Tales from the hospital ward

Clopidrogel hydrogen sulfate/ Iscover Plax Plavix                                 preg risk B Indications: to reduce atherosclerotic events where there is MI, CVA or peripheral arterial disease.   Action: ANTIPLATELET inhibits platelet aggregation, by inhibition of binding of ADP to its platelet receptor.Irreversible modification of platelet, LASTS FOR LIFETIME OF PLATELET-lasts 5days, indicated for those intolerant to aspirin. Adverse : CNS: headache, dizziness, fatigue, depression, pain ENT: rhinitis, epistaxis GI: haemorrhage, abdo pain, dyspepsia, gastritis, constipation, diarrhea, ulcers GU: UTI Haematologic: purpura Musculoskeletal: arthralgia Respiratory: bronchitis, coughing, dyspnea, upper respiratory tract infection Skin : rash, pruritus Flu-like syndrome Contraindications ...

Heparin sodium                                                       preg risk C Indications/actions : prevention of deep vein thrombosis, MI, pulmonary embolism. Accelerates formation of antithrombin III complex, and deactivates thrombin, preventing conversion of fibrinogen to fibrin. Interfere with the normal cascade of events involved in the clotting process. Parenteral Adverse: Haematologic: haemorrhage(excess dose), ^clotting time,thrombocytopenia, white clot syndrome Skin: cutaneous or SC necrosis GI upset Other: irritation, mild pain, haematoma, ulceration, hypersensitivity reactions(chills, fever pururitus, rhinitis, urticaria) anaphylactoid reactions Drug-drug: oral anticoagulants. Increas...

Enoxaparin /Clexane                     preg risk C Indications/actions : Prevention of pulmonary embolism and deep vein thrombosis(hip or knee surgery)/low molecular weight heparin. Interfere with the normal cascade of events involved in the clotting process. Surgery, injury, prolonged bed rest, prescribed by weight. Admin- SC . The bubble in the prefilled syringe, ensures that the full dose and the bubble stays in the syringe. Adverse: CNS: confusion, neurological injury when used with spinal or epidural puncture, fever, pain CV: oedema, peripheral oedema, CV toxicity(chest pain, dizziness,irregular heartbeat) GI: nausea Haematologic: hypochromic anaemia, thrombocytopenia, haemorrhage , ecchymoses; bleeding complicaitons. Skin: rash hives Drug-drug : anticoagulants, drugs that alter platelet function(salycilates) Contraindications: hypersensitivity, major bleeding ...

Tenecteplase(Metalyse) Indications :Thrombolytic  -clot buster (ghost buster)                                                                                      Thrombolytic. Reduction of mortality - Acute MI –       Pulmonary emboli –       Ischemic stroke only available as an injectable. Monitored closely by attending physician. Action: a human tissue plasminogen activator that binds to fibrin. Adverse : uncontrollable bleeding, cardiac arrhythmias, hypersensitivity Drug-drug : anticoagulants, drugs that alter platelet function(salycilates) Contraindications : hypersensitivity, many others, monitored by physician Care considerations : arrange to administer tene...

Warfarin                                   preg risk D I ndications/Actions : DVT,pulmonary embolism, MI, rheumatic heart disease. Interfere with the normal cascade of events involved in the clotting process. Inhibits vitamin K dependent activation of clotting factors. Oral tabs Adverse : Ha ematologic: bleeding, GI upset, Hepatic dysfunction, Headache, fever Other: alopecia, dermatitis, bone marrow suppression, prolonged and painful erection Don’t need to learn drug to drug as there are too many, but any other anticoagulant- lecture Drug- food : avoid foods containing vitamin K, however maintain vit K levels by eating consistent amount of leafy green veg. Avoid alcohol. Contraindications:hyp ersentivity, active bleeding, hepatic disease, renal disease, pregnancy, haemorrhagic stroke within past 6 months, thr...

Atenolol / Anselol, Noten, Tenormin, Tensig  preg risk C Classifications : antihypertensive Action : A beta blocker Adverse reactions:        bradycardia       fatigue, lethargy, vertigo, fever, drowsiness, dizziness     bradycardia, hypotension, HF, intermittent claudication       nausea, diarrhoea       leg pain       dyspnoea, bronchospasm      rash Contraindications: Drug-drug: antihypertensives, use together cautiously;cardiac glycosides, dilitazem, verapamil- excessive bradycardia and increase depressant effect on myocardium; insulin, oral diabetics- altered dosage reauirements with previously stabilised diabetes. Care considerations: ·          Use cautiously in individuals at risk of HF, have bronchospastic disease, diabetes and hyperthyroidism. ·          Che...

Spironolactone/ Aldactone, Spiractin              preg risk B Classifications : diuretic for oedema, hypertension, nephrotic syndrome, diuretic induced hypokalaemia, detection of primary hyper aldosteronism Action : a potassium sparing diuretic that antagonises aldosterone in the distal tubules, increasing sodium and water excretion. Potassium is retained. Both a diuretic and antihypertensive, can be used alone or in combo with other diuretic agents which act more proximally in the renal tubules. Adverse reactions :   CNS: headache, drowsiness, lethargy, confusion, ataxia      GI: abnormal hepatic function, diarrhoea, gastric bleeding, ulceration, cramping, gastritis       GU: inability to maintain erection, menstrual disturbances     Haematologic: agranulocytosis, leucopenia, thrombocytopenia      Metabolic: hyperkalaemi...

Furosemide / Frusid, Lasix Classification s: diuretic. Used for acute pulmonary oedema Adverse reactions : Toxicity- hearing (ototoxicity)   CNS:vertigo , headache, dizziness, parasthesia, restlessness, weakness     CV: volume depletion and dehydration, orthstatic hypotension, thrombophlebitis( with IV admin), fever with ischaemic complications        Eye: blurred or yellowed vision      GI: abdominal discomfort ant pain, diarrhoea, anorexia, nausea, vomiting, constipation, pancreatitis.      GU: nocturia, polyuria, frequent urination, oliguria     Haematologic: agranulocytosis, anaemia, aplastic anaemia, azotaemia, leucopenia, thrombocytopenia, thrombophilia(elderly) aplastic anaemia.       Hepatic : hepatic dysfunction, cholestasis, jaundice         Metabolic: hypokalaemia->  a rrhythmi...

Hydrochlorothiazide/ Diathiazide                   Preg Risk C Classifications: A thiazide diuretic that increased sodium and water excretion by inhibiting sodium and chloride reabsorption in the nephrons distal segment. Adverse reactions:   CNS: dizziness, vertigo, headache, parasthesia, weakness, restlessness     CV: volume depletion and dehydration, orthostatic hypotesnion(agravated by alcohol, barbiturates, or antihypertensive drugs), vasculiltis      Eye: transient blurred vision      GI: anorexia, nuasea, pancreatitis, epigastric distress, vomiting, abdo pain, diarrhoea, constipation      GU: polyuria, frequent urinations, renal failure, interstitial nephritis.     Hepatic: jaundice        Muculoskeletal: muscle cramps, spasm or weakness ...

Hydralazine/Apresoline Classifications : Vasodilator Action : smooth muscle relaxant, indicated for severe hypertension unresponsive to other therapy. Adverse reactions:   CNS: peripheral neuritis, headache, dizziness     CV: orthostatic hypotension, tachycardia, oedema, angina, palpitations, chest pain.      GI: nausea, vomiting, diarrhoea, anorexia, constipation      Haematologic: neutropenia, leucopenia, agranulocytopenia      Skin:rash, flushing, sweating Contraindications: hypersensitivity, CAD, dissecting aortic aneurysm,mitral valve rheumatic Heart disease Care considerations : use cautiously in elderly adults or those with HF, CVA, impaired hepatic or renal function or those taking other hypertensives. Monitor BP, pulse rate and weight frequently. Can be combined with diuretics and beta blockers to decrease sodium retention and tachycardia to prevent anginal atta...

Diltiazem hydrochloride/ Cardizem, Dilzem, Vasocardol         Preg risk C Cla ssifications: calcium channel blocker (antianginal agent)(antiarrhythmic) Indication : Vasospastic angina( Prinzmetal's variant angina), classic chronic angina pectoris, atrial fibrillation,atrial flutter, tachycardia Action : V BP, cardiac workload, and O2 consumption.  Relaxes muscle contraction or other autonomic blockers Adverse :   CNS: headache, dizziness, asthenia, somnolence     CV: oedema, arrhythmias, flushing, bradycardia, hypotension , conduction abnormalities, heart failure, AV block, abnormal ECG      GI: nausea, constipation , abdo discomfort     Hepatic: acute hepatic injury      Skin: rash Contraindications : hypersensitivity, sick sinus syndrome, second or third-degree AV block, bp below 90 mm Hg, acute MI or pulmonary congestion, renal or h...

Irbesartan/ Avapro, Karvea Classifications: Angiotensin II receptor blocker(ARB)           Preg Risk D Action: anti - hypertensive. Inhibits angiotensin II by blocking the binding of angiotensin II to angiotensin on the serface of   vascular smooth muscle. Adverse reactions :   CNS: fatigue, anxiety, dizziness, headache     CV: chest pain, oedema, tachycardia      GI: diarrhoea, dyspepsia, abdominal pain, nausea, vomiting      GU: UTI     Metabolic: increased potassium level     Musculoskeletal: musculoskeletal trauma or pain      Respiratory: URT infection      Skin: rash Drug-drug: potassium sparing diuretics, potassium supplements, salt substitutes, risk of hyperkalaemia. Contraindications : hypersensitivity Care considerations: Alert- use during pregnancy can cause injury and death ...

Captopril /Acenorm, Capoten, Zedace Classifications: Ace Inhibitor IndicAtion: Hypertension, diabetic nephropathy, left ventricular function, following MI Action: ace- meds - inhibit ace- a vasoconstrictor-> makes is a vasodilator, & V renin -> increases urine output Adverse reactions:   CNS: dizziness, fainting, headache, malaise, fatigue, fever     CV: tachycardia , hypotension, angina pectoris      GI: anorexia, dysgeusia, nausea, vomiting , abdominal pain, constipation, dry mouth      Haematologic: leucopenia , agranulocysosis, pancytopenia, anaemia, thrombocytopenia:     Hepatic:transient increase in liver enzyme levels     Metabolic: hyperkalaemia      Respiratory:dry persistent , nonproductive cough, dyspnoea, metallic taste      Skin: urticarial rash , maculopapular rash, pruritis, alopecia, angio-oede...