Drug Data Generic Name Clozapine Trade Name Clozaril, FazaClo

Classification Therapeutic atypical antipsychotic

Pharmacologic tricyclic dibenzodiazepi ne derivative

Patients Dose tab of 100mg/tab OD Minimum Dose 50mg OD Maximum Dose 50mg OD Contents Clozapine Availability 25 mg, 100 mg tablets Routes of administration po Pregnancy Category B

Mechanism of Action Chemical effect: binds to dopamine receptors within limbic system of the CNS and may interfere with adrenergic, cholinergic, histaminergic and serotoninergic receptors Therapeutic Effects: relieves psychotic signs and symptoms Onset unknown Peak weeks Duration 4-12 hours Therapeutic Levels 25-900mg/day Drug Half Life 8-12 hours

Indications Schizophrenia unresponsive to or intolerant of standard therapy with other antipsychotics (treatment refractory). To reduce recurrent suicidal behaviour in schizophrenic patients.

Contraindications Pts taking drugs that suppress bone marrow function and in those with paralytic ileus, uncontrolled epilepsy, history of drug-induced agranulocytosis, myelosuppressive disorders, severe CNS depression or coma, WBC count less than 3,500/mm3 Precaution Use Cautiously in: Patients with prostatic hyperplasia, urinary retention, or angle-closure glaucoma Drug/food interaction Drug-Drug: Anticholinergics: increase anticholinergic effects Antihypertensives: increase hypotensive effects Citalopram: increase clozapine level Digoxin, warfarin: increase levels Psychoactive drugs: produce additive effects

Adverse Reaction CNS: agitation, akathisia, anxiety, ataxia, confusion, depression, disturbed sleep or nightmares, dizziness, drowsiness, fatigue, fever, headache, hyperkinesia, hypokinesia or akinesia, insomnia, myoclonus, rigidity, sedation, seizures, slurred speech, syncope, tremor, vertigo, weakness CV: cardiomyopathy, chest pain, ECG changes, hypertension, hypotension, orthostatic hypotension, tachycardia GI: constipation, dry mouth, excessive salivation, heartburn, nausea, vomiting GU: abnormal ejaculation, incontinence, urinary frequency, urinary urgency, urine retention Hemat: agranulocytosis, leukopenia Metab: hypercholesterolemia, hypertriglyceridemia, severe hyperglycemia, weight gain MS: muscle pain or spasm, muscle weakness Skin: rash

Nursing Responsibilities Before *Assess patients psychotic condition *Monitor baseline WBC and differential counts *Assess for risk factors of diabetes *obtain baseline fasting blood glucose level *obtain laboratory works During *Watch for signs and symptoms of cardiomyopathy, including exertional dyspnea, fatigue, orthopnea *Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded or cheeked. *Monitor for signs of myocarditis (unexplained fatigue, dyspnea, tachypnea, fever, chest pain, palpitations, other signs and symptoms of heart failure, ECG changes *Monitor frequency and consistency of bowel movements. Increasing bulk and fluids in the diet may help to minimize constipation. After *After stopping drug, monitor WBC counts weekly for at least 4 weeks *Monitor closely for recurrent psychotic symptoms *Inform patient of possibility of extrapyramidal symptoms. Instruct patient to report these symptoms immediately. *Inform patient that cigarette smoking can decrease clozapine levels. Risk for relapse increases if patient begins or increases smoking.

Patients indication Relief of psychotic signs and symptoms

Source: Springhouse Nurses Drug Guide. (2008) Philadelphia: Lippincott Williams & Wilkins.

Drug Data Generic Name Carbamazepine Trade Name ApoCarbamazepine, Carbatrol, Epitol, Equetro, Tegretol Patients Dose 200mg/tab 1tab BID Minimum Dose 200mg OD Maximum Dose 400mg OD Contents Carbamazepine Availability Capsules: 100mg, 200mg, 300mg Oral suspension: 100mg/5ml Tablets: 100mg, 200mg Routes of administration po

Classification Therapeutic Anticonvulsant, analgesic Pharmacologic Iminostilbene derivative

Pregnancy Category D

Mechanism of Action Decreases synaptic transmission in the CNS by affecting sodium channels in neurons. Therapeutic Effects: Prevention of seizures. Relief of pain in trigeminal neuralgia. Decreased mania.

Indication Generalized tonic-clonic and complex partial seizures, mixed seizure patterns; trigeminal neuralgia; restless leg syndrome; chorea; acute manic and mixed episodes in bipolar 1 disorder

Contraindications Hypersensitivity; Bone marrow suppression; Concomitant use or use of MAO inhibitors within 14 days Drug/food interaction May increase metabolism of and therefore decrease levels/effectiveness of corticosteroids, doxycycline, felbamate, quinidine, warfarin, benzodiazepine, theophylline, valproic acid, haloperidol Concurrent use (within 2 wk) of MAOI may result in hyperpyrexia, hypertension, seizures and death

Adverse Reaction CNS: ataxia, drowsiness, fatigue, psychosis, sedation, vertigo. EENT: blurred vision, nystagmus, corneal opacities. Resp: pneumonitis. CV: CHF, edema, hypertension, hypotension, syncope. GI: hepatitis, pancreatitis, weight gain. GU: hesitancy, urinary retention. Derm: photosensitivity, rashes, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria. Endo: syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia. Hemat: agranulocytosis, aplastic anemia, thrombocytopenia, eosinophilia, leukopenia. Misc: chills, fever,

Nursing Responsibilities Before * Seizures: Assess frequency, location, duration, and characteristics of seizure activity. *Trigeminal Neuralgia: Assess for facial pain (location, intensity, duration) *Assess mental status (mood, orientation, behavior) and cognitive abilities before and periodically during therapy. During * Monitor CBC, including platelet count, reticulocyte count, and serum iron, weekly during the first 2 mo and yearly thereafter for evidence of potentially fatal blood cell abnormalities. Medication should be discontinued if bone marrow depression occurs * Liver function tests, urinalysis, and BUN should be routinely performed. May increase AST, ALT, serum alkaline phosphatase, bilirubin, BUN, urine protein, and urine glucose levels. Monitor serum ionized calcium levels every 6 mo or if seizure frequency increases. Thyroid function tests and ionized serum calcium concentrations may be decreased; hypocalcemia decreases seizure threshold. After *Instruct patient to take carbamazepine around the clock, as directed. Take missed doses as soon as possible but no just before next dose; do not double doses. *Instruct patients that fever, sore throat, mouth ulcers, easy bruising, petechiae, unusual bleeding, abdominal pain, chills, rash, pale stools, dark urine, or jaundice should be reported to health care professional immediately.

Onset 1 hr Peak 4-12 hrs Duration unknown Therapeutic Levels 412 mcg/ml Drug Half Life 25-65 hrs with single dose; 829 hrs with long-term use

Patients Indication acute manic and mixed episodes in bipolar 1 disorder

Source:

Deglin, J. &Vallerand, A. (2009) Davis Drug Guide for Nurses. 11th ed. Philadelphia: FA Davis Company.

Drug Data Generic Name Biperiden Trade Name Akineton, Biperiden, Artane, Cogentin, Kemadrin Patients Dose 2mg 1tab OD Minimum Dose 2mg 1tab OD Maximum Dose 2mg 1tab OD Contents biperiden hydrochloride Availability Tablets 2 mg (as hydrochloride) - Injection 5 mg/mL (as lactate) Routes of administration po

Classification Therapeutic antiparkinsonian agent

Pharmacologic Anticholinergic

Pregnancy Category C

Mechanism of Action Blocks acteylcholines action at cholinergic receptor sites. This action restores brains normal dopamine and acetylcholine balance, which relaxes muscle movement & decreases rigidity and tremors. It also inhibits dopamine reuptake and storage, which prolongs dopamine action. Onset 1 hr Peak 1-1.5 hr Duration unknown Therapeutic Levels 2mg-16mg/day Drug Half Life 24 hours

Indication *Treatment of all forms of parkinsonism; control of extrapyramidal disorders secondary to neuroleptic drug therapy. Patients Indication control of extrapyramidal disorders secondary to neuroleptic drug therapy

Contraindications Narrow angle glaucoma; bowel obstruction; megacolon. Precaution glaucoma, irregular heartbeat, urination problems, any allergies. Alcohol can increase drowsiness. Limit alcohol use. Drug/food interaction Amantadine May increase anticholinergic adverse reactions. Digoxin May increase digoxin serum levels, especially with slow-dissolution oral digoxin tablets. Haloperidol May worsen schizophrenic symptoms; may decrease haloperidol serum levels; tardive dyskinesia may develop. May decrease action of phenothiazines. May increase incidence of anticholinergic adverse reactions.

Adverse Reaction Cardiovascular Mild transient orthostatic hypotension; bradycardia; tachycardia. EENT Blurred vision; narrow-angle glaucoma; pupillary dilation. CNS Drowsiness; euphoria; disorientation; agitation; memory loss; disturbed behavior. Dermatologic Skin rash. GI Dry mouth; constipation; GI irritation. Genitourinary Urinary retention. Miscellaneous Hyperthermia; heat stroke.

Nursing Responsibilities Before *Advise patient that increasing fluid intake will help decrease dry mouth and constipation. *Instruct patient to pay particular attention to dental hygiene because of problems associated with decreased salivation (eg, increased risk of caries). *Tell patient that stool softeners may be used if constipation occurs. Small doses of milk of magnesia may be helpful. *Warn patient to drink plenty of fluids and take precautions against hyperthermia in hot weather. During * Caution is advised when performing tasks requiring alertness (e.g., driving) since this product may cause drowsiness. *May cause dizziness especially when rising quickly from a seated or lying position. Change positions slowly. *Do not share drug with others. *Inform pt to avoid becoming overheated. Biperiden may cause decreased sweating. This could lead to heat stroke in hot weather or with vigorous exercise. After * If a dose is missed, advise pt to take as soon as remembered unless the next scheduled dose is within 2 hours. If so, skip the missed dose and resume your usual dosing schedule. *Do not double the dose to catch up. *If overdose is suspected, contact *Store at room temperature away from moisture and sunlight.

Source: Springhouse Nurses Drug Guide. (2008) Philadelphia: Lippincott Williams & Wilkins.

Drug Data Generic Name Losartan Trade Name Cozaar

Classification Therapeutic antihypertensiv es

Pharmacologic angiotensin II receptor antagonists Patients Dose 50mg 1 tab OD Minimum Dose 50mg 1 tab OD Maximum Dose 50mg 1 tab OD Contents Losartan Availability 75 mg, 300 mg tablets Routes of administration po Pregnancy Category C

Mechanism of Action Chemical effect: blocks vasoconstrictor and aldosteroneproducing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands Therapeutic Effects: Lowering of blood pressure. Slowed progression of diabetic nephropathy. Decreased risk of stroke in patients with hypertension and left ventricular hypertrophy Onset 6 hr Peak 3-6 wk Duration 5 days Therapeutic Levels 24 hr Drug Half Life 2 hr

Indications Alone or with other agents in the management of hypertension. Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension. Prevention of stroke in patients with hypertension and left ventricular hypertrophy.

Contraindications Contraindicated in: Hypersensitivity; OB: Can cause injury or death of fetus; Lactation: Discontinue drug or provide formula. Precaution CHF (may result in azotemia, oliguria, acute renal failure, and/or death); Volume- or saltdepleted patients or patients receiving high doses of diuretics (correct deficits before initiating therapy or initiate at lower doses); Black patients (may not be effective); Impaired renal function due to primary renal disease or CHF (may worsen renal function); hepatic impairment; Women of childbearing potential Drug/food interaction Antihypertensive effect may be blunted by NSAIDs. Increased antihypertensive effects with other antihypertensives and diuretics. May increase effects of amiodarone, fluoxetine, glimepiride, glipizide, phenytoin, rosiglitazone, and warfarin. Rifampin may_effects of losartan.

Adverse Reaction CNS: dizziness, anxiety, depression, fatigue, headache, insomnia, weakness. CV: hypotension, chest pain, edema, tachycardia. Derm: rashes EENT: nasal congestion, pharyngitis, rhinitis, sinusitis. GI: abdominal pain, diarrhea, druginduced hepatitis, dyspepsia, nausea, vomiting. GU: impaired renal function. F and E: hyperkalemia. MS: arthralgia, back pain, myalgia. Misc: angioedema.

Nursing Responsibilities Before *Assess blood pressure and pulse *Instruct patient to take medication exactly as directed. *May be given without regard to food During *Monitor patient for signs of angioedema (dyspnea, facial swelling) *Monitor weight and assess pt routinely for fluid overload *Monitor renal function and electrolyte levels *Advise to avoid sudden changes in position to decrease orthostatic hypotension After *Note that drug may cause increase uric acid, slight decrease in haemoglobin and haematocrit, neutropenia & thrombocytopenia *Caution pt to avoid salt substitutes containing potassium or food containing high levels of potassium or sodium unless directed by physician *Encourage patient to make lifestyle changes such as exercise and reduction of alcohol.

Patients indication Alone or with other agents in the management of hypertension. Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension. Prevention of stroke in patients with hypertension and left ventricular hypertrophy.

Source: Davis Drug Guide. 2008. 11th ed. Drug Data

Source: Davis Drug Guide. 2008. 11th ed. Classification

Source: Davis Drug Guide. 2008. 11th ed. Mechanism of Action

Source: Davis Drug Guide. 2008. 11th ed. Indication

Source: Davis Drug Guide. 2008. 11th ed. Contraindications

Source: Davis Drug Guide. 2008. 11th ed. Adverse Reaction

Source: Davis Drug Guide. 2008. 11th ed. Nursing Responsibilities

Generic Name Amlodipine besylate Trade Name Norvasc Patients Dose 10 mg tab OD Minimum Dose 10 mg tab OD Maximum Dose 10 mg tab OD Contents Amlodipine besylate Availability 2.5, 5, 10mg Routes of administration po

Therapeutic Antianginal, antihypertensiv e Pharmacologic Calcium channel blocker

Pregnancy Category C

Chemical effect: Inhibits calcium ion influx across cardiac and smooth-muscle cells, thus decreasing myocardial contractility and oxygen demand. Also dilates coronary arteries and arterioles. Therapeutic effect: Reduces blood pressure and prevents angina. Onset unknown Peak 6-9 hrs Duration 24 hrs Therapeutic Levels 2.5 10 mg Drug Half Life 30 50 hrs

*chronic stable angina; vasospastic angina (Prinzmetal [variant] angina) *hypertension

*In patients hypersensitive to drug Precaution: In patients taking other peripheral vasodilators (especially those with severe aortic stenosis) and in those with heart failure; pts with severe hepatic disease Drug/food interaction *grapefruit juice: may increase drug level and adverse effects

CNS: fatigue, headache, somnolence CV: dizziness, edema, flushing, palpitations GI: abdominal pain, dyspepsia, nausea

Patients Indication *hypertension

Before *Assess pts blood pressure or angina *Assess pts and familys knowledge of drug therapy *Administer oral CCBs before meals. However, administer with food when GI distress occurs. *When heart rate is <60, systolic BP is <90mmHg and diastolic BP <60mmHg, or the parameter ordered, delay the dose and contact prescriber During *Instruct to change positions slowly *Monitor glucose, electrolytes, intake and output *Counsel pt to avoid participating in activities requiring alertness until response to drug is known *Do not administer within a few hours of beta blockers. This may result to depressed myocardial contractility and AV conduction, marked hemodynamic deterioration and ventricular fibrillation. After *Keep pt in recumbent position for at least 1 hour after first CCB dose. *Monitor renal and hepatic function *Taper over a 2-week period when discontinuing because abrupt withdrawal may cause severe reactions. *Instruct to report edema and weight gain greater than 3 lbs or 5 lbs per week.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Drug Data

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Classification

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Mechanism of Action

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Indication

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source:Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Contraindications

Adverse Reaction

Nursing Responsibilities

Generic Name Clonidine hydrochloride Trade Name Catapres, CatapresTTS,_Dixarit, Duraclon Patients Dose 75 mcg 1 tab OD Minimum Dose 75 mcg 1 tab OD Maximum Dose 75 mcg 1 tab OD Contents Clonidine Availability Tablets: 25, 100, 200, 300 mcg Transdermal systems: 0.1, 0.2 & 0.3 mg/24 hr Solution for epidural injection: 100 & 500 mcg/ml in 10-ml vials Routes of administration Po, transdermal, epidural

Therapeutic Antihypertensi ve

Pharmacologic Adrenergic (centrally acting)

Pregnancy Category C

Stimulates alphaadrenergic receptors in the CNS; which results in decreased sympathetic outflow inhibiting cardioacceleration and vasoconstriction centers. Prevents pain signal transmission to the CNS by stimulating alpha-adrenergic receptors in the spinal cord. Therapeutic Effects: Decreased blood pressure. Decreased pain. Onset po: 30-60 mins transderm.: 2-3 days epidural: unknown Peak po: 2-4 hr transdermal, epidural: unknown Duration po 8-12 hr transdermal: 7 days epidural: unknown Therapeutic Levels 200-600 mcg Drug Half Life Plasma 12-22 hr CNS 1.3 hr

PO, Transdermal: Management of mild to moderate hypertension. Epidural: Management of cancer pain unresponsive to opioids alone. Unlabeled uses: Management of opioid withdrawal. Patients Indication *Management of mild to moderate hypertension.

Hypersensitivity; Epiduralinjection site infection, anticoagulant therapy, or bleeding problems. Precaution Serious cardiac or cerebrovascular disease; Renal insufficiency; Geri: Appear on Beers list due to increased risk of orthostatic hypotension and adverse CNS effects in geriatric patients ( decrease dose recommended) Drug/food interaction Additive sedation with CNS depressants, including alcohol, antihistamines, opioid analgesics, and sedative/ hypnotics. Additive hypotension with other antihypertensives and nitrates. Additive bradycardia with myocardial depressants, including beta blockers. MAO inhibitors, amphetamines, beta blockers, prazosin, or tricyclic antidepressants may decrease antihypertensive effect. Withdrawal phenomenon may be increased by discontinuation of beta blockers. Epidural clonidine prolongs the effects of epidurally administered local anesthetics. May decrease effectiveness of levodopa. Increased risk of adverse

CNS: drowsiness, depression, dizziness, nervousness, nightmares. CV: bradycardia, hypotension (increased with epidural), palpitations. GI: dry mouth, constipation, nausea, vomiting. GU: erectile dysfunction. Derm: rash, sweating. F and E: sodium retention. Metab: weight gain. Misc: withdrawal phenomenon.

Before *Monitor intake and output ratios and daily weight, and assess for edema daily *Monitor blood pressure and pulse frequently *Note that drug may cause transient increase in blood glucose levels. *Assess pts & familys knowledge of drug therapy During *Administer last dose of the day at bedtime. *If dry mouth occurs, note that frequent mouth rinses, good oral hygiene and sugarless gum or candy may decrease effect. *Monitor patient closely, especially during the first few days of therapy. Respiratory depression or deep sedation may occur. *Instruct to avoid more than 4 cups of caffeinated coffee, tea or cola per day. *Caution pt to take drug at bedtime to avoid drowsiness during the day. After *If dry mouth continues for >2 wks, consult physician *Advise patient to notify health care professional if mental depression, swelling of feet and lower legs, paleness or cold feeling in fingertips or toes, or vivid dreams or nightmares occur. *Periodic eye examination are recommended *Withdraw the drug slowly over 24 days to avoid rebound hypertension.

cardiovascular reactions with verapamil.

Source: Davis Drug Guide. 2008. 11th ed. Drug Data

Source: Davis Drug Guide. 2008. 11th ed. Classification

Source: Davis Drug Guide. 2008. 11th ed. Mechanism of Action

Source: Davis Drug Guide. 2008. 11th ed. Indications

Source: Davis Drug Guide. 2008. 11th ed. Contraindications

Source: Davis Drug Guide. 2008. 11th ed. Adverse Reaction

Source: Davis Drug Guide. 2008. 11th ed. Nursing Responsibilities

Generic Name Isosorbide mononitrate Trade Name IMDUR, ISMO, Isotrate ER, Monoket

Therapeutic Antianginal, vasodilator

Pharmacologic nitrate

Patients Dose 30mg 1 tab OD q HS Minimum Dose 30mg 1 tab OD Maximum Dose 30mg 1 tab OD Contents Isosorbide mononitrate Availability Tablets: 5, 10, 20, 30, 40 mg Tablets (S.L.): 2.5, 5, 10 mg Capsules (extendedrelease): 40mg Routes of administration po, sublingual

Pregnancy Category C

Chemical effect: may reduce cardiac oxygen demand by decreasing left ventricular end diastolic pressure (preload) and, to a lesser extent, systemic vascular resistance (afterload). May increase blood flow through collateral coronary vessels. Therapeutic Effects: relieves angina Onset po 2-60 min S.L. 2-5min Peak po 2-60 min S.L. 2-5 min Duration po 1-12 hr S.L. 1-2 hr Therapeutic Levels 10-160 mg Drug Half Life 5 hours

*acute angina (S.L. form only), prophylaxis in situations likely to cause angina *adjunctive treatment of heart failure *diffuse esophageal spasm without gastroesophageal reflux

Contraindicated in: hypersensitive to nitrates, in those with idiosyncratic reactions to nitrates, and in those with severe hypotension, shock or acute MI with low left ventricular filling pressure Precaution Use Cautiously in patients with blood volume depletion (such as that resulting from diuretic therapy) or mild hypotension Drug/food interaction Antihypersensitives: may increase hypotensive effects Sildenafil, Tadalafil, Vardenafil: may increase hypotensive effects Alcohol: may increase hypotension

CNS: dizziness, headache, weakness CV: ankle edema, fainting, flushing, orthostatic hypotension, palpitations, tachycardia GI: nausea, vomiting Skin: cutaneous vasodilation Other: hypersensitivity reactions, sublingual burning

Before *Monitor BP and pulse *Assess allergy and hypersensitivity to drug or any of its components *Be alert for drug-drug interactions *Exercise caution in pts with blood volume depletion. During *Give drug on empty stomach, either 30 mins before or 1-2 hrs after meals *Dont stop therapy abruptly because coronary vasospasm may occur *Instruct to avoid alcoholic drinks to prevent excessive vasodilatation, hypotension and fainting. After *Advise to avoid sudden position changes to patient *Store drug in cool place, in tightly closed container, away from light. Cotton filler should be discarded because cotton can absorb the drug. *Be alert for adverse drug effects. *Monitor hepatic or renal function.

Patients indication Prophylactic management of angina pectoris.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Drug Data

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Classification

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Mechanism of

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Indications

Source: Springhouse Nurses Drug Guide. 2008. 9th ed. Contraindications

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Adverse Reaction

Nursing Responsibilities

Generic Name Gliclazide Trade Name Diamicron

Therapeutic Antianginal, vasodilator

Patients Dose 80 mg 1 tab OD Minimum Dose 80 mg 1 tab OD Maximum Dose 80 mg 1 tab OD Contents Gliclazide Availability Tablets Routes of administration po

Pharmacologic nitrate

Pregnancy Category C

Action Chemical effect: may reduce cardiac oxygen demand by decreasing left ventricular end diastolic pressure (preload) and, to a lesser extent, systemic vascular resistance (afterload). May increase blood flow through collateral coronary vessels. Therapeutic Effects: relieves angina Onset po 2-60 min S.L. 2-5min Peak po 2-60 min S.L. 2-5 min Duration po 1-12 hr S.L. 1-2 hr Therapeutic Levels 10-160 mg Drug Half Life 5 hours

*acute angina (S.L. form only), prophylaxis in situations likely to cause angina *adjunctive treatment of heart failure *diffuse esophageal spasm without gastroesophageal reflux

Contraindicated in: hypersensitive to nitrates, in those with idiosyncratic reactions to nitrates, and in those with severe hypotension, shock or acute MI with low left ventricular filling pressure Precaution Use Cautiously in patients with blood volume depletion (such as that resulting from diuretic therapy) or mild hypotension Drug/food interaction Antihypersensitives: may increase hypotensive effects Sildenafil, Tadalafil, Vardenafil: may increase hypotensive effects Alcohol: may increase hypotension

CNS: dizziness, headache, weakness CV: ankle edema, fainting, flushing, orthostatic hypotension, palpitations, tachycardia GI: nausea, vomiting Skin: cutaneous vasodilation Other: hypersensitivity reactions, sublingual burning

Before *Instruct times at which antidiabetic should be taken for maximal effectiveness *Monitor laboratory values such as BUN, creatinine levels. *Monitor complete blood count, haemoglobin, electrolyte levels and liver function tests. *Monitor and record blood glucose levels During *Give drug on empty stomach, either 30 mins before or 1-2 hrs after meals *Dont stop therapy abruptly because coronary vasospasm may occur *Warn not to use OTC medications without consulting physician. *Be alert for adverse drug effects After *Advise to avoid sudden position changes to patient *Stress the importance of diet and exercise in the control of diabetes. *Store drug in cool place, in tightly closed container, away from light *Evaluate laboratory values and significant changes after drug therapy

Patients indication Prophylactic management of angina pectoris.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.

Source: Springhouse Nurses Drug Guide. 2008. 9th ed.