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
 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)
o Second generation (cefaclor, cefonicid, ceforanide,
cefotetan, cefoxitin)
o 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
 Differ among the sub groups but are similar within each
subgroups
o 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:
o seizures
o coma
o anaphylaxis
o hypotension
o 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 low-
sodium diets and drug therapy with thiazide
diuretics, methyldopa, NSAIDs, prohenecid,
increase the risk of lithium toxicity.