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What important instructions should the health care professional give the patient who is taking the calcium channel blocker (dihydropyridine) drug nifedipine (Adalat, Procardia)?
- Report rapid heartbeat, increase in angina pain.
- Do not perform hazardous activities such as driving, until effects are known.
- Be aware that facial flushing may occur.
- Report swelling of feet and legs.
- Advise patient to take as prescribed and not to increase dosage.
- Report dizziness, syncope.
- Report bleeding gums, gum tissue growth.
- Obtain regular dental care.
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What important instructions should the health care professional give the patient who is taking the nitrate drugs nitroglycerin (Nitrostat, Nitro-Dur, Nitro-Bid) and isosorbide dinitrate (Isordil)?
- Take over-the-counter analgesic for unrelieved headaches (most subside spontaneously within 20 min).
- Report dizziness, syncope.
- Move slowly from lying down to sitting or standing to prevent injury.
- Do not perform hazardous activity, such as driving, if dizziness occurs.
- Take pulse, and report tachycardia above prescribed parameters.
- Remove transdermal forms for part of each day.
- Take only as many sublingual tablets as needed.
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What important instructions should the health care professional give the patient who is taking the sympathomimetic drug dobutamine (Dobutrex)?
- Be aware that continuous monitoring is performed during administration.
- Report chest pain immediately.
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What important instructions should the health care professional give the patient who is taking the phosphodiesterase inhibitor drug milrinone (Primacor)?
- Be aware that laboratory monitoring is ongoing before, during and after infusion.
- Be aware that ECG rhythm and vital sign monitoring is performed continuously during infusion.
- Report chest pain during infusion.
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What important instructions should the health care professional give the patient who is taking the alpha1 adrenergic blocker drug doxazosin (Cardura)?
- Report dizziness, syncope, rapid heartbeat, or palpitations.
- Take this drug at bedtime.
- Rise slowly from lying to sitting or standing to prevent injury.
- Do not perform hazardous activities, such as driving, for at least 12 hr following first dose and subsequent dosage increases.
- Report an increase in the frequency of headaches
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What important instructions should the health care professional give the patient who is taking the class II/beta adrenergic blocker drug propranolol (Inderal)?
- Check pulse rate daily before taking drug and report pulse slower than 60 beats/min (or prearranged parameter).
- Report shortness of breath, extremity edema, night cough.
- Do not stop taking this drug abruptly; talk to the provider.
- Report increase in angina or new onset of chest pain.
- Report sensations of cold, numbness in hands or feet.
- Protect extremities from severe cold.
- Report confusion, fatigue, drowsiness.
- Avoid hazardous activities, such as driving, until effects are known.
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What important instructions should the health care professional give the patient who is taking the cardiac glycoside digoxin (Lanoxin)?
- Report nausea, loss of appetite, or vomiting.
- Report headache, or visual disturbances.
- Report heart palpitations.
- Learn to monitor pulse rate and report decrease or increase beyond prescribed parameters.
- To decrease risk of toxicity or low serum levels, take digoxin at the same time each day; do not skip or double a dose.
- Report signs of hypokalemia, such as muscle weakness.
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What important instructions should the health care professional give the patient who is taking the fibrate drug gemfibrozil (Lopid)?
- Report nausea, vomiting, diarrhea.
- Report new inability to tolerate fried foods, upper abdominal discomfort and bloating.
- Report muscle or joint pain.
- Report abdominal pain, jaundice, fatigue.
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What important instructions should the health care professional give the patient who is taking the centrally acting alpha2 agonist drug clonidine (Catapres)?
- Take at bedtime to minimize drowsiness, dizziness.
- Do not perform hazardous activities, such as driving, until effects are known.
- Suck hard candies, chew sugarless gum, sip water to minimize dry mouth.
- Be assured that dry mouth will diminish with time.
- Do not abruptly stop taking clonidine; when discontinued, taper according to instructions.
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What important instructions should the health care professional give the patient who is taking the class III/potassium channel blocker drug amiodarone (Cordarone)?
- Take with food or milk if nausea, vomiting, or constipation occur (but be sure to take at consistent times during the day).
- Comply with chest x-ray and pulmonary function testing.
- Report fever, dry cough, shortness of breath or other respiratory symptoms.
- Report sensitivity to light and changes in vision.
- Obtain regular ophthalmic checkups.
- Wear sunglasses when out in sunlight.
- Report dizziness, syncope.
- For oral therapy, monitor pulse rate and report rates slower than 60 beats/min.
- Report weight gain and edema.
- Be aware that skin discoloration may occur.
- Report tremor, dizziness, hallucinations.
- Avoid hazardous activity such as driving if dizziness occurs.
- Due to long half-life of this drug, avoid pregnancy and breastfeeding during therapy and for several months after therapy is discontinued.
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What important instructions should the health care professional give the patient who is taking the thiazide diuretic drug hydrochlorothiazide (HydroDIURIL)?
- Eat foods rich in potassium (if indicated), such as citrus fruits, potatoes, bananas.
- Report signs of electrolyte imbalance, such as confusion, muscle twitching or weakness, irregular pulse, nausea.
- Patients who have diabetes mellitus need to carefully monitor blood glucose levels and notify provider for persistent hyperglycemia.
- Be aware that uric acid levels may increase, usually without symptoms.
- Patient with a history of gout needs to report symptom onset to a provider
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What important instructions should the health care professional give the patient who is taking the class IC/sodium channel blocker drugs flecainide (Tambocor) and propafenone (Rythmol)?
- Report any visual changes (blurred vision, difficulty focusing).
- Have regular ophthalmic examinations.
- Report shortness of breath, edema.
- Comply with temporary use of Holter monitor if necessary
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What important instructions should the health care professional give the patient who is taking the class IB/sodium channel blocker drug lidocaine (Xylocaine)?
- Report numbness of lips, unusual sensations.
- Be aware that continuous cardiac monitoring and frequent vital sign monitoring occurs during infusion.
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What important instructions should the health care professional give the patient who is taking the beta adrenergic blocker drugs atenolol (Tenormin) and metoprolol (Lopressor)?
- Check pulse rate daily before taking the drug and report a pulse slower than 60 beats/min (or prearranged parameter).
- Report shortness of breath, extremity edema, night cough.
- Do not stop taking this drug abruptly; talk to the provider.
- Report increase in angina or new onset of chest pain.
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What important instructions should the health care professional give the patient who is taking the class IV/calcium channel blocker drug verapamil (Calan)?
- Take as prescribed; do not increase dosage.
- Report dizziness, syncope.
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What important instructions should the health care professional give the patient who is taking the direct-acting vasodilator (hydralazine) drug hydralazine (Apresoline)?
- Headache and palpitations may occur 2 to 4 hr following first dose; notify provider if these do not subside.
- Plan to perform quiet, nonhazardous activities following first dose.
- Beginning with a low dose will minimize the first dose effects
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What important instructions should the health care professional give the patient who is taking the adrenergic neuron blocker drug reserpine (Serpalan, Sk-Reserpine)?
- Report feelings of depression, including insomnia, and loss of appetite and interest in daily activities.
- Do not perform dangerous activities, such as driving, until effects are known.
- Move slowly from lying down to sitting and standing to prevent falling.
- Report dizziness, syncope to provider.
- Report prolonged or severe gastrointestinal (GI) effects (diarrhea, cramps).
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What important instructions should the health care professional give the patient who is taking the HMG-CoA reductase inhibitor (statin) drug simvastatin (Zocor)?
- Report muscle or joint pain.
- Report abdominal pain, jaundice, fatigue.
- Comply with periodic liver function testing
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What important instructions should the health care professional give the patient who is taking the loop diuretic furosemide (Lasix)?
- Eat foods rich in potassium (if indicated), such as citrus fruits, potatoes, bananas.
- Report signs of electrolyte imbalance, such as confusion, muscle twitching or weakness, irregular pulse, nausea.
- Have blood pressure monitored frequently.
- Report dizziness, syncope.
- Avoid hazardous activities, such as driving, until effects are known.
- Report new onset of hearing loss, ringing in ears, or vertigo.
- Patients who has diabetes mellitus needs to carefully monitor blood glucose levels and notify provider for persistent hyperglycemia.
- Be aware that uric acid levels may increase, usually without symptoms.
- Patient with a history of gout needs to report symptom onset to a provider
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What important instructions should the health care professional give the patient who is taking the class IA/sodium channel blocker drugs quinidine (Apo-Quinidine, Novo-Quinidine) and procainamide (Pronestyl)?
- Take with food if nausea, vomiting, diarrhea occur.
- Report gastrointestinal (GI) symptoms to provider.
- Monitor pulse rate and report changes from prescribed parameters; keep record of pulse rate.
- Report dizziness, syncope.
- Avoid hazardous activities such as driving if hypotension occurs.
- Do not change prescribed dose or dosage intervals; take at fixed times daily.
- Be aware that monitoring of blood, ECG occurs.
- Report sudden chest pain, dyspnea to provider; call 911 for severe symptoms.
- Be aware of the reasons for use of the IV infusion pump, vital sign equipment, and cardiac monitors.
- Report flushing, headache or feeling of faintness immediately.
- Report symptoms of cinchonism to provider.
- Report onset of rash, fatigue, muscle and joint pain.
- Report fatigue, weakness, easy bruising or infection.
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What important instructions should the health care professional give the patient who is taking the potassium-sparing diuretic drug spironolactone (Aldactone)?
- Report palpitations, irregular pulse, or other signs of hyperkalemia.
- Avoid potassium supplements, large amounts of high potassium foods, and salt substitutes.
- Report menstrual irregularities, abnormal hair growth, deepening of voice, gynecomastia.
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What important instructions should the health care professional give the patient who is taking the alpha/beta blocker drug carvedilol (Coreg)?
- Report dizziness, syncope.
- Move slowly from lying to standing position to prevent falls.
- Do not perform hazardous activity, such as driving, until effects are known.
- Check pulse rate daily before taking drug and report to provider for pulse slower than 60 beats/min (or prearranged parameter).
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What important instructions should the health care professional give the patient who is taking the angiotensin receptor blocker (ARB) drug losartan (Cozaar)?
- Report minor swelling of mouth, throat to provider; call 911 immediately if severe reaction occurs.
- Report frequent headaches or insomnia.
- Report episodes of fainting, dizziness.
- Do not take if pregnant or breastfeeding.
- Tell provider if pregnancy is a possibility
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What important instructions should the health care professional give the patient who is taking the aldosterone antagonist drug spironolactone (Aldactone)?
- Do not take potassium supplements or use potassium-containing salt substitutes or drugs that raise potassium levels unless prescribed by the provider.
- Report palpitations, muscle twitching, weakness, or paresthesias in extremities.
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What important instructions should the health care professional give the patient who is taking the direct renin inhibitor aliskiren (Tekturna)?
- Do not take potassium supplements, salt substitutes, or drugs that raise potassium levels.
- Report palpitations, muscle twitching, weakness, numbness, and tingling.
- Report persistent cough.
- Report minor swelling of the mouth or throat; call 911 immediately for a severe reaction.
- Report diarrhea and abdominal pain.
- Stop taking aliskiren if pregnant; fetal injury may occur after the first trimester
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What important instructions should the health care professional give the patient who is taking the angiotensin-converting enzyme (ACE) inhibitor drug captopril (Capoten)?
- Be aware that hypotension may occur following the first dose.
- Lie supine if lightheadedness occurs.
- Report dry cough.
- Report rash.
- Report metallic or decreased ability to taste foods associated with decreased intake and weight loss.
- Report minor swelling of mouth, throat; call 911 immediately if severe reaction occurs.
- Refrain from using potassium supplements and potassium-containing salt substitutes.
- Report palpitations, muscle twitching, weakness or paresthesias in extremities.
- Report sore throat or other signs of infection.
- Do not take if pregnant or breastfeeding.
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