MANGLAPUS, GIANA L.

BSN IV-A3

DRUG STUDY
1. LOZARTAN
CARDIOVASCULAR AGENT; ANGIOTENSIN II RECEPTOR ANTAGONIST;
ANTIHYPERTENSIVE
Actions
Angiotensin II receptor (type AT1) antagonist acts as a potent vasoconstrictor and primary vasoactive
hormone of the renin–angiotensin–aldosterone system.

Therapeutic Effects
Selectively blocks the binding of angiotensin II to the AT1 receptors found in many tissues (e.g., vascular
smooth muscle, adrenal glands). Antihypertensive effect results from blocking the vasoconstricting and
aldosterone-secreting effects of angiotensin II.

Uses
Hypertension.

Contraindications
Hypersensitivity to losartan, pregnancy [category C (first trimester), category D (second and third
trimesters)], lactation.

Adverse Effects (1%)

CNS: Dizziness, insomnia, headache. GI: Diarrhea, dyspepsia. Musculoskeletal: Muscle cramps, myalgia,
back or leg pain. Respiratory: Nasal congestion, cough, upper respiratory infection, sinusitis.

Nursing Implications
Assessment & Drug EffectS
Monitor BP at drug trough (prior to a scheduled dose).
Monitor drug effectiveness, especially in African-Americans when losartan is used as monotherapy.
Inadequate response may be improved by splitting the daily dose into twice-daily dose.
Lab tests: Monitor CBC, electrolytes, liver & kidney function with long-term therapy.

Patient & Family Education

Notify physician of symptoms of hypotension (e.g., dizziness, fainting).
Notify physician immediately of pregnancy.
Do not breast feed while taking this drug.

2. AMLODIPINE
CARDIOVASCULAR AGENT; CALCIUM CHANNEL BLOCKER; ANTIHYPERTENSIVE AGENT
Actions
Amlodipine is a calcium channel blocking agent that selectively blocks calcium ion reflux across cell
membranes of cardiac and vascular smooth muscle without changing serum calcium concentrations. It
predominantly acts on the peripheral circulation, decreasing peripheral vascular resistance, and increases
cardiac output.

Therapeutic Effects
Amlodipine reduces systolic, diastolic, and mean arterial blood pressure.
MANGLAPUS, GIANA L. BSN IV-A3

Uses
Treatment of mild to moderate hypertension and angina.

Contraindications
Hypersensitivity to amlodipine; pregnancy (category C).

Adverse Effects (1%)

CV: Palpitations, flushing tachycardia, peripheral or facial edema, bradycardia, chest pain, syncope,
postural hypotension. CNS: Light-headedness, fatigue, headache. GI: Abdominal pain, nausea, anorexia,
constipation, dyspepsia, dysphagia, diarrhea, flatulence, vomiting. Urogenital: Sexual dysfunction,
frequency, nocturia. Respiratory: Dyspnea. Skin: Flushing, rash. Other: Arthralgia, cramps, myalgia.
Nursing Implications
Assessment & Drug Effects
Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are
achieved 6–9 h following oral doses.
Monitor for S&S of dose-related peripheral or facial edema that may not be accompanied by weight gain;
rarely, severe edema may cause discontinuation of drug.
Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when
additional antihypertensives or diuretics are added.
Monitor heart rate; dose-related palpitations (more common in women) may occur.

Patient & Family Education

Report significant swelling of face or extremities.
Take care to have support when standing & walking due to possible dose-related light-
headedness/dizziness.
Report shortness of breath, palpitations, irregular heartbeat, nausea, or constipation to physician.
Do not breast feed while taking this drug without consulting physician.

3. TRANEXAMIC ACID
Classification: Anti-fibrinolytic, antihemorrhagic

Indications:
Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and
clinical areas:
Treating heavy menstrual bleeding
Hemorrhage following dental and/or oral surgery in patients with hemophilia
Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral
mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures.
Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid,
lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.
Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia
Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with
hemorrhage
Effective in promoting hemostasis in traumatic injuries.
MANGLAPUS, GIANA L. BSN IV-A3

Preventing hemorrhage after orthopedic surgeries.

Mechanism of Action
Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect
through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug
inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood
clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic
activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin)
the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis.

Contraindications
Allergic reaction to the drug or hypersensitivity
Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for
blood clots
Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates

Nursing Responsibilities
Unusual change in bleeding pattern should be immediately reported to the physician.
For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be
taken during the menstrual period.
Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety
and effectiveness in these children have not been confirmed.
The medication can be taken with or without meals.
Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing.
If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6
hours later. Do not take 2 doses at once.
Inform the client that he/she should inform the physician immediately if the following severe side effects
occur:
Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the
mouth, face, lips or tongue
Calf pain, swelling or tenderness
Chest pain
Confusion
Coughing up blood
Decreased urination
Severe or persistent headache
Severe or persistent body malaise
Shortness of breath
Slurred speech
Slurred speech
Vision changes

4. CITICOLINE
Classification: Neurotonics, Nootropics

Mechanism of Action
MANGLAPUS, GIANA L. BSN IV-A3

Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important
for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.It is
usually known that phospholipid, especially lecithin, decreases following decline in brain activity with
cerebral trauma. Citicoline, which is a co-enzyme, accelerates the biosynthesis of lecithin in the body.

This medication enhances the action of the brain stem ciliary body especially the ascending ciliary body
activating system, which is closely related to consciousness, but does not exert effort on the
extrapyramidal system. Citicoline increases cerebral blood flow and oxygen consumption of the brain and
improves cerebral circulation and metabolism.

Scientific research demonstrates that Citicoline consumption promotes brain metabolism by enhancing
the synthesis of acetyl-choline, restoring phospholipid content in the brain and affecting neuron
membrane excitability and osmosis (by its effect on the ATP-dependent sodium and potassium pump).
When taken orally, its two main components, Cytidine and Choline are absorbed into the bloodstream.

Citicoline is also believed to protect nerve cells when in low oxygen conditions. Citicoline may be used
for nutritional support in cerebral vascular disease, head trauma, stroke, and cognitive disorders. It also is
used by those who have age related mental decline, such as Alzheimer’s and Parkinsons.

Indication
Parkinson’s disease
Head injury
Cerebral vascular disease
Alzheimer’s disease
Cerebral surgery or acute cerebral disturbance
Disturbance of consciousness following brain surgery

Side Effects
Citicoline seems to be safe when taken short-term (up to 90 days). The safety of long-term use is not
known. Most people who take citicoline don’t experience problematic side effects. However, these are the
common side effects reported by some patients:

Body temperature elevation

Restlessness
Headaches
Nausea and vomiting
Diarrhea
Low or high blood pressure
Tachycardia
Sleeping troubles or insomnia
Blurred vision
Chest pains

Nursing Management
Citicoline may be taken with or without food. Take it with or between meals.
The supplement should not be taken in the late afternoon or at night because it can cause difficulty
sleeping.
MANGLAPUS, GIANA L. BSN IV-A3

Women who are pregnant or trying to become pregnant should consult with their doctor before taking the
supplements. Not enough is known about the use of Citicoline during pregnancy and breast-feeding. Stay
on the safe side and avoid use.
Special attention should be paid for administration in the neonate, premature and children.
Contact the physician immediately if allergic reaction such as hives, rash, or itching, swelling in your face
or hands, mouth or throat, chest tightness or trouble breathing are experienced.
Citicoline therapy should be started within 24 hours of a stroke. The physician will prescribe the correct
dosage and the length of time it should be taken for a medical condition.

5. CORALAN
Classification : Anti-Ischaemic Agents

Action
Inhibits the cardiac pacemaker If -current by acting as a hyperpolarization-activated cyclic nucleoside-
gated channel blocker, resulting in ↓ spontaneous pacemaker activity of sinus node. Decreases heart rate
without effecting contractility or ventricular repolarization.

Therapeutic Effect(s):
Lowering of heart rate with reduced need for hospitalization in HF patients.

Indications
This medication is a cardiotonic agent, prescribed for angina pectoris. It helps to lower the heart rate

Contraindications
Contraindicated in patients with severe heart disease, and hypersensitivity. It should not be administered
along with calcium channel blockers.

Side effects
• Heart : Slow heart rate, palpitations, heart block, abnormal heart rhythm, difficulty in breathing and
fainting.
• Central Nervous System : Headache, and dizziness.
• Eye : Blurred vision.
• Gastrointestinal : Nausea, vomiting and constipation.
• Blood : Eosinophilia.
• Musculoskeletal : Muscle cramps and muscle weakness.

Assessment
Assess heart rate prior to, after 2 wks, and periodically during therapy. Adjust dose for a resting heart rate
50–60 bpm. If heart rate >60 bpm, increase dose by 2.5 mg given twice daily up to 7.5 mg twice daily. If
heart rate 50–60 bpm, maintain dose. If heart rate <50 bpm or signs and symptoms of bradycardia
(dizziness, fatigue, hypotension) occur, decrease dose by 2.5 mg given twice daily; if current dose is 2.5
mg given twice daily, discontinue ivabradine.
Monitor ECG periodically during therapy. May cause atrial fibrillation and torsade de pointes.
Discontinue ivabradine if atrial fibrillation occurs

6. OMEPRAZOLE
Classifications: GASTROINTESTINAL AGENT; PROTON PUMP INHIBITOR
MANGLAPUS, GIANA L. BSN IV-A3

Actions
An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by
inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells.
Therapeutic Effects
Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer healing.

Uses
Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4 to 8
wk treatment). Long-term treatment of pathologic hypersecretory conditions such as Zollinger-Ellison
syndrome, multiple endocrine adenomas, and systemic mastocytosis. In combination with clarithromycin
to treat duodenal ulcers associated with Helicobacter pylori.

Contraindications
Long-term use for gastroesophageal reflux disease (GERD), duodenal ulcers; proton pump inhibitors
(PPIs), hypersensitivity; children <2 y; use of OTC formulation in children <18 y or GI bleeding;
pregnancy (category C); use of Zegerid in metabolic alkalosis, hypocalcemia, vomiting, GI bleeding.

Adverse Effects (1%)

CNS: Headache, dizziness, fatigue. GI: Diarrhea, abdominal pain, nausea, mild transient increases in liver
function tests. Urogenital: Hematuria, proteinuria. Skin: Rash.
Diagnostic Test Interference
Omeprazole has been reported to significantly impair peak cortisol response to exogenous ACTH. This
finding is undergoing further investigation.

Nursing Implications
Assessment & Drug Effects
Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged
use.
Patient & Family Education
Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood
in urine.
Report severe diarrhea; drug may need to be discontinued.
Do not breast feed while taking this drug.