Doctor ordered a drug study for a patient taking several medications including Digoxin, Nitroglycerin, Enalapril, Atorvastatin, Lactulose, Furosemide, Spironolactone, and Warfarin. The orders include administration routes, frequencies and time periods. Key information on each drug's classification, mechanism of action, indications, contraindications, adverse reactions and nursing responsibilities are provided.

1. DRUG STUDY
Doctor Order: Before giving the drugs check first the pulse rate (assess apical pulse in one full minute) If rate is less than 60 beats/minute, withhold dose
and notify prescriber
0.5 ml I.V stat 09/30
.25 ml IV every 3 hours 10/01-10/09
Brand Name: Lanoxin
Generic Name: Digoxin
Classification: Cardiac glycoside
Date and time: September 30, 2021 12:10 pm
Mechanism
Action
Indication Contraindications Adverse Reactions
and Side Effects
Nursing Responsibilities Health Teaching
Inhibits the
potassium-
sodium ATPase
thus promoting
increased force
of cardiac
contraction,
cardiac output,
and tissue
perfusion;
decrease
ventricular rate
Atrial
fibrillation, and
flutter.
 To treat
CHF
Contraindicated in
patients
hypersensitive to
drug and in those
with digitalis
induced toxicity,
ventricular
tachycardia unless
caused by heart
failure.
Adverse Reactions
Bradycardia, Visual
disturbances
Life-threatening:
Atrioventricular
block, cardiac
dysrhythmias
Side Effects
Anorexia, vomiting
headache, blurred
vision (yellow-green
halos), diplopia,
photophobia,
drowsiness, fatigue,
confusion
INDEPENDENT
1. Before giving
the drugs check
first the
potassium level
if below 3.5
level *Don’t
give and notify
the Prescriber.
2. Monitor for signs
and symptoms of
drug toxicity. Be
aware that
therapeutic
digoxin levels
range from 0.5 to
2 ng/ml.
1. Advise client to eat
foods rich in
potassium such as
fresh and dried
fruits, and potatoes
2. Educate significant
others and Client on
drug therapy
including drug
name, indication
and adverse effect
to enhance
significant others
understanding on
drugs.

2. *Sign and symptoms
of toxicity
such as Blurring of
vision, Anorexia,
Nausea and vomiting
and Diarrhea).
DEPENDENT
3. Monitor ECG
and blood levels
of digoxin,
electrolytes,
creatinine and
renal function
test By Doctors
order
*Stay alert for
hypocalcemia.
Know that this
condition may
predispose
patient to
digoxin toxicity
and may
decrease digoxin
efficacy.
*Watch closely
for hypokalemia
and
hypomagnesemia

3. Doctor Order:
ER 0.2 mg SLq 5 minutes for maximum of 2 doses in 15 minutes.
WARD 2.5 mg tablet SL prn 09/30-10/09
Brand Name: Nitrostat
Generic Name: Nitroglycerin (Glyceryl trinitrite)
Classification: Nitrite, Antianginal
Date and time: September 30, 2021 12:15 pm
Mechanism
Action
Indication Contraindications Adverse Reactions and
Side Effects
Nursing
Responsibilities
Health Teaching
Decrease
myocardial
demand for
oxygen; decrease
preload by
dilating veins
thus indirectly
decreasing
afterload
To control
angina pectoris.
Hypersensitivity to
nitrites, severe
anemia.
Adverse Reactions
Hypotension, reflex
tachycardia,
paradoxical
bradycardia
Life-threatening:
circulatory collapse
Side Effects
Nausea, vomiting,
headache, dizziness,
syncope, weakness,
lush, confusion, pallor
rash, dry mouth
INDEPENDENT
1. Before giving
the drugs
-Confirm no
known allergy
to
nitroglycerin
2. Monitor vital
signs.
*Hypotension
is associated
with most
antianginal
drugs
3. Offer sips of
water before
giving
sublingual;
dryness may
1. Instruct patient to
take drug regularly
by Doctors order,
and to keep S.L.
form accessible at all
times and put the
medicine in the
meds compartment
to avoid skipping
drink on time.
2. Teach patient to take
oral tablet on empty
stomach, either 30
minutes before or 1
to 2 hours after
meals.
3. Instruct patient to
take S.L. tablet at
first sign of angina
attack. Tell him to

4. inhibit drug
absorption
4. Store S.L.
tablets in
original
container or
other container.
wet tablet with
saliva, place it under
the tongue until
completely
absorbed, and sit
down and rest.
Doctor Order:
1.25 mg IV q 6 hours infuse in 5 mins 09/30-10/02
0.625 mg IV prn 10/03-10/09
Brand Name: vasotec
Generic Name: Enalapril Maleate
Classification: Angiotensin-converting enzyme (ACE) inhibitor
Date and time: September 30, 2021 12:20 pm
Mechanism
Action
Indication Contraindications Adverse Reactions and
Side Effects
Nursing
Responsibilities
Health Teaching
May inhibit
ACE, preventing
conversion of
angiotensin I to
angiotensin II, a
potent
vasoconstrictor.
Less angiotensin
II decreases
peripheral
arterial
resistance,
To treat
hypertension
and also
effective in
treating heart
failure
-Hypersensitivity to
drug or other ACE
inhibitors
-Angioedema
Adverse Reactions
Loss of appetite, Dry
Cough
Side Effects
Dizziness Weakness
headache, Diarrhea,
skin rash, Nausea and
vomiting,
INDEPENDENT
1. Assess for
rapid blood
pressure drop
leading to
cardiovascular
collapse,
especially
when giving
with diuretics.
2. Monitor vital
signs, fluid
1. Inform patient and
significant others
that drug’s full effect
may not occur for
several weeks.
2. Advise patient and
significant others to
report persistent dry
cough with nasal
congestion.
3. Tell patient and
significant others to

5. decreasing
aldosterone
secretion,
reducing sodium
and water
retention and
lowering blood
pressure
intake and
output, and
daily weight.
of drug are
known.
DEPENDENT
3. Monitor CBC
with
differential
counts before
and during
therapy
4. Monitor
potassium
intake and
potassium level
5. Monitor liver
function tests,
BUN, and
creatinine and
electrolyte
levels.
immediately report
swelling of face, eye
area, tongue, lips,
hands, or feet; rash,
hives, or severe
itching; unexplained
fever; unusual
tiredness; yellowing
of skin or eyes;
abdominal pain; or
easy bruising.
4. Instruct patient to
move slowly when
sitting up to avoid
dizziness or light-
headedness from
sudden blood
pressure decrease.

6. Doctor Order: 40 mg PO day 09/30-10/09
Brand Name: Lipitor
Generic Name: Atorvastatin
Classification: HMG-CoA reductase inhibitors, statin, lipid-lowering agents
September 30, 2021 12:30 pm
Mechanism Action Indication Contraindications Adverse Reactions
and Side Effects
Nursing
Responsibilities
Health Teaching
HMG-CoA reductase
inhibitor; inhibits
rate- limiting step in
cholesterol
biosynthesis by
completely inhibiting
HMG-CoA reductase.
-To decrease cholesterol
levels and to decrease serum
lipids especially LDL and
tryglycerines
Hypersensitivity, active
liver disease or
unexplained persistent
elevations of serum
transaminase, porphyria
Adverse
Reactions
Rhabdomyolysis,
myalgia,
photosensitivity
and cataracts
Side Effects
Rare headache,
rush/ pruritus,
constipation/
diarrhea, sinusitis,
pharynitis
INDEPENDENT
1. Tell patient to
take drug at the
same time each
day to maintain
its effect.
2. Observe for
signs and
symptoms of
GI upset.
Taking the
drug with
sufficient water
or with meals
may alleviate
some of the GI
discomfort
DEPENDENT
3. Monitor blood
lipid levels
every 6 to 8
1.Teach patient about
proper dietary
management and maintain
a low fat diet by eating
food that low in animal
fat, cholesterol and
complex sugar.
2. Advise patients that
drug can be taken at any
time of day but taking at
night is good because our
body makes most
cholesterol at night.
3. Encourage client to
report promptly any
unexplained muscle
tenderness or weakness
that may be caused by
rhabdomyolysis
4. Tell patient to inform
prescriber for any side
effects.

7. weeks for the
first months
after the
therapy and
then after 3 to
6 months as
doctors order
4. Monitor
Laboratory for
liver function
test in every
follow up
check up or as
Doctors order

8. Doctor Order: 10 ml OD at night 09/30-10/09
Brand Name: Duphalac
Generic Name: Lactulose
Classification: Pharmacologic class: disaccharide, Therapeutic class: laxative
Date and time: September 30, 2021 1:00 pm
Mechanism Action Indication Contraindications Adverse
Reactions and
Side Effects
Nursing
Responsibilities
Health Teaching
Increases water content
and softens the stool.
Lower PH of the colon,
which inhibits the diffusion
of ammonia from the colon
into the blood thereby
reducing blood .
-To facilitate the
easy passage of
stool and to avoid
exerts force
(Valsalva
maneuver)
-contraindicated in
patients on low-galactose
diet.
GI: Abdominal
cramps,
belching,
diarrhea,
distention,
Flatulence.
1. Assess patients
condition
before starting
therapy, and
regularly there
after to monitor
the drugs
effectiveness.
2. Be alert for
adverse
reactions and
drug
interactions
3. Assess patients
and family’s
knowledge of
drug therapy.
1. Advice minimize sweet
taste, dilute with water or
fruit juice or give with
food.
2. Effects are seen 24 to 48
hrs.
3. Explain to Patient and
family the state of
understanding about drug
therapy.

9. Doctor Order:
20 mg slowly IV push over 2 minutes q 2 hrs. for 24 hours 10/01-10/02
20 mg PO bid 10/03-10/09
Brand Name: Lasix
Generic Name: Furosemide
Classification: Loop Diuretics
Date and time: October 1, 2021 8:00 am
Mechanism
Action
Indication Contraindications Adverse Reactions
and Side Effects
Nursing
Responsibilities
Health Teaching
Inhibit sodium
and chloride
reabsorption
mainly in the
ascending loop
of Henle;
potassium,
magnesium ,
and calcium also
may be excreted
To treat fluid
retention/fluid
overload caused
by CHF and
hypertension
-Contraindicated in
patients
hypersensitive to
drug or in those
with anuria.
Adverse Reactions
Severe dehydration;
marked hypotension
Life-threatening:
Renal failure,
thrombocytopenia,
and agranulocytosis
Side Effects
Nausea, diarrhea,
electrolytes
imbalances, vertigo,
cramping, rash,
headache, weakness,
ECG changes, blurred
vision,
photosensitivity
INDEPENDENT
1. Prior to
administration
check for signs
and symptoms
of volume
depletion, such
as postural
hypotension,
lightheadedness,
and dizziness
2. Monitor urine
output during
hours during
after
administration.
Analyze intake,
output and daily
1. Instruct patient and
significant others to
move slowly when
sitting up or
standing, to avoid
dizziness or light-
headedness from
sudden blood
pressure drop.
2. Advise patient to eat
foods high in
potassium. Provide
other dietary
counseling as
appropriate to help
prevent or minimize
electrolyte
imbalances.

10. weights to
assess response.
3. Monitor blood
pressure
regularly. Be
alert for marked
decrease in
blood pressure
DEPENDENT
1. Monitor serum
electrolyte, uric
acid, glucose,
and BUN levels
as Doctors order
3. Instruct patient and
significant others to
immediately report
ringing in ears,
severe abdominal
pain, or sore throat
and fever (these
symptoms may
indicate toxicity)
.

11. Doctors order: 25 mg P.O OD
Brand Name: Aldactone
Generic Name: Potassium-sparring diuretics
Classification: Potassium sparring
Date and Time: October 01, 2021- 8:03 am.
Mechanism Of
Action
Indication Contraindication Adverse Reactions
and Side Effects
Nursing Responsibilities Health Teaching
Potassium-sparring
diuretics:
antagonizes
aldosterone in the
distal tubules,
increasing sodium
and water
excretion.
Treatment for
hypokalemia or
prevention of
hypokalemia in
patients who would
be at risk if
hypokalemia
occurred;
Digitalized patients,
patients with
cardiac arrhythmias
 To treat
CHF
Contraindicated in patient with
allergy to spironolactone,
hyperkalemia, renal disease,
anuria.
Adverse Reactions
Hyperkalemia,
Agranulocytosis,
hyponatremia
Side Effects
Drowsiness,
dizziness, Nausea,
vomiting, diarrhea,
abdominal cramps,
irritability
INDEPENDENT
1. To enhance
absorption, give
drug with meals
2. Protect drug from
light.
DEPENDENT
3. Monitor electrolyte
levels, fluid intake
and output, weight,
and and blood
pressure.
4. Inform laboratory
that patients is
taking
spironolactone
because drug may
interfere with test
that measure
digoxin level.
1. Instruct patient to
take drugs in
morning to prevent
need to urinate at
night.
2. To prevent serious
hyperkalemia warn
patent to avoid
excessive ingestion
of potassium-rich
foods (such as
citrus fruits,
tomatoes, bananas,
dates and apricots),
potassium
containing salt
substitutes, and
potassium
supplements.

12. Doctor Order: 1mg/tab OD
Brand Name: Coumadin
Generic Name: Warfarin Sodium
Classification: Anticoagulant
Date and time: October 01, 2021 8:00pm
Mechanism
Action
Indication Contraindications Adverse Reactions and
Side Effects
Nursing
Responsibilities
Health Teaching
Inhibit hepatic
synthesis of
vitamin k- which
decrease
prothrombin
and clotting
factors
dependent
activation of
clotting factors
VII,IX and X.
Prevent blood
clotting due to
arterial
fibrillation
because of heart
failure.
Peptic bleeding
ulcer, blood
dyscrasias,
Adverse Reactions
Stomatitis
Life-threatening:
hemorrhage
Side Effects
Anorexia, nausea,
vomiting, diarrhea,
abdominal cramps,
rash, fever
INDEPENDENT
1. Watch for
signs and
symptoms of
bleeding and
hepatitis.
2. Give drug at
the same time
daily.
3. Avoid all IM
injections.
4. Regularly
inspect patient
for bleeding
gums, bruises
on arms or
legs, petechiae,
nosebleeds,
melena, tarry
stools,
hematuria
4. Explain therapy to
patient. Stress
importance of
adhering to schedule
for laboratory tests.
5. Instruct patient and
family to promptly
report unusual
bleeding or bruising.
6. Caution patient to
consult prescriber
before taking herbs.
7. Tell patient not to
vary his intake of
foods high in
vitamin K (such as
leafy green
vegetables, fish,
pork, green tea, and
tomatoes), to avoid
alterations in drug’s
anticoagulant effect.

13. 5. Withhold drug
and call
prescriber at
once in the
event of fever
or rash.
DEPENDENT
2. Draw blood to
establish
baseline
coagulation as
doctors order
3. parameters
before
therapy. PT
and INR as
doctors order

14. Doctor Order: 3.125 mg/ tab b.i.d
Brand Name: Coreg
Generic Name: Carvedilol
Classification: Beta-adrenergic blocking Agents
Date and time: October 1, 2021 9:00 am
Mechanism
Action
Indication Contraindications Adverse Reactions and
Side Effects
Nursing
Responsibilities
Health Teaching
Carvedilol
causes
vasodilation by
blocking the
activity of α-
blockers, mainly
at alpha-1
receptors. It
exerts
antihypertensive
effect partly by
reducing total
peripheral
resistance and
vasodilation. It
is used in
patients with
renal
impairment,
NIDDM or
IDDM
-For treatment
of hypertension
and with heart
failure
Hypersensitivity;
severe chronic heart
failure, bronchial
asthma or related
bronchospastic
conditions.
CNS: pain dizziness,
fever
CV: hypotension,
edema, bradycardia
EENT: sinusitis,
blurred vision
GI: Diarrhea, Nausea
and vomiting
GU: UTI, Hematuria
Hematologic: anemia.
Thrombocytopenia
Metabolic: weight
gain, hyperglycemia
Musculoskeletal: Back
pain, muscle cramps
Respirarotry:
bronchitis, rales,
dyspnea
1. Monitor for
orthostatic
hypotension
and adverse
effects
2. Monitor patient
for any sign of
liver function
test
3. Monitor for
fluid retention
4. Assess patient
for dizziness or
light
headedness for
1 hour after
giving each
new dose
1. Instruct to take drug
with meals.
2. Instruct to do not
stop taking drug
unless instructed to
do so by a health
care provider.
3. Advised to report
difficulty breathing,
swelling of
extremities, changes
in color of stool or
urine, very slow
heart rate, continued
dizziness.
4. Check the BP of the
patient.
5. Inform patient that
improvement of
heart failure
symptoms might

15. take several weeks
of drug therapy