Generic Name: Losartan Brand Name: CozaarClassification: Anti-hypertensive: Angiotensin II Receptor Antagonist/BlockerSuggested Dosage: (PO) Hypertension- 50 mg OD initially (range 25-100 mg/day as a single dose or 2 divided doses)Prevention of stroke in patients with hypertension and left ventricular hypertrophy- 50 mg OD initially Date Ordered: Ordered dose: ??Mode of action: It blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands. It lowers blood pressure. It decreases risk of cardiovascular death in patients with left ventricular systolic dysfunction who are post-MI. It decreases risk of stroke in patients with hypertension and left ventricular hypertrophy.Side/Adverse Reactions:CNS- dizziness, anxiety, depression, fatigue, headache, insomnia, weaknessCV- hypotension, chest pain, edema, tachycardiaDerm- rashesEENT- nasal congestion, pharyngitis, rhinitis, sinusitisGI- abdominal pain, diarrhea, drug-induced hepatitis, dyspepsia, nausea, vomitingGU- impaired renal functionF and E- hyperkalemiaMS- arthralgia, back pain, myalgiaNursing Responsibilities:

1. Assess blood pressure when lying, sitting, and standing, and pulse periodically during therapy.

2. Assess for signs of angioedema such as dyspnea and facial swelling.3. Monitor daily weight and assess patient routinely for resolution of fluid overload

such as peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention.

4. Monitor renal function and electrolyte levels periodically. Serum potassium, BUN, and serum creatinine may be increased.

5. May be administered without regard to meals.6. Emphasize the importance of continuing to take as directed, even if feeling well.7. Caution patient to avoid sudden changes in position to decrease orthostatic

hypotension.8. Caution patient to avoid activities requiring alertness until response to medication

is known. This drug causes dizziness.9. Instruct patient to notify health care professional of swelling of face, eyes, lips, or

tongue occurs, or if difficulty swallowing or breathing occurs.10. Emphasize the importance of follow-up exams to evaluate effectiveness of

medication.11. Encourage patient to comply with additional interventions for hypertension like

weight reduction, low-sodium diet, moderation of alcohol consumption, discontinuation of smoking, regular exercise, and stress management.

12. Instruct patient and family on proper technique for monitoring blood pressure. Advise them to check blood pressure at least weekly and to report significant changes.

Brand Name: Getryl Generic Name: GlimepirideDrug class: Glimepiride (Getryl) is an oral blood glucose lowering drug of the sulfonylurea class. Mechanism of Action:

The primary mechanism of action of glimepiride appears to be dependent on stimulating the release of insulin from functioning pancreas beta cells. In addition, extra-pancreatic effects (e.g. reduction of basal hepatic glucose production and increased peripheral tissue sensitivity to insulin and glucose uptake) may also play a role in the activity of glimepiride. However, as with other sulfonylureas, the mechanism by which glimepiride lowers blood glucose during long-term administration has not been clearly established.

Indications:Glimepiride (Getryl) is indicated as an adjunct to diet and exercise to lower the blood glucose in patients with non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) whose hyperglycemia cannot be controlled by diet and exercise alone. Glimepiride (Getryl) may be used concomitantly with metformin when diet, exercise, and Glimepiride (Getryl) or metformin alone o not result in adequate glycemic control. Glimepiride (Getryl) is also indicated for use in combination with insulin to lower blood glucose in patients whose hyperglycemia cannot be controlled by diet and exercise in conjunction with an oral hypoglycemic agent.

Adverse Reactions:Glimepiride is generally well tolerated. However, following are the side effects reported during treatment with glimepiride.

Hypoglycaemia: Hypoglycaemia is the greatest potential risk with all sulfonylureas.

Visual reactions: There may be temporary visual impairment (e.g. changes in accommodation and/or blurred vision) due to the change in blood glucose levels, especially at the start of treatment.

Gastrointestinal reaction: Occasionally gastrointestinal symptoms such as nausea, vomiting, sensations of pressure or fullness in the epigastrium, abdominal pain, and diarrhea may occur.

Haematologic reactions: Rarely, thrombocytopenia, and in isolated cases, leucopenia may develop. In isolated instances, thrombocytopenic purpura, agranulocytosis, pancytopenia due to myelosuppression, eosinophilia, haemolyti anemia aplastic anemia, erythrocytopenia and granulocytopenia may occur.

Dermatologic reactions: Occasionally, allertic or pseudo-allergic skin reactions (e.g. pruritus, erythema, urticaria, erythematous and maculopapular and bullous skin eruptions or psoriasiforom drug eruption) may occur in patients treated with sulfonylureas

Hepatic reactions: Increased liver enzymes (AST,ALT), abnormal liver function, cholestasis, cholestatis hepatitis, granulomatous hepatitis, bilirubinaemia aernia and liver failure have been reported with sulfonylurea in isolate cases.

Electrolyte imbalance: In isolated cases, hyponatremia has been reported in patients receiving glimepiride and other sulfonylureas, most often in patients who are on other medications or

have medical conditions known to cause hyponatremia or to increase release of anti-diuretic hormone.

Contraindications:• Glimperide is contraindicated in patients with known hypersensitivity to the drug.• Diabetic ketoacidosis, with or without coma. This condition should be treated with insulin.

Precautions:

The patient’s fasting blood glucose and HbA1C must be measured periodically to determine the minimum effective dose for the patient; to detect primary failure, i.e. inadequate lowering of blood glucose at the maximum recommended dose of medication; and to detect secondary failure, i.e., loss of adequate blood glucose lowering response. After an initial period of effectiveness glycosylated hemoglobin levels should be performed to monitor the patient’s response to therapy.

Drug interactions:

• The hypoglycemic action of sulfonylureas may be potentiated by certain drugs, including nonsteroidal anti-inflammatory drugs and other drugs that are highly protein bound, such as salicylate, sulfonamide, chloramphenicol, coumarins, probenecid, monoamine oxidase inhibitors, and beta adrenergic blocking agents. When these drugs are administered to a patient receiving glimepiride, the patient should be observe closely for hypoglycemia.

• Certain drugs tend to produce hyperglycemia and may lead to loss of control. These drugs include the thiazide and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, and isoniazid. When these drugs are administered to a patient receiving glimepiride, the patient should be closely observed for loss of control.

• Glimepiride is metabolized by cytochrome P450 2C9 (CYP2C9). This should be taken into account when glimepiride is co-administered with inducers, inhibitors or substrates of CYP2C9 (e.g. rifampin, fluconazole, amiodarone, tolbutamide, diclofenac, ibuprofen, naproxen).

• H2 receptor antagonists, beta-blockers, clonidine and reserpine may lead to either potentiation or weakening of the blood-glucose-lowering effect.

• Concomitant treatment with a beta-receptor blocker, clonidine guanethidine or reserpine may mask the warning symptoms of a hypoglycemic attack.

• Acute and chronic alcohol intake may either potentiate or attenuate the activity of glimepiride in an unpredictable fashion.

• The hypoglycemic action of sulfonylureas may be potentiated by certain drugs, including nonsteroidal anti-inflammatory drugs and other drugs that are highly protein bound, such as salicylate, sulfonamide, chloramphenicol, coumarins, probenecid, monoamine oxidase inhibitors, and beta adrenergic blocking agents. When these drugs are administered to a patient receiving glimepiride, the patient should be observe closely for hypoglycemia.

• Certain drugs tend to produce hyperglycemia and may lead to loss of control. These drugs include the thiazide and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, and isoniazid.

When these drugs are administered to a patient receiving glimepiride, the patient should be closely observed for loss of control.

• H2 receptor antagonists, beta-blockers, clonidine and reserpine may lead to either potentiation or weakening of the blood-glucose-lowering effect.

• Concomitant treatment with a beta-receptor blocker, clonidine guanethidine or reserpine may mask the warning symptoms of a hypoglycemic attack.

• Acute and chronic alcohol intake may either potentiate or attenuate the activity of glimepiride in an unpredictable fashion.

Nursing Responsibilities:

1. Monitor for the signs and symptoms of hypoglycemia (cold clammy skin, tremors and others)

2. Encourage taking of medication as prescribe

3. Monitor for glucose level regularly

4. Encourage patient to comply with additional interventions for diabetics like weight reduction, , moderation of sweet and carbohydrate intake, regular exercise, and stress management.

5. Instruct patient and family on proper technique for monitoring glucose level. Advise them to check blood glucose level at least daily and to report significant changes.

Generic Name: Gliclazide

Brand Name: Glubitor

Classification: oral hypoglycemic , anti-diabetic drug

Sugested dose:

Ordered dose:

Date Ordered:

Mode of Action: Gliclazide binds to sulfonylurea receptors on the surface of the Beta islet cells found in the pancreas. This binding effectively closes the K+ ion channels. This decreases the efflux of potassium from the cell which leads to the depolarization of the cell. This causes voltage dependent Ca++ ion channels to open increasing the Ca++ influx. The calcium can then bind to and activate calmodulin which in turn leads to exocystosis of insulin vesicles leading to insulin release.

Indication: Type 2 diabetes

Contraindications: Type 1 diabetes,Hypersensitivity to sulfonylureas, Severe renal or hepatic failure, Pregnancy and lactation, Miconazole coprescriptionSide effects: Hypoglycemia, Gastrointestinal disturbance (reported), Skin reactions (rare), Hematological disorder (rare), Hepatic enzyme rises (exceptional)Interactions: Hyperglycemic action may be caused by danazol, chlorpromazine, glucocorticoids, progestogens, or β-2 agonists. Its hypoglycemic action may be potentiated by phenylbutazone, alcohol, fluconazole, β-blockers, and

possibly ACE inhibitors. It has been found that rifampin increases gliclazide metabolism in humans in vivo.

Nursing Responsibilities:

1. Monitor for the signs and symptoms of hypoglycemia (cold clammy skin, tremors and others)

2. Encourage taking of medication as prescribe

3. Monitor for glucose level regularly

4. Encourage patient to comply with additional interventions for diabetics like weight reduction, , moderation of sweet and carbohydrate intake, regular exercise, and stress management.

5. Instruct patient and family on proper technique for monitoring glucose level. Advise them to check blood glucose level at least daily and to report significant changes.

Generic Name: nifedipine

Brand Name: PROCARDIA

Classification: calcium channel blockers, anti-agina, antihypertensive

Suggested dose: Therapy should be initiated with the 10 mg capsule. The starting dose is one 10 mg capsule, swallowed whole, 3 times/day. The usual effective dose range is 10-20 mg three times daily. Some patients, especially those with evidence of coronary artery spasm, respond only to higher doses, more frequent administration, or both. In such patients, doses of 20-30 mg three or four times daily may be effective. Doses above 120 mg daily are rarely necessary. More than 180 mg per day is not recommended.

Ordered dose:

Date Ordered:

Indication: agina pectoris, hypertension, hypertensive crisis

Contraindications: hypersensitivity to the drug

Mode of Action: Inhibit passage of calcium through the voltage gated L-type (for Large/Long-lasting current) calcium channel on vascular smooth muscle cells and cardiac myocytes, reducing calcium availability for muscle contraction.

Side effects: Flushing, Headache, Palpitations- reflecting the reflex tachycardia in response to vasodilatation. Pedal oedema - dilatation of the precapillary 'sphincters' NOT generally a reflection of worsening heart failure! May worsen heart failure due to their negative inotropic effect

Incidence Approximately 10%Cardiovascular: peripheral edemaCentral Nervous System: dizziness or lightheadednessGastrointestinal: nauseaSystemic: headache and flushing, weaknessIncidence Approximately 5%Cardiovascular: transient hypotension

Incidence 2% or LessCardiovascular: palpitationRespiratory: nasal and chest congestion, shortness of breathGastrointestinal: diarrhea, constipation, cramps, flatulenceMusculoskeletal:inflammation, joint stiffness, muscle crampsCentral Nervous System: shakiness, nervousness, jitteriness, sleep disturbances, blurred vision, difficulties in balanceOther: dermatitis, pruritus, urticaria, fever, sweating, chills, sexual difficultiesIncidence Approximately 0.5%Cardiovascular: syncope (mostly with initial dosing and/or an increase in dose), erythromelalgiaIncidence Less Than 0.5%Hematologic: thrombocytopenia, anemia, leukopenia, purpuraGastrointestinal: allergic hepatitisFace and Throat: angioedema (mostly oropharyngeal edema with breathing difficulty in a few patients), gingival hyperplasiaCNS: depression, paranoid syndromeSpecial Senses: transient blindness at the peak of plasma level, tinnitusUrogenital: nocturia, polyuriaOther: arthritis with ANA (+), exfoliative dermatitis, gynecomastiaMusculoskeletal: myalgia

Interactions: Long-acting nitrates: PROCARDIA may be safely co-administered with nitrates, but there have been no controlled studies to evaluate the antianginal effectiveness of this combination.

Digitalis: Since there have been isolated reports of patients with elevated digoxin levels, and there is a possible interaction between digoxin and nifedipine, it is recommended that digoxin levels be monitored when initiating, adjusting, and discontinuing nifedipine to avoid possible over- or under-digitalization.

Quinidine: There have been rare reports of an interaction between quinidine and nifedipine (with a decreased plasma level of quinidine).

Coumarin anticoagulants: There have been rare reports of increased prothrombin time in patients taking coumarin anticoagulants to whom PROCARDIA was administered. However, the relationship to PROCARDIA therapy is uncertain.

Cimetidine: A study in six healthy volunteers has shown a significant increase in peak nifedipine plasma levels (80%) and area-under-the-curve (74%) after a one week course of cimetidine at 1000 mg per day and nifedipine at 40 mg per day. Ranitidine produced smaller, non-significant increases. The effect may be mediated by the known inhibition of cimetidine on hepatic cytochrome P-450, the enzyme system probably responsible for the first-pass metabolism of nifedipine. If nifedipine therapy is initiated in a patient currently receiving cimetidine, cautious titration is advised.

Other Interactions

Grapefruit Juice: Co-administration of nifedipine with grapefruit juice resulted in approximately a 2-fold increase in nifedipine AUC and Cmax with no change in half-life. The increased plasma concentrations are most likely due to inhibition of CYP 3A4 related first-pass metabolism. Co-administration of nifedipine with grapefruit juice is to be avoided.

Nursing Responsibilities:

1. Assess blood pressure when lying, sitting, and standing, and pulse periodically during therapy.

2. Assess for signs of angioedema such as dyspnea and facial swelling.3. Monitor daily weight and assess patient routinely for resolution of fluid overload such as

peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention.4. Monitor renal function and electrolyte levels periodically. Serum potassium, BUN, and

serum creatinine may be increased.5. May be administered without regard to meals.6. Emphasize the importance of continuing to take as directed, even if feeling well.7. Caution patient to avoid sudden changes in position to decrease orthostatic hypotension.8. Caution patient to avoid activities requiring alertness until response to medication is

known. This drug causes dizziness.9. Instruct patient to notify health care professional of swelling of face, eyes, lips, or tongue

occurs, or if difficulty swallowing or breathing occurs.10. Emphasize the importance of follow-up exams to evaluate effectiveness of medication.11. Encourage patient to comply with additional interventions for hypertension like weight

reduction, low-sodium diet, moderation of alcohol consumption, discontinuation of smoking, regular exercise, and stress management.

12. Instruct patient and family on proper technique for monitoring blood pressure. Advise them to check blood pressure at least weekly and to report significant changes.

Generic Name:

Brand Name: metformin

Classification:  oral anti-diabetic drug; biguanide class

Suggested dose: For treating type 2 diabetes in adults, metformin (immediate release) usually is begun at a dose of 500 mg twice a day or 850 mg once daily. 

Ordered dose:

Date Ordered:

Indication: Type 2 diabetes

Contraindications: Metformin is contraindicated in people with any condition that could increase the risk of lactic acidosis, including kidney disorders (creatinine levels over 150 μmol/l, although this is an arbitrary limit), lung disease and liver disease.

Mode of Action: Metformin improves hyperglycemia primarily through its suppression of hepatic glucose production.

Side effects: Nausea, vomiting, gas bloating, diarrhea and loss of appetite.

Interactions: Cimetidine (Tagamet), by decreasing the elimination of metformin from the body, can increase the amount of metformin in the blood by 40%. This may increase the frequency of side effects from metformin.

Nursing Responsibilities:

1. Monitor for the signs and symptoms of hypoglycemia (cold clammy skin, tremors and others)

2. Encourage taking of medication as prescribe

3. Monitor for glucose level regularly

4. Encourage patient to comply with additional interventions for diabetics like weight reduction, , moderation of sweet and carbohydrate intake, regular exercise, and stress management.

5. Instruct patient and family on proper technique for monitoring glucose level. Advise them to check blood glucose level at least daily and to report significant changes.

Generic Name: Flupentixol deconate

Brand Name:

Classification: antipsychotic drug of the thioxanthene class

Suggested dose:

Ordered dose:

Date Ordered:

Indication: Flupentixol's main use is as a long-acting injection given two or three times weekly to individuals with schizophrenia who have poor compliance with medication and suffer frequent relapses of illness. Flupentixol is also used in low doses as an antidepressant.

Contraindications: Flupenthixol should not be given to patients who are hypersensitive to the thioxanthenes. Itis also contraindicated in patients who have suspected or diagnosed subcortical brain damage,blood dyscrasias, pheochromocytoma, liver damage, cerebrovascular or renal insufficiency, severe cardiovascular disorders. Patients with confusion/agitation should not use Flupenthixol.

Women of childbearing potential or during lactation should discuss with the doctors about the potential risk of Flupenthixol to the fetus and child.

Mode of Action: Flupentixol is an anxiolytic, antidepressive agent and a mood stabilizer. It inhibits the central monoamine receptors, particularly the dopamine D1 and D2 receptors. Therefore, it increases the amount of serotonin and noradrenaline that control mood and thinking, and improves mood.

Side effects: The side effects of flupentixol are similar to most other typical antipsychotics, namely extrapyramidal symptoms of akathisia, muscle tremors, and rigidity and antihistamine effects like sedation and somnolence. Constipation, drowsiness, vision changes or dry mouth may occur. restlessness, muscle stiffness, weakness, difficulty speaking, loss of balance, mask- like facial expression, trembling or shaking, dizziness, lip smacking or other uncontrollable movements, difficulty urinating, skin rash/discoloration.

Interactions:

- Monoamine oxidase inhibitors (MAOI): MAOI could theoretically affect flupenthixol pharmacodynamics-Arecoline-Eproxindine

-Ethanol: Flupenthixol and Ethanol cause additive CNS depression- Tricyclic antidepressants: Flupenthixol increases the effect of Tricyclic antidepressants

Nursing Responsibilities:

1. The medicine should be stored at room temperature preferably below 30 degree centigrade and out of reach of children

2. The flupentixol should be kept away from excessive heat and moisture.3. Outdated medicines should be destroyed.4. Do not abruptly stop taking the medication5. Take only as prescribe6. Swallow medicine as a whole do not cut or chew.7. Store medication at room temperature.

Generic Name: Glibenclamide 

Brand Name: Glynamide

Classification: sulfonylureas; oral hypoglycemic, anti-diabetic

Suggested dose:

Ordered dose:

Date Ordered:

Indication:  type II diabetes

Contraindications: allergy to the medication,

Mode of Action: glibenclamide inhibits the ATP dependent potassium efflux from pancreatic (islet) b-cells. This leads to the influx of calcium ions into the cell and to the activation of enzymes that cause the release of insulin. On a long-term basis sulphonylureas probably also influence the hepatic glucose metabolism and the peripheral insulin effect.

Side effects: This drug is a major cause of drug induced hypoglycemia. Cholestatic jaundice is noted.

Interactions: Sulfonamides, beta-blockers, non-steroidal anti-inflammatory agents, etc. hardly increase the risk of hypoglycemia of glibenclamide (on the contrary to many other sulphonylureas).

Nursing Responsibilities:

1. Monitor for the signs and symptoms of hypoglycemia (cold clammy skin, tremors and others)

2. Encourage taking of medication as prescribe

3. Monitor for glucose level regularly

4. Encourage patient to comply with additional interventions for diabetics like weight reduction, , moderation of sweet and carbohydrate intake, regular exercise, and stress management.

5. Instruct patient and family on proper technique for monitoring glucose level. Advise them to check blood glucose level at least daily and to report significant changes.

Generic Name: co-amoxiclav

Brand Name: Augmentin

Classification:  β-lactam antibiotic and  β-lactamase inhibitor

Suggested dose: Adults: The usual adult dose is one 500-mg tablet of amoxicillin/clavulanate potassium every 12 hours or one 250-mg tablet of amoxicillin/clavulanate potassium every 8 hours. For more severe infections and infections of the respiratory tract, the dose should be one 875-mg tablet of amoxicillin/clavulanate potassium every 12 hours or one 500-mg tablet of amoxicillin/clavulanate potassium every 8 hours

Ordered dose:

Date Ordered:

Indication: Lower Respiratory Tract Infections - caused by β-lactamase - producing strains of H. influenzae and M. (Branhamella) catarrhalis.Otitis Media - caused by β-lactamase - producing strains of H. influenzae andM. catarrhalis.Sinusitis - caused by β-lactamase - producing strains of H. influenzae and M. catarrhalis.Skin and Skin Structure Infections - caused by β-lactamase - producing strains of S. aureus, E. coli and Klebsiella spp.Urinary Tract Infections - caused by β-lactamase - producing strains of E. coli, Klebsiella spp., and Enterobacter spp.Contraindications: hypersensitivity to penicillin, It is also contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with amoxicillin/clavulanate potassium.

Mode of Action: penicillin in inhibits bacterial cell wall synthesis, causing lysis of the cell, clavulanate inhibits the action of beta-lactamase that destroys the beta-lactam ring that is responsible for the destruction of the cell wall

Side effects: Gastrointestinal: Diarrhea, nausea, vomiting, indigestion, gastritis, stomatitis,glossitis, black "hairy" tongue, mucocutaneous candidiasis, enterocolitis, and hemorrhagic/pseudomembranous colitis. Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment.

Hypersensitivity Reactions: Skin rashes, pruritus, urticaria, angioedema,serum sickness–like reactions (urticaria or skin rash accompanied by arthritis,arthralgia, myalgia, and frequently fever), erythema multiforme (rarely Stevens-Johnson syndrome), acute generalized exanthematous pustulosis, hypersensitivity vasculitis, and an occasional case of exfoliative dermatitis(including toxic epidermal necrolysis) have been reported. These reactions may be controlled with antihistamines and, if necessary, systemic corticosteroids. Whenever such reactions occur, the drug should be discontinued, unless the opinion of the physician dictates otherwise. Serious and occasional fatal hypersensitivity (anaphylactic) reactions can occur with oral penicillin.

Liver:A moderate rise in AST (SGOT) and/or ALT (SGPT) has been noted in patients treated with ampicillin-class antibiotics, but the significance of these findings is unknown. Hepatic dysfunction, including hepatitis and cholestaticjaundice, increases in serum transaminases (AST and/or ALT), serum bilirubin and/or alkaline phosphatase, has been infrequently reported with amoxicillin/clavulanate potassium. It has been reported more commonly in the elderly, in males, or in patients on prolonged treatment. The histologic findings on liver biopsy have consisted of predominantly cholestatic, hepatocellular, or mixed cholestatic-hepatocellular changes. The onset of signs/symptoms of hepatic dysfunction may occur during or several weeks after therapy has been discontinued. The hepatic dysfunction, which may be severe, is usually reversible. On rare occasions, deaths have been reported

(less than 1 death reported per estimated 4 million prescriptions worldwide). These have generally been cases associated with serious underlying diseases or concomitant medications.

Renal:Interstitial nephritis and hematuria have been reported rarely. Crystalluria has also been reported

Hemic and Lymphatic System: Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported during therapy with penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. A slight thrombocytosis was noted in less than 1% of the patients treated with amoxicillin/clavulanate potassium. There have been reports of increased prothrombin time in patients receiving amoxicillin/clavulanate potassium and anticoagulant therapy concomitantly.

Central Nervous System: Agitation, anxiety, behavioral changes, confusion, convulsions, dizziness, insomnia, and reversible hyperactivity have been reported rarely.

Miscellaneous:Tooth discoloration (brown, yellow, or gray staining) has been rarely reported. Most reports occurred in pediatric patients. Discoloration was reduced or eliminated with brushing or dental cleaning in most cases.

Interactions:  High urine concentrations of ampicillin may result in false-positive reactions when testing for the presence of glucose in urine using CLINITEST ® , Benedict's Solution or therefore amoxicillin/clavulanate potassium, it is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as CLINISTIX® ) be used.

Nursing Responsibilities:

1. Encourage to take adhere to the treatment regiment

2. Take medication as prescribe, take it on time.

3. Monitor for any side effects or allergic reaction

4. Store liquid form in refrigerator

5. Give with food

6. Take with full glass of water

Generic Name:  risperidone Brand Name: RisperdalClassification: antipsychotic

Suggested dose:  Risperidone can be administered once or twice daily. Initial dosing is generally 2 mg/day. Dose increases can occur in increments of 1-2 mg/day, as tolerated, to a recommended dose of 4-8 mg/day. In children, risperidone should be initiated at 0.5 mg once daily, and can be increased in increments of 0.5 or 1 mg/day, as tolerated, to a recommended dose of 2.5 mg/day. 

Ordered dose:

Date Ordered:

Indication: schizophrenia, bipolar mania and autism

Contraindications: patients with a known hypersensitivity to the medication, history of high blood sugar and diabetes, and older patients who are being treated for mental illness from dementia. People with a history of seizures should consult their doctor before using Risperdal, as should patients with cardiovascular disease, cerebrovascular disease, dehydration, diabetes, hyperglycemia, pancreas problems, hypovolemia, Alzheimer's disease, hypothyroidism, pregnancy, and hepatic impairment.

Mode of Action: The exact mechanism of action of risperidone is not known, but, like other anti-psychotics, it is believed that risperidone affects the way the brain works by interfering with communication among the brain's nerves. 

Side effects: The most commonly-noted side effects associated with risperidone are extrapyramidal effects

(sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes), dizziness, hyperactivity,

tiredness, abdominal pain, fatigue, fever and nausea. Risperidone may cause a condition called orthostatic

hypotension during the early phase of treatment (the first week or two). Patients who develop orthostatic hypotension

have a drop in their blood pressure when they rise from a lying position and may become dizzy or even lose

consciousness.

Studies involving risperidone suggest an increased risk of hyperglycemia-related adverse reactions as seen

in diabetes.

Interactions: Risperidone may interfere with elimination by the kidneys of clozapine (Clozaril), a different type of antipsychotic medication, causing increased levels of clozapine in the blood. Increase the risk of side effects with clozapine.

Nursing Responsibilities:

1. Monitor for any extrapyramidal effects (sudden, often jerky, involuntary motions of the head,

neck, arms, body, or eyes)

2. Monitor blood sugar level.

3. Change position slowly, clients taking this medication is prone to orthostatic hypotension

Generic Name: Losartan potasium + Hydrochlorothiazide

Brand Name: combizar

Classification: diuretic

Suggested dose: Usual Initial and Maintenance Adult Dose: 1 tablet of Losartan 50mg + HCTZ 12.5mg FDC once daily.

Ordered dose:

Date Ordered:

Indication: hypertension

Contraindications: hypersensitivity to any component of the product, Hypersensitivity to sulfonamide-derived drugs, Pregnancy, Patients with anuria, severe renal impairment

Mode of Action:

-Mechanism of Losartan potasium :a selective, competitive Angiotensin II receptor type1  (AT1) receptor antagonist, simply it inhibits indirectly some substances occur naturally in ur body that are responsible for body water retention. Thus by decreasing body water volume, the blood volume will decrease then the lowering blood pressure will occur.

-Mechanism of Hydrochlorothiazide:acting on the kidneys to reduce sodium (Na) reabsorption in the distal convoluted tubule. This increases the osmolarity in the lumen of the kidneys, causing less water to be reabsorbed by the collecting ducts. This leads to increased urinary output----->decreasing body water volume -----> decreasing blood volume----> lowering blood pressure.

Side effects: Body as a Whole: chest pain, facial edema, fever, orthostatic effects, syncope

Cardiovascular: angina pectoris, arrhythmias including atrial fibrillation, sinus bradycardia, tachycardia, ventricular tachycardia and ventricular fibrillation, CVA,hypotension, myocardial infarction, second degree AV block

Digestive: anorexia, constipation, dental pain, dry mouth, dyspepsia, flatulence,gastritis, vomiting

General disorders and administration site conditions: malaise

Hematologic: anemia

Metabolic: gout

Musculoskeletal: arm pain, arthralgia, arthritis, fibromyalgia, hip pain, joint swelling, knee pain, leg pain, muscle cramps, muscle weakness, musculoskeletal pain, myalgia, shoulder pain, stiffnes

Nervous System/Psychiatric: anxiety, anxiety disorder, ataxia, confusion,depression, dream abnormality, hypesthesia, insomnia, libido decreased, memory impairment, migraine, nervousness, panic disorder, paresthesia, peripheral neuropathy, sleep disorder, somnolence, tremor, vertigo

Respiratory: dyspnea, epistaxis, nasal congestion, pharyngeal discomfort, respiratory congestion, rhinitis, sinus disorder

Skin: alopecia, dermatitis, dry skin, ecchymosis, erythema, flushing,photosensitivity, pruritus, sweating, urticaria

Special Senses: blurred vision, burning/stinging in the eye, conjunctivitis, decrease in visual acuity, taste perversion, tinnitus

Urogenital: impotence, nocturia, urinary frequency, urinary tract infection.

HydrochlorothiazideOther adverse experiences that have been reported with hydrochlorothiazide, without regard to causality, are listed below:

Body as a Whole: weakness

Digestive: pancreatitis, jaundice (intrahepatic cholestatic jaundice), sialadenitis, cramping, gastric irritation

Hematologic: aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia,thrombocytopenia

Hypersensitivity: purpura, photosensitivity, urticaria, necrotizing angiitis (vasculitis and cutaneous vasculitis), fever, respiratory distress including pneumonitis and pulmonary edema;

Metabolic: hyperglycemia, glycosuria, hyperuricemia

Musculoskeletal: muscle spasm

Nervous System/Psychiatric: restlessness

Renal: renal failure, renal dysfunction, interstitial nephritis

Skin: erythema multiforme including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis

Special Senses: transient blurred vision, xanthopsia.

Interactions: Lithium: lithium excretion will be reduced

Anti-diabetic drug: adjustment to the dose is recomended

Nursing Responsibilities:

1. Assess blood pressure when lying, sitting, and standing, and pulse periodically during therapy.

2. Assess for signs of angioedema such as dyspnea and facial swelling.3. Monitor daily weight and assess patient routinely for resolution of fluid overload such as

peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention.4. Monitor renal function and electrolyte levels periodically. Serum potassium, BUN, and

serum creatinine may be increased.5. May be administered without regard to meals.6. Emphasize the importance of continuing to take as directed, even if feeling well.7. Caution patient to avoid sudden changes in position to decrease orthostatic hypotension.8. Caution patient to avoid activities requiring alertness until response to medication is

known. This drug causes dizziness.9. Instruct patient to notify health care professional of swelling of face, eyes, lips, or tongue

occurs, or if difficulty swallowing or breathing occurs.10. Emphasize the importance of follow-up exams to evaluate effectiveness of medication.11. Encourage patient to comply with additional interventions for hypertension like weight

reduction, low-sodium diet, moderation of alcohol consumption, discontinuation of smoking, regular exercise, and stress management.

12. Instruct patient and family on proper technique for monitoring blood pressure. Advise them to check blood pressure at least weekly and to report significant changes.

13. Encourage to monitor fluid input and output.

Generic Name: biperiden hydrochloride

Brand Name: akineton

Classification:  antiparkinsonian agent of the anticholinergic type

Suggested dose: The usual oral daily doses are between 2 and 16 mg. If possible, patients should be started with a low initial dose which is increased slowly.

Ordered dose:

Date Ordered:

Indication: adjunctive treatment of all forms of Parkinson's disease (postencephalitic, idiopathic, and arteriosclerotic). It seems to exert better effects in the postencephalitic and idiopathic than in the arteriosclerotic type. It relieves muscle rigidity, reduces abnormal sweating and salivation, improves abnormal gait, and to lesser extent, tremor.

Contraindications: Hypersensitivity to biperiden, Narrow angle glaucoma, IleusCaution : Patients with obstructive diseases of the urogenital tract, patients with a known history of seizures and those with potentially dangerous tachycardiaMode of Action: Biperiden has an atropine-like blocking effect on all peripheral structures which are parasympathetic-innervated (e.g. cardiovascular and visceral organs). It also has a prominent central blocking effect on M1 receptors.

Side effects: Atropine-like side effects such as dry mouth; blurred vision; drowsiness; euphoria or disorientation; urinary retention; postural hypotension; constipation; agitation; disturbed behavior may been seen. A case of generalized choreic movements has been reported in a Parkinson's disease patient when biperiden was added to carbidopa/levodopa. A reduction in rapid eye movement (REM) sleep, characterized by increased REM latency and decreased percentage of REM sleep, has been reported. There usually are no significant changes in blood pressure or heart rate in patients who have been given the parenteral form of AKINETON. Mild transient postural hypotension and bradycardia may occur. These side effects can be minimized or avoided by slow intravenous administration. No local tissue reactions have been reported following intramuscular injection. If gastric irritation occurs following oral administration, it can be avoided by administering the drug during or after meals.

Interactions:

Other anticholinergic drugs (e.g. spasmolytics, antihistamines, TCAs) : Side effects of biperiden may be increased.

Quinidine : Increased anticholinergic action (particular on AV conduction). Antipsychotics : Long term use of biperiden may mask or increase the risk of tardive

dyskinesia. Pethidine (meperidine) : Central effects and side effects of pethidine may be

increased. Metoclopramide : Action of metoclopramide is decreased. Alcohol : Risk of serious intoxication.

Nursing Responsibilities:

1. Monitor Pulse rate, and blood pressure

2. Encourage drinking adequate water

3. Encourage slow change in position

4. Give foods high in fiber for easy passage of stool

5. Do not let client do extraneous activities

6. Encourage rest and sleep

7. Administer drug during or after meal if gastric irritation occurs.

Generic Name: Levomepromazine 

Brand Name: Nozinan

Classification:  aliphatic phenothiazine neuroleptic drug, It is a low-potency antipsychotic with strong analgesic and antiemetic properties.

Suggested dose:

Ordered dose:

Date Ordered:

Indication:  psychosis, particular those of schizophrenia, and manic phases of bipolar disorders, Levomepromazine is also used at lower doses for the treatment of nausea and insomnia.

Contraindications:

Mode of Action:

Side effects:

Sleepiness. Weakness or loss of strength (asthenia). Dry mouth. A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in

dizziness and lightheadedness (postural hypotension). Constipation. Skin rashes. Increased sensitivity of the skin to UV light (photosensitivity). Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal

effects). These Parkinson's-like side effects are more likely to happen in people who are taking high doses for long periods of time. Tell your doctor if you are affected in this way.

Interference with the body's temperature regulation (this is more common in elderly people and may cause heat stroke in very hot weather or hypothermia in very cold weather).

Decrease in number of blood cells in the blood (agranulocytosis). Jaundice (tell your doctor straight away if you notice any yellowing of your eyes or skin shile taking this

medicine). Abnormal heart beats (arrhythmias). High temperature combined with falling levels of consciousness, paleness, sweating and a fast heart beat

(neuroleptic malignant syndrome). Requires stopping the medicine and immediate medical treatment.Interactions:

There may be an increased risk of drowsiness and sedation if levomepromazine is used with any of the following, which can also cause drowsiness:

alcohol barbiturates, eg amobarbital, phenobarbital benzodiazepines, eg diazepam, temazepam sedating antihistamines, eg chlorphenamine, hydroxyzine sleeping tablets, eg zopiclone strong opioid painkillers, eg morphine, codeine tricyclic antidepressants, eg amitriptyline.

There may be an increase in side effects such as dry mouth, constipation or heat stroke (in hot and humid conditions) if levomepromazine is used with other medicines that have anticholinergic effects, including the following:

anticholinergic medicines for Parkinson's symptoms, eg procyclidine antihistamines, eg brompheniramine, chlorphenamine other antipsychotic medicines

other antisickness medicines, eg promethazine, meclozine, cyclizine antispasmodic medicines, eg hyoscine medicines for urinary incontinence, eg oxybutynin, flavoxate, tolterodine, propiverine, trospium MAOI antidepressants, eg phenelzine muscle relaxants, eg baclofen tricyclic antidepressants, eg amitriptyline.

Medicines that increase the risk of a type of abnormal heart rhythm, seen as a 'prolonged QT interval' on an ECG, should be avoided in combination with levomepromazine. These medicines include the following:

antiarrhythmics (medicines to treat abnormal heart beats), eg amiodarone, procainamide, disopyramide, sotalol

the antihistamines astemizole, mizolastine or terfenadine atomoxetine certain antidepressants, eg amitriptyline, imipramine, maprotiline certain antimalarials, eg halofantrine, chloroquine, quinine, mefloquine, Riamet certain other antipsychotics, eg thioridazine, haloperidol, sertindole, pimozide cisapride intravenous erythromycin or pentamidine moxifloxacin.

There may also be an increased risk of a prolonged QT interval if medicines that can alter the levels of salts such as potassium or magnesium in the blood, eg diuretics such as furosemide, are used in combination with levomepromazine.Levomepromazine may enhance the blood pressure-lowering effects of certain medicines used to treat high blood pressure (antihypertensives). If you are taking medicines for high blood pressure you should tell your doctor if you feel dizzy or faint after starting treatment with this medicine, as your blood pressure medicines may need adjusting.Levomepromazine may oppose the effect of antiepileptic medicines.Levomepromazine may oppose the effects of dopamine agonists used to treat Parkinson's disease, eg levodopa, apomorphine, bromocriptine, cabergoline, pergolide, ropinirole, rotigotine.

Nursing Responsibilities:

1. Do not give medication with other relaxant or drugs/substances that can cause drowsiness.

2. Give only as ordered

3. Encourage to slowly change position

4. Monitor liver enzymes

5. Monitor for extrapyramidal effects

6. Keep client away from sunlight

7. Hydrate client

8. Keep client thermoregulated