Drug Study

Drug Data Generic Name Clozapine

Trade Name Clozaril, FazaClo

Classification Therapeutic atypical antipsychotic

Pharmacologic tricyclic dibenzodiazepi ne derivative

Patients Dose ½ tab of 100mg/tab OD

Minimum Dose 50mg OD Maximum Dose 50mg OD Contents Clozapine Availability 25 mg, 100 mg tablets

Routes of administration po

Pregnancy Category B

Mechanism of Action Chemical effect: binds to dopamine receptors within limbic system of the the CNS CNS and and may may inte interfe rfere re with adrenergic, cholinergic, histaminergic and serotoninergic receptors

Indications

Contraindications

Adverse Reaction

Nursing Responsibilities

Schizophrenia unresponsi unresponsive ve to or into intole lera rant nt of standard therapy with other antipsychotics (treatment refr refrac acto tory ry). ). To reduce reduce recurrent recurrent suicidal behaviour in schizophrenic patients.

Pts Pts taki taking ng drug drugs s that that suppre suppress ss bone bone marro marrow w function and in those with paralytic ileus, uncont uncontrol rolled led epile epilepsy psy,, histo history ry of drug-i drug-indu nduced ced agranulo agranulocytos cytosis, is, myelomyelosuppre suppressi ssive ve disord disorders ers,, severe CNS depression or coma, coma, WBC WBC count count less less than 3,500/mm3

CNS: CNS: agitat agitation ion,, akathi akathisia sia,, anxiet anxiety, y, ataxia ataxia,, confus confusion ion,, depressi depression, on, disturbed disturbed sleep sleep or night nightma mares res,, dizzin dizziness ess,, drowsine drowsiness, ss, fatigue, fatigue, fever, fever, head headac ache he,, hype hyperk rkin ines esia ia,, hypo hypoki kine nesi sia a or akin akines esia ia,, insomnia, myoclonus, rigidity, sedation, sedation, seizures seizures,, slurred slurred speech speech,, syncop syncope, e, tremo tremor, r, vertigo, weakness CV: cardiomy cardiomyopath opathy, y, chest chest pain, ECG changes, hypertens hypertension, ion, hypotensi hypotension, on, orth orthos osta tati tic c hypo hypote tens nsio ion, n, tachycardia GI: constipat constipation, ion, dry mouth, mouth, ex ce ces si si ve ve sa lili va va titio n, n, heartburn, nausea, vomiting GU: abnormal abnormal ejaculat ejaculation, ion, in co co nt nt in ine nc nc e, e, ur in ina ry ry frequency frequency,, urinary urinary urgency, urgency, urine retention Hema Hemat: t: agra agranu nulo locy cyto tosi sis, s, leukopenia Metab: hypercholesterolemia, hypercholesterolemia, hypertriglyceridemia, hypertriglyceridemia, severe hyperglycemia, weight gain MS: muscle pain or spasm, spasm, muscle weakness Skin: rash

Before *Assess patient’s psychotic condition *Monitor *Monitor baseline baseline WBC and differenti differential al counts *Assess for risk factors of diabetes *obtain *obtain baseline baseline fasting fasting blood blood glucose glucose level *obtain laboratory works

Therapeutic Effects: Effects: relieves relieves psychotic psychotic signs signs and symptoms Onset unknown Peak weeks Duration 4-12 hours Therapeutic Levels 25-900mg/day

Patient’s indication Relief of psycho psychotic tic signs signs and symptoms

Precaution Use Cautiously in: Patie Patients nts with with prosta prostatic tic hype hyperp rpla lasi sia, a, urin urinar ary y retention, or angle-closure glaucoma Drug/food interaction Drug-Drug: Anticholinergics: Anticholinergics: increase anticholinergic anticholinergic effects Antihypertensives: incr increa ease se hypo hypote tens nsiv ive e effects Cita Citalo lopr pram am:: incr increa ease se clozapine level Digoxin, warfarin: increase levels Psyc Psycho hoac acti tive ve drug drugs: s: produce additive effects

Drug Half Life 8-12 hours

Source: Springhouse Nurse’s Drug Guide. (2008) Philadelphia: Philadelphia: Lippincott Williams & Wilkins.

During *Wat *Watch ch for for sign signs s and and symp sympto toms ms of cardio cardiomyo myopat pathy, hy, inclu includin ding g exerti exertiona onall dyspnea, fatigue, orthopnea *Obs *Obser erve ve pati patien entt care carefu full lly y when when administe administering ring medicatio medication n to ensure ensure that medic medicati ation on is actual actually ly taken taken and not hoarded or cheeked. *Mon *Monit itor or for for sign signs s of myoc myocar ardi diti tis s (unexplained fatigue, dyspnea, tachypnea, fever, chest pain, palpitations, other signs and sympto symptoms ms of heart heart failur failure, e, ECG ECG changes *Monitor *Monitor frequency frequency and consisten consistency cy of bowel bowel movement movements. s. Increasin Increasing g bulk and fluids fluids in the diet may help to minimize minimize constipation. After *After stopping drug, monitor WBC counts weekly for at least 4 weeks *Monitor *Monitor closely closely for recurrent recurrent psychotic psychotic symptoms * In In fo for m pa titi en en t of p os os si sibi lili ty ty of extrapyramidal symptoms. Instruct patient to report these symptoms immediately. *Inform patient that cigarette smoking can decr decrea ease se cloz clozap apin ine e leve levels ls.. Risk Risk for for relaps relapse e increa increases ses if patien patientt begins begins or increases smoking.

Drug Data

Classification

Generic Name Carbamazepine

Therapeutic Anticonvulsant, analgesic

Trade Name ApoCarbamazepine, Carbatrol, Epitol, Equetro, Tegretol Patients Dose 200mg/tab 1tab BID

Minimum Dose 200mg OD Maximum Dose 400mg OD Contents Carbamazepine Availability Capsules: 100mg, 200mg, 300mg Oral suspension: 100mg/5ml Tablets: 100mg, 200mg Routes of administration po

Pharmacologic Iminostilbene derivative

Pregnancy Category D

Mechanism of Action Decreases synaptic transmission in the CNS by affecting sodium channels in neurons. Therapeutic Effects: Prevention of seizures. Relief of pain in trigeminal neuralgia. Decreased mania.

Onset 1 hr Peak 4-12 hrs Duration unknown

Indication

Contraindications

Generalized tonic-clonic and complex partial seizures, mixed seizure patterns; trigeminal neuralgia; restless leg syndrome; chorea; acute manic and mixed episodes in bipolar 1 disorder

Hypersensitivity; Bone marrow suppression; Concomitant use or use of MAO inhibitors within 14 days

Patient’s Indication acute manic and mixed episodes in bipolar 1 disorder

Adverse Reaction

CNS: ataxia, drowsiness, fatigue, psychosis, sedation, vertigo. EENT: blurred vision, nystagmus, corneal opacities. Resp: Drug/food interaction pneumonitis. May increase metabolism CV: CHF, edema, of and therefore decrease hypertension, levels/effectiveness of hypotension, syncope. corticosteroids, GI: hepatitis, pancreatitis, doxycycline, felbamate, weight gain. quinidine, warfarin, GU: hesitancy, urinary benzodiazepine, retention. Derm: theophylline, valproic acid, photosensitivity, rashes, haloperidol Stevens-Johnson Concurrent use (within 2 syndrome, toxic wk) of MAOI may result in epidermal necrolysis, hyperpyrexia, urticaria. Endo: hypertension, seizures syndrome of and death inappropriate antidiuretic ho rmon e ( SI ADH) , hyponatremia. Hemat: agranulocytosis, aplastic anemia, thrombocytopenia, eosinophilia, leukopenia. Misc: chills, fever,

Therapeutic Levels 4–12 mcg/ml Drug Half Life 25-65 hrs with single dose; 829 hrs with long-term use

Source:

Deglin, J. &Vallerand, A. (2009) Davis’ Drug Guide for Nurses. 11 th ed. Philadelphia: FA Davis Company.

Nursing Responsibilities Before * Seizures: Assess frequency, location, duration, and characteristics of seizure activity. *Trigeminal Neuralgia: Assess for facial pain (location, intensity, duration) *Assess mental status (mood, orientation, behavior) and cognitive abilities before and periodically during therapy. During * Monitor CBC, including platelet count, reticulocyte count, and serum iron, weekly during the first 2 mo and yearly thereafter for evidence of potentially fatal blood cell abnormalities. Medication should be discontinued if bone marrow depression occurs * Liver function tests, urinalysis, and BUN should be routinely performed. May increase AST, ALT, serum alkaline phosphatase, bilirubin, BUN, urine protein, and urine glucose levels. Monitor serum ionized calcium levels every 6 mo or if seizure frequency increases. Thyroid function tests and ionized serum calcium c onc en tr at io ns may be d ec rea se d; hypocalcemia decreases seizure threshold. After *Instruct patient to take carbamazepine around the clock, as directed. Take missed doses as soon as possible but no just before next dose; do not double doses. *Instruct patients that fever, sore throat, mouth ulcers, easy bruising, petechiae, unusual bleeding, abdominal pain, chills, rash, pale stools, dark urine, or jaundice should be reported to health care professional immediately.

Drug Data Generic Name Biperiden

Trade Name Akineton, Biperiden, Artane, Cogentin, Kemadrin

Patients Dose 2mg 1tab OD Minimum Dose 2mg 1tab OD Maximum Dose 2mg 1tab OD Contents biperiden hydrochloride Availability Tablets 2 mg (as hydrochloride) - Injection 5 mg/mL (as lactate)


Classification Therapeutic antiparkinsonian agent

Pharmacologic Anticholinergic

Pregnancy Category C

Mechanism of Action Blocks acteylcholine’s action at cholinergic receptor sites. This action restores brain’s normal dopamine and acetylcholine balance, which relaxes muscle movement & decreases rigidity and tremors. It also inhibits dopamine reuptake and st or age , whi ch prolongs dopamine action. Onset 1 hr Peak 1-1.5 hr Duration unknown Therapeutic Levels 2mg-16mg/day Drug Half Life 24 hours

Indication *Treatment of all forms of parkinsonism; control of extrapyramidal disorders secondary to neuroleptic drug therapy.

Patient’s Indication control of extrapyramidal disorders secondary to neuroleptic drug therapy

Contraindications Narrow angle glaucoma; b owe l o bs tr uct io n; megacolon.

Adverse Reaction

Cardiovascular Mild transient orthostatic hypotension; bradycardia; tachycardia. Precaution EENT glaucoma, irregular Blurred vision; narrow-angle heartbeat, urination glaucoma; pupillary dilation. problems, any allergies. CNS Alcohol can increase Drowsiness; euphoria; drowsiness. Limit alcohol disorientation; agitation; use. memory loss; disturbed behavior. Drug/food interaction Dermatologic Amantadine Skin rash. May increase GI anticholinergic adverse Dry mouth; constipation; GI reactions. irritation. Digoxin Genitourinary May increase digoxin Urinary retention. serum levels, especially Miscellaneous with slow-dissolution oral Hyperthermia; heat stroke. digoxin tablets. Haloperidol May worsen schizophrenic symptoms; may decrease haloperidol serum levels; tardive dyskinesia may develop. May decrease action of phenothiazines. May increase incidence of anticholinergic adverse reactions.

Source: Springhouse Nurse’s Drug Guide. (2008) Philadelphia: Lippincott Williams & Wilkins.

Nursing Responsibilities Before *Advise patient that increasing fluid intake will help decrease dry mouth and constipation. *Instruct patient to pay particular attention to dental hygiene because of problems associated with decreased salivation (eg, increased risk of caries). *Tell patient that stool softeners may be used if constipation occurs. Small doses of milk of magnesia may be helpful. *Warn patient to drink plenty of fluids and take precautions against hyperthermia in hot weather. During * Caution is advised when performing tasks requiring alertness (e.g., driving) si nc e t hi s p ro du ct ma y ca us e drowsiness. *May cause dizziness especially when rising quickly from a seated or lying position. Change positions slowly. *Do not share drug with others. * Inf or m p t t o av oid be co ming overheated. Biperiden may cause decreased sweating. This could lead to heat stroke in hot weather or with vigorous exercise. After * If a dose is missed, advise pt to take as soon as remembered unless the next scheduled dose is within 2 hours. If so, skip the missed dose and resume your usual dosing schedule. *Do not double the dose to catch up. *If overdose is suspected, contact *Store at room temperature away from moisture and sunlight.

Drug Data Generic Name Losartan

Classification Therapeutic antihypertensiv es

Trade Name Cozaar Pharmacologic angiotensin II receptor antagonists Patients Dose 50mg 1 tab OD

Minimum Dose 50mg 1 tab OD Maximum Dose 50mg 1 tab OD Contents Losartan Availability 75 mg, 300 mg tablets



Mechanism of Action Chemical effect: blocks vasoconstrictor and aldosteroneproducing effects of angiotensin II at r ec ep to r s it es , including vascular smooth muscle and the adrenal glands

Indications

Alone or with other agents in the management of hypertension. Tr eatment of diabetic nephropathy in patients with type 2 diabetes and hypertension. Pr ev en tio n of Therapeutic stroke Effects: Lowering of in patients with blood pressure. hypertension and Slowed progression left ventricular of diabetic hypertrophy. nephropathy. Decreased risk of stroke in patients with hypertension Patient’s and left ventricular indication hypertrophy Alone or with other agents in the Onset management of 6 hr hypertension. Tr eatment of Peak diabetic 3-6 wk nephropathy in patients with type Duration 2 diabetes and 5 days hypertension. Pr ev en tio n of Therapeutic Levels stroke 24 hr in patients with hypertension and Drug Half Life left ventricular 2 hr hypertrophy.

Contraindications Contraindicated in: Hypersensitivity; OB: Can cause injury or death of fetus; Lactation: Discontinue drug or provide formula.

Adverse Reaction

CNS: dizziness, anxiety, depression, fatigue, headache, insomnia, weakness. CV: hypotension, chest pain, edema, tachycardia. Derm: rashes EENT: nasal congestion, Precaution pharyngitis, rhinitis, sinusitis. CHF ( ma y r esu lt i n GI: abdominal pain, diarrhea, drugazotemia, oliguria, acute induced hepatitis, dyspepsia, renal failure, and/or nausea, vomiting. death); Volume- or salt- GU: impaired renal function. depleted patients or F and E: hyperkalemia. MS: patients rearthralgia, back pain, myalgia. ceiving high doses of Misc: angioedema. diuretics (correct deficits before initiating therapy o r in it iat e at lo wer doses); Black patients (may not be effective); Impaired renal function due to primary renal disease or CHF (may worsen renal function); hepatic impairment; Women of childbearing potential Drug/food interaction Antihypertensive effect may be blunted by NSAIDs. Increased antihypertensive effects with other antihypertensives and diuretics. May increase effects of amiodarone, fluoxetine, glimepiride, glipizide, phenyt oin, r osi gli ta zo ne , an d warfarin. Rifampin may_effects of losartan.

Nursing Responsibilities Before *Assess blood pressure and pulse * In st ruc t pa tie nt to t ake medication exactly as directed. *May be given without regard to food

During *Monitor patient for signs of angioedema (dyspnea, facial swelling) *Monitor weight and assess pt routinely for fluid overload *Monitor renal function and electrolyte levels *Advise to avoid sudden changes in position to decrease orthostatic hypotension After *Note that drug may cause increase uric acid, slight decrease in haemoglobin and haematocrit, neutropenia & thrombocytopenia * Cau tio n pt t o av oi d sa lt substitutes containing potassium or food containing high levels of potassium or sodium unless directed by physician *Encourage patient to make lifestyle changes such as exercise and reduction of alcohol.

Source: Davis’ Drug Guide. 2008. 11th ed. Drug Data

Source: Davis’ Drug Guide. 2008. 11th ed. Classification

Source: Davis’ Drug Guide. 2008. 11th ed. Mechanism of Action

Source: Davis’ Drug Guide. 2008. 11th ed. Indication

Source: Davis’ Drug Guide. 2008. 11th ed. Contraindications

Source: Davis’ Drug Guide. 2008. 11th ed. Adverse Reaction

Source: Davis’ Drug Guide. 2008. 11th ed. Nursing Responsibilities

Generic Name Amlodipine besylate

Trade Name Norvasc Patients Dose 10 mg tab OD

Therapeutic Antianginal, antihypertensiv e

Pharmacologic Calcium channel blocker

Minimum Dose 10 mg tab OD Maximum Dose 10 mg tab OD


Chemical effect: Inhibits calcium ion influx across cardiac and smooth-muscle cells, thus decreasing myocardial contractility and oxygen demand. Also dilates coronary arteries and arterioles. Therapeutic effect: Reduces blood pressure and prevents angina.

Contents Amlodipine besylate

Onset unknown

Availability 2.5, 5, 10mg

Peak 6-9 hrs


Duration 24 hrs Therapeutic Levels 2.5 – 10 mg Drug Half Life 30 – 50 hrs

*chronic stable angina; vasospastic angina (Prinzmetal [variant] angina) *hypertension

*In patients hypersensitive to drug

CNS: f at ig ue , h ea da ch e, somnolence CV: dizziness, edema, flushing, Precaution: palpitations In patients taking other GI: abdominal pain, dyspepsia, peripheral vasodilators nausea (especially those with severe aortic stenosis) and in those with heart failure; pts with severe hepatic disease

Patient’s Indication *hypertension

Drug/food interaction *grapefruit juice: may increase drug level and adverse effects

Before *Assess pt’s blood pressure or angina * As ses s pt ’s a nd f amil y’ s knowledge of drug therapy *Administer oral CCBs before meals. However, administer with food when GI distress occurs. *When heart rate is <60, systolic BP is <90mmHg and diastolic BP <60mmHg, or the parameter ordered, delay the dose and contact prescriber During *Instruct to change positions slowly *Monitor glucose, electrolytes, intake and output *Counsel pt to avoid participating in activities requiring alertness until response to drug is known *Do not administer within a few hours of beta blockers. This may result to depressed myocardial contractility and AV conduction, marked hemodynamic deterioration and ventricular fibrillation. After *Keep pt in recumbent position for at least 1 hour after first CCB dose. *Monitor renal and hepatic function *Taper over a 2-week period when discontinuing because abrupt withdrawal may cause severe reactions. *Instruct to report edema and weight gain greater than 3 lbs or 5 lbs per week.

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Drug Data

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Classification

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Mechanism of Action

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Indication

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed.

Contraindications

Source:Springhouse Nurse’s Drug Guide. 2008. 9th ed.

Adverse Reaction



Generic Name Clonidine hydrochloride

Trade Name Catapres, CatapresTTS, _ Dixarit, Duraclon

Therapeutic Antihypertensi ve

Pharmacologic Adrenergic (centrally acting)

Patients Dose 75 mcg 1 tab OD Minimum Dose 75 mcg 1 tab OD Maximum Dose 75 mcg 1 tab OD Contents Clonidine Availability Tablets: 25, 100, 200, 300 mcg Transdermal systems: 0.1, 0.2 & 0.3 mg/24 hr Solution for epidural injection: 100 & 500 mcg/ml in 10-ml vials Routes of administration Po, transdermal, epidural


Stimulates alphaadrenergic receptors in the CNS; which results in decreased sympathetic outflow inhibiting cardioacceleration and vasoconstriction centers. Prevents pain signal transmission to the CNS by stimulating alpha-adrenergic receptors in the spinal cord. Therapeutic Effects: Decreased blood pressure. Decreased pain. Onset po: 30-60 mins transderm.: 2-3 days epidural: unknown Peak po: 2-4 hr transdermal, epidural: unknown Duration po 8-12 hr transdermal: 7 days epidural: unknown Therapeutic Levels 200-600 mcg Drug Half Life Plasma 12-22 hr CNS 1.3 hr

PO, Transdermal: Management of mild to moderate hypertension. Epidural: Management of cancer pain unresponsive to opioids alone. Unlabeled uses: Management of opioid withdrawal.

Hypersensitivity; Epidural—injection site infection, anticoagulant therapy, or bleeding problems.

CNS: drowsiness, depression, di zz in es s, n er vou sn es s, nightmares. CV: bradycardia, hypotension (increased with epidural), palpitations. Precaution GI: dry mouth, constipation, Se rio us c ar dia c or nausea, vomiting. cerebrovascular disease; GU: erectile dysfunction. Renal insufficiency; Geri: Derm: rash, sweating. Appear on Beers list due F and E: sodium retention. to increased risk of Metab: weight gain. orthostatic Misc: withdrawal phenomenon. Patient’s hypotension and adverse Indication CNS effects in geriatric *Management of patients ( decrease dose mild to moderate recommended) hypertension. Drug/food interaction Additive sedation with CNS de pr es sa nt s, including alcohol, antihistamines, opioid analgesics, and sedative/ hypnotics. Additive hypotension with other antihypertensives and nitrates. Addit ive bradycardia with myocardial depressants, including beta blockers. MAO inhibitors, amphetamines, beta blockers, prazosin, or tricyclic antidepressants may decrease antihypertensive effect. Withdrawal phenomenon may be increased by discontinuation of beta b loc ker s. Ep id ur al clonidine prolongs the effects of epidurally administered local anesthetics. May decrease effectiveness of levodopa. Increased risk of adverse

Before *Monitor intake and output ratios and daily weight, and assess for edema daily *Monitor blood pressure and pulse frequently *Note that drug may cause transient increase in blood glucose levels. *Assess pt’s & family’s knowledge of drug therapy During *Administer last dose of the day at bedtime. *If dry mouth occurs, note that frequent mouth rinses, good oral hygiene and sugarless gum or candy may decrease effect. *Monitor patient closely, especially during the first few days of therapy. Respiratory depression or deep sedation may occur. *Instruct to avoid more than 4 cups of caffeinated coffee, tea or cola per day. *Caution pt to take drug at bedtime to avoid drowsiness during the day. After *If dry mouth continues for >2 wks, consult physician *Advise patient to notify health care professional if mental depression, swelling of feet and lower legs, paleness or cold feeling in fingertips or toes, or vivid dreams or nightmares occur. *Periodic eye examination are recommended *Withdraw the drug slowly over 24 days to avoid rebound hypertension.

cardiovascular reactions with verapamil.

Source: Davis’ Drug Guide. 2008. 11th ed. Drug Data

Source: Davis’ Drug Guide. 2008. 11th ed. Classification

Source: Davis’ Drug Guide. 2008. 11th ed. Mechanism of Action

Source: Davis’ Drug Guide. 2008. 11th ed. Indications

Source: Davis’ Drug Guide. 2008. 11th ed. Contraindications

Source: Davis’ Drug Guide. 2008. 11th ed. Adverse Reaction

Source: Davis’ Drug Guide. 2008. 11th ed. Nursing Responsibilities

Generic Name Isosorbide mononitrate

Therapeutic Antianginal, vasodilator

Trade Name IMDUR, ISMO, Isotrate ER, Monoket

Pharmacologic nitrate

Patients Dose 30mg 1 tab OD q HS


Minimum Dose 30mg 1 tab OD Maximum Dose 30mg 1 tab OD Contents Isosorbide mononitrate

Chemical effect: may reduce cardiac oxygen demand by decreasing left ventricular end diastolic pressure (preload) and, to a lesser extent , systemic vascular resistance (afterload). May increase blood flow through collateral coronary vessels. Therapeutic Effects: relieves angina Onset po 2-60 min S.L. 2-5min Peak po 2-60 min S.L. 2-5 min

Availability Tablets: 5, 10, 20, 30, 40 mg Tablets (S.L.): 2.5, 5, 10 mg Capsules (extendedrelease): 40mg

* acu te an gi na (S.L. form only), prophylaxis in situations likely to cause angina *adjunctive treatment of heart failure *diffuse esophageal spasm without gastroesophageal reflux

Duration po 1-12 hr S.L. 1-2 hr

Contraindicated in: hypersensitive to nitrates, in those with idiosyncratic reactions to nitrates, and in those with severe hypotension, shock or acute MI with low left ventricular filling pressure

CNS: dizziness, headache, weakness CV: ankle edema, fainting, flushing, orthostatic hypotension, palpitations, tachycardia GI: nausea, vomiting Skin: cutaneous vasodilation Other: hypersensitivity reactions, sublingual burning

Precaution Use Caut iously in patients with blood volume depletion (such as that resulting from diuretic therapy) or mild hypotension

Before *Monitor BP and pulse *Assess allergy and hypersensitivity to drug or any of its components *Be alert for drug-drug interactions *Exercise caution in pts with blood volume depletion. During *Give drug on empty stomach, either 30 mins before or 1-2 hrs after meals *Don’t stop therapy abruptly because coronary vasospasm may occur *Instruct to avoid alcoholic drinks to prevent excessive vasodilatation, hypotension and fainting.

Patient’s Drug/food interaction indication Antihypersensitives: may Prophylactic increase hypotensive management of effects angina pectoris. Sildenafil, Tadalafil, Vardenafil: may increase hypotensive effects Alcohol: may increase hypotension

After *Advise to avoid sudden position changes to patient *Store drug in cool place, in tightly closed container, away from light. Cotton filler should be discarded because cotton can absorb the drug. *Be alert for adverse drug effects. * Mon it or he pa tic or r ena l function.

Therapeutic Levels 10-160 mg Drug Half Life 5 hours

Routes of administration po, sublingual

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Drug Data

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Classification

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Mechanism of

Source: Springhouse Nurse’s Drug Guide. 2008. 9th ed. Indications


Contraindications


Adverse Reaction



Generic Name Gliclazide

Therapeutic Antianginal, vasodilator

Trade Name Diamicron

Patients Dose 80 mg 1 tab OD

Pharmacologic nitrate

Minimum Dose 80 mg 1 tab OD Maximum Dose 80 mg 1 tab OD


Contents Gliclazide

Action Chemical effect: may reduce cardiac oxygen demand by decreasing left ventricular end diastolic pressure (preload) and, to a lesser extent , systemic vascular resistance (afterload). May increase blood flow through collateral coronary vessels. Therapeutic Effect s: relieves angina Onset po 2-60 min S.L. 2-5min Peak po 2-60 min S.L. 2-5 min

Availability Tablets


* acu te an gi na (S.L. form only), prophylaxis in situations likely to cause angina *adjunctive treatment of heart failure *diffuse esophageal spasm without gastroesophageal reflux

Duration po 1-12 hr S.L. 1-2 hr

Contraindicated in: hypersensitive to nitrates, in those with idiosyncratic reactions to nitrates, and in those with severe hypotension, shock or acute MI with low left ventricular filling pressure

CNS: dizziness, headache, weakness CV: ankle edema, fainting, flushing, orthostatic hypotension, palpitations, tachycardia GI: nausea, vomiting Skin: cutaneous vasodilation Other: hypersensitivity reactions, sublingual burning

Precaution Use Caut iously in patients with blood volume depletion (such as that resulting from diuretic therapy) or mild hypotension

During *Give drug on empty stomach, either 30 mins before or 1-2 hrs after meals *Don’t stop therapy abruptly because coronary vasospasm may occur *Warn not to use OTC medications without consulting physician. *Be alert for adverse drug effects

Patient’s Drug/food interaction indication Antihypersensitives: may Prophylactic increase hypotensive management of effects angina pectoris. Sildenafil, Tadalafil, Vardenafil: may increase hypotensive effects Alcohol: may increase hypotension

After *Advise to avoid sudden position changes to patient *Stress the importance of diet and exercise in the control of diabetes. *Store drug in cool place, in tightly closed container, away from light *Evaluate laboratory values and significant changes after drug therapy

Therapeutic Levels 10-160 mg Drug Half Life 5 hours






Before *Instr uct times at which antidiabetic should be taken for maximal effectiveness *Monitor laboratory values such as BUN, creatinine levels. *Monitor complete blood count, haemoglobin, electrolyte levels and liver function tests. *Monitor and record blood glucose levels



Drug Study

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