DRUG STUDY

DATE ORDERED
11 20 - 2012

MEDICATION/ TREATMENT Amlodipine besylate (Norvasc)

ACTIONS
Physiologic: Inhibits influx of extracellular calcium ions thereby decreasing myocardial contractility, relaxing coronary and vascular muscles, and decreasing peripheral resistance. Pharmacologic: Calcium Channel Blocker, Antihypertensive

INDICATION
Essential hypertension, chronic stable angina pectoris, and vasospastic angina (prizmetals angina).

NURSING CONSIDERATION
Monitor patient for worsening angina. Monitor heart rate and rhythm and blood pressure, especially at start of therapy. Asses for heart failure;report signs and symptoms (peripheral edema, dyspnea) to prescriber promptly. Give sublingual nitroglycerin, as prescribed, if patient has signs or symptoms of acute myocardial infarction (especially when dosage is increased.)

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Atorvastatin Calcium (Lipitor)

ACTIONS
Physiologic: Inhibits HMG-CoA reductase, which catalyzes first step in cholesterol synthesis; this action reduces concentrations of serum cholesterol and lowdensity lipoproteins, linked to risk of coronary artery disease. Pharmacologic: LipidLowering Agent

INDICATION
Prevention of cardiovascular disease in patients without clinically evident coronary heart disease but with multiple CHD risk factors. Adjunct to other lipid-lowering treatments in patients with homozygous familial hypercholesterolemia

NURSING CONSIDERATION
Monitor patient for signs and symptoms of allergic response. Evaluate for muscle weakness ( a symptom of myositis and possibly rhabdomyolysis.) Be aware that reduction in dosage and periodic monitoring of creatine kinase level may be considered for patients taking drugs that may increase atorvastatin level. Monitor liver function test results and blood lipid levels.

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Diazepam

ACTIONS
Physiologic: Produces anxiolytic effect and CNS depression by stimulating gammaaminobutyric acid receptors. Relaxes skeletal muscles of spine by inhibiting polysynaptic afferent pathways. Controls seizures by enhancing presynaptic inhibition.

INDICATION
Anxiety disorders Before cardioversion Before endoscopy Status epilepticus and severe recurrent convulsive seizures.

NURSING CONSIDERATION
Monitor vital signs and respiratory and neurologic status. Supervise ambulation, especially in elderly patients. Monitor CBC and kidney and liver function test results. Avoid sudden drug withdrawal. Taper dosage gradually to termination of therapy.

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Pantoprazole Sodium (Pantoloc)

ACTIONS
Physiologic: Reduces gastric acid secretion and increases gastric mucus and bicarbonate production, creating protective coating on gastric mucosa. Pharmacologic: Proton pump inhibitor, GI agent

INDICATION
Erosive esophagitis caused by gastroesophageal reflux disease (GERD). Erosive esophagitis Pathologic hypersecretory conditions

NURSING CONSIDERATION
Assess for asymptomatic improvement. Monitor blood glucose level in diabetic patient.

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Potassium Chloride (Kalium Durule)

ACTIONS
Physiologic: Maintains acid base balance, isotonicity, and electrophysiologic balance throughout bodu tissues: crucial to nerve impulse transmission and contraction of cardiac, skeletal, and smooth muscle, Also essential for normal renal function and carbohydrate metabolism. Pharmacologic: Electrolyte replacement, nutritional supplement

INDICATION
To prevent potassium depletion

NURSING CONSIDERATION
Monitor real function, fluid intake and output, and potassium, creatinine, and blood urea nitrogen levels. Assess vital signs and ECG. Stay alert for arrhythmias. Monitor neurologic status Watch for neurologic complications. Monitor I.V. site for irritation. Know that potassium is contraindicated in patients with several renal impairment.

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Magnesium Chloride (Tri-mag)

ACTIONS
Physiologic: Increases osmotic gradient in small intestine, which draws water into intestines and causes distention. Pharmacologic: Electrolyte replacement, laxative, antacid, anticonvulsant

INDICATION
Mild magnesium deficiency. Acute nephritis to control hypertension, encephalopathy and seizures in children.

NURSING CONSIDERATION
Monitor IV site carefully to avoid extravasation and tissue necrosis. In comatose patient, insert indwelling urinary catheter as ordered to monitor urine output. Monitor renal function tests, urinary output, fluid balance, central venous pressure, and electrolyte levels. Watch for excessive fluid loss and signs and symptoms of hypovolemia and dehydration. Assess for evidence of circulatory overload.

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Sodium Bicarbonate (Gaviscon)

ACTIONS
Physiologic: Restores body buffering capacity; neutralizes excess acid. Pharmacologic: Fluid and electrolyte agent, Alkalinizer, Antacid

INDICATION
Metabolic Acidosis Urinary Alkalization Renal Tubular Acidosis

NURSING CONSIDERATION
When giving I.V., closely monitor arterial blood gas results and electrolyte levels. Stay alert for signs and symptoms of metabolic alkalosis and electrolyte imbalances. Monitor fluid intake and output. Assess for fluid overload. Avoid rapid infusion, which may cause tetany. Watch for inflammation at I.V. site.

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Clopidogrel Bisulfate (Plavix)

ACTIONS
Physiologic: Inhibits platelet aggregation by blocking binding of adenosine diphosphate to platelets, thereby preventing thrombus formation. Pharmacologic: Platelet aggregation inhibitor, Antiplatelet drug

INDICATION
Acute Coronary Syndrome (unstable angina or non-Q-wave MI) To reduce atherosclerotic events in patients with recent myocardial infarction or cerebrovascular accident and in those with established peripheral arterial disease or acute coronary syndrome.

NURSING CONSIDERATION
Monitor hemoglobin and hematocrit periodically. Monitor patient for unusual bleeding or bruising; drug significantly increases risk of bleeding. Assess for occult GI blood loss if patient is receiving naproxen concurrently with clopidogrel.

DATE ORDERED
11-20-2012

MEDICATION/ TREATMENT
Isosorbide Dinitrate (Isordil)

ACTIONS
Physiologic: Promotes peripheral vasodilation and reduces preload and afterload, decreasing myocardial oxygen consumption and increasing cardiac output. Also dilates coronary ateries, increasing blood flow and improving collateral circulation. Pharmacologic: Nitrate, Anti-anginal

INDICATION
Treatment and prophylaxis in situations likely to provoke acute angina pectoris. Prophylaxis of angina pectoris

NURSING CONSIDERATION
Monitor ECG and vital signs closely, especially blood pressure. In suspected overdose, assess for signs and symptoms of increased intracranial pressure. Monitor arterial blood gas values and methemoglobin levels.