Name Of Drug Dosage Drug Class Indication Contraindication Adverse Effect Nursing Responsibilities

Generic : Atorvastatin Calcium

Trade name:Lipitor/ Simvastatin

40 mg/ tab 1 tab OD @ HS

Antihyperlipidemic To reduce the risk of MI, stroke, angina, and revascularization procedures in patients with no evidence of CAD with multiple risk factors.

Heterozygous familial hypercholesterolemia.

Adjunct to diet to reduce elevated LDL, total cholesterol, apo B, and triglyceride levels to increase HDL level in patients with primary hypercholesterolemia and mixed dyslipidemia.

Contraindicated in patients hypertensive to the drug and in those with active liver disease or conditions linked with unexplained persistent increases in transaminase levels.

Adolescent girl must be at least 1 year post-menarche

Nausea & vomiting, diarrhea, abdominal pain, constipation, dyspepsia & flatulence. Headache, skin rashes, dizziness, blurred vision, insomnia, dysgeusia. Cholestatic jaundice, pruritus, hypoglycemia, hyperglycemia. Anorexia, pancreatitis, alopecia, weight gain, Stevens-Johnson syndrome. Back & chest pain, muscle cramps, peripheral edema, malaise & fatigueDrug and food interaction:Cyclosporine, fibric acid derivatives, erythromycin, niacin, azole antifungals. Oral antacid containing Mg & Al hydroxide, colestipol, efavirenz & rifampin. Digoxin. Protease inhibitors, diltiazem HCl & grapefruit juice. Norethindrone

Monitor patient’s lipid and liver function levels at baseline and periodically thereafter.

Monitor patient for signs of rhabdomyolyis, especially if taking more than one class of lipid lowering drugs.

Asses patient’s and family’s knowledge of drug therapy.

& ethinylestradiol.

Generic: Enalapril Maleate

Trade name: Buergli

5 mg/ tab 1 tab OD

AntihypertensiveACE inhibitor

Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics

Treatment of acute and chronic CHF

Treatment of asymptomatic left ventricular dysfunction (LVD)

Unlabeled use: Diabetic nephropathy

Contraindicated with allergy to enalapril.

Use cautiously with impaired renal function; salt or volume depletion (hypotension may occur); lactation, pregnancy.

CNS: Headache, dizziness, fatigue, insomnia, paresthesias

CV: Syncope, chest pain, palpitations, hypotension in salt- or volume-depleted patients

GI: Gastric irritation, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, elevated liver enzymes

GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency, impotence

Hematologic: Decreased hematocrit and hemoglobin

Other: Cough, muscle cramps, hyperhidrosis

Assessment History: Allergy to

enalapril, impaired renal function, salt or volume depletion, lactation, pregnancy

Physical: Skin color, lesions, turgor; T; orientation, reflexes, affect, peripheral sensation; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, renal and liver function tests, CBC, and differential

Interventions Alert surgeon, and

mark patient's chart with notice that enalapril is being taken; the angiotensin II formation subsequent to compensatory renin release

InteractionsDrug-drug

Decreased hypotensive effect if taken concurrently with indomethacin, rifampin

during surgery will be blocked; hypotension may be reversed with volume expansion.

Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril.

Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.

Arrange for reduced dosage in patients with impaired renal function.

Monitor patient carefully because peak effect may not be seen for 4 hr. Do not administer second dose until BP has

been checked.

Teaching points Do not stop taking

the medication without consulting your health care provider.

Be careful in any situation that may lead to a drop in blood pressure (diarrhea, sweating, vomiting, dehydration).

Avoid over-the-counter medications, especially cough, cold, and allergy medications that may interact with this drug.

These side effects may occur: GI upset, loss of appetite, change in taste perception (will pass with time); mouth sores (use frequent mouth care); rash; fast heart rate; dizziness, light-headedness (usually passes in

a few days; change position slowly, limit activities to those not requiring alertness and precision).

Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.

Generic: Aspirin

Trade name: Tromcor

AntipyreticAnalgesic (nonopioid)Anti-inflammatoryAntirheumaticAntiplateletSalicylateNSAID

Mild to moderate pain

Fever Inflammatory

conditions—rheumatic fever, rheumatoid arthritis, osteoarthritis

Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli

Reduction of risk of death or nonfatal MI in

Allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K

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

Assessment History: Allergy to

salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children

patients with history of infarction or unstable angina pectoris

MI prophylaxis Unlabeled use:

Prophylaxis against cataract formation with long-term use

deficiency (increased risk of bleeding)

Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye's syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial

related 20–25 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)

InteractionsDrug-drug

with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation

Physical: Skin color, lesions; temperature; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, stool guaiac, renal and liver function tests

Interventions Give drug

with food or after meals if GI upset occurs.

Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus.

hemorrhage, stillbirths, neonatal death); lactation.

Increased risk of bleeding with oral anticoagulants, heparin

Increased risk of GI ulceration with steroids, phenylbutazone, alcohol, NSAIDs

Increased serum salicylate levels due to decreased salicylate excretion with urine acidifiers (ammonium chloride, ascorbic acid, methionine)

Increased risk of salicylate toxicity with carbonic anhydrase inhibitors, furosemide

Decreased serum salicylate levels with corticosteroids

Decreased serum salicylate levels due to increased renal excretion of salicylates with acetazolamide,

Do not crush, and ensure that patient does not chew sustained-release preparations.

Do not use aspirin that has a strong vinegar-like odor.

Institute emergency procedures if overdose occurs: gastric lavage, induction of emesis, activated charcoal, supportive therapy.

Teaching points Take extra

precautions to keep this drug out of the reach of children; this drug can be very dangerous for children.

Use the drug

methazolamide, certain antacids, alkalinizers

Decreased absorption of aspirin with nonabsorbable antacids

Increased methotrexate levels and toxicity with aspirin

Increased effects of valproic acid secondary to displacement from plasma protein sites

Greater glucose lowering effect of sulfonylureas, insulin with large doses (> 2 g/day) of aspirin

Decreased antihypertensive effect of captopril, beta-adrenergic blockers with salicylates; consider discontinuation of aspirin

Decreased uricosuric effect of probenecid,

only as suggested; avoid overdose. Avoid the use of other over-the-counter drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose can occur.

Take the drug with food or after meals if GI upset occurs.

Do not cut, crush, or chew sustained-release products.

Over-the-counter aspirins are equivalent. Price does not reflect effectiveness.

These side effects may occur: Nausea, GI

sulfinpyrazone Possible

decreased diuretic effects of spironolactone, furosemide (in patients with compromised renal function)

Unexpected hypotension may occur with nitroglycerin

Drug-lab test Decreased

serum protein bound iodine (PBI) due to competition for binding sites

False-negative readings for urine glucose by glucose oxidase method and copper reduction method with moderate to large doses

upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirin's effects on blood clotting).

Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting.

of aspirin Interference

with urine 5-HIAA determinations by fluorescent methods but not by nitrosonaphthol colorimetric method

Interference with urinary ketone determination by the ferric chloride method

Falsely elevated urine VMA levels with most tests; a false decrease in VMA using the Pisano method

Name Of Dosage Drug Class Indication Contraindication Adverse Effect Nursing

Drug Responsibilities

Generic :

Trade name: