ANTI-HYPERTENSIVE

& DIURETICS
MACP 1213

Disediakan oleh:
Maizatul Neza Junus
Kolej Pembantu Perubatan, Seremban

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 OBJEKTIF
• Menerangkan tindakan ubat anti-
hypertensive dan diuretics.
• Menerangkan kesan sampingan ubat.
• Menyatakan contoh, dos dan cara
pemberian ubat.
• Menyatakan indikasi dan kontraindikasi
ubat.
• Menyatakan nasihat yang relevan semasa
penggunaan/ pemberian ubat.

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 Hypertension

• Adalah keadaan dimana

tekanan darah meningkat dari
paras normal.

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 • Tekanan normal darah:
– Systolic pressure > 120mm Hg
– Diastolic pressure > 80mm Hg
• Hypertension:
– Systolic pressure > 140mm Hg
– Diastolic pressure > 90mm Hg

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 Anti-Hypertensive

• Adalah ubat yang digunakan

bagi merawat ‘hypertension’/
mengurangkan tekanan
darah.

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Jenis-jenis
Anti-Hypertensives
• ACE Inhibitors
• Angiotensin II Receptor
Antagonist
• Beta Blockers
• Calcium Channel Blockers
• Diuretics
• Others
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 ACE Inhibitors

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 ACE

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 Tindakan

• Menghalang tindakan
“angiotensin converting
enzyme (ACE)”.
• Maka ACE tidak boleh
menukarkan ‘angiotensin I’
kepada ‘angiotensin II’.

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 • Bila angiotensin II berkurang,
– pembebasan aldosterone dan
Vasoconstriction akan
berkurang
• Kekurangan aldosterone
menyebabkan penyingkiran
sodium dan air.
• Sodium yang rendah dalam
darah akan menurunkan
tekanan darah.
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 ACE ACE Inhibitors

Decreased
blood pressure

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 Indication
• Hypertension
• Heart Failure
• Left ventricular dysfunction
• Acute & post MI

Contoh ubat

• captopril (Capoten)
• enalapril (Innovace)

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 1. captopril (Capoten 25mg)
Category: B

• Adult:
Dose
– Initial: 12.5mg bid PO
– Maintenance: 25mg bid PO
– Max: 50mg bid PO
• Peads:
– Safety & efficacy not established
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Kesan sampingan
• Gastric irritation
• Peptic ulcer
• Proteinuria
• Rash
• Cough
• Flushing
• Angioedema
Contraindication
• Allergic to drugs
• Pregnancy

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 Cautious
• Impaired renal function
• Lactation
Interaction
• Potassium-sparing diuretics
– Tingkatkan aktiviti captopril
• Indomethacin, salicylates,
NSAIDs
– Kurangkan aktiviti captopril

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 2. enalapril
(Renitec 10mg/ 20mg)
Category: B

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 Dose
• Adult:
– Initial: 10mg/day PO (Mild)
20mg/day PO (Moderate
to severe)
– Maintenance: 20mg/day PO
– Max: 40mg/day
• Peads:
– Initial: 0.08mg/day PO
– Max: 5mg/day
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 Kesan sampingan
• Headache
• Dizziness
• Nausea
• Diarrhea
• Decreased hemoglobin
• Cough
• Fatigue

Contraindication
• Sama seperi captopril

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 Cautious
• Sama seperi captopril

Interaction
• Anti-Hypertensives,
Potassium-sparing diuretics,
Potassium supplements
– Tingkatkan aktiviti captopril
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 Angiotensin II Receptor
Antagonist
Tindakan
• Menghalang tindakan angiotensin II
iaitu dengan
– Menghalang ‘vosoconstriction’
– Menghalang tindakan aldosterone
• Maka tekanan darah akan menurun.

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 ACE
Angiotensin II
Receptor Antagonist

Decreased
blood pressure

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 Indication

• Hypertension (pada pesakit

yang tak boleh terima ACE
inhibitors)

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 Contoh ubat

• irbesartan (Aprovel)
• losartan (Cozaar)
• telmisartan (Micardis)
• valsartan (Diovan)

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 1. irbesartan (Aprovel)
Category: A

Dose
• Adult:
– 150mg to 300mg/day PO

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 Kesan sampingan
• Diarrhea
• Dyspepsia/ heart burn
• Fatigue headache
• Urinary Tract Infection (UTI)
• Angioedema

Contraindication
• Allergic to drugs
• Pregnancy

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 Cautious
• Angioedema
• Impaired renal/ hepatic function
• Hyperkalemia
• Lactation

Interaction
• Lithium

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 2. losartan (Cozaar)
Category: A

Dose
• Adult:
– Usual: 50mg/day PO
– Jika perlu tambahkan dos
selepas beberapa minggu ke
100mg/day PO
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Kesan sampingan
• Angioedema
• Dizziness (pening)
• Headache
• Cough (batuk)

Contraindication
• Allergic to drugs
• Pregnancy

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 Cautious
• Angioedema
• Elderly
• Coronary Artery Disease (CAD)

Interaction
• Fluconazole
• Lithium
• Rifampicin

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 Beta
Blockers

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 Beta Blockers
• Adalah ubat yang mengurangkan
rangsangan simpatetik ke atas jantung
(reduce the excitability of the heart).
• Dengan demikian ia mengurangkan
‘cardiac output’ dan mengurangkan
rintangan dalam salur darah.
• Maka tekanan darah akan berkurang.

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 Indication

• Arrhythmias
• Hypertension
• Angina pectoris
• Myocardial Infarction (MI)

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 Contoh ubat
• atenolol (Tenormin)
• esmolol HCl (Brevibloc)
• labetalol (Trandate)
• metoprolol (Betaloc)
• oxprenolol (Trasicor)
• propranolol HCl (Inderal)
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 1. atenolol (Tenormin)
Category: B

Dose
• Adult:
– 50-100mg/day PO (divided dose)
• Peads:
– Safety & efficacy not established
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 Interactions

• Clonidine
• Beta blockers (others)

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 2. esmolol HCl
(Brevibloc 10mg/ml)
Category: A*

Dose
• Adult:
– Usual: 50-200mcg/kg/min IV
infusion (not for direct IV inj)
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 Interaction

• Catecholamine depleting
drugs
• Verapamil

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 3. labetalol (Trandate)

Category: A*

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 Dose
• Adult:
– 100mg/day PO (with food)
– Elderly 50mg/day PO (with
food)
– Increase at intervals of 14 days
to 200mg bd
– Up to 400mg bd (3-4 divided
dose)
– Max: 2.4g/day
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 Interaction
• Alpha blockers
• Cimetidine
• Digoxin
• Calcium channel blockers
• Halothane
• Hypoglycemic agents
• Imipramine
• Methyldopa
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 4. metoprolol (Betaloc)

Category: B

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 Dose
• Adult:
– Initial: 50mg/day PO (single or
divided dose)
– Maintenance: 100-200mg/day
PO (1-2 doses)
– Max: 400mg/day
• Peads:
– Safety & efficacy not established
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 Interactions

• Alpha blockers
• Amiodarone
• Chlorpromazine
• Cimetidine

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 5. oxprenolol (Trasicor)
Category: B

Dose
• Adult:
– 80mg bid PO
– Max: 480mg/day
• Peads:
– Safety & efficacy not established
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 Interactions

• Clonidine
• Beta blockers (others)

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 6. propranolol HCl
(Inderal)
Category: B

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 Dose
• Adult:
– Initial: 40-80mg bd PO
– Usual Range: 160-320mg/day

• Peads:
– Initial: 1mg/kg/day (divided
dose)
– Can increase to 2-4mg/kg/day
(divided dose)
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 Interactions Kesan sampingan
• Alpha blockers • Fatigue
• Amiodarone • Orthostatic hypotension
• Chlorpromazine • CHF
• Cimetidine • Bradycardia
• Pulmonary edema
• Bronchospasm
• Peripheral
vasoconstriction
• Nausea & Diarrhea

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 Contraindication Cautious
• Allergic to beta • Renal
blockers disease
• Sinus
• Peripheral
bradycardia
vascular
• 2° or 3° Heart
disease
block
• Cardiac Failure
• Bronchospasm
• Pregnancy
• Lactation
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 Calcium Channel
Blockers

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 CALCIUM CHANNEL
BLOCKERS
• Menghalang pergerakan ion calcium
merentasi membran sel.
• Paras calcium bagi transmisi impuls
berkurang.
• Vasoconstriction (pengecutan salur
darah) akan dihalang.
• Sebaliknya, mempunyai kesan
pengembangan ke atas arteri.
• Maka tekanan darah akan berkurang.

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 Indication
• Arrhythmias
• Hypertension
• Angina pectoris

Contoh ubat
• diltiazem HCl (Herbesser)
• verapamil HCl (Isoptin)
• nifedipine (Adalat)
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 1. diltiazem HCl
(Herbesser)
Category: B

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 Dose
• Dose Adult:
– 60mg tid PO (elderly bid)
– Increase if necessary to
360mg/day
– Max: 480mg/day
• Dose Peads:
– Safety & efficacy not
established
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 Interactions
• Aspirin
• Beta blockers
• Carbamazepine (Anti-epileptics)
• Cisapride (Gastroesophageal reflux/
sembelit)
• Digoxin
• Lipid lowering drugs
• Nifedipine
• Saquinavir (Anti-retroviral)
• Rifampin (Anti-TB)
• Anti-coagulants

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 2. verapamil HCl
(Isoptin)
Category: B

Dose
• Dose Adult:
– 80-120mg tid/day PO
– Do not exceed 480mg/day (in
long term treatment)
– Take regularly ½ hr before meal
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 • Dose Peads:
– < 1 yr: 0.1-0.2mg/kg
– 1-15 yr: 0.1-0.3mg/kg
– Do not exceed 5mg (PO/IV)

Interactions
• Beta Blockers
• Anesthetic (inhalation)
• Digoxin

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 3. nifedipine (Adalat)
Category: B

Dose
• Dose Adult:
– Initial 10mg tid PO (elderly 5mg)
– Maintenance: 10-20mg tid PO
– > 180mg/day is not
recommended
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 • Dose Peads:
– Safety & efficacy not
established

Interactions

• Beta blockers
• Digoxin
• Diltiazem

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Kesan Sampingan Contraindication
• Dizziness • Allergic to Drug
• Headache • Impaired renal/
• Peripheral edema hepatic function
• Hypotension • Heart block
• Nausea & • Acute MI
diarrhea • Hypotension
• Constipation • Lactation
• Flushing • Pregnancy

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 Cautious
• Heart block (1°)
• CHF
• Gastrointestinal
hypermotility
• Hypotension
• Impaired liver function

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 Anti-Adrenergics
• Bertindak dengan mengurangkan
tindakan simpatetik ke atas jantung dan
salur darah.
• Dengan demikian menyebabkan
– Pengurangan dalam ‘Cardiac output’.
– Vasodilation (Pengembangan salur
darah).
• Maka tekanan darah akan berkurang.

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 Contoh ubat

• methyldopa (Aldomet)

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 1. methyldopa (Aldomet)
Category: B

Indication
• Hypertension

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 Dose
• Adult:
– 250mg bd-tds PO
– Increase gradually at intervals of
2 or more days
– Max: 3000mg/day (3g)
• Elderly:
– 125mg bd PO
– Increase gradually
– Max: 2000mg/day (2g)
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Kesan Sampingan
• Sedation
• Headache
• Nausea & vomiting
• Bradycardia
• Constipation
• Bone marrow
depression
• Hemolytic anemia
• Jaundice
1/17/2019
Contraindication
• Allergic to Drug
• Active hepatic
disease
• History of hepatic
disease
ANTI HYPERTENSIVE AND DIURETICS DRUGS 82
 Cautious Interactions
• Renal failure • Anti-
• Pregnancy hypertensives
• Lactation • Lithium
• MAOIs
(Monoamine
Oxidase
Inhibitors)

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 Alpha Blockers

• Menyekat neurotransmitter
adrenergic dan seterusnya
menyebabkan pengembangan
salur darah (vasodilation).
• Dengan demikian tekanan
darah akan turun.

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 Contoh ubat

• Prazosin (Minipress)

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 1. Prazosin (Minipress)
Category: B

Indication
• Hypertension
• CHF (Congestive Heart Failure)
• BPH (Benign Prostatic
Hyperplasia)
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 Dose
• Adult:
– 0.5mg bd-tds
– Increase to 1mg bd-tds (after 3-7
days)
– Max: 20mg/day (divided dose)
• Peads:
– Safety & efficacy not
established
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Kesan Sampingan Contraindication
• Dizziness • Allergic to Drug
• Drowsiness • Lactation
• Headache
• Nausea Cautious
• Weakness • CHF
• Palpitation • Renal failure
• Orthostatic • Pregnancy
hypotension

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 Interactions

• Anti-hypertensives
– Increase the effect of
Prazosin
• NSAIDs
– Decrease the effect of
Prazosin

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 Diuretics

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 Diuretics
• Menghalang penyerapan
semula ion natrium , klorida
dan air di tubul berlingkar
distal serta ‘ascending loop of
henle’ dalam ginjal.

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 Indication

• Hypertension
• Edema

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 Jenis-jenis diuretics

• Thiazide Diuretics
• Loop Diuretics
• Potassium Sparing
Diuretics
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 i. Thiazide Diuretics
• Menghalang penyerapan semula ion
natrium , klorida dan air di tubul
berlingkar distal serta ‘ascending loop
of henle’ dalam ginjal.
• Meningkatkan penyingkiran ion
sodium, chloride dan air.
• Maka kekurangan sodium dan chloride
dalam darah akan menurunkan tekanan
darah.

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 1. Chlorothiazide
(Chlotride)
Category: B

Dose
• Adult:
– 0.5-2g/day PO (single or
divided dose)
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Kesan sampingan Contraindication
• Ruam (rashes) • Allergic to
• Thrombocytopenia chlorothiazide
• Impotent • Renal failure
(reversible on • Anuria
withdrawal of • Hepatic coma
drugs)
Cautious Interactions
• Electrolyte • Cardiac glycosides
imbalance • Lithium
• Renal/ liver disease
• Pregnancy
• Lactation
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 ii. Loop Diuretics
• Menghalang penyerapan semula
ion natrium, klorida dan air di
tubul proksimal, loop of Henle &
tubul distal dalam ginjal.
• Meningkatkan penyingkiran ion
sodium, chloride dan air.
• Maka kekurangan sodium dan
chloride dalam darah akan
menurunkan tekanan darah.

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 1. Furosemide
(Lasix)
Category: B

Dose
• Adult:
– 40mg bid/day PO

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Kesan
sampingan Contraindication

• Electrolyte • Allergic to
imbalance furosemide
• Anorexia • Severe renal
failure
• Nausea &
• Hepatic coma
vomiting
• Anuria
• Dizziness
• Pregnancy
• Rash • Lactation
• Orthostatic
Hypotension
• Photosensitivity
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 Cautious Interactions
• Pregnancy • Digitalis
• Lactation • Aminoglycoside
antibiotics
• Cisplatin
• Phenytoin
• NSAIDs

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 iii. Potassium Sparing
Diuretics
• Menghalang penyerapan semula ion
sodium dan air di tubul proksimal, loop
of Henle & tubul distal dalam ginjal.
• Meningkatkan penyingkiran ion sodium
dan air.
• Maka kekurangan sodium dan chloride
dalam darah akan menurunkan tekanan
darah.
• Tetapi diuretics ini akan meningkatkan
penyerapan semula ion potassium.
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 1. Amiloride HCl 5mg,
Hydrochlorohiazide 50mg
(Moduretic)
Category: B

Dose
• Adult:
– 1-2 tabs/day PO (single or
divided dose)
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Kesan sampingan Contraindication
• Headache • Allergic to
• Dizziness amiloride
• Nausea & vomiting • Hyperkalemia
• Anorexia
• Hyperkalemia
• Hypotension
• Rash

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 Cautious Interactions

• Renal/ hepatic • Spironolactone,

disease Potassium
• Diabetes supplement, Diet
rich in potassium,
• Pregnancy
ACE Inhibitors
• Lactation
– Increased
hyperkalemia
• Digoxin
– Decreased effect
of amiloride
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NASIHAT PENGAMBILAN ANTI-
HYPERTENSIVE
Jika anda terlupa atau tertinggal dos, ambil sebaik sahaja anda teringat.
Walau bagaimanapun, jika telah hampir dengan waktu pengambilan dos
yang seterusnya, abaikan dos tersebut dan kembali ke jadual asal. Jangan
gandakan dos untuk menggantikan dos yang tertinggal.
Kepatuhan terhadap pengambilan ubat-ubatan antihipertensif amat
penting bagi mendapat manfaat yang diharapkan. Tidak patuh kepada
pengambilannya akan mengakibatkan kegagalan dalam rawatan.
Kebanyakan individu yang menghidapi hipertensi tidak mengalami
sebarang gejala. Ini menjadikan pesakit sukar untuk melihat manfaat yang
diperolehi melalui pengambilan ubat antihipertensif secara berterusan.

Ambil ubat seperti yang telah diarahkan oleh doktor walaupun anda
berasa sihat. Bincang dengan doktor atau ahli farmasi dan maklumkan
sekiranya anda mengalami sebarang kesan sampingan akibat
pengambilan ubat-ubatan tersebut agar rawatan yang paling sesuai boleh
diberikan bagi mengawal hipertensi.
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NASIHAT PENGAMBILAN DIURETICS
Sebelum mengambil diuretics, beritahu doktor anda jika anda
mempunyai penyakit buah pinggang, penyakit hati, gout, lupus,
kencing manis atau alahan
Untuk memastikan ubat ini tidak menyebabkan kesan bahaya,
darah anda perlu diuji mengikut jadual. Fungsi buah inggang
atau hati anda juga perlu diuji. Jangan ponteng perjumpaan
dengan doktor.
Diuretics akan menyebabkan anda kencing lebih selalu dan
anda boleh mengalami kekurangan air. Ikutlah arahan doktor
tentang potassium supplement atau mendapatkan cukup garam
dalam permakanan anda. Elakkan daripada mengalami
kekurangan air
Teruskan penggunaan diuretics bersama rawatan penyakit
darah tinggi walaupun anda merasa baik.
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 TUTORIAL
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 Soalan
1. Terangkan cara tindakan &
berikan contoh ubat anti-
hypertensive jenis
i. ACE Inhibitors
ii. Angiotensin II receptor
antagonist
iii. Beta Blockers
2. Nyatakan kesan sampingan
dan kontraindikasi anti-
hypertensive jenis
i. ACE Inhibitors
ii. Angiotensin II receptor
antagonist
iii. Beta Blockers
 Soalan
3. Terangkan cara tindakan
serta berikan contoh ubat anti-
hypertensive jenis
i. Calcium Channel Blockers
ii. Peripheral vasodilators
iii. Anti-adrenergics
iv. Alpha blockers
4. Nyatakan kesan sampingan
dan kontraindikasi ubat anti-
hypertensive jenis
i. Calcium Channel Blockers
ii. Peripheral vasodilators
iii. Anti-adrenergics
iv. Alpha blockers
 Soalan
5. Senaraikan jenis-jenis
diuretics serta terangkan
cara tindakannya?
6. Berikan contoh ubat bagi
setiap jenis diuretics?
7. Nyatakan kesan sampingan
dan kontraindikasi ubat
setiap jenis diuretics?
PERBINCANGAN..
1. Nama Ubat
2. Indikasi
3. Dos (Dewasa/Kanak-kanak)
4. Cara Pemberian
5. Kesan Sampingan
6. Kontraindikasi
7. Nasihat pemberian (jika ada)

**Nama ubat baru yang lain (rujuk www.mims.com.my)