Drug Classification: Antipyretic Analgesic (nonopioid) Anti-inflammatory Antirheumatic Antiplatelet Salicylate NSAID

Pharmacologic action Analgesic and antirheumatic effects are attributable to aspirins ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin

Indication Mild to moderate pain Fever Inflammatory conditions rheumatic fever, rheumatoid arthritis, osteoarthritis Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris

Contraindication Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombine mia, vitamin K deficiency (increased risk of bleeding) Use cautiously with impaired renal function; chickenpox,

Side effect Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirins effects on blood clotting). Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting, bloody stools.

Nursing responsibility BLACK BOX WARNING: Do not use in children and teenagers to treat chickenpox or flu symptoms without review for Reyes syndrome, a rare but fatal disorder. Give drug with food or after meals if GI upset occurs. Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus. Do not crush, and ensure that patient does not chew SR preparations. Do not use aspirin that has a strong vinegarlike odor.

Name: Aspirin Dosage: ADULTS Minor aches and pains: 325650 mg q 4 hr. Arthritis and rheumatic conditions: 3.26 g/day in divided doses. Acute rheumatic fever: 58 g/day;

modify to maintain serum salicylate level of 1530 mg/dL. TIAs in men:1,300 mg/day in divided doses (650 mg bid or 325 mg qid). MI prophylaxis: 75 325 mg/day.

intermediary. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs at low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation.

MI prophylaxis Unlabeled use: Prophylaxis against cataract formation with long-term use

influenza (risk of Reyes syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal

WARNING: Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis, activated charcoal, supportive therapy.

Take extra precautions to keep this drug out of the reach of children; this drug can be very dangerous for children.

Use the drug only as suggested; avoid overdose. Avoid the use of other over-thecounter drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose can occur.

Take the drug with food or after meals if GI upset occurs.

Do not cut, crush, or chew sustained-release products.

effects: low birth weight, increased intracranial hemorrhage, stillbirths, neonatal death); lactation.

Over-the-counter aspirins are equivalent. Price does not reflect effectiveness.

Drug Classification: Adenosine diphosphate (ADP) receptor antagonist Antiplatelet name:

Pharmacologic action Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.

Indication Treatment of patients at risk for ischemic events history of MI, ischemic stroke, peripheral artery disease Treatment of patients with acute coronary syndrome

Contraindication Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation. Use cautiously with bleeding disorders, recent surgery, hepatic impairment, pregnancy.

Side effect Dizziness, lightheadedness (this may pass as you adjust to the drug); headache (lie down in a cool environment and rest; OTC preparations may help); nausea, gastric distress (eat frequent small meals); prolonged bleeding (alert doctors, dentists of this drug use). Report skin rash, chest pain, fainting,

Nursing responsibility Provide small, frequent meals if GI upset occurs (not as common as with aspirin). Provide comfort measures and arrange for analgesics if headache occurs.

Generic Clopidogrel Brand Name: Plavix Dosages: ADULTS

Recent MI, stroke, or established peripheral arterial disease: 75 mg PO daily. Acute coronary

syndrome: 300 mg PO loading dose, then 75 mg/day PO with aspirin, given at a dose from 75325 mg once daily

severe headache, abnormal bleeding.

Drug Classification: -Anticoagulant -Low Molecular Weight Heparin GENERIC enoxaparin BRAND Lovenox NAME:

NAME:

Dosage: - DVT prophylaxis: 30 mg subcutaneously bid with initial dose soon as possible after surgery, not more than 24 hr after surgery. Continue thr oughout the postoperative period for 710 days; then 40 mg daily subcutaneously for

Pharmacol ogic action Lowmolecularweight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing the formation of clots.

Indication Prevention of DVT, which may lead to pulmonary embolism following hip replacement, knee replacement surgery, abdominal surgery Prevention of ischemic complications of unstable angina and nonQ-wave MI Treatment of DVT, pulmonary embolus with warfarin Prevention of DVT in medical patients who are at risk for thromboembolic complications due to severely restricted mobility during acute

Contraindication Contraindi cated with hype rsensitivit y to enoxap arin, heparin, pork products; severe thromboc ytopenia; uncontroll ed bleeding. Use cautiously with pregnanc y or lactation, history of GI bleed, spinal

Side effect bleeding. Fever, nausea, diarrhea, and fluid retention are common. Less commonly, enoxaparin can induce abnormal liver tests in the blood, suggesting mild damage to the liver, and a reduction in blood platelets and red blood cells. Mild local irritation, pain, hematoma, ecchymosis, and erythema may occur at the site of injection. Hypersensitivity reactions also may occur.

Nursing responsibility - Give drug as soon as possible after hip surgery, within 12 hr of knee surgery, and within 2 hr preoperatively for abdominal surgery. - Give deep subcutaneous injections; do not give enoxaparin by IM injection. - Administer by deep subcutaneous injection; patient should be lying down. Alternate between the left and right anterolateral and posterolater al abdominal wall. Introduce the whole length of the needle into a skin fold held between the thumb and forefinger; hold the skin fold throughout the injection. - Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites. - Do not mix with other injections or infusions.

up to 3 wk may be used. -Patients undergoing abdominal surgery: 40 mg/day subcutaneously begun within 2 hr preoperatively and continued for 710 days. -Outpatient DVT treatment: 1 mg/kg subcutaneously q 12 hr. -Unstable angina and nonQ-wave MI: 1 mg/kg subcutaneously q 12 hr for 28 days. -Inpatient DVT treatment: 1.5 mg/kg subcutaneously once daily. -Prevention of DVT in high-risk medical patients: 40 mg/day subcutaneously for 611 days, has been used up to 14 days.

illnesses

tap, spinal/epi dural anesthesi a

- Store at room temperature; fluid should be clear, colorless to pale yellow. - Provide for safety measures (electric razor, soft toothbrush) to prevent injury to patient who is at risk for bleeding. - Check patient for signs of bleeding; monitor blood tests. - Alert all health care providers that patient is on enoxaparin. - Discontinue and initiate appropriate therapy if thromboembolic episode occurs despite enoxaparin therapy. .

Drug Classification: Beta- adrenergic

Pharmacologic action Unknown. A selective beta blocker that

Indication Hypertension Acute MI

Contraindication -Hypersensitive to drug.

Side effect -CV: hypotension -GI: nausea

and

Nursing responsibility -Always check patients apical pulse

blocking agents GENERIC NAME: Metoprolol HCL BRAND NAME: Lopressor

selectively blocks beta1 receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses rennin secretion

Angina Pectoris

-Patient with sinus bradycardia, -cardiogenic shock and heart failure

vomiting -Respi: dyspnea -Skin: rash

-Monitor BP -Store drug at room temperature. -Inform patient about the side effects and adverse effects of the medication. -Advise patient to take it with meals. -Tell patient to report if he/she feels shortness of breath. -Tell patient That metoprolol is not advisable to breastfeeding mothers. -Advise not to withdrawn drug abruptly