Drug Study G e n e r i c B r a n d

N a m e

N i f e d i p i n e C C , A f e d i t a b b l o c k e r AntianginalAntihyp

N a m e

A d a l a t Calcium

Classification ertensive

channel

S u g g e s t e d d o s e 5 m g 1 c a p q 8 Mode of Action Inhib i t s t h e i n f l u x o f c a l c i u m t h r o u g h t h e c e l l membrane, resulting in a depression of contraction.Dilates coronary vessels in both normal and ischemictissues and inhibits spasms of coronary arteries Indication For the management of vasospastic g i n a , c h r o n i c stable angina and hypertension .C o n t r a i n d i c a t i o n H y p e r s e n s i t i v i t y . Adverse reaction CV: peripheral and pulmonary edema,hypotension, palpitations. CNS: dizziness, sleep disturbances, headache. Respiratory: dyspnea, cough, respiratoryinfection, chest congestion. Drug interaction Barbiturates / Nifedipine effects Cimetidine / Bioavailability of nifedepine an

Nursingintervention Ensure that patients do not chew or divide SRtablets. Monitor patient carefully (BP, cardiac rhythm,and output) while drug is being adjusted totherapeutic dose Note any hypotensive response, increased HRthat result from peripheral vasolidations If therapy is to be discontinued, graduallydecrease dosage to prevent withdrawalsyndrome

Maintain fluid intake of 2-3 L/day to avoidconstipation43 Avoid activities that require mental alertnessuntil drug effects realized; may cause dizzinessor lightheadedness. Inform patient for possible side effects: Nausea,vomiting (eat frequent small meals); dizziness,light-headedness, vertigo (avoid driving,operating dangerous machinery; take specialprecautions to avoid falling); muscle cramps,joint stiffness, sweating, sexual difficulties(reversible) Report persistent headache, flushing, nausea,palpitations

methylprednisolone (meth ill predni ss' oh lone) methylprednisolone Oral: Medrol, Meprolone (CAN) methylprednisolone sodium succinate IV, IM injection: A-Methapred, Solu-Medrol Pregnancy Category C Drug classes Corticosteroid Glucocorticoid Hormone Therapeutic actions Enters target cells and binds to intracellular corticosteroid receptors, initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects. Indications Hypercalcemia associated with cancer Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas Trichinosis with neurologic or myocardial involvement

 Unlabeled use: Septic shock Contraindications and cautions Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation; allergy to tartrazine or aspirin in products labeledM e d ro l. Use cautiously with kidney or liver disease, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus, pregnancy. Available forms Tablets2, 4, 8, 16, 24, 32 mg; powder for injection40, 125, 500 mg/mL, 1, 2 g/vial

Dosages ADULTS Individualize dosage, depending on severity and response. Give daily dose before 9 AM to minimize adrenal suppression. For maintenance, reduce initial dose in small increments at intervals until the lowest satisfactory clinical dose is reached. If long-term therapy is needed, consider alternate-day therapy with a short-acting corticosteroid. After long-term therapy, withdraw drug slowly to prevent adrenal insufficiency. Oral 448 mg/day. For alternate-day therapy, give twice the usual dose every other morning. IV, IM 1040 mg IV administered over 1 to several min. Give subsequent doses IV or IM. Caution: Rapid IV administration of large doses (more than 0.51 g in less than 10120 min) has caused serious cardiac complications. PEDIATRIC PATIENTS Individualize dosage on the basis of severity and response rather than by formulae that correct doses for age or weight. Carefully observe growth and development in infants and children on prolonged therapy. Minimum dose of methylprednisolone is 0.5 mg/kg per 24 hr. High-dose therapy: 30 mg/kg IV infused over 1020 min; may repeat q 46 hr, but no longer than 72 hr. Pharmacokinetics Route Onset Peak Duration

Oral Varies 12 hr 1.21.5 days IV Rapid Rapid Unknown IM Rapid 48 days 15 wk Metabolism: Hepatic; T1/2: 78188 min Distribution: Crosses placenta; enters breast milk Excretion:Urine IV facts Preparation: No additional preparation is required. Infusion: Inject directly into vein or into tubing of running IV; administer slowly, over 1 20 min to reduce cardiac effects. Incompatibilities: Do not combine with calcium gluconate, glycopyrrolate, insulin, nafcillin, penicillin G sodium, tetracycline. Adverse effects Effects depend on dose, route, and duration of therapy. CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis, cataracts, increased IOP, glaucoma CV:Hypot ension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias Electrolyte imbalance: Na+ and fluid retention, hypokalemia, hypocalcemia

Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect), increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels, hypothalamic-pituitary-adrenal (HPA) suppression with systemic therapy longer than 5 days GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite, weight gain Hypersensitivity: Anaphylactoid reactions Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass,

osteoporosis, spontaneous fractures Other: Immunosuppression; aggravation or masking of infections; impaired wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae; subcutaneous fat atrophy Interactions Drug-drug Increased therapeutic and toxic effects with erythromycin, ketoconazole, troleandomycin Risk of severe deterioration of muscle strength when given to myasthenia gravis patients who are receiving ambenonium, edrophonium, neostigmine, pyridostigmine Decreased steroid blood levels with barbiturates, phenytoin, rifampin Decreased effectiveness of salicylates Drug-lab test False-negative nitroblue-tetrazolium test for bacterial infection Suppression of skin test reactions Nursing considerations Assessment History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; pregnancy; lactation Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion prominence of superficial veins, R and adventitious sounds, serum electrolytes, blood glucose Interventions Use caution with the 24-mg tablets marketed asM e dro l ; these contain tartrazine, which may cause allergic reactions, especially in people who are allergic to aspirin. Give daily dose before 9 AM to mimic normal peak corticosteroid blood levels. Increase dosage when patient is subject to stress. Taper doses when discontinuing high-dose or long-term therapy. Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

Teaching points Do not to stop taking the oral drug without consulting your health care provider. Avoid exposure to infections. Report unusual weight gain, swelling of the extremities, muscle weakness, blackor tarry stools, fever, prolonged sore throat, colds or other infections, worseningof disorder. Adverse effects inItal ic are most common; those inBold are life-threatening