DRUG STUDY

1. Name of Drug: Amlopidine Desired Dosage/Timing/Route: 10mg 1tab PO Classification: Antianginal; Antihypertensive; Calcium channel blocker Mechanism of Action: Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane calcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity o conduction of the cardiac impulse, depression of myocardial contractility , and dilation of coronary arteries and arterioles; these effects lead to decreased cardiac work, decreased cardiac oxygen consumption , and in patients with vasospastic (Prinzmetals) angina, increased delivery of oxygen to cardiac cells. Specific Indication: Essential hypertension, alone or in combination with other antihypertensives Contraindication: Contraindicated with allergy to amlopidine Adverse Effects: Dizziness, light-headedness, headache, flushing, abdominal discomfort Nursing Responsibilities: 1. Check BP before administering the drug. 2. Administer drug without regard to meals and instruct patient to take with meals if upset stomach occurs. 3. Anticipate patient of the side effects that may experience. 4. Tell patient to report if there are unusual felt to prevent complication. 2. Name of Drug: Captopril Desired Dosage/Timing/Route: 25mg 1 tab sublingual Classification: ACE inhibitor; Antihypertensive Mechanism of Action: Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased in the antihypertensive action. Specific Indication: Treatment of hypertension alone or in combination; management of hypertensive crisis Contraindication: Contraindicated with allergy to captopril Adverse Effects: Gastric irritation, urinary frequency, dry mouth Nursing Responsibilties: 1. Check BP before administering drug. 2. Monitor patient for drop in BP secondary to reduction fluid volume (due to excessive perspiration, dehydration, vomiting, or diarrhea); excessive hypotension may occur 3. Instruct patient to take drug 1 hour before meal and do not take drug with food. 4. Anticipate patient of the side effects that may experience. 5. Tell patient to report if there are unusual felt to prevent complication. Name of Drug: Ranitidine Desired Dosage/Timing/Route: 50mg IVTT Classification: Histamine-2 (H2) antagonist

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Mechanism of Action: Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin, and pentagastrin. Specific Indication: Treatment of heartburn, acid indigestion, sour stomach Contraindication: Contraindicated wit allergy to ranitidine Adverse Effects: Headache, dizziness, abdominal pain Nursing Responsibilities: 1. Administer drug with meals and at bedtime. 2. Anticipate patient of the side effects that may experience. 3. Provide concurrent antacid therapy to relieve pain. 4. Tell patient to report if there are unusual felt to prevent complication. 4. Name of Drug: Metoclopramide Desired Dosage/Timing/Route: 1amp IVTT Classification: Antiemetic; Dopaminergic blocker; GI stimulant Mechanism of Action: Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretion; appears to sensitize tissues to action of acetylcholine; relaxes pyloric spincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin. Specific Indication: Treatment of nausea and vomiting of a variety of etiologies. Contraindication: Contraindicated with allergy to metoclopramide Adverse Effects: Drowsiness, dizziness, diarrhea Nursing Responsibilities: 1. Monitor BP carefully during IV administration. 2. Anticipate patient of the side effects that may experience. 3. Tell patient to report if there are unusual felt to prevent complication. Name of Drug: Citicoline Desired Dosage/Timing/ Route: 1 gm q8 IVTT Classification: Nootropics & Neurotonics Mechanism of Action: Citicoline increases blood flow and O2 consumption in the brain. It is also involved in the biosynthesis of lecithin. Specific Indication: Cerebrovascular disorders including ischemic stroke Contraindication: Any allergy or hypersensitivity to the drug; Parasympathetic hypertonia Adverse Effects: Stomach pain, diarrhea; hypotension, tachycardia, bradycardia Nursing Responsibilities: 1. Take Citicholine as prescribed 2. Take Citicholine on time 3. Monitor patients neurologic status 4. Note if there are signs of slurring of speech 5. Note for adverse reactions 6. Teach patient on how to take the drug

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Name of Drug: Telmisartan Desired Dosage/Frequency/Route: Classification: Angiotensin II receptor antagonist; Antihypertensive Mechanism of Action: Selectively clocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the rennin-angiotensin system, as well as the release of aldosterone, leading to decreased BP. Specific Indication: Treatment of hypertension, alone or in combination with other Antihypertensives Contraindication: Contraindicated with hysensitivity to telmisartan Adverse Effects: Light-headedness, headache dizziness, hypotension, vomiting, dry Mouth Nursing Responsibilities: 1. Monitor patients BP carefully. 2. Monitor patient closely in any situation that may lead to a decrease in BP secondary to reduction in fluid volume-excessive perspiration, dehydration, vomiting, diarrhea--excessive hypotension can occur. 3. Instruct patient to take drug without regard to meal. 4. Anticipate patient of the side effects that may experience. 5. Tell patient to report if there are unusual felt to prevent complication.

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Name of Drug: phenytoin (Dilantin) Desired Dosage/Frequency/ Route: 100mg 1cap PO Classification: Antiarrhythmic, group1b; Antiepileptic; Hydantoin Mechanism of Action: Has antiepileptic activity without causing general CNS depression; stabilizes neuronal membranes and prevents hyperexcitability caused by excessive stimulation; limits the spread of seizure activity from an active focus; also effective in treating cardiac arrhythmias, especially those induced by cardiac glycosides; antiarrythmic properties are very similar to those of lidocaine; both are class IB antiarrhythmics. Specific Indication: Control of grand mal (tonic-clonic) and psychomotor seizures. Contraindication: Contraindicated with hypersensitivity to hydantoins Adverse Effects: slurred speech, mental confusion, drowsiness, irritability, nausea, vomiting Nursing Responsibilites: 1. Give oral drug with or without food in a consistent manner. Give with food if patient complains of GI upset. 2. Instruct patient to maintain good oral hygiene to prevent gum disease. 3. Anticipate patient of the side effects that may experience. 4. Tell patient to report if there are unusual felt to prevent complication.

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Name of Drug: Prednisone Desired Dosage/Frequency/Route: 5mg 1 tab PO Classification: Corticosteroid (intermediate acting); Glucocorticoid; Hormone Mechanism of Action: Enters target cells and binds to intracellular corticosteroid receptors, initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects. Specific Indication: Replacement therapy in adrenal cortical insufficiency Contraindication: Contraindicated with infections Adverse Effects: headache, hypotension, increased appetite, nausea, vomiting, muscle weakness Nursing Responsibilities: 1. Administer once-a-day doses before 9am to mimic normal peak corticosteroid blood levels. 2. Instruct patient to avoid exposure to infections. 3. Anticipate patient of the side effects that may experience. 4. Tell patient to report if there are unusual felt to prevent complication. Name o Drug: Nicardipine Desired Dosage/Frequency/Route: 4 amps in 460mL D5LR via solution set Classification: Antianginal; Antihypertensive; Calcium channel blocker Mechanism of Action: Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; calcium is involved in the generation of the action potential in specialized automatic and conducting cells in the heart, in arterial smooth muscle, and in excitation-contraction coupling in cardiac muscle cells. Inhibition of calcium flow results in the depression of impulse formation in specialized cardiac pacemaker cells, in slowing of the velocity of conduction of the cardiac impulse, in the depression o myocardial contractility, and in the dilation of coronary arteries and arterioles; these effects lead to decreased cardiac work, decreased cardiac energy consumption, and increased delivery of oxygen to myocardial cells. Specific Indication: Management of essential hypertension alone or with other antihypertensives Contraindication: Contraindicated with allergy to nicardipine Adverse Effects: Dizziness, light-headedness, headache, hypotension, flushing, rash, nausea Nursing Responsibilities: 1. Monitor the patients carefully (BP, ouput) while drug is being titrated to therapeutic dose; dosage may be increased more rapidly in hospitalized patients under close supervision. 2. Provide small frequent meals if GI upset occurs. 3. Anticipate patient of the side effects that may experience. 4. Tell patient to report if there are unusual felt to prevent complication.

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