NAME Nitroglycerin Rx FC Coronary vasodilator antianginal CC Nitrate affects how bld carries oxygen TU Prevention of anginal attack USE Chronic stable angina pectoris prophylaxis of angina pain HF associated with acute MI controlled hypotension in surgical procedures anal fissures NAME Midodrine ProAmatine FC Adrenergic agonist TU vasopressor USE tx symptomatic orthostatic hypotension DOSAGE Adult SL dissolve tab under tongue when pain begins may repeat q5min until relief occurs take no more than 3 tab 15 min use 1 tab prophylactically 5 10 min before activities SUS REL cap q6 12hr on empty stomach TOP 1 2 inches q8hr increase to 4 in q4hr as needed IV 5 mcg min then increase by 5 mcg min q3 5min if no response after 20 mcg min increase by 10 20 mcg min until desired response transdermal apply a patch daily to a site free from hair remove patch at bedtime to provide 10 12 hr nitrate free interval to avoid tolerance PT EDUCATION avoid alcohol product may cause headache tolerance usually develops use nonopioid analgesic product may be taken before stressful activity exercise sexual activity SL tab may sting when product comes in contact with mucous membranes Caution patient to avoid hazardous activities if dizziness occurs Instruct patient to comply with complete medical regimen Advise patient to make position changes slowly to prevent fainting Advise patient to never use erectile dysfunction products sildenafil tadalafil vardenafil may cause severe hypotension death ACTION Decreases preload and afterload which thus decreases left ventricular end diastolic pressure and systemic vascular resistance dilates coronary arteries and improves blood flow through coronary vasculature dilates arterial venous beds systemically SIDE EFFECTS Headache flushing dizziness postural hypotension tachy Collapse syncope palpitations nausea vomiting pallor sweating rash NURSING CONSIDERATIONS 1 Monitor orthostatic B P pulse 2 Assess pain duration time started activity being performed character check for tolerance if taken over long period 3 Monitor for headache light headedness decreased B P may indicate a need for decreased dosage DOSAGE PO 10 mg TID max 40 mg day PT EDUCATION take medication as directed first does should be taken shortly after waking up second dose at midday third dose before evening meal and at least 4 hours before bedtime take missed dose as soon as remember unless almost time for next dose do not double doses ACTION activates the alpha adrenergic receptors of the arteries and veins resulting in increased vascular tone and increased blood pressure Headache SIDE EFFECTS common mild tremors nervousness dizziness toxic seizures from excessive CNS stimulation hypotension or hypertension dysrhythmias palpitations fatigue malaise insomnia dry mouth nausea two most life threatening effects involve CNS and CV system ANTIDOTE manage the symptoms and support pt NURSING CONSIDERATIONS 1 report immediately to physician sensations a w supine hypotension I e pounding in ears headache blurred vision awareness of heart beating 2 d c drug and report to physician if s s of bradycardia develop i e dizziness pulse slowing fainting 3 monitor regular supine and standing BP Stop if supine BP increases excessively determine acceptable parameters 4 monitor all patients closely for behavior changes 5 monitor carefully effect of the drug in diabetics with orthostatic hypotension and those taking flu cortisone acetate which may increase IOP NAME Hydrocerin Cream Lanolin alcohol NAME Pramipexole Rx Mirapex FC Emollient USE moisturizer to treat or prevent dry rough scaly itchy skin and minor skin irritations such as diaper rash skin burns from radiation therapy FC Antiparkinsonian Agent CC Dopamine receptor agonist activates dopamine non ergot TU Decreased symptoms of Parkinson s disease involuntary movements USE Idiopathic Parkinson s disease restless leg syndrome DOSAGE Use as directed PT EDUCATION Follow all the directions on the label for proper use Apply to the skin only Avoid sensitive areas such as your eyes inside your mouth nose and the vaginal groin area unless the label or your doctor directs you otherwise Check the label for directions about any areas or types of skin where you should not apply the product such as on the face any areas of broken chapped cut irritated scraped skin or on a recently shaved area of the skin ACTION SIDE EFFECTS Can be used safely and effectively with no side effects However burning stinging redness or irritation may occur DOSAGE Initial treatment Adult PO from a starting dose of 0 375 mg day given in 3 divided doses increase gradually by 0 125 mg dose at 5 7 day intervals until total daily dose of 4 5 mg is reached ER 0 375 mg qd may increase up to 0 75 mg day then increments of 0 75 mg day 5 7 days max 4 5 mg day Restless leg syndrome Adult PO 0 125 mg 2 3 hr before bedtime increase gradually max 0 5 mg day PT EDUCATION Advise patient that therapeutic effects may take several wk to a few mo change positions slowly to prevent orthostatic hypotension product exactly as prescribed if product is discontinued abruptly parkinsonian crisis may occur if treatment is to be discontinued taper over 1 wk avoid alcohol OTC sleeping products Teach patient to notify prescriber of impulse control disorders shopping ACTION Selective agonist for D2 receptors presynaptic postsynaptic sites binding at D3 receptor contributes to antiparkinson effects SIDE EFFECTS Agitation insomnia psychosis hallucinations depression dizziness headache confusion amnesia dream disorder asthenia dyskinesia hypersomnolence sudden sleep onset impulse control disorders Orthostatic hypotension edema syncope tachycardia increased B P heart rate Blurred vision antidiuretic hormone secretion SIADH nausea anorexia constipation dysphagia dry mouth impotence urinary frequency hemolytic anemia leukopenia agranulocytosis Pruritus NURSING CONSIDERATIONS 1 Monitor B P ECG respiration during initial treatment hypo hypertension should be reported 2 Assess mental status affect mood behavioral changes depression complete suicide assessment 3 Assess for involuntary movements in parkinsonism akinesia tremors staggering gait muscle rigidity drooling these symptoms should improve with therapy 4 Assess for sleep attacks may fall asleep during activities without warning may need to discontinue medication CONTRAINDICATIONS Hypersensitivity