Enalapril, Metropolol, Aspirin, Citicoline

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The key takeaways are about different drugs like enalapril, metoprolol, aspirin and citicoline and their properties, interactions, contraindications and nursing responsibilities.

The different classifications of drugs mentioned are: anti-hypertensive, ACE inhibitor, beta blocker, NSAIDs, central stimulant.

Some of the drug interactions mentioned are: enalapril with acebutolol, abacavir, acetylsalicylic acid; metoprolol with quinidine, amiodarone, hydralazine; aspirin with alcohol, corticosteroids, analgin, phenylbutazone and oxyphenbutazone.

DRUG ANALYSIS

GENERIC & MODE OF ACTION DRUG INTERACTION CONTRAINDICATION NURSING RESPONSIBILITIES


BRAND NAME
Enalapril – (Vasotec) Normally, angiotensin I is Acebutolol, Abacavir, Patients who are  Assess if he/she is allergy to
converted to angiotensin II Acetylsalicylic acid hypersensitive to this enalapril.
by an angiotensin- product and patients with  Monitor patients on diuretic
converting enzyme history of angioedema therapy for excessive
(ACE). ... Enalaprilat, the hypotension after the first
active metabolite of few doses.
enalapril, inhibits ACE.  Be careful if any situation
Inhibition of ACE that may lead to a drop-in
decreases levels of blood pressure (diarrhea,
angiotensin II leading to sweating, vomiting
less vasoconstriction and dehydration)
decreased blood pressure.  The patient may experience
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS GI upset, loss of appetite,
Anti-hypertensive, Absorption: Well For the treatment of Dizziness, change in taste perception.
ACE inhibitor absorbed from the GI tract essential or renovascular lightheadedness,
(approx 60%). Time to hypertension and weakness, dry cough.
peak plasma symptomatic congestive
concentration: Oral: heart failure. It may be
Enalapril: Approx 1 hr; used alone or in
DOSAGE enalaprilat: 3-4 hr. combination with thiazide
5mg Distribution: Distributed diuretics.
into milk (trace amounts),
crosses the placenta and
appears to cross the blood-
brain barrier poorly.
Plasma protein binding:
50-60% (enalaprilat).
Metabolism: Extensively

Gabriel P. Matibag
hydrolysed to enalaprilat
in the liver via esterases.
Excretion: Via urine
(43% as enalaprilat and
18% as enalapril); faeces
(27% as enalaprilat and
6% as enalapril).
Elimination half-life:
Approx. 11 hr.

Gabriel P. Matibag
DRUG ANALYSIS

GENERIC & MODE OF ACTION DRUG INTERACTION CONTRAINDICATION NURSING RESPONSIBILITIES


BRAND NAME
Metropolol Metoprolol selectively Quinidine, Amiodarone, 2nd or 3rd degree AV  Monitor BP during drug
inhibits β1-adrenergic Hydralazine block, sick sinus therapy
receptors but has little or syndrome, hypotension,  Advise patient to change
no effect on β2-receptors decompensated heart position slowly to minimize
except in high doses. It failure, sinus bradycardia, orthostatic hypotension
does not exhibit membrane severe peripheral arterial  Advise patient to notify
stabilizing or intrinsic circulatory disorders, health care providers if
sympathomimetic activity. cardiogenic shock, severe experiencing DOB,
asthma and wheezing, cold hands and
bronchospasm, untreated feet.
phaeochromocytoma,
Prinzmetal's angina,
metabolic acidosis.
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
Beta blocker Absorption: Absorbed To reduce blood pressure Weakness, drowsiness,
readily and completely for and to reduce the risk of dizziness, blurred vision
the GI tract. cardiovascular
Bioavailability increased
by food. Bioavailability:
Approx 50%. Time to
DOSAGE peak plasma
47.5mg concentration: Approx 1.5-
2 hr (oral).
Distribution: Widely
distributed, enters breast
milk, crosses the placenta
and blood-brain barrier.
Volume of distribution:

Gabriel P. Matibag
3.2-5.6 L/kg. Plasma
protein binding: Approx
12%.
Metabolism: Extensively
hepatic via CYP2D6
isoenzyme and undergoes
oxidative deamination, O-
dealkylation followed by
oxidation and aliphatic
hydroxylation.
Excretion: Via urine (as
metabolites and unchanged
drug). Elimination half-
life: 3-4 hr (fast
hydroxylators); approx 7
hr (poor hydroxylators).

Gabriel P. Matibag
DRUG ANALYSIS

GENERIC & MODE OF ACTION DRUG INTERACTION CONTRAINDICATION NURSING RESPONSIBILITIES


BRAND NAME
Aspirin Aspirin is an analgesic, Alcohol, corticosteroids, Hypersensitivity (attacks of  Should be taken with food
anti-inflammatory and analgin, phenylbutazone asthma, angioedema,  Advise patient to report
antipyretic. It inhibits and oxyphenbutazone may urticaria or rhinitis), active tinnitus, unusual bleeding,
cyclooxygenase, which is increase risk of GI peptic ulceration; pregnancy of gums, black tarry stools,
responsible for the ulceration. Aspirin (3rd trimester), children <12 or fever lasting than 3 days.
synthesis of prostaglandin increases phenytoin levels. yr., patients with hemophilia  Avoid taking alcohol when
and thromboxane. It also May antagonize actions of or hemorrhagic disorders, medication is ongoing.
inhibits platelet uricosurics and gout, severe renal or hepatic
aggregation. spironolactone. impairment, lactation.

CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS


NSAIDS Absorption: Rapidly Used to treat mild to GI disturbances;
absorbed from the GI tract moderate pain. prolonged bleeding time,
(oral); less reliable rhinitis, urticaria and
(rectal); absorbed through epigastric discomfort;
the skin (topical). Peak angioedema, salicylism,
plasma concentrations tinnitus; bronchospasm.
DOSAGE after 1-2 hr.
80mg/2tabs Distribution: Widely
distributed; crosses the
placenta; enters breast
milk. Protein-binding: 80-
90%.
Metabolism: Hepatic;
converted to metabolites.
Excretion: Via urine by

Gabriel P. Matibag
glomerular filtration,
active renal tubular
secretion and passive
tubular reabsorption (as
unchanged drug); via
hemodialysis; 15-20
minutes

Gabriel P. Matibag
DRUG ANALYSIS

GENERIC & MODE OF ACTION DRUG INTERACTION CONTRAINDICATION NURSING RESPONSIBILITIES


BRAND NAME
Citicoline Promotes brain Levodopa, Parasympathetic  Instruct patient to take the
metabolism by restoring Meclophenoxate hypertonia medication as prescribed.
phospholipid content in  Teach the patient that
the brain and regulation of citicoline may be taken with
neuronal membrane or without food.
excitability.  Monitor for adverse effects;
instruct patient to report
immediately if he/she
develops chest tightness,
tingling in mouth and throat,
headache, diarrhea and
blurring of vision.
CLASSIFICATION PHARMACOKINETICS INDICATION SIDE EFFECTS
Central stimulant Citicoline is metabolized Increase blood flow and Hypotension, Headache,
to yield the free nucleotide Nausea, Vomiting
uridine and choline. Both oxygen consumption in the
elements cross the blood- brain and treatment if
brain barrier, become cerebrovascular disorders.
incorporated into brain
DOSAGE membrane phospholipids
500mg and increase the
production of
neurotransmitters in the
central nervous system,
including the synthesis of
acetylcholine,
noradrenaline and
dopamine.

Gabriel P. Matibag
Gabriel P. Matibag

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