N

N

Sublingual: Acute relief of angina pectoris.

Oral, topical: Long-term prophylactic treatment of angina pectoris.

Intravenous: Adjunctive treatment in HF associated with acute MI. Produce controlled hypotension during surgical procedures; control B/P in perioperative hypertension, angina unresponsive to organic nitrates or beta-blockers.

Relaxes most smooth muscles, including arteries and veins. Effect is primarily on veins (decrease left/right ventricular end-diastolic pressure). In angina, nitrates decrease myocardial work and O₂ requirements (decrease preload by venodilation and afterload by arteriodilation). Nitrates also appear to redistribute blood flow to ischemic myocardial areas, improving perfusion without increasing coronary blood flow.

Name	Availability	Dosage Range	Side Effects
Isosorbide dinitrate (p. 646) (Isordil)	T: 5 mg, 10 mg, 20 mg, 30 mg, 40 mg T (ER): 40 mg SL: 2.5 mg, 5 mg C (SR): 40 mg	SL: 2.5–5 mg PO: 10–40 mg 2–3 times/day PO (SR): 40 mg 1–2 times/day	Flushing, headaches, nausea, vomiting, orthostatic hypotension, restlessness, tachycardia
Isosorbide mononitrate (p. 646) (Imdur, ISMO)	T: 30 mg, 60 mg, 120 mg	PO: 30–240 mg once/day	Same as isosorbide dinitrate
Nitroglycerin (p. 857) (Minitran, Nitro-Bid, Nitro-Dur, Nitrostat)	SL: 0.4 mg C (SR): 2.5 mg, 6.5 mg, 9 mg Topical: 2% ointment Trans: 0.1 mg/hr, 0.2 mg/hr, 0.3 mg/hr, 0.4 mg/hr, 0.6 mg/hr, 0.8 mg/hr I: 5 mg/ml Infusion: 100 mcg/ml, 200 mcg/ml	SL: 0.4 mg up to 3 times q15min SR: 2.5–26 mg 3–4 times/day Trans: 0.1–0.8 mg/hr T: 1–2 inches up to 4–5 inches q4h	Flushing, hypotension, tachycardia, headache, dizziness, nausea, dyspnea

C, Capsules; ER, extended-release; I, injection; SL, sublingual; SR, sustained-release; T, tablets; Trans, transdermal.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Provide symptomatic relief from pain/inflammation in the treatment of musculoskeletal disorders (e.g., rheumatoid arthritis [RA], osteoarthritis, ankylosing spondylitis), analgesic for low to moderate pain, reduction in fever (many agents not suited for routine/prolonged therapy due to toxicity). By virtue of its action on platelet function, aspirin is used in treatment or prophylaxis of diseases associated with hypercoagulability (reduces risk of stroke/heart attack).

Exact mechanism for anti-inflammatory, analgesic, antipyretic effects unknown. Inhibition of enzyme cyclo-oxygenase, the enzyme responsible for prostaglandin synthesis, appears to be a major mechanism of action. May inhibit other mediators of inflammation (e.g., leukotrienes). Direct action on hypothalamus heat-regulating center may contribute to antipyretic effect.

Name	Availability	Dosage Range	Side Effects
Aspirin (p. 89)	Caplet: 500 mg Suppository: 300 mg, 600 mg T: 325 mg T (EC): 81 mg, 325 mg T (chew): 81 mg	Analgesic/antipyretic: 325–650 mg q4–6h prn Anti-inflammatory: 2.4–3.6 g/day	GI discomfort, dizziness, headaches, increased risk of bleeding
Celecoxib (p. 231) (Celebrex)	C: 50 mg, 100 mg, 200 mg, 400 mg	200 mg q12h (Maximum: 600 mg day 1, then 400 mg/day)	Diarrhea, back pain, dizziness, heartburn, headaches, nausea, abdominal pain
Diclofenac (p. 355) (Voltaren)	T: 25 mg, 50 mg, 75 mg	50 mg tid	Indigestion, constipation, diarrhea, nausea, headaches, fluid retention, abdominal cramps
Diflunisal (Dolobid)	T: 500 mg	Arthritis: 0.5–1 g/day in 2 divided doses P: 250–500 mg q8–12h	Headaches, abdominal cramps, indigestion, diarrhea, nausea
Etodolac (p. 458) (Lodine)	T: 400 mg, 500 mg T (ER): 400 mg, 500 mg, 600 mg C: 200 mg, 300 mg	Arthritis: 600–1,000 mg/day in divided doses P: 200–400 mg q6–8h as needed	Indigestion, dizziness, headaches, bloated feeling, diarrhea, nausea, weakness, abdominal cramps
Fenoprofen (Nalfon)	C: 200 mg, 400 mg T: 600 mg	Arthritis: 300–600 mg 3–4 times/day P: 200 mg q4–6h as needed	Nausea, indigestion, anxiety, constipation, shortness of breath, heartburn
Ibuprofen (p. 594) (Advil, Caldolor, Motrin)	I: 100 mg/ml T: 100 mg, 200 mg, 400 mg, 600 mg, 800 mg T (chewable): 50 mg, 100 mg C: 200 mg S: 100 mg/5 ml, 100 mg/2.5 ml	Inflammatory disease: 400–800 mg/dose 3–4 times/day Pain: 200–400 mg/dose q4–6h as needed	Dizziness, abdominal cramps, abdominal pain, heartburn, nausea
Indomethacin (p. 618) (Indocin)	C: 25 mg, 50 mg C (SR): 75 mg S: 25 mg/5 ml	Arthritis: 25–50 mg/dose 2–3 times/day Bursitis/tendonitis: 75–150 mg/day GA: 150 mg/day	Fluid retention, dizziness, headaches, abdominal pain, indigestion, nausea
Ketoprofen (p. 658) (Orudis KT)	C: 25 mg, 50 mg C (ER): 200 mg	Arthritis: 50 mg 4 times/day or 75 mg 3 times/day P: 25–50 mg q6–8h as needed	Headaches, anxiety, abdominal pain, bloated feeling, constipation, diarrhea, nausea
Ketorolac (p. 660) (Toradol)	T: 10 mg I: 15 mg/ml, 30 mg/ml	P: (PO): 10 mg q4–6h as needed; (IM/IV): 60–120 mg/day in divided doses	Fluid retention, abdominal pain, diarrhea, dizziness, headaches, nausea
Meloxicam (p. 745) (Mobic)	C: 7.5 mg, 15 mg S: 7.5 mg/5 ml	Arthritis: 7.5–15 mg once daily	Heartburn, indigestion, nausea, diarrhea, headaches
Nabumetone (p. 819) (Relafen)	T: 500 mg, 750 mg	Arthritis: 1–2 g/day in 1–2 divided doses	Fluid retention, dizziness, headaches, abdominal pain, constipation, diarrhea, nausea
Naproxen (p. 828) (Anaprox, Naprosyn)	T: 250 mg, 375 mg, 500 mg T (CR): 375 mg, 500 mg S: 125 mg/5 ml	Arthritis: 500–1,000 mg/day in 2 divided doses P: 250 mg q6–8h as needed	Tinnitus, fluid retention, shortness of breath, dizziness, drowsiness, headaches, abdominal pain, constipation, heartburn, nausea
Oxaprozin (p. 899) (Daypro)	C: 600 mg T: 600 mg	Arthritis: 600–1,200 mg once daily	Constipation, diarrhea, nausea, indigestion
Piroxicam (p. 966) (Feldene)	C: 10 mg, 20 mg	Arthritis: 10–20 mg/day in 1–2 divided doses	Abdominal pain, stomach pain, nausea
Sulindac (p. 1137) (Clinoril)	T: 150 mg, 200 mg	Arthritis: 150 mg bid GA: 200 mg bid	Dizziness, abdominal pain, constipation, diarrhea, nausea

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Tags: Saunders Nursing Drug Handbook 2015

Mar 8, 2017 | Posted by admin in NURSING | Comments Off

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