Question

Complete three 3 different drugs used to treat a patient diagnosed with angina, each medication including their generic /brand name , category class, expected Pharmacological Action, Complications, Contraindications/Precautions, Interactions, Medication Administration, Evaluation of Medication Effectiveness, Therapeutic Use, Nursing Interventions, and Client Education.

Answer 1

1.Isosorbide mononitrate

generic/ brand name:Imdur, Monoket, and ISMO.

category class: Nitrates.

expected pharmacological action: It have a direct relaxant effect on vascular smooth muscles, and the dilation of coronary vessels improves oxygen supply to the myocardium. The dilation of periphera veins, and in higher doses peripheral arteries, reduces preload and after-load, and thereby lowers myocardial oxygen

complications: headache, dizziness, weakness, nausea and vomiting, peripheral edema, flushing, syncope, tachycardia, palpitations and postural hypotension.

contraindications:

• significant anemia
• methemoglobinemia
• a type of blood disorder
• Right ventricular infarction
• hypertrophic cardiomyopathy
• a hemorrhage in the brain
• low blood pressure
• abnormal absorption of food nutrients in the gastrointestinal tract
• high pressure within the skull
• allergic to isosorbide dinitrate or any of its ingredients

interaction:Some products that may interact with this drug include: drugs to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), riociguat.Isosorbide mononitrate is very similar to isosorbide dinitrate. Do not use medications containing isosorbide dinitrate while using isosorbide mononitrate.This medication may interfere with certain laboratory tests (including cholesterol levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug

medication administration:Nitrates have many different forms with various routes of administration.[Nitroglycerin, also known as glyceryl trinitrate (GTN), can be administered as a patch, ointment, capsule, spray, intravenous infusion, or a sublingual tablet.[3]Sublingual nitroglycerin is the therapy of choice for acute Nitrates have many different forms with various routes of administration.[3] Nitroglycerin, also known as glyceryl trinitrate (GTN), can be administered as a patch, ointment, capsule, spray, intravenous infusion, or a sublingual tablet.[3]Sublingual nitroglycerin is the therapy of choice for acute anginal episodes since it avoids first-pass metabolism, allowing for immediate and short anginal relief.[3] Transdermal, ointment, and spray are other options with similar efficacy but are less popular.[3] The capsule form of nitroglycerin has a longer duration of action and require larger doses. Intravenous nitroglycerin is useful for hypertensive emergencies.[2][3]anginal episodes since it avoids first-pass metabolism, allowing for immediate and short anginal relief.[3] Transdermal, ointment, and spray are other options with similar efficacy but are less popular.[3The capsule form of nitroglycerin has a longer duration of action and require larger doses. Intravenous nitroglycerin is useful for hypertensive emergencies.[2][

evaluvation of medication administration:An exercise test (treadmill, Brace protocol) was performed before and at 1, 6,8 and 10 hours after oral administration of the drug. The patients were randomly assigned to receive IS-5-MN or placebo, and after 1 week of therapy were crossed over to the other formulations. The drag increased the exercise duration from 321 to 455 seconds at 1 hour (p < 0.001). Time to moderate angina increased from 237 to 324 seconds (p < 0.05) and time to ST depression ≥1 mm increased from 150 to 307 seconds (p < 0.01) at 1 hour. Placebo had no effect on any of the exercise parameters. Although partially attenuated at 6 hours, the effect of IS-5-MN remained statistically significant even at 8 hours, but not at 10 hours. It is concluded that the duration of action of a single tablet of IS-5-MN, given orally, is 8 hours.

therapeutic use:used to prevent angina (chest pain) caused by coronary artery disease (heart disease).

nursing interventions and client Education:Take the isosorbide before chest pain begins, when activities or situation may precipitate an attack. Take oral isosorbide dinitrate on an empty stomach, 1 hour before or 2 hours after meals; do not chew or crush sustained-release preparations; do not take isosorbidemononitrate to relieve acute anginal episodes.Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall. Avoid drinking alcohol. Alcohol may increase certain side effects of isosorbidemononitrate (dizziness, drowsiness, feeling light-headed, or fainting).

2.Propranolol

generic name:Inderal, Inderal LA, InnoPran XL, and Hemangeol

category class:beta blocker

pharmacological action:is a non-selective beta receptor antagonist. It competes with sympathomimetic neurotransmitters for binding to receptors, which inhibits sympathetic stimulation of the heart.

complications:

• Allergic reactions.
• Breathing problems
• Changes in blood sugar
• Cold hands or feet
• Nightmares or trouble sleeping
• Dry, peeling skin
• Hallucinations
• Muscle cramps or weakness
• Slow heart rate
• Swelling of your legs or ankles
• Sudden weight gain
• vomiting

contraindications:

• Reversible airway diseases, particularly asthma or chronic obstructive pulmonary disease (COPD)
• Slow heart rate (bradycardia) (<60 beats/minute)
• Sick sinus syndrome.
• Atrioventricular block (second- or third-degree)
• Shock.
• Severe low blood pressure.
• Cocaine toxicity.

interaction:Some products that may interact with this drug include: alpha blockers (e.g., prazosin), aluminum hydroxide, anticholinergics (e.g., atropine, scopolamine), chlorpromazine, other drugs to treat high blood pressure (e.g., clonidine, hydralazine, methyldopa), epinephrine, fingolimod, haloperidol, other heart medications

medication administration:
Swallow the long-acting oral capsules and tablets whole. Do not break, chew, crush, or open them. Propranolol extended-release capsules should be taken at bedtime (10 pm). This medicine may be taken with or without food.The propranolol IV dose recommended in clinical practice guidelines is 1 mg IV over 1 minute, which may be repeated every 2 minutes to a suggested maximum of 3 doses. 0.01 mg/kg/dose slow IV push over 10 minutes, repeat every 6 to 8 hours as needed. May titrate dosage gradually as needed for clinical effect.

Therapeutic use:

treat high blood pressure. treat illnesses that cause an irregular heartbeat, like atrial fibrillation. prevent future heart disease, heart attacks and strokes. prevent chest pain caused by angina

Nursing interventions and client education:Provide continuous cardiac and regular BP monitoring with IV form. Change to oral form as soon as possible. Give oral drug with food to facilitate absorption.Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

3.Nefidipine:

Generic name:Procardia, Procardia XL, Adalat CC, Nifedical XL, Adalat, Afeditab CR, and Nifediac CC

category class:calcium channel blocker

Action:Nifedipine is a peripheral arterial vasodilator which acts directly on vascular smooth muscle. The binding of nifedipine to voltage-dependent and possibly receptor-operated channels in vascular smooth muscle results in an inhibition of calcium influx through these channels.

complications:Nifedipine lowers your blood pressure and makes it easier for your heart to pump blood around your body. headache, flushing, constipation, feeling tired and swollen ankles. These usually improve after a few days of treatment.

contraindications:

• porphyria.
• myasthenia gravis.
• a skeletal muscle disorder.
• a sudden worsening of angina called acute coronary syndrome.
• severe narrowing of the aortic heart valve.
• severe heart failure.
• low blood pressure.

significantly low blood pressure.m

• porphyria.
• myasthenia gravis.
• a skeletal muscle disorder.
• a sudden worsening of angina called acute coronary syndrome.
• severe narrowing of the aortic heart valve.
• severe heart failure.
• low blood pressure.
• significantly low blood pressure.

Medication administration:Nifedipine comes as a capsule and an extended-release (long-acting) tablet to take by mouth. The capsule is usually taken three or four times a day. The extended-release tablet should be taken once daily on an empty stomach, either 1 hour before or 2 hours after a meal.

uses:Nifedipine is a medicine used to treat high blood pressure. If you have high blood pressure, taking nifedipine helps to prevent future heart disease, heart attacks and strokes. Nifedipine is also used to prevent chest paincaused by angina.

nursing interventions :Assess for anginal pain, including location, intensity, duration, and alleviating and aggravating factors. - Assess cardiac status with BP, pulse, respiration and ECG. - Monitor potassium and liver function tests throughout treatment with nifedipine.

client education:

You can take nifedipine before or after meals. Do not bite, chew or break the tablets/capsules. When you first start taking nifedipine you may get a headache or feel flushed. These symptoms usually go after a few days.