DRUG REVIEW Drug Name Telmisartan (Micardis) 40mg/cap once daily

Mode of Action

Indication

Contraindication

Adverse Drug Reaction CNS disturbances, dizziness Visual disturbances (blurred or yellowish vision)

Increases the force of myocardial contraction. Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes. Increase cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect) .

Management of chronic Intermittent complete cardiac failure where systolic heart block or 2nd degree dysfunction or ventricular AV block especially dilatation is dominant. if there is a history of Stokes-Adams attacks Cardiac failure accompanied by atrial fibrillation. Arrhythmia caused by cardiac glycoside Management of certain intoxication supraventricular arrhythmias, particularly chronic atrial supraventricular arrhyth flutter &fibrillation mia caused by WolffParkinson-White syndrome Ventricular tachycardia or fibrillation Hypertrophic obstructive cardiomyopathy Hypersensitivity to digitalis glycoside

Nursing Responsibilities 1. Monitor apical pulse before administering. 2. Monitor blood pressure periodically in patients receiving IV Digoxin Monitor input and output ratios and daily weights. Observe patients for signs and symptoms of toxicity

Arrhythmia or cardiac 3. conduction disturbances (bigeminy, trigeminy, 4. PR prolongation, sinus bradycardia) Nausea, Vomiting, Diarrhea Urticarial or scarlatiniform w/eosinophilia

5. Before administering initial loading dose, determine whether patient has taken any digitalis preparations in the preceding 2-3 weeks. 6. Oral preparations can be administered without regards to meals.

Drug Name

Mode of Action

Indication

Contraindication

Adverse Drug Reaction

Nursing Responsibilities

Etoricoxib (Arcoxia) 120mg/tab every 4 hours as needed for pain

Selectively inhibits cyclooxygenase- 2 (COX-2) COX-2 which is an isoform of the enzyme that has been postulated to be primarily responsible for the synthesis of mediators of pain, inflammation, and fever. Affects central nervous system functions towards fever induction, pain perception and cognitive function. Does not inhibit COX-1 at thereby has no effect on gastric prostaglandin synthesis and on platelet function

Active peptic ulceration or active gastrointestinal (GI) bleeding. For the symptomatic relief of osteoarthritis (OA), Patients who have rheumatoid arthritis (RA), experienced ankylosing spondylitis, and the bronchospasm, acute pain and signs of inflammation rhinitis, nasal polyps, associated with acute gouty angioneurotic oedema, arthritis. urticaria, or allergic-type reactions after taking acetylsalicylic acid or NSAIDs including COX-2 inhibitors. Severe hepatic dysfunction (serum albumin <25 g/l or Child-Pugh score 10). Estimated renal creatinine clearance <30 ml/min. Inflammatory bowel disease. Patients with hypertension whose blood pressure is persistently elevated above 140/90mmHg and has not been adequately controlled. Established ischaemic heart disease, peripheral arterial disease, and/or Short-term treatment of moderate pain

Hypersensitivity Reactions: Swelling of the face, lips, tongue or throat which may cause difficulty in swallowing or breathing Insomnia or increased anxiety Severe increase in blood pressure Confusion, Hallucinations Decreased Platelets Atrial Fibrillation or abnormal rhythm of the heart Heart failure Stomach pain or Stomach ulcers that may become serious and may bleed, and may occur at any time during use and without warning

Assess client for history of allergic reaction to Arcoxia or for previous heart failure, heart attack, bypass surgery, angina, peripheral arterial disease, or transient ischaemic attack. Monitor blood pressure regularly while taking this medication. Take medication with a glass of water to avoid dehydration. Arcoxia may be taken regardless of food intake. Stop the medication immediately if gastrointestinal lesions occur.

cerebrovascular disease.