Anti Hypertensive Anti Infective Antimanic Agents
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Antihypertensive Drugs Anti-infectives Antimanic Agents
Chronoz
Antihypertensive Drugs
General Information and action
Hypertension · Circulatory disease characterized by a sustained elevation of systolic or diastolic blood pressure, or both. · Abnormally high BP (a reading of 140/90 mm Hg or greater) · May be due to the following: 1. Renal Stenosis 2. Renal disease 3. eclampsia 4. pheochromocytoma
Essential or Primary Hypertension -Hypertension with unknown cause
Classification of Essential Hypertension
Mild (140/90) Moderate (160/95) Severe (200/110)
Classifications of antihypertensive drugs Angiotensin-converting enzyme (ACE) inhibitors (benzapril)\ Beta-adrenergic blockers (atenolol) Calcium channel blockers (verapamil) Diuretics (chlorothiazide) Centrally acting alpha-adreneric agonists (clonidine) Peripherally acting alpha-adrenergic blockers (guanadrel) Direct-acting vasodilators (diazoxide)
Related Body Systems
- Central Nervous System (CNS), Cardiovascular (CV), URIN
General Use:
Reduce blood pressure to a normal BP of below 140/90 mmHg or to the lowest level tolerated.
Note: if BP is not reduced significantly by weight loss, reduction of sodium in the diet and smoking cessation-------stepped-care drug regimen is initiated. Step 1---single antihypertensive is used Step 2---second antihypertensive is added different from the first Step 3---third drug is added to or is substituted for one of the drugs in step 1 and 2.
--Drugs are added or substituted until the BP is at the desired level.
Contraindications
Hypersensitivity to any individual antihypertensive drug.
Adverse Reactions and Side Effects · Some cause CNS symptoms:
Drowsiness
Sedation
Fatigue
Palpitations, orthostatic hypotension, changes in HR Anticholinergic side effects:
Dry mouth
Constipation
Nursing Precautions
· Persons with active liver disease should be carefully monitored. · Choice of drugs for pregnant and lactating women is carefully monitored · Alpha-adrenergic agonists and beta blockers should not be discontinued abruptly. · Vasodilation caused by some drugs may cause rapid heartbeat, which is commonly controlled by the concomitant administration of a beta blocker. · Vasodilation may aggravate symptoms on patient with coronary insufficiency, recent MI and CVD. · Sodium and water retention · In diabetic patient- an increase in insulin requirements or in the dose of oral hypoglycemic drugs may be needed—also, changes in dietary control · Mental depression Patients with history of peptic ulcer should be monitored carefully.
Interactions
· Hypokalemia resulting from diuretics----increases risk of digitalis toxicity. · When ACE inhibitors are given with potassium (K) supplements or K-sparing diuretics------Hyperkalemia may result. · Effectiveness of antihypertensive drugs can be decreased by numerous drugs groups such as: o Antihistamines o Nonsteroidal anti-inflammatory agents o Some types of bronchodialtors o Decongestants o Antidepressants. Most antihypertensive drugs when accompanied with another antihypertensive drugs results in the increase of hypotensive effect.
Anti infectives
o o
Aminoglycosides (amikacin, gentamicin, kanamycin, neomycin, netilmicin, streptomysin, tobramycin) è Interrupt protein synthesis by acting on a specific ribosome in the microorganism. è Bacteriocidal Cephalosporins è Inhibit cell wall synthesis è Bacteriocidal 3 generations: o First generation (cefadroxil. Cefazolin, cephalexin, cephalothin, cephapirin, cephradine) Second generation (cefaclor, cefonicid, ceforanide, cefotetan, cefoxitin) Third generation (cefixime)
Flouroquinolones (ciprofloxacin) Macrolides (erythromycin) Penicillins o Natural Penicillins (amoxicillin) o Penicillinase-resistant penicillins (cloxacillin) o Extended-Spectrum Penicillins (carbenicillin) Sulfonamides (sulfacetamide) Tetracyclines (doxycycline)
Related Body Systems IMMUNE
General Information and action
-penicillins and the sulfonamides è Recognized as anti-infective agents in 1928 and 1935, respectively. Anti-infectives è Kill or inhibit the growth of susceptible pathogenic bacteria. è Bacteriocidal if they kill the organism è Bacteriostatic if they inhibit growth of organism è Not active against fungi, viruses, or most mycobacteria.
Functions of Anti-infectives:
1. Inhibition of cell wall synthesis 2. Inhibition of protein synthesis (either by impeding the replication of genetic information or impairing the translation of that information.) 3. Alteration or disruption of cell membrane permeability 4. Inhibition of essential metabolic synthesis NOTE: anti-infectives are classified according to their chemical similarities and antibacterial spectrum (whether they are effective against only a few kinds of organisms or against many).
General use:
-Used to treat and prevent many kinds of bacterial infections. In some cases, surgical incision and drainage, wound debridement or other supportive therapy is needed to cure the infection.
Contraindications
Hypersensitivity to an individual drug or subgroup. Cross-sensitivity among agents within a subgroup or between groups that are chemically similar may occur
Adverse reaction and side effect o o o o o o
Differ among the sub groups but are similar within each subgroups reactions for all penicillins are similar but reactions between penicillins and aminoglycosides differ. Many anti infectives cause GI irritation, nausea and diarrhea. Penicillins cause more life threatening reactions than other subgroups: seizures coma anaphylaxis hypotension shortness of breath urticaria (hives)
Most of these effects are probably due to an allergic reaction: Rashes and joint pain may also occur with penicillins Cephalosporin have adverse reactions and side effects similar to the penicillins but they also may cause pseudomembranous colitis Aminoglycosides are nephrotoxic and autotoxic and may cause nephrotoxicity, deafness and vestibular problems.
Nursing precautions
Culture and sensitivity testing should be done before beginning anti-infective therapy to determine the pathogenic organism and the drugs best able to treat the infection. Because anti infectives are metabolize in the liver and excreted by the kidneys, patients with lymphatic or renal impairment need close monitoring and sometimes a reduction in dosage. Some anit infectives may have undesirable effect on the fetus so they are given to pregnant women only when necessary.
Many anti-infectives appear in breast milk so they are seldom given to lactating women. Anti-infectives should be used at the lowest dose possible and for the shortest time necessary to control the infection in order to reduce the risk of superinfections and the development of resistant bacteria.
Interactions
Probenecid blocks the tubular excretion of penicillins and cephalosporins, thus uncreasing blood levels of these drugs. Note: this increases the effectiveness of penicillins and cephalosporins, but may also increase severity of side effects. Concurrent use of bacteriostatic agents decreases the effectiveness of penicillins, which are bacteriocidal.
Some cephalosporins and the extended-spectrum penicillins inhibit platelet aggregation and decreases the synthesis of prothrombin in the liver. Note: this may increase the risk of bleeding when given concurrently with anticoagulants/ antiplatelet agents and with NSAIDs. Absorption of many anti-infectives is decreased when antacids are administered concurrently. The fluoroquinolones may increase serum levels of the bronchodilator theopylline, leading to toxicity.
Antimanic Agents
General Action and Information
Lithium is the only antimanic drug in current use Alters sodium transport in nerve and muscle cells inhibits release of norepinephrine and dopamine, but not serotonin, from stimulated neurons slightly increases intraneuronal stores of catecholamines decreases intraneuronal content of second messengers and may thereby selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state.
Related Body Systems CNS
General use:
main indication is treatment of bipolar disorder augmenting antidepressants treatment of aggression (manic episodes) and prevent recurrence PTSD and conduction defects in children
Contraindications Contraindicated in the presence of hypersensitivity to tartrazine (in tablets marketed as Lithane) ignificant renal or cardiovascular disease severe debilitation, dehydration; sodium depletion, patients on diuretics (lithium decreases sodium reabsorption, and hyponatremia increases lithium retention) pregnancy lactation Note: Use caution in the presence of protracted sweating and diarrhea; suicidal or impulsive patients; infection with fever.
Adverse Reactions and Side Effects
Mild GI disturbances Fine tremor of the hands Muscle weakness Vertigo Giddiness Weight gain Edema Dazed feeling Hypothyroidism and rarely hyperthyroidism Mild polyuria and polydipsia
Reactions are related to serum lithium levels (toxic lithium levels are close to therapeutic levels: Therapeutic levels in acute mania range between 1 and 1.5 mEq/L; Therapeutic levels for maintenance are 0.6 to 1.2 mEq/L). 2.5 mEq/L (life-threatening toxicity)
Nursing precautions
Monitor Electrolyte imbalance; elderly Lithium is used cautiously in patients with chronic renal, CV and thyroid disease. Long-term therapy may suppress thyroid function leading to hypothyroidism. Use in pregnancy is limited to those cases in which the benefits of drug therapy outweigh the risk of malformation of the fetus.
Interactions
· Lithium used with phenothiazines (antipsychotics) may decrease the effectiveness of the phenothiazines and mask signs of lithium toxicity · Potassium iodide may increase the hypothyroid effects of lithium. · Aminophylline, phenothiazines, sodium bicarbonate, and sodium chloride may increase the excretion rate of lithium and decrease its effect. · Lithium may prolong neuromuscular blockade during general anesthesia Low sodium plasma levels may occur with lowsodium diets and drug therapy with thiazide diuretics, methyldopa, NSAIDs, prohenecid, increase the risk of lithium toxicity.
Chronoz
Antihypertensive Drugs
General Information and action
Hypertension · Circulatory disease characterized by a sustained elevation of systolic or diastolic blood pressure, or both. · Abnormally high BP (a reading of 140/90 mm Hg or greater) · May be due to the following: 1. Renal Stenosis 2. Renal disease 3. eclampsia 4. pheochromocytoma
Essential or Primary Hypertension -Hypertension with unknown cause
Classification of Essential Hypertension
Mild (140/90) Moderate (160/95) Severe (200/110)
Classifications of antihypertensive drugs Angiotensin-converting enzyme (ACE) inhibitors (benzapril)\ Beta-adrenergic blockers (atenolol) Calcium channel blockers (verapamil) Diuretics (chlorothiazide) Centrally acting alpha-adreneric agonists (clonidine) Peripherally acting alpha-adrenergic blockers (guanadrel) Direct-acting vasodilators (diazoxide)
Related Body Systems
- Central Nervous System (CNS), Cardiovascular (CV), URIN
General Use:
Reduce blood pressure to a normal BP of below 140/90 mmHg or to the lowest level tolerated.
Note: if BP is not reduced significantly by weight loss, reduction of sodium in the diet and smoking cessation-------stepped-care drug regimen is initiated. Step 1---single antihypertensive is used Step 2---second antihypertensive is added different from the first Step 3---third drug is added to or is substituted for one of the drugs in step 1 and 2.
--Drugs are added or substituted until the BP is at the desired level.
Contraindications
Hypersensitivity to any individual antihypertensive drug.
Adverse Reactions and Side Effects · Some cause CNS symptoms:
Drowsiness
Sedation
Fatigue
Palpitations, orthostatic hypotension, changes in HR Anticholinergic side effects:
Dry mouth
Constipation
Nursing Precautions
· Persons with active liver disease should be carefully monitored. · Choice of drugs for pregnant and lactating women is carefully monitored · Alpha-adrenergic agonists and beta blockers should not be discontinued abruptly. · Vasodilation caused by some drugs may cause rapid heartbeat, which is commonly controlled by the concomitant administration of a beta blocker. · Vasodilation may aggravate symptoms on patient with coronary insufficiency, recent MI and CVD. · Sodium and water retention · In diabetic patient- an increase in insulin requirements or in the dose of oral hypoglycemic drugs may be needed—also, changes in dietary control · Mental depression Patients with history of peptic ulcer should be monitored carefully.
Interactions
· Hypokalemia resulting from diuretics----increases risk of digitalis toxicity. · When ACE inhibitors are given with potassium (K) supplements or K-sparing diuretics------Hyperkalemia may result. · Effectiveness of antihypertensive drugs can be decreased by numerous drugs groups such as: o Antihistamines o Nonsteroidal anti-inflammatory agents o Some types of bronchodialtors o Decongestants o Antidepressants. Most antihypertensive drugs when accompanied with another antihypertensive drugs results in the increase of hypotensive effect.
Anti infectives
o o
Aminoglycosides (amikacin, gentamicin, kanamycin, neomycin, netilmicin, streptomysin, tobramycin) è Interrupt protein synthesis by acting on a specific ribosome in the microorganism. è Bacteriocidal Cephalosporins è Inhibit cell wall synthesis è Bacteriocidal 3 generations: o First generation (cefadroxil. Cefazolin, cephalexin, cephalothin, cephapirin, cephradine) Second generation (cefaclor, cefonicid, ceforanide, cefotetan, cefoxitin) Third generation (cefixime)
Flouroquinolones (ciprofloxacin) Macrolides (erythromycin) Penicillins o Natural Penicillins (amoxicillin) o Penicillinase-resistant penicillins (cloxacillin) o Extended-Spectrum Penicillins (carbenicillin) Sulfonamides (sulfacetamide) Tetracyclines (doxycycline)
Related Body Systems IMMUNE
General Information and action
-penicillins and the sulfonamides è Recognized as anti-infective agents in 1928 and 1935, respectively. Anti-infectives è Kill or inhibit the growth of susceptible pathogenic bacteria. è Bacteriocidal if they kill the organism è Bacteriostatic if they inhibit growth of organism è Not active against fungi, viruses, or most mycobacteria.
Functions of Anti-infectives:
1. Inhibition of cell wall synthesis 2. Inhibition of protein synthesis (either by impeding the replication of genetic information or impairing the translation of that information.) 3. Alteration or disruption of cell membrane permeability 4. Inhibition of essential metabolic synthesis NOTE: anti-infectives are classified according to their chemical similarities and antibacterial spectrum (whether they are effective against only a few kinds of organisms or against many).
General use:
-Used to treat and prevent many kinds of bacterial infections. In some cases, surgical incision and drainage, wound debridement or other supportive therapy is needed to cure the infection.
Contraindications
Hypersensitivity to an individual drug or subgroup. Cross-sensitivity among agents within a subgroup or between groups that are chemically similar may occur
Adverse reaction and side effect o o o o o o
Differ among the sub groups but are similar within each subgroups reactions for all penicillins are similar but reactions between penicillins and aminoglycosides differ. Many anti infectives cause GI irritation, nausea and diarrhea. Penicillins cause more life threatening reactions than other subgroups: seizures coma anaphylaxis hypotension shortness of breath urticaria (hives)
Most of these effects are probably due to an allergic reaction: Rashes and joint pain may also occur with penicillins Cephalosporin have adverse reactions and side effects similar to the penicillins but they also may cause pseudomembranous colitis Aminoglycosides are nephrotoxic and autotoxic and may cause nephrotoxicity, deafness and vestibular problems.
Nursing precautions
Culture and sensitivity testing should be done before beginning anti-infective therapy to determine the pathogenic organism and the drugs best able to treat the infection. Because anti infectives are metabolize in the liver and excreted by the kidneys, patients with lymphatic or renal impairment need close monitoring and sometimes a reduction in dosage. Some anit infectives may have undesirable effect on the fetus so they are given to pregnant women only when necessary.
Many anti-infectives appear in breast milk so they are seldom given to lactating women. Anti-infectives should be used at the lowest dose possible and for the shortest time necessary to control the infection in order to reduce the risk of superinfections and the development of resistant bacteria.
Interactions
Probenecid blocks the tubular excretion of penicillins and cephalosporins, thus uncreasing blood levels of these drugs. Note: this increases the effectiveness of penicillins and cephalosporins, but may also increase severity of side effects. Concurrent use of bacteriostatic agents decreases the effectiveness of penicillins, which are bacteriocidal.
Some cephalosporins and the extended-spectrum penicillins inhibit platelet aggregation and decreases the synthesis of prothrombin in the liver. Note: this may increase the risk of bleeding when given concurrently with anticoagulants/ antiplatelet agents and with NSAIDs. Absorption of many anti-infectives is decreased when antacids are administered concurrently. The fluoroquinolones may increase serum levels of the bronchodilator theopylline, leading to toxicity.
Antimanic Agents
General Action and Information
Lithium is the only antimanic drug in current use Alters sodium transport in nerve and muscle cells inhibits release of norepinephrine and dopamine, but not serotonin, from stimulated neurons slightly increases intraneuronal stores of catecholamines decreases intraneuronal content of second messengers and may thereby selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state.
Related Body Systems CNS
General use:
main indication is treatment of bipolar disorder augmenting antidepressants treatment of aggression (manic episodes) and prevent recurrence PTSD and conduction defects in children
Contraindications Contraindicated in the presence of hypersensitivity to tartrazine (in tablets marketed as Lithane) ignificant renal or cardiovascular disease severe debilitation, dehydration; sodium depletion, patients on diuretics (lithium decreases sodium reabsorption, and hyponatremia increases lithium retention) pregnancy lactation Note: Use caution in the presence of protracted sweating and diarrhea; suicidal or impulsive patients; infection with fever.
Adverse Reactions and Side Effects
Mild GI disturbances Fine tremor of the hands Muscle weakness Vertigo Giddiness Weight gain Edema Dazed feeling Hypothyroidism and rarely hyperthyroidism Mild polyuria and polydipsia
Reactions are related to serum lithium levels (toxic lithium levels are close to therapeutic levels: Therapeutic levels in acute mania range between 1 and 1.5 mEq/L; Therapeutic levels for maintenance are 0.6 to 1.2 mEq/L). 2.5 mEq/L (life-threatening toxicity)
Nursing precautions
Monitor Electrolyte imbalance; elderly Lithium is used cautiously in patients with chronic renal, CV and thyroid disease. Long-term therapy may suppress thyroid function leading to hypothyroidism. Use in pregnancy is limited to those cases in which the benefits of drug therapy outweigh the risk of malformation of the fetus.
Interactions
· Lithium used with phenothiazines (antipsychotics) may decrease the effectiveness of the phenothiazines and mask signs of lithium toxicity · Potassium iodide may increase the hypothyroid effects of lithium. · Aminophylline, phenothiazines, sodium bicarbonate, and sodium chloride may increase the excretion rate of lithium and decrease its effect. · Lithium may prolong neuromuscular blockade during general anesthesia Low sodium plasma levels may occur with lowsodium diets and drug therapy with thiazide diuretics, methyldopa, NSAIDs, prohenecid, increase the risk of lithium toxicity.
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