Metoprolol

Classification: Antihypertensive; Beta1-selective adrenergic blocker

Uses: Hypertension, alone or with other drugs esp. diuretics. 

Immediate release tablets and injection: prevention of reinfarction in MI patients who are hemodynamically stable or within 3-10 days of the acute MI.

Long term treatment of angina pectoris

Actions: Competetively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and release of renin, and lowering bp; acts in CNS to reduce sympathetic outflow and vasoconstrictor tone.

Administration and Dosage: for Hypertension: Initially, 100 mg per day PO in single or divided doses; gradually increase dosage at weekly intervals.  Usual maintenance dosage is 100-450 mg/day.

Side Effects: Allergic pharyngitis, rash, fever, sore throat, laryngospasm, dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech, heart failure, cardiac arrhythmias, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension, Eye irritation, sweating, dry eyes, conjunctivitis, dry skin, blurred visions, Gastric pain, flatulence, constipation, diarrhea, nausea, vomitting, anorexia, ischemic colitis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis, Impotence, decreased libido, dysuria, Peyronie's disease, nocturia, frequent urination, joint pain, muscle cramp, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis.

Nursing Implications: Contraindicated with sinus bradycardia, second or third degree heart block, cardiogenic shock, heart failure, second and third ttrimesters of pregnancy.  Use cautiously with diabetes or throtoxicosis; astma or COPD; pregnancy.   Take drug early in the day so sleep will not be distrubed by increased urination.  Weight patient daily and record weights.  Protect skin from sun and bright lights.  Report rapid weight change.  Monitor blood pressure, ECG, and pulse frequently during dose adjustment and periodically during therapy.  Monitor frequency of prescription refulls to determine compliance.  Monitor vitals and ECG every 5-15 minutes during and for several hours after parenteral administration.  If heart rate <40 especially if cardiac output is also decreased, administer atropine 0.25-0.5 mg IV.  MOnitor intake and output ratios and daily weights.  Assess routinely for signs and symptoms of CHF: dsypnea, rales/crackles, weight gain, peripheral edemaa, jugular venous distention. 

Vancomycin Elixer

Classification: Antibiotic

Uses: Parenteral, potentially life threatening infections, severe staph. infections, prevention of bacterial endocarditis in penicillin-allergic patients undergoing dental, upper respiratory, GI, or GU surgery or invasive procedures.

Action: Bactericidal: inhibits cell wall synthesis of susceptible organisms, causing cell death

Administration and Dosage: 500 mg-2 g/day PO in three or four divided doses for 7-10 days; 500 mg IV every 6 hr or 1 g IV every 12 hr

Side Effects: Ototoxicity, Hypotension, Urticaria, nausea, nephrotoxicity

Nursing Implications: Not for IM administration, reconstitute with 10ml sterila water for injection; 500mg/mL concentration results.  Dilute reconstituted solution with 100-200 mL of /9% sodium chloride injection or D5W for intermittent infusion.  Geriatric patients or patients with renal failure: monitor dosage and serum levels very carefully.  Dosage nomogram is available for determining the dose according to creatinine clearance. Assess patient for infection, obtain specimens for culture and sensitivity.  Monitor IV site closely.  Monitor blood pressure througought IV infusion.  Monitor intake and output ratios and daily weight.  Evaluate cranial nerve function by audiometry.  Assess patient for signs of superinfection.  Peak serum vancomycin levels should not exceed 25-40.

Nephrocap

Classification: Multi-vitamin

Uses: Nephrocaps drug is a prescription multi-vitamin drug used for people with chronic renal failure, uremia; impaired metabolic functions of the kidney

Action: Nephrocaps drug is to maintain levels when the dietary intake of vitamins is inadequate or excretion and loss are excessive. Also, Nephrocaps drug is highly effective as a stress vitamin.

Administration and dosage: One softgel of Nephrocaps drug daily or as directed by a physician. If on dialysis, take after treatment

Side effects: dizziness, headaches, mild diarhea, nausea, swelling of the entire body, severe allergic reactions.

Nursing Implications: Assess patient for side effects after administration of medication.

Clonidine

Classification: Antihypertensive, central analgesic, sympatholytic

Uses: Hypertension, used alone or as part of combination therapy, treatment of severe pain in cancer patients in combination with opiates, epidural more effective with neuropathic pain.  Unlabeled uses: tourette's syyndrome; migraine, decreases severity and frequency; menopausal flushing, decreases severity and frequency of episodes; chronic methadone detoxification, rapid opiate detox, alcohol benxodiazepuine withdrawal treatment; management of hypertensive urgencies, atrial fibrillation, ADHD

Action: Stimulates CNS, alpha2-adrenergic receptors, inhibits sympathetic

Administration and dosage: Individualize dosage.  Initial dose is 0.1 mg bid; for maintenance dosage, increase in increments of 0.1 or 0.3 mg to reach desired response.  Common range is 0.2-0.6 mg/day, in divided doses; maximum dose is 2.4  Minimize sedation by slowly increasing daily dosage; giving majority of daily dose at bedtime.

Side effects: Drowsiness, sedation, dizziness, headache, fatigue that tends to diminish within 4-6 weeks, dreams, nightmares, insomnia, hallucinations, delirium, nercoursness, restlessness, anxiety, depression, retinal degenreation, heart failure, orthostatic hypotension, palpitations, tachycardia, bradycardia, Raynaud's phenomenon, ECG abnormalities manifested as Wenckebach period or ventricular trigeminy.  Rash, angioneurotic edema, hives, urticaria, hair thinning and alopecia, pruritus, dryness, itching or burning of the eyes, pallor, dry mouth, constipation, anorexia, malaise, nausea, vomitting, parotid pain, impotence, sexual dysfunction, nocturia, difficulty in micturition, urinary retention, weight gain, transient hyperglycemia or elevated serum creatine phohokinase level, weaness, muscle or joint pain, cramps of the lower limbs, dryness of the nasal mucosa, fever.

Nursing Implications: Name confusion has occured between clonidine and Klonopin use caution!  Contraindicated with hypersensitivity to clonidine or any adhesive layer components of the transdermal system.  Use cautiously with severe coronary insufficiency, recent MI, cerebrovascular disease; chronic renal failure; pregnancy, lactation.  Monitor intake and output ratios and daily weight, and assess for edema daily, especially at beginning of therapy.  Monitor bp and pulse frequently during initial dosage adjustment and periodically throughout therapy.  Assess PQRST of pain. 

Nuvolog

Classification: Insulin 

Uses: To control hyperglycemia in diabetes

Action: Insulin Aspart, regulates glucose metabolism, lowers blood glucose by facilitating cellular uptake of glucose and simultaneously inhibiting glucose output from the liver.

Administration and dosage: Individualize does.  Inject SQ within 5-10 minutes before a meal.  Draw first when mixing with NPH human insulin; inject immediately.  Do not mix with crystalline zinc insulins, animal source insulins, or other manufacturerer insulins.  Do not use or mix with any other insulin or diluent in pump.  Do not freeze, protect from light.

Side effects: Hypoglycemia, hypokalemia, lipodystrophy, hypersensitvity reaction, injection site reactions, pruritus, rash.

Nursing Implications: Assess FPG, HbA1c, renal function, LFTs, pregnancy status, infections, alcohol consumption, exercise routines, and possible drug interactions.  Monitor FPG, HbA1c, hypokalemia, renal function, diabetic ketoacidosis, vision changes, lipodystrophy, allergic reactions, monitor for signs of hypoglycemia (sweating, palpitations, seizures, disorietnation, tremors).