Generic name: Metoprolol

Therapeutic: antianginals, antihypertensive

Pharmacologic: beta blockers (block epinephrine and adrenaline)
Action: competes with adrenergic neurotransmitters such as epinephrine/adrenaline
(catecholamines) for binding at beta(1)-adrenergic receptors in the heart. Beta(1)receptor blockade results in a decrease in heart rate, cardiac output, and blood
pressure. LESS SLOWLY WITH LESS FORCE
Therapeutic Effects: Decreased BP and heart rate. Decreased frequency of attacks
of angina pectoris. Decreased rate of cardiovascular mortality and hospitalization in
patients with heart failure.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue.
CV: BRADYCARDIA, HF, PULMONARY EDEMA
EENT: blurred vision, stuffy nose
GU: erectile dysfunction, decreased libido, urinary frequency.
Derm: rashes.
Endo: hyperglycemia, hypoglycemia.
Assessment: Monitor BP and pulse before therapy

Teaching: Metoprolol may impair your thinking or reactions, alcohol can increase
certain side effects,
Risk Factors: Cholesterol, HTN, smoking, diabetes, sedentary lifestyle, family Hx of
heart disease
CAD = most common cause
These agents have moderate afterload reduction properties and cause slight
preload reduction
CO = HR x SV

Generic: amlodipine (NORVASC)

Therapeutic: anti-hypertensives
Pharmacologic: calcium channel blockers
Action: Lowers blood pressure by relaxing blood vessels in order for the heart not to
have to pump so hard
Therapeutic Effects: Systemic vasodilation resulting in decreased BP. Coronary
vasodilation resulting in decreased frequency and severity of attacks of angina.
Adverse Reactions/Side Effects:
CNS: dizziness, fatigue.
CV: peripheral edema, angina, bradycardia, hypotension, palpitations.
Derm: flushing.
Assessment: Monitor BP and pulse before therapy, during dose titration, and
periodically during therapy. Monitor ECG periodically during prolonged therapy.
Risk factors: age, race, family Hx, being overweight, not being physically active,
smoking, too little potassium; helps balance sodium, drinking too much alcohol.
Teaching: This drug may make you dizzy. Do not drive, use machinery, or do any
activity that requires alertness until you are sure you can perform such activities
safely. Limit alcoholic beverages.
DECREASED AFTERLOAD and CONTRACTILITY

Generic: hydrochlorothiazide
Therapeutic: anti-hypertensives, diuretics
Action: Increases urinary output and reduces the bodys sodium and water volume
Therapeutic Effects: Lowering of BP in hypertensive patients and diuresis with
mobilization of edema.
Treatment of edema associated with: HF, Renal dysfunction
Adverse Reactions/Side Effects:
CNS: dizziness, drowsiness, lethargy, weakness.
CV: hypotension.
Derm: STEVENS-JOHNSON SYNDROME, photosensitivity, rash.
Endo: hyperglycemia.
F and E: hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis,
hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia.
EENT: acute angle-closure glaucoma
F and E: hypokalemia, dehydration, hypercalcemia,
Hemat: Thrombocytopenia
Metab: hypercholesterolemia, hyperuricemia.
MS: muscle cramps.

Assessment: Monitor BP and pulse before therapy

Risk Factors:
Teaching: morning and evening to avoid nocturia, diet high in potassium, change
positions slowly to eliminate orthostatic hypertension, report is gain more than 2lbs
per day or 5 lbs per week.

Generic: acetaminophen
Therapeutic: antipyretics, nonopioid analgesics (act peripherally)
Action: Inhibits the synthesis of prostaglandins that may serve as mediators of
pain and fever, primarily in the CNS. Has no significant anti-inflammatory properties
or GI toxicity.
Adverse Reactions/Side Effects:
CNS: drowsiness.
CV: vasodilation, tachycardia, hypotension.
EENT: rhinorrhea.
Resp: bronchospasm, bronchial/tracheal irritation, chest tightness, increased
secretions.
GI: nausea, vomiting, stomatitis.
Derm: rash, clamminess, pruritus, urticarial (hives/skin rash)
Teaching: Avoid drinking alcohol. It may increase your risk of liver damage while
taking acetaminophen. Do not take this medication without a doctor's advice if you
have ever had alcoholic liver disease (cirrhosis) or if you drink more than 3 alcoholic
beverages per day.

Generic: potassium
Drug classification: mineral and electrolyte replacements/supplements
Action: Maintain acid-base balance, isotonicity, and electrophysiologic balance of
the cell. Activator in many enzymatic reactions; essential to transmission of nerve
impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion;
renal function; tissue synthesis; and carbohydrate metabolism.
Side Effects: ARRHYTHMIAS, abdominal pain, diarrhea, flatulence, nausea, vomiting
Assessment:
Assess for signs and symptoms of hypokalemia (weakness, fatigue, U wave on ECG,
arrhythmias, polyuria, polydipsia (abnormally great thirst)) and hyperkalemia (see
Toxicity and Overdose).
Why pt. might be taking this medication?
- Prevention and correction of serum potassium depletion.
Risk factors: kidney disease, overuse of diuretics, excess sweating, diarrhea, and
vomiting, magnesium deficiency

Generic: fentanyl
Therapeutic: opioid analgesics, anesthetic adjuncts
Pharmacologic: opioid agonists
Action: Binds to opiate receptors in the CNS, altering the response to and
perception of pain. Therapeutic Effects:
Decrease in severity of chronic pain.
Side Effects:
CNS: confusion, sedation, weakness, dizziness, restlessness.
Resp: APNEA, bronchoconstriction, laryngospasm,
GI: anorexia, constipation, dry mouth, nausea, vomiting.
Resp: APNEA, respiratory depression.
CV: bradycardia.
GI: anorexia, constipation, dry mouth, nausea, vomiting.
Derm: sweating, erythema.
Local: application site reactions.
MS: skeletal and thoracic muscle rigidity.
Misc: physical dependence, psychological dependence
Assessment:

Desired outcome: Decrease in severity of pain without a significant alteration in

level of consciousness, respiratory status, or BP.
Teaching: Heat can increase the amount of drug you absorb through your skin and
may cause harmful effects. Fentanyl may be habit forming and should be used only
by the person it was prescribed for. Never share fentanyl with another person,
especially someone with a history of drug abuse or addiction.

Generic: Gabapentin
Therapeutic: analgesic adjuncts, therapeutic, anticonvulsants, (mood stabilizers)
Action:
Mechanism of action is not known. May affect transport of amino acids across and
stabilize neuronal membranes. Relieves pain for certain conditions in the nervous
system
Therapeutic Effects: Decreased post herpetic pain. Decreased leg restlessness.
Side Effects:
CNS: SUICIDAL THOUGHTS, confusion, depression, dizziness, drowsiness, sedation,
anxiety
EENT: abnormal vision, nystagmus.
CV: hypertension.
GI: weight gain, anorexia, flatulence, gingivitis.
MS: RHABDOMYOLYSIS, arthralgia, increase creatine kinase.
Neuro: ataxia, altered reflexes, hyperkinesia, paresthesia.
Misc: MULTIORGAN HYPERSENSITIVITY REACTIONS, facial edema.
Desired outcomes:
Decreased frequency of or cessation of seizures. Decreased postherpetic neuralgia
pain, Decreased intensity of neuropathic pain. Decreased frequency of

migraine headaches, Increased mood stability, Decrease effects of restless leg

syndrome.
Teaching: you should know that this medication may make you drowsy or dizzy,
may slow your thinking, and may cause loss of coordination. Do not drive a car or
operate machinery

Generic: metformin
Therapeutic: antidiabetics
Pharmacologic: biguanides
Action: Decreases hepatic glucose production. Decreases intestinal glucose
absorption. Increases sensitivity to insulin.
Therapeutic Effects: Maintenance of blood glucose.
Adverse Reactions/Side Effects:
GI: abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste.
F and E: LACTIC ACIDOSIS.
Misc: decreased vitamin B12 levels.
Assessment:
Monitor serum folic acid and vitamin B12 every 12 yr in long-term therapy.
Metformin may interfere with absorption.
Inform patient that metformin may cause an unpleasant or metallic taste that
usually resolves spontaneously.
Why pt. might be taking this medication: To help them with their blood sugar
levels; diabetes mellitus type II
Teaching: Instruct patient to take metformin at the same time each day. Symptoms
of lactic acidosis (chills, diarrhea, dizziness, low BP, muscle pain, sleepiness, slow
heartbeat or pulse, dyspnea, or weakness)

Beta2 agonist bronchodilator (ie.Ventolin) SHAKE WELL BEFORE EACH

SPRAY
Priming
Before using for 1st time, if inhaler has not been used for >2 weeks, or if it has been
dropped, prime inhaler by releasing 4 sprays into air, away from face
Action: Cyclic adenosine monophosphate, cAMP is a second messenger

important in many biological processes; a derivative of adenosine

triphosphate (ATP) and used for intracellular signal transduction in many
different organisms, conveying the cAMP-dependent pathway.
Anticholinergic bronchodilator (ie.Atrovent)
Anticholinergic bronchodilators (or muscarinic receptor antagonists) block
the parasympathetic nerve reflexes that cause the airways to constrict, so
allow the air passages to remain open
WAIT 15 MINUTES

Corticosteroids*** (ie.Flovent)
Fluticasone
propionate
is
a
man-made
steroid
of
the glucocorticoid family which is related to the naturally-occurring
steroid hormone, cortisol or hydrocortisone, produced by the adrenal
glands. Glucocorticoid steroids have potent anti-inflammatory actions.

Generic: Quetiapine
Therapeutic: CNS agent, psychotherapeutic, atypical, antipsychotic
Action:
Probably acts by serving as an antagonist of dopamine and serotonin. Also
antagonizes histamine H1 receptors and alpha1-adrenergic receptors.
Therapeutic Effects: Decreased manifestations of psychoses, depression, or acute
mania.
Side Effects:
CNS:
NEUROLEPTIC
MALIGNANT
SYNDROME,
SEIZURES,
dizziness.
GI:
PANCREATITIS, anorexia, constipation, dry mouth, dyspepsia. Endo: weight gain.
Assessment:
Monitor mental status (mood, orientation, behavior) before and periodically during
therapy.
Assess for suicidal tendencies, especially during early therapy. Restrict amount of
drug available to patient. Risk may be increased in children, adolescents, and adults
< (or equal to) 24
Assess weight and BMI initially and throughout therapy.

Monitor BP (sitting, standing, lying) and pulse before and frequently during initial
dose titration. If hypotension occurs during dose titration, return to the previous
dose.
Desired Outcome:
Decrease in excited, manic, behavior, Decrease in signs of depression in patients
with bipolar disorder.
Trade: Nitroglycerin
Therapeutic: antianginals
Pharmacologic: nitrates
Action:
Increases coronary blood flow by dilating coronary arteries and improving collateral
flow to ischemic regions. Produces vasodilation (venous greater than arterial).
Decreases left ventricular end-diastolic pressure and left ventricular end-diastolic
volume (preload). Reduces myocardial oxygen consumption.
Therapeutic Effects: Relief or prevention of anginal attacks. Increased cardiac
output. Reduction of BP.
Side Effects:

CNS: dizziness, headache, apprehension, restlessness, weakness. EENT: blurred

vision. CV: hypotension, tachycardia.
Assessment:
Assess location, duration, intensity, and precipitating factors of patients anginal
pain.
Monitor BP and pulse before and after administration. Patients receiving IV
nitroglycerin require continuous ECG and BP monitoring. Additional hemodynamic
parameters may be monitored.

A PEG is a feeding tube that is placed into your stomach (see Figure
1, left). If the tube cant be placed into your stomach, you may
have a PEJ tube placed instead (see Figure 1, right). A PEJ tube is
placed in your jejunum, which is the first part of your small
intestine. The tube is placed during a procedure called an
endoscopy.

Endoscopy is a nonsurgical procedure used to examine a

person's digestive tract. Using an endoscope, a flexible tube

with a light and camera attached to it, your doctor can view
pictures of your digestive tract on a color TV monitor.

Generic name: FER-IN-SOL

Trade name: ferrous sulfate (30%
elemental iron
Therapeutic: antianemics
Pharmacologic: iron supplements
Action: An essential mineral found in hemoglobin, myoglobin, and many enzymes.
Enters the bloodstream and is transported to the organs of the reticuloendothelial
system (liver, spleen, bone marrow), where it is separated out and becomes
part of iron stores.
Pertinent side effects:
GI: nausea; PO, constipation, dark stools, diarrhea, epigastric pain, GI bleeding;
Misc: staining of teeth
Nursing considerations:
- Assess nutritional status and dietary history to determine possible cause of anemia
and need for patient teaching.
- Assess bowel function for constipation or diarrhea. Notify health care professional
and use appropriate nursing measures should these occur.
- Assess patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal
edema, wheezing) for at least 30 min following injection. Notify health care
professional immediately if these occur. Keep epinephrine and resuscitation
equipment close by in the event of an anaphylactic reaction.

- Advise patient that stools may become dark green or black and that this change is
harmless.
- Instruct patient to follow a diet high in iron
Trade: aspirin
Generic: acetylsalicylic acid
Drug classes: Antipyretic
Analgesic
Anti-inflammatory
Antiplatelet
NSAID
Therapeutic actions
- Analgesic and antirheumatic effects; ability to inhibit the synthesis of
prostaglandins, important mediators of inflammation. Aspirin probably acts in the
thermoregulatory center of the hypothalamus to block effects of endogenous
pyrogen by inhibiting synthesis of the prostaglandin intermediary.
- Inhibition of platelet aggregation is attributable to the inhibition of platelet
synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet
aggregation.
Side Effects:
- Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea,
hemorrhage, excitement, confusion, asterixis, pulmonary edema, seizures, tetany,

metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure (dose
related, 2025 g in adults, 4 g in children)
Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps,
asthma, rhinitis), GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia,
hepatotoxicity
Hematologic: Occult blood loss, hemostatic defects
Hypersensitivity: Anaphylactoid reactions to anaphylactic shock
Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea,
mental confusion, lassitude (dose related)
Teaching points
- Take the drug with food or after meals if GI upset occurs.
- You may experience these side effects: Nausea, GI upset, heartburn (take drug with
food); easy bruising, gum bleeding (related to aspirins effects on blood clotting).
- Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult
breathing; nausea, vomiting, bloody stools.
- Patients who have asthma, allergies, and nasal polyps or who are allergic to
tartrazine are at an increased risk for developing hypersensitivity reactions.

Generic: docusate sodium

Trade: Selax, Soflax
Pharmacologic: stool softeners
Action: increases the amount of water in the stool to facilitate BM
Adverse Reactions/Side Effects:
EENT: throat irritation. GI: mild cramps,
diarrhea. Derm: rashes.
Assessment:
- Assess for abdominal distention, presence of bowel sounds, and usual pattern of
bowel function.
- Assess color, consistency, and amount of stool produced.
Evaluation/Desired Outcomes
A soft, formed bowel movement, usually within 2448 hr. Therapy may take 35 days
for results. Rectal dose forms produce results within 215 min.
Why pt. might be taking this medication: Pt. might be experiencing side effect
(constipation) from the anticholinergic medication.
OR
Pt. might be having difficulty with BM; given in order to facilitate BM.

Generic name: lactulose

Therapeutic: laxatives
Pharmacologic: osmotics
Action: Increases water content and softens the stool and lowers the pH of the
colon.
Side effects:
GI: belching, cramps, distention, flatulence, diarrhea. Endo: hyperglycemia (diabetic
patients).
Assessment:
- Assess patient for abdominal distention, presence of bowel sounds, and normal
pattern of bowel function.
- Assess color, consistency, and amount of stool produced.
- Monitor serum electrolytes periodically when used chronically. May cause diarrhea
with resulting hypokalemia and hypernatremia.
Teaching:
- Encourage patients to use other forms of bowel regulation, such as increasing bulk
in the diet, increasing fluid intake, and increasing mobility. Normal bowel habits are
individualized and may vary from 3 times/day to 3 times/wk.

- Caution patients that this medication may cause belching, flatulence, or abdominal
cramping. Health care professional should be notified if this becomes bothersome or
if diarrhea occurs.
Dex lansoprazole
Therapeutic: antiulcer agents
Pharmacologic:
proton-pump
inhibitors
Action: Binds to an enzyme in the presence of acidic gastric pH, preventing the final
transport of hydrogen ions into the gastric lumen.
Therapeutic Effects: Diminished accumulation of acid in the gastric lumen, with
lessened acid reflux.
Side Effects:
GI: PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea,
flatulence, nausea, vomiting. F and E: hypomagnesemia MS: bone fracture.
Assessment
- Assess patient routinely for epigastric or abdominal pain and for frank or occult
blood in stool, emesis, or gastric aspirate.
- Monitor bowel elimination. Diarrhea, abdominal cramping, fever, and bloody stools
should be reported to health care professional promptly as a sign of
pseudomembranous colitis.

TEACHING
- Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods
that may cause an increase in GI irritation.
- Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to
health care professional promptly, especially if accompanied by fever or bloody
stools. Do not treat with antidiarrheals without consulting health care professional.
GENERIC NAME: vitamin D
DRUG CLASS AND MECHANISM: Vitamin D is a necessary vitamin for the growth
and development of bones. Vitamin D is commonly known as ergocalciferol (Vitamin
D2) and cholecalciferol (Vitamin D3). Vitamin D2 and D3 are broken down to their
active form, calcitriol, in the body. Calcitriol works by increasing absorption of
calcium and phosphorus in the body. Calcitriol also prevents loss of calcium and
phosphorus from kidneys so they are absorbed back in the body to maintain
sufficient levels.
- It helps to absorb dietary calcium and phosphorus from the intestines.

- It suppresses the release of parathyroid hormone, a hormone that causes bone

resorption.
- Through these actions, vitamin D keeps the calcium and phosphate levels in the
blood normal, thereby promoting bone health. Vitamin D may have other benefits,
such as improving muscle and immune function, but these areas require more
research.
PRESCRIBED FOR: Vitamin D is used for treating hypoparathyroidism, vitamin D
resistant rickets, and low vitamin D levels. Over-the-counter Vitamin D preparations
are commonly used for low Vitamin D levels.
Side effects: weakness, fatigue, sleepiness, headache, loss of appetite, dry
mouth, metallic taste, nausea, vomiting, and others

Trade: memantine
Generic: Ebixa, Namenda, Namenda
XR
Therapeutic: anti-Alzheimers agents
Pharmacologic: N-methyl-D-aspartate
Antagonist
Indications:
Moderate to severe dementia/neurocognitive disorder associated with Alzheimers
disease.
Action
Binds to CNS N-methyl-D-aspartate (NMDA) receptor sites, preventing binding of
glutamate, an excitatory neurotransmitter.
Therapeutic Effects: Decreased symptoms of dementia/cognitive decline. Does
not slow progression. Cognitive enhancement. Does not cure disease.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache, sedation. CV: hypertension. Derm: rash. GI:
diarrhea, weight gain. GU: urinary frequency. Hemat: anemia.
Assessment
- Assess cognitive function (memory, attention, reasoning, language, ability to
perform simple tasks) periodically during therapy.
- Lab Test Considerations: May cause anemia.

Potential Nursing Diagnoses

Disturbed thought process (Indications)
Risk for injury (Side Effects) - Impaired environmental interpretation syndrome
TEACHING
- Caution patient and caregiver that memantine may cause dizziness.
- Teach patient and caregivers that improvement in cognitive functioning may take
months; degenerative process is not reversed.
Evaluation/Desired Outcomes
Improvement in neurocognitive decline (memory, attention, reasoning, language,
ability to perform simple tasks) in patients with Alzheimers disease