About drug types

1. Amrit Pokhrel
Pharmacist

2.  Blood pressure = CO × SVR
• CO = cardiac output
• SVR = systemic vascular resistance
 Hypertension = high blood pressure

4. Blood Pressure Classification
BP Classification SBP mmHg DBP mmHg
Normal < 120 and < 80
Pre-
hypertension*
120-139 or 80-89
Stage 1
Hypertension
140-159 or 90-99
Stage 2
Hypertension
> 160 or > 100

5. Antihypertensive Drugs
 Categories
 Adrenergic drugs
 Angiotensin-converting enzyme (ACE) inhibitors
 Angiotensin II receptor blockers (ARBs)
 Calcium channel blockers (CCBs)
 Diuretics
 Vasodilators

6. Adrenergic Drugs
 Alpha Blocker
Prazocine, Terazocine
 Beta-Blocker
Selective B1 Blocker- Metoprolol, Atenolol
Non Selective B- Blocker- Propranolol
 B and Alpha Blocker-Labetalol, Carvedilol
 Centrally acting alpha2 receptor agonists
 clonidine
 methyldopa
 Can be used for hypertension in pregnancy

7. Adrenergic Drugs:
Adverse Effects
 Most common
 Bradycardia with reflex tachycardia
 Dry mouth
 Drowsiness, sedation
 Constipation
 Depression
 Edema

8. Angiotensin-Converting
Enzyme (ACE) Inhibitors
 Large group of safe and effective drugs
 Often used as first-line drugs for HF
and hypertension
 May be combined with a thiazide diuretic or calcium
channel blocker
captopril
enalapril
Lisinopril
Ramipril

10. ACE Inhibitors: Adverse Effects
 Fatigue
 Dizziness
 Headache
 Mood changes
 Impaired taste
 Possible hyperkalemia
 Dry, nonproductive cough, which reverses when
therapy is stopped

11. Angiotensin II Receptor Blockers
 Also referred to as angiotensin II blockers or ARBs
 Well tolerated
 Do not cause a dry cough
losartan
irbesartan
olmesartan
telmisartan

13. Diuretics
 Decrease plasma and extracellular fluid volumes
 Results
 Decreased preload
 Decreased cardiac output
 Decreased total peripheral resistance
 Overall effect
 Decreased workload of the heart and decreased blood
pressure
 Fruosemide
 Thiazide
 Spironolactone

14. Vasodilators
 Directly relax arteriolar and/or venous smooth muscle
 Results in:
 Decreased systemic vascular response
 Decreased afterload
 Peripheral vasodilation
diazoxide
hydralazine HCl
minoxidil
sodium nitroprusside

15. Nursing Implications
 obtain a thorough health history and head-to-toe
physical examination
 Assess for contraindications to specific
antihypertensive drugs
 Educate patients about the importance of not missing
a dose and taking the medications exactly as
prescribed
 Monitor BP during therapy; instruct patients to
keep a log of regular BP checks

16. Nursing Implications (Contd)
 Instruct patients that these drugs should not be
stopped abruptly because this may cause a rebound
hypertensive crisis, and perhaps lead to stroke
 Oral forms should be given with meals so that
absorption is more gradual and effective
 Administer IV forms with extreme caution, and use an
IV pump
 Instruct patients to report unusual shortness of
breath; difficulty breathing; swelling of the feet,
ankles, face, or around the eyes; weight gain or loss;
chest pain; palpitations; or excessive fatigue

17. Nursing Implications (Contd)
 Patients should not take any other medications,
including over-the-counter drugs, without first getting
the approval of their physician
 Educate patients about lifestyle changes that may be
needed
 Weight loss
 Stress management
 Supervised exercise
 Dietary measures

18. Hypertensive Emergencies
 A hypertensive emergency is an acute, marked
elevation in blood pressure that is associated with
signs of target-organ damage.
 These can include pulmonary edema, cardiac
ischemia, neurologic deficits, acute renal failure,
aortic dissection, and eclampsia.
 Drugs:
 Sodium Nitroprusside (20-300 mcg/min) – dose
titration and monitoring
 GTN (5-20 mcg/min) – cardiac surgery, LVF, MI and
angina
 Esmolol (0.5 mg/kg bolus) and 50-200mcg/kg/min -
useful in reducing cardiac work

20. Antidiabetic/Hypoglycemic Agents
 Insulin
 Oral Agents

21. Insulin
 Used in the treatment of
Type 1 Diabetes Mellitus
Diabetic Ketoacidosis
 Insulin preparations
Classified base on
 Onset of action
 Duration of action
 Degree of purity

22. Types of Insulin
Type Appearance Onset of
action
Duration
Rapid Acting
Insulin
Lispro/Aspart
Clear 0.2- 0.4 Hrs 3-5Hrs
Short Acting
Regular Insulin Clear 0.5- 1 hrs 6-8 Hrs
Intermediate
Acting
Insulin Zinc
Suspension or
Lente
Cloudy 1-2 hrs 20-24 Hrs
Long Acting
Insulin Glargin Clear 2-4 Hrs 24 hrs

23. Pre-mixed Insulin
 Pre-mixed combinations of
short and intermediate acting
insulins (biphasic)
 Cloudy (needs re-suspending)
 e.g. 30/70 Mixture = 30% fast acting
+ 70% intermediate acting
 Onset 30 minutes
 Peak 2 - 8 hours
 Duration up to 24 hours

24. Side Effects
 Hypoglycemia
 Local reactions
 Allergy
 Edema

25. Storage of Insulin
Before use Store in fridge
In-use vials Store in fridge (3 months)
Out of fridge at max 250 C
(4 to 6 weeks)
In-use pens Out of fridge at max 250 C (4 weeks)

26. Insulin Delivery
 Insulin devices (pens)
 Durable (replace insulin cartridge)
 Disposable (no need to replace cartridge)
 Insulin vials and syringes

27. Insuline Device
Advantages
 Improved dose accuracy
 More convenient
 Easy to use
 Portable
 Quick and discreet
 May improve client self-management/compliance
 Preferred by patients
Disadvantages
 Cannot mix insulin in a free-mixing regimen

28. Insulin Pumps
 Continuous subcutaneous insulin infusion
 Battery operated
 Programmable computer
 Basal insulin throughout day
 Bolus insulin before meals
 Needles/catheters changed
every 2-3 days

29. Insulin Pumps

30. Nursing Implication
 When insulin is ordered, ensure:
◦ Correct route
◦ Correct type of insulin
◦ Timing of the dose
◦ Correct dosage
 Insulin order and prepared dosages are second-
checked with another nurse
◦ Check blood glucose level before giving insulin
◦ Roll vials between hands them to mix suspensions – no shaking!
◦ Ensure correct storage of insulin vials
◦ ONLY insulin syringes, calibrated in units, to administer insulin
◦ Ensure correct timing of insulin dose with meals

31. Nursing Implication
• Provide thorough patient education regarding self-
administration of insulin injections, including timing of
doses, monitoring blood glucoses, and injection site
rotations

32. Oral Hypoglycemic Agents
 Sulfonylureas
Gliclazide
Glimepiride
Glipizide
 Biguanides
Metformin
 Glitazones
Pioglitazone
 Meglitinide
Repaglimide
 α- Glucosidase
Inhibitors
Acarbose
 Newer Drugs
Sitagliptine
Linagliptine

33. Nursing Implications Oral
Antidiabetic drugs
 Always check blood glucose levels before giving
 Usually given 30 minutes before meals
 Administer the medication at exact time – with
meal or when food is in sight
 Alpha-glucosidase inhibitors are given with the first
bite of each main meal
 Metformin is taken with meals to reduce GI effects

34. Hypolipidemic Drugs
 There are number of groups of drugs
 HMG-CoA reductase inhibitors
 Atorvasatatin
 Simvastatin
 Rosuvastatin
 Cholesterol absorption inhibitors
 Ezetimibe
 Bile acid sequestrants
 Cholestyramine
 Fibric acid derivatives
 Gemfibrozil
 Fenofibrate

35. Statins
 Reduce LDL level up to 30%
 Raise HDL level up to 20%
Adverse Effects
 Headache, dizziness,
alteration of taste, insomnia,
abdominal cramping and
photosensitivity
 May cause myalgias, leg ache, and
muscle weakness
 Contraindicated during pregancy
 Ezetimibe:
 Modestly reduces total
cholesterol, LDL, and
triglyceride blood
levels
 Ideal to combine with
other hypolipidemic
drugs
 Adverse effects—
abdominal pain,
fatigue, coughing,
diarrhea, back pain,
and arthralgia

36. Fibrates
Use
to decrease triglycerides
Adverse effects
nausea, vomiting, diarrhea, and
flatulence

37. Thank You