia.
Pharmacologic  Assess Hgb, Hct, for
class: evidence of bleeding;
Thieno-pyridine serum ALT, AST, bilirubin,
derivative BUN, creatinine;
signs/symptoms of hepatic
Therapeutic Class: insufficiency during
Anti-platelet therapy.
Dose, Timing, Route
PATIENT/FAMILY TEACHING
75mg, 1 tab PO, OD  Give without regard to food.
Avoid grapefruit products.
 It may take longer to stop
bleeding during drug
therapy.
 Report any unusual
bleeding.
 DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
Generic Name: Used as platelet Irreversibly inhibits Occasional: GI  High doses of BASELINE ASSESSMENT
Acetysalicylic Acid aggregation inhibitor cyclo-oxygenase distress (including aspirin may  Do not use if vinegar-like
(Aspirin) in the prevention of enzyme, resulting in abdominal distention, produce GI odor is noted (indicates
transient ischemic a decreased cramping, heartburn,  bleeding and/or chemical breakdown).
attacks (TIAs), formation of mild nausea); allergic gastric mucosal  Assess history of GI bleed,
cerebral prostaglandin reaction (including lesions. peptic ulcer disease, OTC
thromboembolism, precursors. bronchospasm,  Reye’s syndrome, use of products that may
Brand Name: MI or reinfarction. Irreversibly pruritus, urticaria). characterized by contain aspirin.
Asaphen E.C. , inhibits formation of persistent  Assess type, location,
Ascriptin, Bayer, thromboxane, vomiting, signs of duration of pain,
Bufferin, Durlaza, resulting in inhibiting brain dysfunction, inflammation.
Ecotrin, Entro platelet aggregation. may occur in  Inspect appearance of
phen , Novasen ) children taking affected
aspirin with recent  joints for immobility,
viral infection deformities, skin condition.
(chickenpox,  Therapeutic serum level
Drug Class:  common cold, or  for antiarthritic effect:
Pharmacologic flu). Low-grade 20–30 mg/dL (toxicity
class: aspirin toxicity occurs if level is greater
Non-Steroidal Anti- characterized by than 30 mg/dL).
inflammatory Drug tinnitus,
generalized INTERVENTION/EVALUATION
Therapeutic Class: pruritus (may be  May give with water, milk,
Anti-inflammatory, severe), headache, meals if GI distress occurs.
antipyretic,analgesic dizziness, flushing,  Monitor urinary pH (sudden
, anti platelet. tachycardia, acidification, pH from 6.5 to
hyperventilation, 5.5, may result in toxicity).
Dose, Timing, Route diaphoresis, thirst.  Assess skin for evidence of
Marked toxicity ecchymosis.
80mg, 1 tab PO, OD characterized by  If given as antipyretic,
hyperthermia, assess temperature directly
restlessness, before and 1 hour after
seizures, giving medication. Evaluate
 abnormal for therapeutic response:
breathing patterns, relief of pain, stiffness,
respiratory failure, swelling; increased joint
coma. mobility; reduced joint
tenderness; improved grip
strength.

PATIENT/FAMILY TEACHING
 Do not, chew, crush,
dissolve, or divide enteric-
coated tablets.
 Avoid alcohol, OTC
pain/cold products that may
contain aspirin.
 Report ringing of the ears
or persistent abdominal GI
pain, bleeding.
 Therapeutic anti-inflamma
 tory effect noted in 1–3
wks. • Behavioral changes,
persistent vomiting may be
early signs of Reye’s
syndrome; contact
physician.
 DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
Generic Name: Primary prevention of Interferes with Generally well Potential for ocular lens BASELINE ASSESSMENT
Rosuvastatin cardiovascular cholesterol tolerated. Side effects opacities.  Obtain dietary history,
disease (risk biosynthesis by are usually mild, Hypersensitivity especially fat consumption.
reduction of MI, inhibiting conversion transient. reaction, hepatitis,  Assess baseline lab
stroke, arterial of the enzyme HMG Occasional (9%– rhabdomyolysis occur results: serum cholesterol,
revascularization) CoA to mevalonate, a 3%): Pharyngitis, rarely triglycerides, LFT.
without clinically precursor to headache, diarrhea,
Brand Name: evident CAD, but with cholesterol. dyspepsia, nausea, INTERVENTION/EVALUATION
Crestor, Apo- multiple risk factors. Therapeutic Effect: depression.  Monitor serum cholesterol,
Rosuvastatin Decreases Rare (Less Than HDL, LDL, triglycerides for
LDL, VLDL, plasma 3%): Myalgia, therapeutic response.
triglyceride levels; asthenia, back pain.  Lipid levels should be
increases HDL monitored within 2–4
concentration. weeks of initiation of
therapy or change in
dosage.
Drug Class:  Monitor LFT at 12 weeks
Pharmacologic following initiation of
class: therapy, at any elevation of
HMG-CoA reductase dose, and periodically (e.g.,
Inhibitor semiannually) thereafter.
Therapeutic Class:  Monitor CPK if myopathy is
Anti-hyperlipidemic suspected.
Dose, Timing, Route  Monitor daily pattern of
bowel activity, stool
20mg, 1 tab PO, OD consistency.
HS  Assess for headache, sore
throat.
 Be alert for myalgia,
weakness.

PATIENT/FAMILY TEACHING
 Periodic lab tests are
essential part of therapy.
 Maintain appropriate diet
(important part of
treatment).
 Report unexplained muscle
pain, tenderness,
weakness, esp. if
associated with fever,
malaise.
 DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
Generic Name: Prevention, treatment Inhibits diffusion of Occasional: Severe diarrhea may BASELINE ASSESSMENT
Lactulose of portal-systemic NH3 into blood by Abdominal cramping, cause dehydration,  Question usual stool
encephalopathy `converting NH3 to flatulence, increased electrolyte imbalance. pattern, frequency,
(including hepatic NH4+; enhances thirst, abdominal dis Long-term use may characteristics. Conduct
precoma, coma); diffusion of NH3 from comfort. result in laxative neurological exam in pts
treatment of blood to gut, where it Rare: Nausea, dependence, chronic with elevated serum
constipation. is converted to NH4+; vomiting constipation, loss of ammonia levels, symptoms
Brand Name: produces osmotic normal bowel function. of encephalopathy.
Apo-Lactulose , effect in colon,  Assess hydration status.
Constulose, resulting in colon
Enulose, Generlac, distention, promoting INTERVENTION/EVALUATION
Kristalose peristalsis.  Encourage adequate fluid
Therapeutic intake.
Effect: Promotes  Assess bowel sounds for
increased peristalsis, peristalsis. Monitor daily
bowel evacuation; pattern of bowel activity,
Drug Class: decreases serum stool consistency; record
Pharmacologic ammonia time of evacuation.
class: concentration.  Assess for abdominal
Lactose Derivative disturbances.
Therapeutic Class:  Monitor serum electrolytes
Hyperosmotic in patient’s with prolonged,
laxative, ammonia frequent, excessive use of
detoxicant. medication.
 Monitor encephalopathic
Dose, Timing, Route patient’s for symptom
improvement (alertness,
30cc, PO, OD HS orientation, ability to follow
commands).

PATIENT/FAMILY TEACHING
 Institute measures to
promote defecation:
increase fluid intake,
 exercise, high-fiber diet.
Drink plenty of fluids.
 If therapy was started to
treat high ammonia levels,
notify physician if
worsening of confusion,
lethargy, weakness occurs
 DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
Generic Name: Short-term treatment Inhibits hydrogen- Inhibits hydrogen- Pancreatitis, INTERVENTION/EVALUATION
Omeprazole (4–8 wks) of erosive potassium adenosine potassium adenosine hepatotoxicity,  Evaluate for therapeutic
esophagitis triphosphatase triphosphatase interstitial response (relief of GI
diagnosed by endos (H+/K+ ATP pump), (H+/K+ ATP pump), nephritis occur rarely. symptoms).
copy), symptomatic an enzyme on the an enzyme on the May increase risk of C.  Question if GI discomfort,
gastroesophageal surface of gastric surface of gastric difficile infection. nausea, diarrhea occurs.
reflux disease parietal cells. parietal cells.
Brand Name: (GERD) poorly Therapeutic Effect: Therapeutic Effect: PATIENT/FAMILY TEACHING
Losec , PriLOSEC, responsive to other Increases gastric pH, Increases  Report headache, onset of
PriLOSEC treatment. H. pylori– reduces gastric acid gastric pH, reduces black, tarry stools, diarrhea,
OTC associated duodenal production. gastric acid abdominal pain.
ulcer (with amoxicillin production.  Avoid alcohol.
and clarithromycin).  Swallow capsules whole;
Long-term treatment do not chew, crush,
of pathologic dissolve, or divide.
hypersecretory  Take before eating.
Drug Class: conditions,
Pharmacologic treatment of active
class: duodenal ulcer or
Benzimidazole. active benign gastric
ulcer. Maintenance
Therapeutic Class: healing of erosive
Proton Pump esophagitis. OTC,
Inhibitor
Dose, Timing, Route

40mg, IVTT, q 24h

 DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
Generic Name: To reduce the risk of Sacubitril inhibits Occasional (9%): Angioedema (less than BASELINE ASSESSMENT
Sacubitril-Valsartan cardiovascular neprilysin, increas Cough, dizziness. 1% of pts), hypotension  Obtain baseline BMP; CBC
death and ing peptide levels (18% of pts), orthostatic in patient’s with baseline
hospitalization in pts that are degraded by hypotension (2% of anemia.
with chronic HF neprilysin (e.g., pts),impairment/decrease  Obtain B/P, heart rate
(NYHA class II-IV) natriuretic peptides). in renal function due to immediately before each
and reduced ejection Valsartan directly inhibition of renin- dose, in addition to regular
Brand Name: fraction. antagonizes angioten angiotensin-aldosterone monitoring (be alert for
Entresto sin II receptors; system (5% of pts), fluctuations).
blocks elevation of serum  Assess hydration status.
vasoconstrictor, creatinine greater than Correct hydration/sodium
aldosterone secreting 50% from baseline (1.4% depletion prior to initiation.
effects of angiotensin of patient’s), renal  Receive medication history
II, inhibiting binding impairment including and
of angiotensin II to oliguria, azotemia, acute  screen for interactions, esp.
AT1 receptors. renal failure (5% of pts), concomitant use of
Drug Class: Therapeutic hyperkalemia (12% of aliskiren, ACE inhibitors,
Pharmacologic Effect: Decreases pts), serum potassium ARBs, potassium-sparing
class: risk of mortality in elevation greater than diuretics, potassium
Angiotensin patients with chronic 5.5 mEq/L (4% of pts) supplements.
receptor neprilysin HF; produces have occurred.  Verify negative pregnancy
inhibitor . vasodilation; status.
decreases peripheral  Question history of
Therapeutic Class: resistance; hepatic/renal impairment,
Antihyertensive decreases B/P. renal artery stenosis;
angioedema,
hypersensitivity reaction.
Dose, Timing, Route INTERVENTION/EVALUATION
 Monitor BMP, esp. serum
50mg 1 tab, PO, OD BUN, creatinine,
potassium.
 Monitor for hyperkalemia,
hypotension. If hypotension
occurs, place pt in supine
position, feet slightly
elevated; consider
interrupting treatment or
altering dose of diuretic,
antihypertensive drugs and
screen for
dehydration/serum sodium
depletion. If pt positive for
dehydration, be cautious
 with PO/IV administration.
Over hydration may
exacerbate HF.
 Assist with ambulation if
dizziness occurs.
 Monitor for hypersensitivity
reaction, including
angioedema.
 If angioedema occurs,
interrupt treatment and
institute therapy to protect
airway patency.

PATIENT/FAMILY TEACHING
 Go slowly from lying to
standing.
 Be cautious of fluid intake.
Over hydration may lead to
worsening of HF, while
under hydration may lead
to low blood pressure.
 Report urine changes such
as darkened urine,
decreased output.
 Immediately report allergic
reactions such as difficulty
breathing, itching, rash,
tongue swelling; symptoms
of high potassium levels
such as extreme fatigue,
muscle weakness,
palpitations.
 Diuretics (water pills) may
increase risk of low
pressure or low potassium
levels.
DRUG INDICATION MECHANISM OF SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION
Generic Name: To reduce the risk of Reduces pontaneous Occasional (10%– May increase risk of BASELINE ASSESSMENT
Ivabradine hospitalization for pacemaker activity of 3%): Bradycardia, atrial fibrillation (8.3%  Obtain baseline HR, B/P.
worsening HF in the cardiac sinus hypertension, of pts). Bradycardia,  Receive full medication
patient’s with stable, node by blocking phosphenes (visual sinus arrest, or heart history and screen for
symptomatic chronic HCN channels that disturbances, block may occur. interactions.
HF with left are responsible for luminous Bradycardia occurred in  Screen for
ventricular ejection cardiac current, which phenomena), visual 10% of pts. Risk factors contraindications as listed
Brand Name: fraction less than or regulates heart rate. brightness. for bradycardia may in Precautions.
Corlanor equal to 35%, who Does not affect include sinus node  Question history of atrial
are in sinus rhythm ventricular dysfunction, conduction fibrillation, bradycardia,
with a resting heart repolarization or defects (e.g., first- or hypertension.
rate greater than or myocardial. second-degree AV
equal to 70 bpm, and Contractility. block, bundle branch INTERVENTION/EVALUATION
either are on Also inhibits retinal block), ventricular  Frequently monitor HR,
maximally tolerated current involved in dysplasiasynchrony, or B/P.
dose of beta blockers reducing bright light use of negative  Diligently monitor for atrial
Drug Class: or have a in retina. chronotropic drugs. fibrillation, bradycardia,
Pharmacologic contraindication to Therapeutic Effect: Phosphenes, a syncope. If symptomatic
class: beta blocker use. Reduces heart rate. transient enhanced bradycardia occurs,
Hyper polarization- brightness in the visual temporary cardiac pacing
activated cyclic field (which may or infusion of beta-
nucleotide-gated include halos, stimulating agents may be
(HCN) channel stroboscopic or warranted.
blocker. kaleidoscopic effect,  Monitor for hypersensitivity
colored bright lights, or reaction.
Therapeutic Class: multiple images) may  Monitor for visual changes.
Reduces risk of occur. Phosphenes are Initiate fall precautions.
worsen usually triggered by
ing HF. sudden variations in PATIENT/FAMILY TEACHING
light intensity and  Take medication with
generally occur within meals.
the first 2 mos of  Avoid grapefruit products,
treatment. Other herbal supplements such
adverse reactions such as St. John’s wort.
as angioedema,  Report symptoms of low
diplopia, erythema, heart rate such as
confusion, dizziness,
hypotension, pruritus, fatigue, fainting, low blood
rash, syncope, pressure, pallor.
urticaria, vertigo, visual  Report symptoms of atrial
impairment occur fibrillation such as chest
rarely. Overdose may pressure, palpitations,
lead to severe and shortness of breath.
prolonged bradycardia  Treatment may cause
requiring temporary luminous phenomena
cardiac pacing or (phosphenes), a transient
infusion of IV beta- visual brightness that may
stimulating agents. include halos, light
sensitivity, or colored bright
lights.
 Avoid tasks that require
alertness, motor skills until
response to drug is
established. Report allergic
reactions such as hives,
itching, rash, tongue
swelling.
 Be cautious of fluid intake.
Over hydration may lead to
worsening of HF, while
under hydration may lead
to low blood pressure.
 Report urine changes such
as darkened urine,
decreased output.
 Immediately report allergic
reactions such as difficulty
breathing, itching, rash,
tongue swelling; symptoms
of high potassium levels
such as extreme fatigue,
muscle weakness,
palpitations; suspected
 pregnancy.
 Diuretics (water pills) may
increase risk of low
pressure or low potassium
levels.