Brand name :Isordil

Generic name: Isosorbide dinitrate

Indication: Prevention and treatment of angina pectoris, for congestive heart failure, torelieve pain,
dysphagia and spasm in esophageal spasm with GE reflux.
Drug classification: Antianginal agent, nitrate, vasodilator, coronary
Mechanism of action:s t i m u l a t i o n o f i n t r a c e l l u l a r c y s t i c - G M P r e s u l t s i n v a s
c u l a r smooth muscle relaxation of both arterial and venous vasculature.
Increasedvenous pooling decreases ventricular pressure (pre-load) and arterial
dilatationdecreases arterial resistance (afterload). Therefore this reduces cardiac
oxygend e m a n d b y d e c r e a s i n g l e f t v e n t r i c u l a r p r e s s u r e a n d s y s t e m a t i
c v a s c u l a r resistance by dilating arteries. Additionally, coronary artery dilation
improvescollateral flow to ischemic regions; esophageal smooth muscle is relaxed via thesame
mechanism.
Dosage: angina pectoris oral 5-30mg qid. Sublingual 5-10mg 2-3 hourly. Acute CHF oral10-
40mg qid. Sublingual 5-10mg 2 hourly. chronic CHF initially 5-10 mg daily2 hourly sublingually.
maintenance 20-40mg qid orally.
Special precaution: tolerance and cross tolerance to other nitrate and nitrites may occur.Pregnancy,
lactation and children. Patients prone to or affected by hypotension
or vol. depletion; severe hypotensive response; paradoxical bradycardia,i
ncreased angina may accompany nitrate induced hypotension, hypertrophiccardiomyop
athy.
Pregnancy risk factor:
Adverse reactions: f l u s h i n g , v a s c u l a r h e a d a c h e , c e r e b r a l i s c h e m i a a s s o c i a t e
d with p o s t u r a l h y p o t e n s i o n , n a u s e a , v o m i t i n g , w e a k n e s s , r e s t l e s s n
e s s , p a l o r , perspiration and collapse, drug rash and or exfoliative dermatitis.
Contraindications:
hypersensitivity
Form:
tab 5mg x 100s, 500s; 10mg x 100s, 500sSublingual tab 5mg x 100s
Nursing responsibilities
:

Inform or educate patient not to chew crush sublingual or sustained
r e l e a s e dosage form

Do not change brands without consulting the physician or pharmacist, keep tablets
or capsules in original container tightly closed.

8 to 12 hour nitrate free interval is needed each day to prevent tolerance
Medical Diagnosis:
hydrocephalus, status post- shunt insertion
Category:Indication/ContraindicationM e c h a n i s m o f A c t i o n S i d e E
f f e c t s / Adverse EffectsNursing ConsiderationsGeneric Name:
furosemide
Brand Name:
Lasix
Classification:
Diuretics
Dosage:
5mg(0.5ml)
Frequency:
Every 12 hours. Hold for BP less than 85 systolic
Route:
IV Push
INDICATIONS
:Edemad u e t o c a r d i a c , hepatic & renal disease, burns; mild to
moderateH T N , h y p e r t e n s i v e crisis, acuteheart failure,reduced urinary outputdue
to gestoses, chronicrena l failure ,nephrotic syndrome.
CONTRADICTIONS
:Anuria; hepatic coma & precoma; severehypokalemia &/or hyponatremia;hypovolemia w/ or
w/ohypotension.Hypersensitivity tosulfonamides.Inhibit reabsorption of sodium and water in
thea s c e n d i n g l i m b o f t h e l o o p o f H e n l e b y i n t e r f e r i n g w i t h
t h e chloride binding site of t h e 1 N a + , 1 K + , 2 C l -
c o t r a n s p o r t s y s t e m . Loop diuretics increaset h e r a t e o f d e l i v e r y o f t u b u
l a r f l u i d a n d electrolytes to the distals i t e s o f h y d r o g e n a n d potassium ion
secretion,w h i l e p l a s m a v o l u m e c o n t r a c t i o n i n c r e a s e s aldosterone production.The i
ncreased deliverya n d h i g h a l d o s t e r o n e levels promote sodiumreabsorption at the
distaltubules, thus increasingt h e l o s s o f p o t a s s i u m and hydrogen ions.
•
low blood pressure,
•
dehydration andelectrolyte depletion (for example, sodium, potassium).
•
jaundice,
•
ringing in theears (tinnitus),
•
sensitivity tolight(photophobia),
•
rash,
•
pancreatitis,
•
nausea,
•
diarrhea,
•
abdominal pain,anddizziness.Increased bloodsugar and uricacid levels
•
Assess patient’s nderlyingcondition before startingtheraphy.
•
Monitor for renalcardiac,neurologic, GImanifestations of hypokalemia.
•
Monitor for CNS, GI,cardiovascular,integumentarymneurologic manifestationsof jypocalcemia,
•
Monitor for CNS,hyperactive reflexes,depressed cardiacoutput,nausea, vomiting,tachycardia
•
Assess fluid volumestatus(urine,color, qualityand specific gravity)
•
Assess patient tinnitus, or pain
Generic(Trade
Name)DosageFr
equencyClassifi
cation Indication
Contraindication
AdverseReactio
nNursing Respo
nsibilitiesIpratro
piumBr,Salbuta
mol/albuterolsulf
ate(Combivent )
Neb q 4
hours(12 am-
4am-8am-12pm-
4pm-
8pm)Antiasthma
tic
&COPDPreparati
onsManagement
of reversiblebro
nchospasmasso
ciated
withobstructivea
irway diseasesin
patients
whorequire
morethan a
singlebronchodil
ator 1.)

Patients who
isallergic to
theDrugs.2.)

Patients
withHypertropic
obstructivecardi
omyopathy3.)

Patientshavingta
chyarrythmia.Fin
e tremor
of Skeletal
Muscle;Palpitati
ons;Headache,di
zziness,nervous
ness;Dryness of
themouth,
throatirritation;u
rinaryretention.1
.)

Use Cautiously
to patientswith
known
sensitivity
toatropine,
soybeans,
soyalecithin,
and peanuts.2.)

Assess Vital
Signs
Beforedrug
administration3.)

Observe for
paradoxicalbron
chospasm
(Wheezing).
If Condition
occurs,
withholdMedicat
ion and
notifyphysician
or other
healthcare
professionalimm
ediately.4.)
Instruct patient
to contacthealth
care
professionalimm
ediately if
shortness
of breath is not
relieved
bymedication or
isaccompanied
bydiaphoresis,
dizziness,palpita
tions, or chest
pain.5.)

Advise the
patient to
rinsemouth with
water after
usingthe
nebulizer to
minimize dry