Question

The Instructor will assign ten      (10) drug cards per week, in specific areas. Each card will be worth 1      point. You will not receive the points for the cards if they are not submitted      within the week when due.

· Cards must be handwritten,      legible, and on ruled index cards.

· All information required on the      card must be completed or you will not receive the point for the card.

· The following information must      be on the Drug Card for Each Drug:

• Generic and Trade /Brand Names       ( American Only )
• Classifications:
  • Therapeutic
  • Pharmacological
• Indications/Uses
• Contraindications
• Adverse reactions by all       systems
• Safe dosage range
• 3 nursing implications
• Action

1.    Quidine

2.    Procainamide

3.    Cialis

4.    Nadolol

5.    Ranexa

6.    Adenosine

7.    Xarelto

8.    Eliquis

9.    Pradaxa

10. Urokinase

11      Celexia

12     Remeron

`13    epinephrine

   14 cymbalta

Answer 1

1.    Quidine

• Generic and Trade /Brand Names- Quinaglute, Quinidex
• Classifications:
  • Therapeutic - class 1a
  • Pharmacological - sodium channel blocking drug
• Indications/Uses - used in most atrial and ventricular arrhythmias ,sustained ventricular arrhythmias associated with acute myocardial infarction.
• Contraindications - Quinidine is contraindicated in patients with complete AV block, severe intraventricular conduction defects, left bundle-branch block, or ventricular ectopy. Quinidine is contraindicated in patients with digitalis-induced AV conduction disorders.
• Adverse reactions -Decresed cardiac contractility, Prolonged QRS, QT Proarrhythmic Hypotension with IV administration Lupus-like syndrome with Pronestyl Anticholinergic effects: dry mouth, decreased urine output.
• Safe dosage range - 100 to 600 mg/dose orally every 4 to 6 hours; begin at 200 mg/dose and titrate to desired effect (maximum daily dose: 3 to 4 g).
• 3 nursing implications-  Monitor QRS duration for increase >50% from baseline Monitor for prolonged QT Monitor N-acetyl procainamide (NAPA) laboratory values during procainamide therapy
• Action -Moderate depression of depolarization; prolongs repolarization Treats and prevents atrial and ventricular dysrhythmias

2.    Procainamide

• Generic and Trade /Brand Names - Pronestyl
• Classifications: -
  • Therapeutic - class 1a
  • Pharmacological - antiarryhmic
• Indications/Uses -Procainamide is effective against most atrial and ventricular arrhythmias. However, many clinicians attempt to avoid long-term therapy because of the requirement for frequent dosing and the common occurrence of lupus-related effects. Procainamide is the drug of second or third choice (after lidocaine or amiodarone) in most coronary care units for the treatment of sustained ventricular arrhythmias associated with acute myocardial infarction
• Contraindications -
• high levels of potassium in the blood.
• low amount of potassium in the blood.
• decreased blood platelets.
• very low levels of granulocytes.
• a type of white blood cell.
• myasthenia gravis.
• a skeletal muscle disorder.
• heart attack within the last 30 days.
• Adverse reactions - Procainamide’s cardiotoxic effects include excessive action potential prolongation, QT-interval prolongation, and induction
  of torsades de pointes arrhythmia and syncope. Excessive slowing of conduction can also occur. New arrhythmias can be precipitated. A troublesome adverse effect of long-term procainamide therapy is a syndrome resembling lupus erythematosus and usually consisting of arthralgia and arthritis. In some patients, pleuritis, pericarditis, or parenchymal pulmonary disease also occurs. Renal lupus is rarely induced by procainamide. During long-term therapy, serologic abnormalities (eg, increased antinuclear antibody titer) occur in nearly all patients, and in the absence of symptoms, these are not an indication to stop drug therapy. Approximately one third of patients receiving longterm procainamide therapy develop these reversible lupusrelated symptoms. Other adverse effects include nausea and diarrhea (in about 10% of cases), rash, fever, hepatitis (< 5%), and agranulocytosis (approximately 0.2%).
• Safe dosage range - If a rapid procainamide effect is needed, an intravenous loading dose of up to 12 mg/kg can be given at a rate of 0.3 mg/kg/ min or less rapidly. This dose is followed by a maintenance dosage of 2–5 mg/min, with careful monitoring of plasma levels. The risk
  of gastrointestinal (GI) or cardiac toxicity rises at plasma concentrations greater than 8 mcg/mL or NAPA concentrations greater than 20 mcg/mL. To control ventricular arrhythmias, a total procainamide dosage of 2–5 g/d is usually required. In an occasional patient who accumulates high levels of NAPA, less frequent dosing may be possible. This is also possible in renal disease, where procainamide elimination is slowed.
• 3 nursing implications - Monitor QRS duration for increase >50% from baseline Monitor for prolonged QT Monitor N-acetyl procainamide (NAPA) laboratory values during procainamide therapy
• Action - Moderate depression of depolarization; prolongs repolarization Treats and prevents atrial and ventricular dysrhythmias.

3.    Cialis

• Generic and Trade /Brand Names - Tadalafil
• Classifications:
  • Therapeutic - erectile dysfunction
  • Pharmacological -  phosphodiesterase (PDE) inhibitors
• Indications/Uses - erectile dysfuction , benign prostatic hyperplasia and pulmonary artery hypertension
• Contraindications - Cialis is contraindicated in patients currently being treated with nitrates, regularly or intermittently. The concomitant use of Cialis with nitrates can potentiate the hypotensive effect of nitrates causing a sudden and dangerous drop in blood pressure, dizziness, fainting, heart attack or stroke
• Adverse reactions - The most common potential side effects when using tadalafil are headache, stomach discomfort or pain, indigestion, burping, acid reflux, back pain, muscle aches, flushing, and stuffy and runny nose. These side effects reflect the ability of PDE5 inhibition to cause vasodilation (cause blood vessels to widen), and usually resolve after a few hours. Back pain and muscle aches can occur 12 to 24 hours after taking the drug, and these symptoms usually resolve within 48 hours of onset.vision loss and sudden hearing loss also
• Safe dosage range 5-20 mg
• 3 nursing implications erectile dysfunction,BPH, PAH
• Action

  Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic guanosine monophosphate (more commonly known as cyclic GMP or cGMP) in smooth muscle cells. cGMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.

  The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Tadalafil (and sildenafil and vardenafil) inhibits PDE5. However, because sexual stimulation is required to initiate the local penile release of nitric oxide, tadalafil's inhibition of PDE5 will have no effect without direct sexual stimulation of the penis.