Mariano, Claudine A.

Clinical Pharmacy

1. Indications, contraindications and caution, adverse reactions and mechanism of action of the ff.:
a) Alpha Blocker Peripherally
b) Aminoglycosides
c) ACEi
d) Antacids
e) Antianginals

Class of drugs ALPHA BLOCKER AMINOGLYCOSIDES ACEi ANTACIDS ANTIANGINALS

PERIPHERALLY
Mechanism of action Block the effect of Inhibition of Inhibits the Neutralize gastric Act by increasing
sympathetic nerves bacterial protein angiotensin – acidity by coronary blood flow
on blood vessels by synthesis, thereby converting enzyme stimulating and oxygen supply,
binding to alpha binding bacterial from converting AI production of or by preventing
blockers located on 30S ribosomal to A II and reduce mucous, vasospasm and
the vascular subunit, inhibiting systemic vascular prostaglandins, clot formation, and
smooth muscle the translocation of resistance by and bicarbonate associated
the peptidyl-tRNA preventing the from gastric glands decreases in blood
from the A-site to breakdown flow
the P-site, and also bradykinin &
causing misreading substance P
of mRNA (potent
vasodilator)
Indications Hypertension, Treatment of For hypertension Acute relief of For angina pectoris
Raynaud’s, CHF, tuberculosis as and heart failure symptoms or chest pain
benign prostatic second line associated with
hyperplasia therapy, serious PUD, hyperacidity,
gram-negative and heartburn
bacillary infections
Contraindications Incontinence, fluid Allergy, should be Allergy, Allergy, severe Asthma, heart
retention avoided in patients hyperkalemia renal failure, and block, COPD,
with myasthenia electrolyte hyperkalemia,
gravis because of disturbance Allergy, acute MI,
the risk of hypotension, heart
prolonged block
neuromuscular
blockade
Caution Patients who need Patients with renal Caution when Patients who have Patients who are
alpha blockers for failure prescribing to recently suffered taking sildenafil or
 BPH, but have a female patients of massive upper other PDE
history of childbearing age gastrointestinal inhibitors, Caution
hypotension or bleeding in DM – B1
postural heart selective preferred,
failure, should use dosage reduction
these drugs with in patients with
caution, as it may hepatic failure,
result in an even Monitor carefully if
greater decrease in patient has CHF
blood pressure
Adverse drug reaction Dizziness, fatigue, Ototoxicity, Fatigue, dizziness, Milk of magnesia – Facial blush,
drowsiness, nephrotoxicity, mood swings, H/A diarrhea; throbbing
hypotension, neuromuscular *dry nonproductive Aluminum & headache, palor,
headache blockade cough* calcium forms – weakness,
constipation; dizziness,
Calcium – kidney Bradycardia,
stones; and dizziness,
Alkalosis Hypotension,
constipation,
dyspnea, wheezing

2. Suggest planning and implementation for the indication, adverse effects or side effects for each class of drugs

Class of Drugs PLANNING IMPLEMENTATION

ACE inhibitors  Optimize patient outcomes  Encourage the patient to implement lifestyle
changes such as weight reduction, smoking
cessation, decreased intake of alcohol,
dietary restriction of salt or fats and
increased exercise.

Antianginals  Optimal response to drug therapy  CCB: Taken without regard to meals unless
 Meeting of patient needs related to the GI upset occurs then give with meals.
management of common ADRs
 Nitrates: If headaches occur might decrease
continued therapy, may use aspirin or
acetaminophen or may be an indication of
the nitrates effectiveness.
Administered by the sublingual (under the
tongue), buccal (between the cheek and
gum). Instruct the patient to place the buccal
tablet between the cheek and gum or

Antacids  Optimal response to therapy
 Understanding of drug regimen
 Increase fluid intake
Aminoglycosides  Optimize patient outcomes
 Controlling the infectious process or
prophylaxis of bacterial infection
 Management of ADR
Alpha blocker peripherally  Optimize patient outcomes
3. Patient teaching/counseling necessary for each class of drugs.
For Alpha Blocker Peripherally
 Patients on Gastro Intestinal Therapeutic System (GITS) preparation should be told no to crush/chew the
tablets
 Monitor for hypotension
between the upper lip and gum above the
incisors and allow it to dissolve.
Administer drug on empty stomach one hour
before or two hours after meal to ensure
optimum drug absorption.
 Prevention of nausea in patients undergoing
cancer therapy:
 Administer the drugs before
chemotherapy is given
 Give first dose IV during therapy; ask
patient to take it orally when at home
for specific time period
 Explain the importance of taking the
drug as directed
 Tell patient to inform primary health care
provider if she/he dislike the taste of antacid
or has difficulty chewing tablet form
 Emphasize avoiding driving or performing
other hazardous tasks due to drowsiness
 Enteric coated erythromycin given with
neomycin
 Explain the importance of completing the
entire course of treatment
 Advise to take drug at prescribed time
intervals and to not increase or omit dosage
unless advised
 Advise to avoid alcoholic beverages during
therapy
 Be sure your doctor knows about other
medications you take such as beta blocker,
CCB, or other medications for erectile
dysfunction.
  You should take this medication once a day

For Aminoglycosides
 If an aminoglycoside is used during pregnancy or if the patient becomes pregnant while taking an
aminoglycoside, she should be apprised of the potential hazard to the fetus.
 You should not use two doses at the same time.
 Make sure your doctor knows if you are taking any other antibiotic medicines such as amikacin (Amikin®),
gentamicin, netilmicin (Netromycin®), tobramycin, or vancomycin or any "water pills" such as Lasix® or
Edecrin®. These medicines taken with streptomycin may increase the risk of hearing problems.
 This medicine may contain a sulfite. Make sure your doctor knows if you are allergic to sulfites or have
asthma.

For ACEi
 Never double-up your dose or take extra medication to make up for the missed dose
 Cough is very frequent in patients receiving angiotensin-converting enzyme inhibitors (ACEIs)
For Antacids
 For patients taking the chewable tablet form of this medicine:
 Chew the tablets well before swallowing. This is to allow the medicine to work faster and be more
effective.
 For patients taking this medicine for a stomach or duodenal ulcer:
 Take it exactly as directed and for the full time of treatment as ordered by your doctor, to obtain
maximum relief of your symptoms.
 Take it 1 and 3 hours after meals and at bedtime for best results, unless otherwise directed by your
doctor.
 For patients taking aluminum carbonate or aluminum hydroxide to prevent kidney stones:
 Drink plenty of fluids for best results, unless otherwise directed by your doctor.
 If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next
dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

For Antianginals
 Take this medication by mouth as directed by your doctor, usually twice a day. Each day, take the first dose
when you wake up, then take the second dose 7 hours later. It is important to take the drug at the same
times each day. Do not change the dosing times unless directed by your doctor.
 Bedtime use not recommended because of risk of aspiration
 Placing under upper lip (above incisors) against gum or between cheek and upper gum; placing between
upper lip (above incisors) and gum if food or drink to be taken within 3 to 5 hours; patients with dentures may
place anywhere between cheek and gum
 Regular tablet or extended-release capsule or tablet—Taking with full glass of water on empty stomach
 Sublingual tablet—Placing under the tongue; avoiding eating, drinking, smoking, or using chewing tobacco
while tablet is dissolving
 Not taking sildenafil while taking this medication because excessive hypotension and possibly death can occur