74

IX. PHARMACOLOGIC MANAGEMENT

Generic
Name
Brand
Name

Classification

Indication
Mechanism
Of
Action
Dosage
And
Frequency

Adverse
Reactions

Nursing Consideration
A
T
O
R
V
A
S
T
A
T
I
N
Lipitor Anti- hyperlipi
demic HMG-
CoA
reductase
inhibitor
An
adjunct to
diet in the
treatment
of
elevated
total
cholester
ol, mixed
dyslipide
mia,
atheroscl
erosis
A fungal
metabolite
that inhibits
the enzyme
(HGM-CoA)
that catalyzes
the first step
in the
cholesterol
synthesis
pathway,
resulting in a
decrease in
serum
10 mg
OD

Nausea,
dyspepsia,
diarrhea,
constipation,
vomiting,
rhinitis,
sinusitis,
cough,
dyspnea,
pneumonia
Arrange for proper
consultation about need for
diet and exercise changes
Administer drug at bed time
Monitor patient closely for
signs of muscle injury,
especially higher doses
Provide comfort measures to
deal with headache, muscle
cramps, or nausea
Offer support and
encouragement to deal with
disease, diet, drug therapy,
and follow-up care.
75




cholesterol,
serum LDLs
(associated
with
increased risk
of coronary
artery
disease) and
either an
increase or
no change in
serum HDLs
(associated
with
decreased).
76



Generic
Name
Brand
Name

Classification

Indication
Mechanism
Of
Action
Dosage
And
Frequency

Adverse
Reactions

Nursing Consideration

C
L
O
P
I
D
O
G
R
E
L


N
O
R
P
L
A
T

Anti
platelet

Treatme
nt of
patients
at risk
for
ischemic
events
and
peripher
al
arterydis
ease,
acute
coronary

Inhibits
platelet
aggregati
on by
blocking
ADP
receptors
on
platelets,
preventing
clumping
of
platelets.

75 mg
OD


Headache,
dizziness,
weakness,
hypertension,
edema,
nausea, GI
distress,const
ipation,
diarrhea.
Increased
bleeding risk


77


syndrom
e, as a
loading
dose
with
aspirin
to
prevent
adverse
cardiac
events in
coronary
stent
implanta
tion


78



Generic
Name
Brand
Name

Classification

Indication
Mechanism
Of
Action
Dosage
And
Frequency

Adverse
Reactions

Nursing Consideration
M
E
T
O
P
R
O
L
O
L
Betaloc Beta1-
selective
adrenergic
blocker, Anti-
hypertensive
Hyper
tension,
alone or
with other
drugs,
especially
diuretics
Preve
ntion of
reinfarction
in MI
patients
who are
hemodynam
ically stable
Competitively
blocks beta-
adrenergic
receptors in the
heart and
juxtaglomerular
apparatus,
decreasing the
influence of the
sympathetic
nervous
system on
these tissues
and the
excitability of
100 mg
Once daily
Pharyngitis,
erythematous
rash, fever, sore
throat,
laryngospasm
Dizziness,
vertigo, tinnitus,
fatigue,
emotional
depression,
paresthesias,
sleep
disturbances,
hallucinations,
disorientation,
Do not discontinue drug
abruptly after long-term
therapy (hypersensitivity to
catecholamines may have
developed, causing
exacerbation of angina, MI,
and ventricular arrhythmias).
Taper drug gradually over 2
wk with monitoring.
Ensure that patient
swallows the ER tablets
whole; do not cut, crush, or
chew.
Consult physician about
withdrawing drug if patient is
79


or within 3
10 days of
the acute MI
(immediate-
release
tablets and
injection)
Treat
ment of
angina
pectoris
Treat
ment of
stable,
symptomati
c CHF of
the heart,
decreasing
cardiac output
and the release
of renin, and
lowering BP;
acts in the CNS
to reduce
sympathetic
outflow and
vasoconstrictor
tone.
memory loss,
slurred speech
CHF, cardiac
arrhythmias,
peripheral
vascular
insufficiency,
claudication,
CVA, pulmonary
edema,
hypotension
Rash, pruritus,
sweating, dry
skin
Eye irritation,
dry eyes,
to undergo surgery
(controversial).
Give oral drug with food to
facilitate absorption.
Provide continual cardiac
monitoring for patients
receiving IV metoprolol.
80


ischemic,
hypertensiv
e, or
cardiomyop
athic origin
(Toprol-XL
only)
conjunctivitis,
blurred vision
Gastric pain,
flatulence,
constipation,
diarrhea,
nausea,
vomiting,
anorexia,
ischemic colitis,
renal and
mesenteric
arterial
thrombosis,
retroperitoneal
fibrosis,
81


hepatomegaly,
acute
pancreatitis
Impotence,
decreased libido,
Peyronie's
disease, dysuria,
nocturia,
frequent
urination







82



Generic
Name
Brand
Name

Classification

Indication
Mechanism
Of
Action
Dosage
And
Frequency

Adverse
Reactions

Nursing Consideration
N
I
C
A
R
D
I
P
I
N
E
Perdipine Therapeutic:
antianginals,
antihypertensi
ve
Pharmacolog
ic: calcium
channel
blockers.
Manageme
nt of:
Hypertensio
n, Angina
pectoris, Va
sospastic
(Prinzmetal
s) angina.
Inhibits the
transport of
calcium into
myocardial and
vascular
smooth muscle
cells, resulting
in inhibition of
excitation-
contraction
coupling and
subsequent
contraction.
Therapeutic
Effects:
PO
(Adults): 2
0mg 3
times
daily,may
increase
q3 days
(range 20
40mg 3
times
daily); or
30 mg
twice daily
as
sustained-
CNS: abnormal
dreams, anxiety,
confusion,
dizziness,
drowsiness,
headache,
jitteriness,
nervousness,
psychiatric
disturbances,
weakness. EENT
: blurred vision,
disturbed
equilibrium, epist
axis,
1. Advise patient to take
medication exactly as directed,
even if feeling well. Take
missed doses as soon as
possible unless almost time for
next dose; do not double
doses. May need to be
discontinued gradually.
2. Instruct patient on technique
for monitoring pulse. Instruct
patient to contact health
care professional if heart rate
is <50 bpm.
3. Advise patient to avoid
grapefruit and grapefruit juice
83


Systemic
vasodilation
resulting in
decreased
blood pressure.
Coronary
vasodilation res
ulting in
decreased
frequency and
severity
of attacks of
angina.
release
form (up
to 60mg
twice
daily). IV
(Adults): T
o replace
PO use
0.5
2.2mg/hr
continuous
infusion.
For acute
hypertensi
ve episode
s5mg/hr
tinnitus. Resp: c
ough,
dyspnea, shortne
ss of
breath. CV:ARR
HYTHMIAS,
CHF, peripheral
edema,
bradycardia,
chest pain,
hypotension,
palpitations,
syncope,
tachycardia. GI:
abnormal results
in liver function
during therapy.
4. Caution patient to change
positions slowly to minimize
orthostatic hypotension.
5. May cause drowsiness or
dizziness. Advise patient to
avoid driving or other activities
requiring alertness until
response to the medication is
known.
6. Instruct patient to avoid
concurrent use of alcohol or
OTC medications, especially
cold preparations, without
consulting health
care professional.
84


titrated as
needed (up
to
15 mg/hr).
studies, anorexia
, constipation,
diarrhea, dry
mouth, dysgeusi
a, dyspepsia,
nausea,
vomiting. GU: dy
suria, nocturia,
polyuria, sexual
dysfunction, urin
ary
frequency. Derm
: dermatitis,
erythemamultifor
me, flushing,
increased
7. Advise patient to notify
health care professional if
irregular heartbeat, dyspnea,
swelling of hands and feet,
pronounced dizziness nausea,
constipation, or hypotension
occurs or if headache is
severe or persistent.
8. Caution patient to wear
protective clothing and to use
sunscreen to prevent
photosensitivity reactions.
9. Angina: Instruct patient on
concurrent nitrate or beta-
blocker therapy to continue
taking both medications as
85


sweating,
photosensitivity,
pruritus/urticaria,
rash.Endo: gyne
comastia, hyperg
lycemia. Hemat:
anemia, leukope
nia,
thrombocytopeni
a. Metab:
weight gain. MS:
joint stiffness,
muscle
cramps. Neuro:
paresthesia,
tremor. Misc:ST
directed and to
use SL nitroglycerin as
needed for anginal attacks.
10. Advise patient to contact
health care professional if
chest pain does not improve,
worsens
after therapy, or occurs with
diaphoresis; if shortness of
breath; or if persistent
head ache occurs.
86


EVENS-
JOHNSON SYN
DROME, gingival
hyperplasia.







87



Generic
Name
Brand
Name

Classification

Indication
Mechanism
Of
Action
Dosage
And
Frequency

Adverse
Reactions

Nursing Consideration
O
M
E
P
R
A
Z
O
L
E
Losec Gastrointestinal
Agent; Proton
Pump Inhibitor
Duodenal
and
gastric
ulcer.
Gastroeso
phageal
reflux
disease
including
severe
erosive
esophagiti
s (4 to 8
wk
treatment)
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
Gastroeso
phageal
Reflux,
Erosive
Esophagit
is,
Duodenal
Ulcer
adult: PO
20 mg
once/d for
48 wk
Gastric
Ulcer
adult: PO
CNS:Headache,
dizziness,
fatigue.
GI:Diarrhea,
abdominal pain,
nausea, mild
transient
increases in liver
function tests.
Urogenital:Hem
aturia,
proteinuria.
Skin:Rash.
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.
88


. Long-
term
treatment
of
pathologic
hypersecr
etory
conditions
such as
Zollinger-
Ellison
syndrome,
multiple
endocrine
adenomas
, and
parietal cells.

20 mg
b.i.d. for 4
8 wk
Hypersecr
etory
Disease
adult:PO
60 mg
once/d up
to 120 mg
t.i.d.
Duodenal
Ulcer
Associate
d with H.
pylori
89


systemic
mastocyto
sis. In
combinati
on with
clarithrom
ycin to
treat
duodenal
ulcers
associate
d with
Helicobact
er pylori.
adult:PO
40 mg
once/d for
14 d, then
20 mg/d for
14 days, in
combinatio
n with
clarithromy
cin 500 mg
t.i.d. for 14
days




90



Generic
Name
Brand
Name

Classification

Indication
Mechanism
Of
Action
Dosage
And
Frequency

Adverse
Reactions

Nursing Consideration
Sodium
Bicarbon
ate
Sodium
Bicarbon
ate
Gastrointestinal
agent; antacid;
fluid and
electrolyte
balance agent.
Systemic
alkalinizer
to correct
metabolic
acidosis (as
occurs in
diabetes
mellitus,
shock,
cardiac
arrest, or
vascular
collapse), to
minimize
uric acid
Short-acting,
potent
systemic
antacid.
Rapidly
neutralizes
gastric acid to
form sodium
chloride,
carbon
dioxide, and
water. After
absorption of
sodium
bicarbonate,
Adult:PO
0.32 g 1
4 times/d
or 1/2 tsp
of powder
in glass of
water
Urinary
Alkalinizer
Adult:PO
4 g initially,
then 12 g
q4h
Child:PO
84840
mg/kg/d in
divided
doses
Cardiac
Arrest
Adult:IV 1
mEq/kg of
a 7.5% or
8.4%
solution
GI: Belching,
gastric
distention,
flatulence.
Metabolic:
Metabolic
alkalosis;
electrolyte
imbalance:
sodium overload
(pulmonary
edema),
hypocalcemia
(tetany),
hypokalemia,
Assessment & Drug Effects
- Be aware that long-term
use of oral preparation with
milk or calcium can cause
milk-alkali syndrome:
Anorexia, nausea, vomiting,
headache, mental confusion,
hypercalcemia,
hypophosphatemia, soft tissue
calcification, renal and ureteral
calculi, renal insufficiency,
metabolic alkalosis.
- Lab tests: Urinary
alkalinization: Monitor urinary
91


crystallizatio
n
associated
with
uricosuric
agents, to
increase the
solubility of
sulfonamide
s, and to
enhance
renal
excretion of
barbiturate
and
salicylate
plasma alkali
reserve is
increased
and excess
sodium and
bicarbonate
ions are
excreted in
urine, thus
rendering
urine less
acid. Not
suitable for
treatment of
peptic ulcer
because it is
initially,
then 0.5
mEq/kg
q10min
depending
on arterial
blood gas
determinati
ons (8.4%
solutions
contain 50
mEq/50
mL), give
over 12
min
Child:IV
0.51
mEq/kg of
a 4.2%
solution
q10min
depending
on arterial
blood gas
determinati
ons, give
over 12
min
milk-alkali
syndrome,
dehydration.
Others: Rapid IV
in neonates
(Hypernatremia,
reduction in CSF
pressure,
intracranial
hemorrhage).
Skin: Severe
tissue damage
following
extravasation of
IV solution.
Urogenital:
pH as a guide to dosage (pH
testing with nitrazine paper
may be done at intervals
throughout the day and
dosage adjustments made
accordingly).
- Lab tests: Metabolic
acidosis: Monitor patient
closely by observations of
clinical condition;
measurements of acid-base
status (blood pH, Po2, Pco2,
Hco3-, and other electrolytes,
are usually made several
times daily during acute
period).
92


overdosage
. Commonly
used as
home
remedy for
relief of
occasional
heartburn,
indigestion,
or sour
stomach.
Used
topically as
paste, bath,
or soak to
relieve
short-acting,
high in
sodium, and
may cause,
gastric,
distention,
systemic,
alkalosis, and
possibly acid-
rebound.
Metabolic
Acidosis
Adult:IV
25
mEq/kg by
IV infusion
over 48 h
Infant:IV
23
mEq/kg/d
of a 4.2%
solution
over 48 h
Renal calculi or
crystals,
impaired kidney
function.
- Observe for signs of
alkalosis (over treatment)
- Observe for and report S&S
of improvement or reversal of
metabolic acidosis.
Patient & Family Education
- Do not use sodium
bicarbonate as antacid. A
nonabsorbable OTC
alternative for repeated use is
safer.
- Do not take antacids longer
than 2 wk except under advice
and supervision of a physician.
Self-medication with routine
93


itching and
minor skin
irritations
such as
sunburn,
insect bites,
prickly heat,
poison ivy,
sumac, or
oak. Sterile
solutions
are used to
buffer acidic
parenteral
solutions to
prevent
doses of sodium bicarbonate
or soda mints may cause
sodium retention and
alkalosis, especially when
kidney function is impaired.
- Be aware that commonly
used OTC antacid products
contain sodium bicarbonate:
Alka-Seltzer, Bromo-Seltzer,
Gaviscon.
- Do not breast feed while
taking this drug without
consulting physician.

94


acidosis.
Also as a
buffering
agent in
many
commercial
products
(e.g.,
mouthwash
es,
douches,
enemas,
ophthalmic
solutions).