CHAPTER VII DRUG STUDY Name of Patient: R.V.C.

Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Classification Generic Name: Omeprazole Mechanism of Action Indication GERD/ maintenance of healing in erosive esophagitis: Duodenal ulcers short term treatment of active benign gastric ulcer. Patholoigic hypersecreto ry conditions, including ZollingerEllison syndrome. Reduction of risk GI bleeding in critically ill patients. Contraindication Omeprazole is contraindicated with patients having hypersensitivity to it. Metabolic alkalosis and hypocalcemia, liver disease, increased risk of hip fractures in patient using high- doses for > 1 year old; Barter;s syndrome, hypokalemia, and respiratory alkalosis. Side Effects Dizziness, drowsiness, headache, fatigue, weakness, chest pain Nursing Responsibilities Administer on empty stomach, at least 1 hour before a meal. For patient with NGT or enteral feeding, suspend feeding for 3 hours before and 1 hour after administration. If administered through a nasogastric tube, suspend in 20 ml of water. Stir well and drink immediately. May cause occasional drowsiness or dizziness. Caution patient to avoid driving and other

Proton Pump Binds to an Inhibitor enzyme on gastric parietal cells Brand in the Name: presence of Zegerid acidic gastric pH, Dosage: preventing the 40 mg OD final transport pre of hyrogen breakfast ions into the gastric lumen. Route: Intravenous Date ordered: January 05, 2014

activities requiring alertness until response to medication is known. Advise patient to report onset of black, tarry stools, diarrhea, abdominal pain or persistent headache to healthcare professional promptly.

Name of Patient: R.V.C. Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Classification Generic Name: Furosemide Brand Name: Lasix Dosage: 40 mg OD Route: Oral Date ordered: January 06, 2014 Loop Diuretic Mechanism of Action Inhibits the reabsorption of sodium and chloride in the proximal and distal tubules as well as the ascending loop of Henle; this results in the excreation of sodium, chloride and to a lesser degree, potassium and bicarbonate ions. Indication Edema associated with CHF, nephritic syndrome, hepatic cirrhosis, and ascites. Contraindication Side Effects Hypotension Water/electr olyte depletion Abdominal pain Dizziness Anemia Nursing Responsibilities Note reasons for therapy, clinical presentation, other agents trialed, and outcome. When more than 40 mg/day is required, give in divided doses Monitor BP, weight, breath sounds I&O, electrolyte; observe for S&S of hypokalemia and for edema With rapid diuresis, observe for dehydration and circulatory collapse; monitor BP and pulse

Furosemide is contraindicated in patients with anuria or who are hypersensitive to the drug. The manufacturer states that the drug should be IV for acute discontinued in pulmonary patients with edema. progressive renal disease if PO to treat increasing hypertension azotemia and in conjuction oliguria occur with during therapy. spironolacto ne, triamterene, and other diuretics except ethacrynic acid.

Name of Patient: R.V.C. Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Classification Generic Name: Metoclopra mide Brand Name: Reglan Dosage: 1 amp PRN Route: Intravenous Date ordered: January 05, 2014 Gastrointestin al agent; prokinetic agent (gi stimulant) Mechanism of Action Metoclopramide enhances the motility of the upper GI tract and increases gastric emptying without affecting gastric, biliary or pancreatic secretions. It increases duodenal peristalsis which decreases intestinal transit time, and increases lower oesophageal sphincter tone. Indication Treatment of nausea and vomiting of a variety of etiologies: Emesis during pregnancy and labor, gastric ulcer, anorexia nervosa Contraindication GI haemorrhage, mechanical obstruction and perforation; phaeochromocyto ma; history of seizures. Side Effects restlessness, drowsiness, hypotension, hypertension, headache, depression, hypersensitivity reactions (e.g. bronchospasm, rash) Nursing Responsibilities Monitor BP carefully during IV administration. Give intravenous doses slowly Monitor for extrapyramidal reactions, and consult physician if they occur.

Name of Patient: R.V.C. Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Generic Name: Captopril Brand Name: Capoten Dosage: 25 mg tab TID Route: Oral Date ordered: January 05, 2014 Classification cardiovascular agent; angiotensinconverting enzyme (ace) inhibitor; antihypertensiv e agent Mechanism of Action Inhibits angiotensinconverting enzyme resulting in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Indication Hypertension; in conjunction with digitalis and diuretics in CHF, diabetic nephropathy. Contraindicatio n Angioedema, hypersensitivity to captopril or ACE inhibitors; hypotension; Side Effects Dry mouth, drowsiness, dizziness, headache, constipation, Nursing Responsibilities Monitor BP closely following the first dose. A sudden exaggerated hypotensive response may occur within 13 h of first dose, especially in those with high BP or on a diuretic and restricted salt intake. Advise bed rest and BP monitoring for the first 3 h after the initial dose. Monitor therapeutic effectiveness. At least 2 wk of therapy may be required before full therapeutic effects are achieved.

Name of Patient: R.V.C. Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Classification Generic Name: Atorvastati n Calcium Brand Name: Lipitor/ Simvastatin Dosage: 40 mg 1 tab OD @ HS Route: Oral Date ordered: January 05, 2014 Antihyperlipid emic HMG coenzyme A (HMG CoA) inhibitor Mechanism of Action Inhibits HMG CoA, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs (associated with increased risk of CAD), and increases serum HDLs (associated with decreased risk of CAD); increases hepatic LDL recapture sites, enhances reuptake and catabolism of LDL; lowers triglyceride levels. Indication To reduce the risk of MI, stroke, angina, and revascularizatio n procedures in patients with no evidence of CAD with multiple risk factors. Heterozygous familial hypercholesterol emia. Adjunct to diet to reduce elevated LDL, total cholesterol and triglyceride levels to increase HDL level in patients with primary hypercholestero lemia and mixed dyslipidemia. Contraindicati on Contraindicate d in patients hypertensive to the drug and in those with active liver disease or conditions linked with unexplained persistent increases in transaminase levels. Side Effects Constipation , diarrhea, fatigue, gas, heartburn, and headache. Nursing Responsibilities Monitor patients lipid and liver function levels at baseline and periodically thereafter. Administer drug without regard to food, but at same time each day. Withhold atorvastatin in any acute, serious condition (severe infection, hypotension, major surgery, trauma, severe metabolic or endocrine disorder,s eizures) that may suggest myopathy or serve as risk factor for development of renal failure. Asses patients and familys knowledge of drug therapy.

Name of Patient: R.V.C. Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Classification Generic Name: Tramadol Brand Name: Ultram Dosage: 50 mg PRN for severe pain Route: Intravenous Date ordered: January 05, 2014 Opioid analgesic Mechanism of Action Tramadol acts as a -opioid receptor agonist, serotonin releasing agent, norepinep hrine reuptake inhibitor, NMDA receptor antagon ist 5-HT2C receptor antagonist, (7)5 nicotinic acetylcholine receptor antagon ist TRPV1 receptor agonist, and M1 and M3 muscarinic acetylcholine receptor antagonist. Indication Contraindication Side Effects Nursing Responsibilities 1) Determine patients past or present history of addiction to or dependence on opoids. 2) Instruct patient to increase fluid intake to prevent dry mouth and constipation. 3) For better analgesic effect, give drugs before onset of intense pain. 4) Reassess level of pain at least 30 minutes after administration. 5) Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations decrease or rate is below 12 breaths/minute.

Relief of Hypersensitivity to Sweating moderate to the drug moderately Dizziness severe pain.. Raised intracranial Nausea pressure Dry mouth Severe renal impairment Fatigue Constipation

Name of Patient: R.V.C. Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Classification Generic Name: Clopidogrel Brand Name: Thrombix Dosage: 75 mg 1 tab OD Route: Oral Date ordered: January 05, 2014 Antiplatelet agents; Platelet aggregation inhibitors Mechanism of Action Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. Indication Reduction of atherosclerot ic events (MI, stroke, vascular death) in patients at risk for such events including recent MI, acute coronary syndrome (unstable angina/nonQ-wave MI), stroke, or peripheral vascular disease. Contraindication Hypersensitivity Side Effects Nursing Responsibilities Assess patient for symptoms of stroke, peripheral vascular disease, or MI periodically during therapy. Administer once daily without regard to food. Instruct patient to take medication exactly as directed. Take missed doses as soon as possible unless almost time for next dose; do not double doses. Advise patient to notify health care professional promptly if fever, chills, sore throat, or unusual bleeding or bruising occurs.

Dizziness, Fatigue, Pathologic Headache. bleeding (peptic Dyspnea ulcer, intracranial Chest Pain, hemorrhage) Hypertension.

Name of Patient: R.V.C. Age: 63 years old Admitting Diagnosis: Acute Coronary Syndrome, Non ST Elevation Myocardial Infarction diffused wall Drug Name Classification Generic Name: Isosorbide Dinitrate Brand Name: Isoket Dosage: 5 mg PRN for chest pain Route: Oral Date ordered: January 05, 2014 Anti-angina Mechanism of Action Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption. Indication Contraindication Side Effects Headache, weakness, dizziness, faintness Tachycardia, angina, perspiration, cold sweat Nursing Responsibilities Assess for pain: duration, time started, activity being performed, character, intensity Assess orthostatic hypotension, blood pressure at baseline and during treatment

Dinitrate: Contraindicated Treatment with allergy to and nitrates, severe prevention of anemia, head angina trauma, cerebral pectoris hemorrhage, hypertrophic cardiomyopathy, postdural hypotension