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49 Cards in this Set

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This drug is used for the management/prevention of Motion Sickness and vertigo

Has Central anticholernergic, cns depressant and antihistaminic properties; decreases excitability of the middle ear labyrinth and depresses conduction in the middle ear vestibular cerebellar pathways.
meclizine HCL
This drug is contraindicated in hypersensitivity and pregnancy.

Use cautiously in : prostatic hypertrophy; narrow-angle glaucoma; geriatric; children or lactation
meclizine HCL
This drugs side effects are: drowsiness, fatigue, blurred vision, and dry mouth
meclizine HCL
This drug interacts with additive CNS depression with other CNS depressants, includin alcohol, and other antihistamines, opioid analgesics, and sedative/hypnotics; additive anticholinergic effects with other drugs possessing anticholinergic properties, includin some anticholinergicd properties, including some antihistamine,s antidepressants, atropine, haloperiodol, phenothiazines, quinidine, and disopyramide.
meclizine HCL
Implications for this drug:
Assess patient for level of sedation after administration; assess patient for nausea and vomitting before and 60 minutes after administration; assess degree of vertigo periodically in patients receiving this for labyrinthitis; may cause false negative results in skin tests using allergen extracts and must be discontinued for 72 hours before testing.
meclizine HCL
Teaching for this drug:
instruct patient to take exactly as directed. If a dose is missed, take as soon as possible unless almost time for next dose. do not double dose.

may cause drowiness.

Frequent mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dyness of mouth.

Have take one hour before conditions for motion sickness may occur
meclizine HCL
This drugs is for the relief a nonproductive cough due to minor throat or bronchial irritation from inhaled irritants or colds.
benzonatate (Tessalon)
This drug is contraindicated in:
Hypersensitivity to this drug; cross-sensitivity with other ester-type local anethetics (tetracaine, procaine, and others) may occur.
Use cautiously in pregnancy, lactation, or children <10 years.
benzonatate (Tessalon)
Adverse reaction of this drug are: headache, mild dizziness, sedation, burning sensation in eyes, nasal congestion, constipation, GI upset, nausea, prurtitus, skin eruptions, chest numbness, chilly sensation, hypersensitivity reactions
benzonatate (Tessalon)
Interactions for this drug are:
Additive CNS depression may occur with antihistamines, alcohol, opioids, and sedative/hypnotics.
benzonatate (Tessalon)
Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced. Maintain fluid intake of 1500-2000 ml to decrease viscosity of bronchial secreations
benzonatate (Tessalon)
Caution patient to avoid driving to other activities requiring alertness until response to the medication is known.
benzonatate (Tessalon)
This drug thins secretions so that they can be removed; it's adverse effects are bronchospasms. postural drainage and tracheal suction when necessary.
acetylcysteine (Mucomyst)
This drug is used for: Moderate to severe pain
Also used for:
Analgesia during labor
Sedation prior to surgery
Supplemention in balanced anesthesia
pentazocine HCL (Talwin)
This drug is
Contraindicated in:

Hypersensitivity; Patients who are physically dependent on opioids (may precipitate withdrawal).
Use Cautiously in:
Head trauma ;History of drug abuse ;Increased intracranial pressure; Severe renal, hepatic, or pulmonary disease; Hypothyroidism;Adrenal insufficiency ;Alcoholism
Geriatric, debilitated patients, or patients with severe liver impairment (dosage reduction recommended)
Undiagnosed abdominal pain
Prostatic hypertrophy;
Patients who have recently received opioid agonists
Pregnancy (has been used during labor but may cause respiratory depression in the newborn);Lactation or children (safety not established).
pentazocine HCL (Talwin)
CNS: dizziness , euphoria , hallucinations , headache , sedation , confusion, dysphoria, floating feeling, unusual dreams.
EENT: blurred vision, diplopia, miosis (high doses).
Resp: respiratory depression.
CV: hypertension, hypotension, palpitations.
GI: nausea , constipation, dry mouth, ileus, vomiting.
GU: urinary retention.
Derm: clammy feeling, sweating.
Local: severe tissue damage at subcut sites.
Misc: physical dependence, psychological dependence, tolerance.
pentazocine HCL (Talwin)
INTERACTIONS
Drug–Drug:

Use with caution in patients receiving MAO inhibitors (may result in unpredictable reactions—decrease initial dose of pentazocine to 25% of usual dose)
Additive CNS depression with alcohol , antihistamines , and sedative/hypnotics
May precipitate withdrawal in patients who are physically dependent on opioid analgesic agonists
May ↓ analgesic effects of other opioids .
Drug–Natural:

Concomitant use of kava , valerian ,or chamomile can ↑ CNS depression.
pentazocine HCL (Talwin)
Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25–50%. Pentazocine produces respiratory depression, but this does not markedly increase with increased doses.
pentazocine HCL
Lab Test Considerations: May cause ↑ serum amylase and lipase levels.
Toxicity and Overdose: If an opioid antagonist is required to reverse respiratory depression or coma, naloxone (Narcan) is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 ml of 0.9% NaCl and administer 0.5 ml (0.02 mg) by direct IV push every 2 min. For patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 ml of 0.9% NaCl for a concentration of 10 mcg/ml and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain.
pentazocine HCL
Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis.
Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dry mouth.
pentazocine HCL
INDICATIONS
Reversal of CNS depression and respiratory depression because of suspected opioid overdosage.
Unlabelled Uses:
Management of refractory circulatory shock.
naloxone HCL
Contraindicated in:

Hypersensitivity.
Use Cautiously in:

Cardiovascular disease
Patients physically dependent on opioids (may precipitate severe withdrawal)
Pregnancy (may cause withdrawal in mother and fetus if mother is opioid dependent)
Lactation (safety not established)
Neonates of opioid-dependent mothers
naloxone HCL
CV: hypertension, hypotension, ventricular fibrillation, ventricular tachycardia.
GI: nausea, vomiting.
INTERACTIONS
Drug–Drug:

Can precipitate withdrawal in patients physically dependent on opioid analgesics
Larger doses may be required to reverse the effects of buprenorphine , butorphanol , nalbuphine , pentazocine , or propoxyphene
Antagonizes postoperative opioid analgesics .
naloxone (Narcan)
Monitor respiratory rate, rhythm, and depth; pulse, ECG, blood pressure; and level of consciousness frequently for 3–4 hr after the expected peak of blood concentrations. After a moderate overdose of a short half-life opioid, physical stimulation may be enough to prevent significant hypoventilation. The effects of some opioids may last longer than the effects of naloxone, and repeat doses may be necessary.
naloxone (Narcan)
INDICATIONS
Relief of signs and symptoms of osteoarthritis
Relief of signs and symptoms of rheumatoid arthritis in adults
Reduction of the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP), as an adjunct to usual care (endoscopic surveillance, surgery).
ACTION
Inhibits the enzyme COX-2. This enzyme is required for the synthesis of prostaglandins
Has analgesic, anti-inflammatory, and antipyretic properties.
Therapeutic Effects:
Decreased pain and inflammation caused by arthritis
Decreased number of colorectal polyps.
celecoxib (celebrex)
Contraindicated in:

Hypersensitivity
Cross-sensitivity may exist with other NSAIDs, including aspirin
History of allergic-type reactions to sulfonamides
History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs, including the aspirin triad (asthma, nasal polyps, and severe hypersensitivity reactions to aspirin)
Advanced renal disease
Should not be used in late pregnancy (may cause premature closure of the ductus arteriosus).
Use Cautiously in:

Concurrent therapy with corticosteroids or anticoagulants, long duration of NSAID therapy, history of smoking, alcoholism, geriatric patients, or poor general health status (increased risk of GI bleeding)
Pre-existing renal disease, heart failure, liver dysfunction, concurrent diuretic or ACE inhibitor therapy (increased risk of renal impairment)
Hypertension or fluid retention
Renal insufficiency (may precipitate acute renal failure)
Serious dehydration (correct deficits before administering)
Pre-existing asthma
Pregnancy or children <18 yr (safety not established, use not recommended during late pregnancy).
Exercise Extreme Caution in:

History of ulcer disease or GI bleeding.
celecoxib (celebrex)
CNS: dizziness, headache, insomnia.
GI: GI BLEEDING , abdominal pain, diarrhea, dyspepsia, flatulence, nausea.
Derm: rash.
INTERACTIONS
Drug–Drug:

Significant interactions may occur when celecoxib is coadministered with other drugs that inhibit the CYP450 2C9 enzyme system
May decrease the effectiveness of ACE inhibitors , thiazide diuretics , and furosemide
Although celecoxib may be used with aspirin , the combination may increase the risk of GI bleeding
Fluconazole increases celecoxib blood levels (dosage reduction recommended)
May increase the risk of bleeding with warfarin
May increase serum lithium levels
Does not inhibit the cardioprotective effect of low-dose aspirin .
celecoxib (celebrex)
Assess patient’s range of motion, degree of swelling, and pain in affected joints before and periodically throughout therapy.
Assess patient for allergy to sulfonamides, aspirin, or NSAIDs. Patients with these allergies should not receive celecoxib.
Lab Test Considerations: May cause elevated AST and ALT levels.
May cause hypophosphatemia and elevated BUN.
celecoxib (celebrex)
General: Do not confuse with Celexa (citalopram) or Cerebyx (fosphenytoin).
PO: May be administered without regard to meals.
PATIENT/FAMILY TEACHING

Instruct patient to take celecoxib exactly as directed. Do not take more than prescribed dose. Increasing doses does not appear to increase effectiveness.
Advise patient to notify health care professional promptly if signs or symptoms of GI toxicity (abdominal pain, black stools), skin rash, unexplained weight gain, or edema occurs. Patients should discontinue celecoxib and notify health care professional if signs and symptoms of hepatotoxicity (nausea, fatigue, lethargy, pruritus, jaundice, upper right quadrant tenderness, flu-like symptoms) occur.
Advise patient to notify health care professional if pregnancy is planned or suspected.
Advise patients with FAP to continue routine surveillance procedures.
celecoxib (celebrex)
INDICATIONS
Edema due to:
CHF
Hepatic or renal disease
Hypertension.
Unlabelled Uses:
Hypercalcemia of malignancy.
ACTION
Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule
Increases renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium
May have renal and peripheral vasodilatory effects
Effectiveness persists in impaired renal function.
Therapeutic Effects:
Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions)
Decreased blood pressure.
furosemide (Lasix)
Contraindicated in:

Hypersensitivity
Cross-sensitivity with thiazides and sulfonamides may occur
Pre-existing electrolyte imbalance, hepatic coma, or anuria
Some liquid products may contain alcohol, avoid in patients with alcohol intolerance.
Use Cautiously in:

Severe liver disease (may precipitate hepatic coma; concurrent use with potassium-sparing diuretics may be necessary)
Electrolyte depletion
Geriatric patients (difficulty assessing hearing status; increased risk of hypotension)
Diabetes mellitus
Increasing azotemia
Pregnancy, lactation, or children (safety not established; has been used in children).
furosemide (Lasix)
CNS: dizziness, encephalopathy, headache, insomnia, nervousness.
EENT: hearing loss, tinnitus.
CV: hypotension.
GI: constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting.
GU: excessive urination.
Derm: photosensitivity, rashes.
Endo: hyperglycemia.
F and E: dehydration , hypochloremia , hypokalemia , hypomagnesemia , hyponatremia , hypovolemia , metabolic alkalosis .
Hemat: blood dyscrasias.
Metab: hyperglycemia, hyperuricemia.
MS: arthralgia, muscle cramps, myalgia.
Misc: increased BUN.
INTERACTIONS
Drug–Drug:

↑ hypotension with antihypertensives , nitrates , or acute ingestion of alcohol
↑ risk of hypokalemia with other diuretics , piperacillin , amphotericin B , stimulant laxatives , and corticosteroids
Hypokalemia may ↑ risk of digoxin toxicity
↓ lithium excretion, may cause toxicity
↑ risk of ototoxicity with aminoglycosides
May ↑ the effectiveness of warfarin , thrombolytic agents , or anticoagulants
furosemide (Lasix)
ASSESSMENT

Assess fluid status during therapy. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify physician or other health care provider if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
Monitor blood pressure and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension.
Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Patients taking digitalis glycosides are at increased risk of digitalis toxicity because of the potassium-depleting effect of the diuretic. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia.
Assess patient for tinnitus and hearing loss. Audiometry is recommended for patients receiving prolonged high-dose IV therapy. Hearing loss is most common after rapid or high-dose IV administration in patients with decreased renal function or those taking other ototoxic drugs.
Assess for allergy to sulfonamides.
Lab Test Considerations: Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically throughout therapy. May cause ↓ serum potassium, calcium, and magnesium concentrations. May also cause ↑ BUN, serum glucose, creatinine, and uric acid levels.
furosemide (Lasix)
Administer medication in the morning to prevent disruption of sleep cycle.
Administer orally with food or milk to minimize gastric irritation. Tablets may be crushed if patient has difficulty swallowing.
When using furosemide for hypercalcemia, replace extracellular volume and sodium chloride to maintain fluid volume and increase calcium excretion effectively.
furosemide (Lasix)
General: Instruct patient to take furosemide as directed. Take missed doses as soon as possible; do not double doses.
Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient that the use of alcohol, exercise during hot weather, or standing for long periods during therapy may enhance orthostatic hypotension.
Instruct patient to consult health care professional regarding a diet high in potassium (see Appendix Q).
Advise patient to consult health care professional before taking OTC medication or herbal products concurrently with this therapy.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Advise patient to contact health care professional immediately if muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
Advise patient taking furosemide tablets not to change brands when refilling prescription; bioavailability among brands is variable.
Advise diabetic patients to monitor blood glucose closely; may cause increased blood glucose levels.
Emphasize the importance of routine follow-up examinations.
Hypertension: Advise patients on antihypertensive regimen to continue taking medication even if feeling better. Furosemide controls but does not cure hypertension.
Reinforce the need to continue additional therapies for hypertension (weight loss, exercise, restricted sodium intake, stress reduction, regular exercise, moderation of alcohol consumption, cessation of smoking).
furosemide (Lasix)
Counteract potassium loss caused by other diuretics
Used with other agents (thiazides) to treat edema or hypertension
Hyperaldosteronism
Unlabelled Uses:
Management of CHF (low doses).
spironolactone (aldactone)
Contraindicated in:

Hypersensitivity
Hyperkalemia.
Use Cautiously in:

Hepatic dysfunction
Geriatric or debilitated patients or patients with diabetes mellitus (increased risk of hyperkalemia,presence of age-related renal dysfunction; dosage adjustments may be necessary))
Renal insufficiency (BUN >30 mg/dl or CCr <30 ml/min)

Pregnancy, lactation, or children (safety not established).
spironolactone (aldactone)
CNS: dizziness; clumsiness, headache.
CV: arrhythmias.
Endo: gynecomastia.
F and E: hyperkalemia , hyponatremia.
Hemat: dyscrasias.
MS: muscle cramps.
Misc: allergic reactions.
spironolactone (aldactone)
↑ hypotension with acute ingestion of alcohol , other antihypertensives , or nitrates
Use with ACE inhibitors , angiotensin II receptor antagonists , indomethacin , potassium supplements , or cyclosporine ↑ risk of hyperkalemia
↓ lithium excretion
Effectiveness may be ↓ by NSAIDs
may ↑ effects of digoxin
spironolactone (aldactone)
Monitor intake and output ratios and daily weight during therapy.
If medication is given as an adjunct to antihypertensive therapy, monitor blood pressure before administering.
Monitor response of signs and symptoms of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia). Assess patient frequently for development of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, cardiac arrhythmias). Patients who have diabetes mellitus or kidney disease and geriatric patients are at increased risk of developing these symptoms.
Periodic ECGs are recommended in patients receiving prolonged therapy.
Lab Test Considerations: Serum potassium levels should be evaluated before and routinely during therapy. Withhold drug and notify physician or other health care professional if patient becomes hyperkalemic.
Monitor BUN, serum creatinine, and electrolytes before and periodically during therapy. May cause ↑ serum magnesium, uric acid, BUN, creatinine, potassium, plasma renin activity, and urinary calcium excretion levels. May also cause ↓ sodium levels.
Discontinue potassium-sparing diuretics 3 days before a glucose tolerance test because of risk of severe hyperkalemia.
may cause false ↑ of plasma cortisol concentrations. should be withdrawn 4–7 days before test.
spironolactone (aldactone)
PO: Administer in AM to avoid interrupting sleep pattern.
Administer with food or milk to minimize gastric irritation and to increase bioavailability
spironolactone (aldactone)
General: Emphasize the importance of continuing to take this medication, even if feeling well. Instruct patient to take medication at the same time each day. Take missed dosesas soon as remembered unless almost time for next dose. Do not double doses.
Caution patient to avoid salt substitutes and foods that contain high levels of potassium or sodium unless prescribed by health care professional.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to consult with health care professional before taking any OTC decongestants, cough or cold preparations, or appetite suppressants concurrently with this medication because of potential for increased blood pressure.
Advise patients taking triamterene to use sunscreen and protective clothing to prevent photosensitivity reactions.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Inform patient that triamterene may cause bluish-colored urine.
Advise patient to notify health care professional if muscle weakness or cramps; fatigue; or severe nausea, vomiting, or diarrhea occurs.
Emphasize the need for follow-up exams to monitor progress.
Hypertension: Reinforce need to continue additional therapies for hypertension (weight loss, restricted sodium intake, stress reduction, moderation of alcohol intake, regular exercise, and cessation of smoking). Medication helps control but does not cure hypertension.
Teach patient and family the correct technique for checking blood pressure weekly.
spironolactone (aldactone)
INDICATIONS
Management of mild to moderate hypertension
Treatment of edema associated with:
CHF
Renal dysfunction
Cirrhosis
Corticosteroid therapy
Estrogen therapy.
hydrochlorothiazide
Contraindicated in:

Hypersensitivity
Cross-sensitivity with other thiazides or sulfonamides may exist
Some products contain tartrazine and should be avoided in patients with known intolerance
Anuria
Lactation.
Use Cautiously in:

Renal or severe hepatic impairment
Pregnancy (jaundice or thrombocytopenia may be seen in the newborn).
hydrochlorothiazide
CNS: dizziness, drowsiness, lethargy, weakness.
CV: hypotension.
GI: anorexia, cramping, hepatitis, nausea, vomiting.
Derm: photosensitivity, rashes.
Endo: hyperglycemia.
F and E: hypokalemia , dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia.
Hemat: blood dyscrasias.
Metab: hyperuricemia , elevated lipids.
MS: muscle cramps.
Misc: pancreatitis.
hydrochlorothiazide
Drug–Drug:

Additive hypotension with other antihypertensives , acute ingestion of alcohol , or nitrates
Additive hypokalemia with corticosteroids , amphotericin B , mezlocillin , piperacillin , or ticarcillin
Decreases the excretion of lithium
Cholestyramine or colestipol decreases absorption
Hypokalemia increases risk of digoxin toxicity
NSAIDs may decrease effectiveness
Allopurinol may increase the risk of hypersensitivity reactions.
Drug–Natural:

Licorice and stimulant laxative herbs ( aloe , cascara sagrada , senna ) may increase risk of potassium depletion
Concomitant use with ginkgo may decrease antihypertensive effects.
hydrochlorothiazide
General: Monitor blood pressure, intake, output, and daily weight and assess feet, legs, and sacral area for edema daily.
Assess patient, especially if taking digitalis glycosides, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Notify physician or other health care professional if these signs of electrolyte imbalance occur. Patients taking digoxin are at risk of digoxin toxicity because of the potassium-depleting effect of the diuretic.
Assess patient for allergy to sulfonamides.
Hypertension: Monitor blood pressure before and periodically throughout therapy.
Monitor frequency of prescription refills to determine compliance.
Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN, serum creatinine, and uric acid levels before and periodically throughout therapy.
May cause increase in serum and urine glucose in diabetic patients.
May cause an increase in serum bilirubin, calcium, creatinine, and uric acid, and a decrease in serum magnesium, potassium, sodium, and urinary calcium concentrations.
May cause decreased serum protein-bound iodine (PBI) concentrations.
May cause increased serum cholesterol, low-density lipoprotein, and triglyceride concentrations.
hydrochlorothiazide
IMPLEMENTATION

General: Administer in the morning to prevent disruption of sleep cycle.
Intermittent dose schedule may be used for continued control of edema.
PO: May give with food or milk to minimize GI irritation. Tablets may be crushed and mixed with fluid to facilitate swallowing.
Intermittent Infusion: Reconstitute chlorothiazide with at least 18 ml of sterile water for injection for a concentration of 25 mg/ml. Shake to dissolve. Stable for 24 hr at room temperature. May be diluted further with D5W or 0.9% NaCl.
hydrochlorothiazide
General: Instruct patient to take this medication at the same time each day. If a dose is missed, take as soon as remembered but not just before next dose is due. Do not double doses.
Instruct patient on use of calibrated dropper for measuring hydrochlorothiazide concentrated oral solution.
Instruct patient to monitor weight biweekly and notify health care professional of significant changes.
Caution patient to change positions slowly to minimize orthostatic hypotension. This may be potentiated by alcohol.
Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Instruct patient to discuss dietary potassium requirements with health care professional (see Appendix Q).
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Advise patient to report muscle weakness, cramps, nausea, vomiting, diarrhea, or dizziness to health care professional.
Emphasize the importance of routine follow-up exams.
Hypertension: Advise patients to continue taking the medication even if feeling better. Medication controls but does not cure hypertension.
Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, regular exercise, smoking cessation, moderation of alcohol consumption, and stress management).
Instruct patient and family in correct technique for monitoring weekly blood pressure.
Advise patient to consult health care professional before taking OTC medication, especially cough or cold preparations, concurrently with this therapy.
hydrochlorothiazide