omeprazole
Heartburn Relief , Losec_ ,
Mepradec , Prilosec, Prilosec OTC,
Ratio-Omeprazole_, Sandoz
Omeprazole_, Zanprol , Zegerid
Pharmacologic class: Proton pump
inhibitor
Therapeutic class: Antiulcer drug
Pregnancy risk category C
Action
Reduces gastric acid secretion and increases
gastric mucus and bicarbonate
production, creating protective coating
on gastric mucosa and easing discomfort
from excess gastric acid
Availability
Capsules (delayed-release): 10 mg,
20 mg, 40 mg
Powder for oral suspension: 20 mg
Tablets (delayed-release): 20 mg
1Indications and dosages
➣Gastroesophageal reflux disease
Adults: 20 mg P.O. (capsules, powder)
daily for 4 weeks
➣Erosive esophagitis
Adults: 20 mg P.O. (capsules, powder)
daily for 4 to 8 weeks
➣Short-term treatment of active
duodenal ulcer
Adults: 20 mg P.O. (capsules, powder)
daily for 4 weeks. Some patients may
need 4 additional weeks of therapy.
➣To reduce risk of duodenal ulcers
caused by Helicobacter pylori
Adults: 40 mg P.O. (capsules) daily in
morning, given with clarithromycin t.i.d.
for 2 weeks; then 20 mg daily for 2 weeks
➣Gastric ulcers
Adults: 40 mg P.O. (capsules) daily for
4 to 8 weeks
➣Pathologic hypersecretory conditions,
including Zollinger-Ellison
syndrome
Adults: Initially, 60 mg P.O. (capsules)
daily; may increase up to 120 mg t.i.d.
Divide daily dosages above 80 mg.
➣Frequent heartburn (two or more
episodes a week)
Adults ages 18 and older: 20 mg P.O.
(OTC tablets) daily for 14 days
Off-label uses
● Posterior laryngitis
● To enhance pancreatin efficacy in
treating steatorrhea in cystic fibrosis
patients
Contraindications
● Hypersensitivity to drug or its
components
Precautions
Use cautiously in:
● hepatic disease
● pregnant or breastfeeding patients
● children (safety not established).
Administration
● Give 30 to 60 minutes before a meal,
preferably in morning.
● If desired, give concurrently with
antacids.
● Know that if patient has ulcer at start
of therapy, treatment may be extended.
● When giving through nasogastric
tube, use powder for oral suspension,
or separate capsule and mix pellets
with water. Agitate syringe while
injecting. After administration, flush
with 30 to 60 ml of water.
● Don’t crush capsules.
● Be aware that symptomatic response
doesn’t rule out gastric cancer.
Route Onset Peak Duration
P.O. Within 1 hr Within 2 hr 72-96 hr
P.O. Unknown 10-90 min Unknown
(delayed)
Adverse reactions
CNS: dizziness, headache, asthenia
GI: nausea, vomiting, diarrhea, constipation,
abdominal pain
Musculoskeletal: back pain
Respiratory: cough, upper respiratory
tract infection
Skin: rash
Interactions
Drug-drug. Ampicillin, cyanocobalamin,
iron salts, ketoconazole: reduced
absorption of these drugs
Clarithromycin: increased omeprazole
blood level
Diazepam, phenytoin, warfarin: prolonged
elimination and increased effects
of these drugs
Digoxin: increased digoxin absorption
and blood level, possible digoxin
toxicity
Drugs metabolized by CYP450 system:
competitive metabolism
Drug-diagnostic tests. Alanine phosphatase,
alkaline aminotransferase, aspartate
aminotransferase, bilirubin: increased
levels
Gastrin: increased level during first
1 to 2 weeks of therapy
Patient monitoring
● Assess vital signs.
● Check for abdominal pain, emesis,
diarrhea, or constipation.
● Evaluate fluid intake and output.
● Watch for elevated liver function test
results (rare).
Patient teaching
● Tell patient to take 30 to 60 minutes
before a meal, preferably in morning.
● Instruct patient to swallow capsules
or tablets whole and not to chew or
crush them. If he can’t swallow capsule,
tell him he may open it, carefully
sprinkle and mix entire contents into 1
tbsp of cool applesauce, and swallow
immediately with glass of water.
● Inform patient taking OTC delayedrelease
tablets for heartburn that full
effect may take 1 to 4 days. Advise him
not to take tablets for more than 14
days without consulting healthcare
professional.
● Caution patient to avoid driving and
other hazardous activities until he
knows how drug affects concentration
and alertness.
● As appropriate, review all other significant
adverse reactions and interactions,
especially those related to the
drugs and tests mentioned above
Combivent Nebules
Combivent Nebules contain two active
ingrediants, Albuterol and Ipratropium.
Combivent Nebules contain 2.5mg of Albuterol
and 0.5mg of Ipratropium in each 2.5ml size
nebule. Each nebule contain 2.5ml volume. Each
box contains 20 Nebules. The total volume of one
box is thus 20 nebules x 2.5ml/nebule, or 50ml.
Thus, the concentration of drug per nebule is:
Albuterol 1mg/ml and Ipratropium 0.2mg/ml (or
2.5mg Albuterol and 0.5mg Ipratropium per 2.5ml
nebule). Nebules are also sometimes called
Respules.
Combivent is used to prevent bronchospasm in
people with chronic obstructive pulmonary
disease (COPD) who are also using other
medicines to control their condition.Combivent
may also be used for other purposes not listed in
this medication guide. 
What is the important information about
Combivent
Do not use Combivent if you are allergic to it, or
to atropine (Atreza, Sal-Tropine), soybeans,
peanuts, or other food products that contain soya
lecithin. Call your doctor right away if you feel
that this medicine is not working as well as usual,
or if it makes your condition worse. If it seems like
you need to use more of any of your medications
in a 24-hour period, talk with your doctor. 
Extreme heat can cause the medicine canister to
burst. Do not store your inhaler in your car on hot
days. Do not throw an empty canister into open
flame. 
Do not use Combivent if you are allergic to it, or
to atropine (Atreza, Sal-Tropine), soybeans,
peanuts, or other food products that contain soya
lecithin. If you have any of these other conditions,
you may need a dose adjustment or special tests
to safely use Combivent: 
 heart disease, high blood pressure, or
congestive heart failure
 diabetes
 a seizure disorder such as epilepsy
 glaucoma
 overactive thyroid
 enlarged prostate, problems with urination
 liver or kidney disease. FDA pregnancy category
C. It is not known whether Combivent is harmful
to an unborn baby. Tell your doctor if you are
pregnant or plan to become pregnant during
treatment. It is not known whether albuterol or
ipratropium pass into breast milk or if it could
harm a nursing baby. Do not use Combivent
without telling your doctor if you are breast-
feeding a baby. 
Where can I get more information on Combivent
Nebules? 
For more information on Combivent Nebules,
Combivent Nebules prescribed Patients, who are
trying place an order for Combivent Nebules from
an online pharmacy store can place their
 prescription order at CanadaDrugsOnline.com
which is an online Canadian pharmacy store.
hydrocortisone
Ala-Cort, Ala-Scalp, Cetacort,
Colocort, Cortef, Cortenema, Hi-Cor,
Hycort_, Hytone, Stie-Cort, Synacort,
Texacort
hydrocortisone acetate
Cortifoam, Hydrocortistab
hydrocortisone butyrate
Locoid
hydrocortisone sodium
succinate
A-hydroCort, Solu-Cortef
hydrocortisone valerate
Westcort
Pharmacologic class: Short-acting
corticosteroid
Therapeutic class: Anti-inflammatory
(steroidal)
Pregnancy risk category C
Action
Suppresses inflammatory and immune
responses, mainly by inhibiting
migration of leukocytes and phagocytes
and decreasing inflammatory
mediators
Availability
Cream, gel, lotion, ointment, solution:
various strengths
vial, 250 mg/vial, 500 mg/vial, 1,000
mg/vial
Intrarectal aerosol foam: 90 mg
Oral suspension: 10 mg/5 ml
Retention enema: 100 mg/60 ml
Spray (topical): 1%
Tablets: 5 mg, 10 mg, 20 mg
1Indications and dosages
➣Replacement therapy in adrenocortical
insufficiency; hypercalcemia due
to cancer; arthritis; collagen diseases;
dermatologic diseases; autoimmune
and hematologic disorders; trichinosis;
ulcerative colitis; multiple sclerosis;
proctitis; nephrotic syndrome;
aspiration pneumonia
hydrocortisone, hydrocortisone
cypionate—
Adults and children: 20 to 240 mg/day
P.O.
hydrocortisone acetate (suspension)—
Adults and children: 5 to 75 mg by
intra-articular injection (depending on
joint size) q 2 to 3 weeks
hydrocortisone acetate (intrarectal
foam)—
Adults and children: One applicatorful
of intrarectal foam daily or b.i.d. for
2 to 3 weeks; then one applicatorful
every other day
hydrocortisone sodium phosphate—
Adults and children: 15 to 240 mg/day
subcutaneously, I.M., or I.V., adjusted
according to response
hydrocortisone sodium succinate—
Adults and children: 100 to 500 mg
I.M. or I.V.; may repeat at 2-, 4-, or
6-hour intervals, depending on response
and condition
hydrocortisone retention enema—
Adults and children: 100 mg P.R. at
bedtime for 21 nights or until desired
response; patient should retain enema
for at least 1 hour.
➣Itching and inflammation caused
by skin conditions
Adults and children: Thin film of topical
preparation applied to affected
area one to four times daily, depending
on drug form and severity of condition
Off-label uses
● Phlebitis
● Stomatitis
Contraindications
● Hypersensitivity to drug, alcohol,
bisulfites, or tartrazine (with some
products)
● Systemic fungal infections
● Concurrent use of other immunosuppressant
corticosteroids
● Concurrent administration of livevirus
vaccines
Precautions
Use cautiously in:
● hypertension, osteoporosis, glaucoma,
renal or GI disease, hypothyroidism,
cirrhosis, thromboembolic disorders,
myasthenia gravis, heart failure
● pregnant or breastfeeding patients
● children ages 6 and younger (safety
not established).
Administration
● Give oral form with food or milk to
avoid GI upset.
● Give I.V. injection of sodium succinate
form over 30 seconds to a few
minutes.
● Know that drug may be given as intermittent
or continuous I.V. infusion.
Dilute in normal saline solution, dextrose
5% in water, or dextrose 5% in
normal saline solution.
● Inject I.M. deep into gluteal muscle.
Rotate injection sites to prevent muscle
atrophy.
● Be aware that subcutaneous administration
may cause muscle atrophy or
sterile abscess.
2Never abruptly discontinue highdose
or long-term systemic therapy.
● Know that systemic forms typically
are used for adrenal replacement
rather than inflammation.
heat, hydration, inflammation, denuding,
and thinning of skin increase topical
drug absorption.
Route Onset Peak Duration
P.O. 1-2 hr 1-2 hr 1-1.5 days
I.V. Immediate Unknown 1-1.5 days
I.M. Rapid 4-8 hr 1-1.5 days
P.R. Slow 3-5 days 4-6 days
Spray Unknown Unknown Unknown
(topical),
subcut.
Adverse reactions
CNS: headache, nervousness, depression,
euphoria, personality changes,
psychoses, vertigo, paresthesia, insomnia,
restlessness, conus medullaris syndrome,
meningitis, increased intracranial
pressure, seizures
CV: hypotension, hypertension, thrombophlebitis,
heart failure, shock, fat
embolism, thromboembolism,
arrhythmias
EENT: cataracts, glaucoma, increased
intraocular pressure, epistaxis, nasal
congestion, perforated nasal septum,
dysphonia, hoarseness, nasopharyngeal
or oropharyngeal fungal infections
GI: nausea, vomiting, esophageal candidiasis
or ulcer, abdominal distention,
dry mouth, rectal bleeding, peptic ulceration,
pancreatitis
Hematologic: purpura
Metabolic: sodium and fluid retention,
hypokalemia, hypocalcemia,
hyperglycemia, hypercholesterolemia,
amenorrhea, growth retardation, diabetes
mellitus, cushingoid appearance,
hypothalamic-pituitary-adrenal suppression
with secondary adrenal insufficiency
(with abrupt withdrawal or
high-dose, prolonged use)
Musculoskeletal: osteoporosis, aseptic
joint necrosis,muscle pain or weakness,
steroid myopathy, loss of muscle mass,
tendon rupture, spontaneous fractures
Respiratory: cough, wheezing, rebound
congestion, bronchospasm
Skin: rash, pruritus, urticaria, contact
dermatitis, acne, bruising, hirsutism,
petechiae, striae, acneiform lesions,
skin fragility and thinness, angioedema
Other: altered taste; anosmia; appetite
changes; weight gain; facial edema; increased
susceptibility to infection;
masking or aggravation of infection;
adhesive arachnoiditis; injection site
pain, burning, or atrophy; immunosuppression;
hypersensitivity reactions
including anaphylaxis
Interactions
Drug-drug. Amphotericin B, loop and
thiazide diuretics, mezlocillin, piperacillin,
ticarcillin: additive hypokalemia
Fluoroquinolones: increased risk of tendon
rupture
Hormonal contraceptives: prolonged
half-life and increased effects of hydrocortisone
Insulin, oral hypoglycemics: increased
requirements for these drugs
Live-virus vaccines: decreased antibody
response to vaccine, increased risk of
adverse reactions
Nonsteroidal anti-inflammatory drugs:
increased risk of adverse GI reactions
Phenobarbital, phenytoin, rifampin: decreased
hydrocortisone efficacy
Somatrem: inhibition of growthpromoting
effect
Drug-diagnostic tests. Calcium,
potassium, thyroxine, triiodothyronine:
decreased levels
Cholesterol, glucose: increased levels
Digoxin assays: false elevation (with
some test methods)
Nitroblue tetrazolium test: falsenegative
result
Drug-herbs. Echinacea: increased
immunostimulation
Ginseng: potentiation of immunomodulation
Drug-behaviors. Alcohol use: increased
risk of gastric irritation and GI ulcers
Patient monitoring
2In high-dose therapy (which
should not exceed 48 hours), watch
closely for signs and symptoms of depression
or psychotic episodes.
● Monitor blood pressure, weight, and
electrolyte levels regularly.
● Assess blood glucose levels in diabetic
patients. Expect to increase insulin or
oral hypoglycemic dosage.
2Monitor patient’s response during
weaning from drug.Watch for adrenal
crisis, which may occur if drug is discontinued
too quickly.
Patient teaching
● Instruct patient to take daily P.O.
dose with food by 8 A.M.
2Urge patient to immediately report
unusual weight gain, face or leg
swelling, epigastric burning, vomiting
of blood, black tarry stools, irregular
menstrual cycles, fever, prolonged sore
throat, cold or other infection, or
worsening of symptoms.
● Tell patient using topical form not to
apply occlusive dressing unless instructed
by prescriber.
● Advise patient to discontinue topical
drug and notify prescriber if local irritation
occurs.
● Instruct patient to eat small, frequent
meals and to take antacids as needed to
minimize GI upset.
● Tell patient that response to drug will
be monitored regularly.
2Caution patient not to stop taking
drug abruptly.
● In long-term use, instruct patient to
have regular eye exams.
● Instruct patient to wear medical identification
stating that he’s taking this drug.
● As appropriate, review all other significant
and life-threatening adverse
reactions and interactions, especially
those related to the drugs, tests, herbs,
and behaviors mentioned above.
Endostatin is a naturally-occurring 20-kDa C-terminal
fragment derived from type XVIII collagen. It is
reported to serve as an anti-angiogenic agent,
similar toangiostatin and thrombospondin.
Endostatin is a broad spectrum angiogenesis
inhibitor and may interfere with the pro-angiogenic
action of growth factors such as basic fibroblast
growth factor(bFGF/FGF-2) and vascular endothelial
growth factor (VEGF).[1]
moxifloxacin hydrochloride
Avelox, Vigamox
Pharmacologic class: Fluoroquinolone
Therapeutic class: Anti-infective
Pregnancy risk category C
FDA BOXED WARNING
● Fluoroquinolones for systemic use
are associated with an increased risk of
tendinitis and tendon rupture in all
ages. This risk is further increased in
patients usually over age 60, with concomitant
use of corticosteroids, and in
kidney, heart, and lung transplant
recipients.
Action
Selectively inhibits DNA synthesis by
disrupting DNA replication and transcription
and suppressing protein synthesis,
causing bacterial cell death
Availability
Injection (premixed): 400 mg/250-ml
bag
Ophthalmic solution: 5% (3 ml in 6-ml
bottle)
Tablets: 400 mg
1Indications and dosages
➣Acute bacterial sinusitis
Adults: 400 mg P.O. or I.V. q 24 hours
for 10 days
➣Acute bacterial exacerbation of
chronic bronchitis
Adults: 400 mg P.O. or I.V. q 24 hours
for 5 days
➣Community-acquired pneumonia
Adults: 400 mg P.O. or I.V. q 24 hours
for 7 to 14 days
➣Uncomplicated skin and skinstructure
infections
Adults: 400 mg P.O. or I.V. q 24 hours
for 7 days
➣Bacterial conjunctivitis
Adults: Instill one drop of ophthalmic
solution into affected eye t.i.d. for 7
days.
Contraindications
● Hypersensitivity to drug, its components,
or other fluoroquinolones
Precautions
Use cautiously in:
● underlying CNS diseases or disorders,
renal impairment, cirrhosis, bradycardia,
acute myocardial ischemia,
prolonged QTc interval, uncorrected
hypokalemia, dialysis
● elderly patients
● pregnant or breastfeeding patients
(safety not established except in postexposure
inhalation anthrax)
● children younger than age 18 (except
in postexposure inhalation anthrax)
● children younger than age 1 (ophthalmic
use).
Administration
● Give premixed I.V. dose over 60 minutes.
Avoid bolus or rapid infusion.
● Don’t mix with other drugs in same
I.V. line.
● Know that although milk or yogurt
may impair absorption of P.O. moxifloxacin,
drug may be given with other
calcium products.
Route Onset Peak Duration
P.O. Within 1 hr 1-3 hr 24 hr
I.V. Rapid End of 24 hr
infusion
Ophthalmic Unknown Unknown Unknown
Adverse reactions
CNS: dizziness, drowsiness, headache,
confusion, light-headedness, insomnia,
agitation, hallucinations, acute psychoses,
tremor, seizures
CV: hypertension, vasodilation, tachycardia,
prolonged QT interval,
arrhythmias
EENT: conjunctivitis; decreased visual
acuity; keratitis; eye dryness, discomfort,
pain, pruritus, and hyperemia;
subconjunctival hemorrhage; tearing;
otitis media; pharyngitis; rhinitis (all
with ophthalmic solution)
GI: nausea, diarrhea, abdominal pain,
pseudomembranous colitis
GU: vaginitis
Hematologic: eosinophilia, thrombocytopenia,
leukopenia
Musculoskeletal: joint pain, tendinitis,
tendon rupture
Respiratory: increased cough (with
ophthalmic solution)
Skin: rash, photosensitivity, phototoxicity,
Stevens-Johnson syndrome
Other: altered taste, fever (with ophthalmic
solution), phlebitis at I.V. site,
superinfection, hypersensitivity reactions
including anaphylaxis
Interactions
Drug-drug. Amiodarone, bepridil,
disopyramide, erythromycin, pentamidine,
phenothiazines, pimozide, procainamide,
quinidine, sotalol, tricyclic
antidepressants: increased risk of serious
adverse cardiovascular reactions
Antacids, bismuth subsalicylate, iron
salts, sucralfate, zinc salts: decreased
moxifloxacin absorption
Theophylline: increased theophylline
blood level and possible toxicity
Drug-diagnostic tests. Alanine aminotransferase,
alkaline phosphatase, aspartate
aminotransferase, bilirubin, lactate
dehydrogenase, platelets: increased
levels
Drug-food. Concurrent tube feedings,
milk, yogurt: impaired absorption of
P.O. moxifloxacin
Drug-herbs. Dong quai, St. John’s wort:
phototoxicity
Fennel: decreased moxifloxacin absorption
Drug-behaviors. Sun exposure: phototoxicity
Patient monitoring
2Watch for hypersensitivity reaction
(such as anaphylaxis) and other
allergic reactions, which may occur after
initial dose.
● Monitor cardiovascular and neurologic
status closely.
2Stay alert for tendinitis and
Achilles tendon rupture.
● Monitor CBC and liver function
tests.
● Assess GI status. Report signs or
symptoms of pseudomembranous
colitis.
● Watch closely for superinfection.
Patient teaching
● Advise patient to take tablets once a
day with or without food, 4 hours before
or 8 hours after antacids,multivitamins,
sucralfate, or preparations containing
aluminum, magnesium, iron,
or zinc.
2Tell patient drug may cause serious
allergic reactions even several days
after therapy begins. Advise him to
stop taking drug and report these reactions
immediately.
2Urge patient to stop taking drug
and promptly report tendon pain, diarrhea
with blood or pus, and signs
and symptoms of superinfection.
● Teach patient how to use eye drops.
Caution him to avoid touching applicator
tip to eye, finger, or other
object.
● Instruct patient being treated for
bacterial conjunctivitis not to wear
contact lenses.
● Caution patient to avoid driving and
other hazardous activities until he
knows how drug affects concentration
and alertness.
● As appropriate, review all other significant
and life-threatening adverse
reactions and interactions, especially
those related to the drugs, tests, foods,
herbs, and behaviors mentioned
above.
felodipine
Cardioplen , Felotens , Keloc ,
Neofel ,Plendil, Renedil_,
Vascalpha
Pharmacologic class: Calcium channel
blocker
Therapeutic class: Antihypertensive,
antianginal
Pregnancy risk category C
Action
Impedes extracellular calcium ion movement
across membranes of myocardial
muscle cells, depressing myocardial contractility
and impulse formation; slows
impulse conduction velocity and dilates
coronary arteries and peripheral arterioles.
Net effect is reduced cardiac workload
and lower blood pressure.
Availability
Tablets (extended-release): 2.5 mg,
5 mg, 10 mg
1Indications and dosages
➣Hypertension
Adults: Initially, 5 mg P.O. daily. Depending
on response, may decrease to
2.5 mg or increase to a maximum of
10 mg P.O. daily at 2-week intervals.
Dosage adjustment
● Hepatic impairment
● Elderly patients
Off-label uses
● Heart failure
● Angina pectoris or vasospastic
(Prinzmetal’s) angina
Contraindications
● Hypersensitivity to drug
Precautions
Use cautiously in:
● cardiac disease, arrhythmias, severe
hepatic or renal impairment
● elderly patients
● pregnant or breastfeeding patients
● children (safety not established).
Administration
● Give without regard to meals.
● Make sure patient swallows tablet
whole without crushing or chewing.
Route Onset Peak Duration
P.O. 1 hr 2-4 hr Up to 24 hr
Adverse reactions
CNS: headache, drowsiness, dizziness,
syncope, nervousness, anxiety, psychiatric
disturbances, paresthesia,
insomnia, asthenia, confusion, irritability
CV: chest pain, peripheral edema, hypotension,
palpitations, tachycardia,
angina, arrhythmias,myocardial infarction,
atrioventricular block
EENT: rhinorrhea, sneezing, pharyngitis
GI: nausea, vomiting, diarrhea, constipation,
abdominal discomfort, dyspepsia,
abdominal cramps, flatulence, dry
mouth ● Explain that exercise and hot weather
Hematologic: anemia may increase drug’s hypotensive effects.
Musculoskeletal: back pain ● Tell patient to report peripheral edema,
Respiratory: bronchitis persistent headache, or flushing.
Skin: dermatitis, rash, pruritus, urticaria, ● Advise patient to use hard candy or
erythema gum if dry mouth or thirst occurs.
Other: dysgeusia, gingival hyperplasia, ● Tell female patient to inform
facial edema, thirst, warm sensation prescriber if she is pregnant or breastfeeding.
Interactions ● As appropriate, review all other significant
Drug-drug. Antifungals, cimetidine, and life-threatening adverse
erythromycin, propranolol, ranitidine: reactions and interactions, especially
increased felodipine blood level, those related to the drugs, foods, and
increased risk of toxicity behaviors mentioned above.
Barbiturates, hydantoins: decreased
felodipine blood level
Beta-adrenergic blockers, digoxin,
disopyramide, phenytoin: bradycardia,
conduction defects, heart failure
Fentanyl, nitrates, other antihypertensives,
quinidine: additive hypotension
Nonsteroidal anti-inflammatory drugs:
decreased antihypertensive effects
Drug-food. Grapefruit juice: increased
felodipine blood level and effects
Drug-behaviors. Acute alcohol ingestion:
additive hypotension
Patient monitoring
2Don’t give to patient with heart
block unless he has a pacemaker.
2Use extreme caution when administering
to patients with pulmonary
hypertension, renal insufficiency,
heart failure, or compromised
ventricular function (especially those
receiving beta-adrenergic blockers
concurrently).
● Monitor fluid intake and output, and
weigh patient daily.
● Monitor ECG and vital signs. Assess
for signs and symptoms of heart block.
● Assess for reflex tachycardia, angina,
and sustained hypotension.
● Check hepatic profile and alkaline
phosphatase level in patients with
hepatic impairment.
Patient teaching
● Tell patient drug controls but doesn’t
cure high blood pressure, so he should
keep taking it even if he feels well.
● Instruct patient to move slowly when
rising, to avoid light-headedness or
dizziness from sudden blood pressure
decrease.