ACTION

inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

INDICATION
Edema associated with CHF Cirrhosis with ascites or renal dysfunction For hypertension or in combination with other antihypertensive medications. ICP, nephritic syndrome, hepatic cirrhosis

GENERIC NAME: Furosemide BRAND NAME: Lasix CLASSIFICATION: Loop Diuretics DOSAGE & ROUTE: 40 mg IV q 8 CONTRAINDICATION ADVERSE EFFECTS
Contraindicated to patients hypersensitive to drug or any of its components and in those with anuria. Use cautiously in patient with hepatic cirrhosis. Patients with allergies to sulfonamides may also be allergic to furosemide. Vertigo, headache, paresthesia, orthostatic hypotension, thrombophlebitis, abdominal pain, Hypokalemia, anemia, muscle spasm

NURSING RESPONSIBILITIES
Monitor serum glucose, and electrolyte Increase Potassium in the diet plan except aldactone Monitor Intake and Output daily Check for any signs of fliud and electrolyte imbalance Check vital signs especially HR and BP Monitor patients carefully especially elderly T ake with or after meals and in AM Move the patient slowly to avoid risk of orthostatic hypotension Avoid intake of alcohol

ACTION
Inhibits the sodium-potassium ATP phase.

INDICATION
V-fib, V-flutter, CHF, pulmonary edema, atrial fibrillation and or flutter, and paroxysmal atrial contractions

GENERIC NAME: Digoxin BRAND NAME: Lanoxin CLASSIFICATION: Cardiac Glycosides DOSAGE & ROUTE: .25mg tab OD CONTRAINDICATION ADVERSE EFFECTS
Contraindicated in patients hypersensitive to the drug or any of its components and in those with digitalis-induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure. CNS: hallucinations, paresthesia, stupor, vertigo. CV: Arrythmias, heart failure, hypotension. EENT: blurred vision, diplopia, light flashes, photophobia, yellowgreen halos around visual images.

NURSING RESPONSIBILITIES
Monitor K+, Mg++, ECG, liver/renal function tests, drug level (therapeutic level 0.5-2.0 mg/ml, toxicity is >2.0 mg/ml). Before each dose assess apical pulse for full minute, record and report changes in

Use cautiously in patients with acute MI, in complete Av block, sinus bradycardia, PVCs,, chronic constrictive pericarditis, hyperthropic cardiomyopathy, renal insufficiency, severe pulmonary disease, or hypothyroidism.

GI: anorexia, diarrhea, nausea, vomiting. Side Effects: CNS: agitation, dizziness, fatigue, generalized weakness, headache, malaise. GI: Nausea

rate or rhythm. Withhold drug and contact provider if pulse is < 60/min. or >100 (adults) or < 110/minute (children) Weigh daily Monitor I&O and signs of CHF

ACTION
Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

INDICATION
Relief of moderate to severe acute and chronic pain Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage Analgesic adjunct during anesthesia Component of most preparations that are referred to as Brompton's cocktail or mixture, an oral alcoholic solution that is used for chronic severe pain, especially in terminal cancer patients Intraspinal use with

GENERIC NAME: Morphine Sulfate BRAND NAME: CLASSIFICATION: Opioid agonist analgesic DOSAGE & ROUTE: 10mg/1tab BID CONTRAINDICATION ADVERSE EFFECTS
Contraindicated with hypersensitivity to opioids; diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature bloodbrain barrier more readily); after biliary tract surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor). Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may decrease respiratory drive and increase airway resistance); lactation (wait 46 hr after administration to nurse the baby); CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm,

NURSING RESPONSIBILITIES
Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Tell patient to lie down during IV administration. Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration. Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients who

microinfusion devices for the relief of intractable pain Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema

acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction.

bronchospasm, edema GI: Nausea, vomiting, anorexia, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Respiratory: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest Side Effects GI: dry mouth, constipation. Skin: Tissue irritation and induration (SC injection). Other: sweating,physical tolerance and dependence, psychological dependence

receive opioids for medical reasons do not develop dependence syndromes Teaching points Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives, tranquilizers, over-the-counter drugs. Swallow controlled-release preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew them. Do not take leftover medication for other disorders, and do not let anyone else take your prescription. These side effects may occur: Nausea, loss of appetite (take with food, lie quietly); constipation (use laxative); dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness and visual acuity). Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.

ACTION
Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may

INDICATION Prophylactic treatment of angina pectoris

GENERIC NAME: Isosorbide-5-mononitrate BRAND NAME: Imdur CLASSIFICATION: anti- anginal drug DOSAGE & ROUTE: 60mg OD CONTRAINDICATION ADVERSE EFFECTS
headache, hypotension w/ dizziness and nausea, tachycardia

NURSING RESPONSIBILITIES
Monitor BP and heart rate. Assess location, duration, intensity, and precipitating factors of anginal

increase blood flow through the collateral coronary vessels

pain.