Generic name: Captopril Brand name: Capoten

General Action:: Antihypertensive; angiotensin-converting enzymeinhibitor (ACE inhibitor) Specific actions: Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased blood pressure, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive Available forms: Tablets

Dosages ADULTS Hypertension: 25 mg PO bid or tid; if satisfactory response is not noted within 12 wk, increase dosage to 50 mg bidtid; usual range is 25150 mg bidtid PO with a mild thiazide diuretic. Do not exceed 450 mg/day. CHF: 6.2512.5 mg PO tid in patients who may be salt or volume depleted. Usual initial dose, 25 mg PO tid; maintenance dose, 50100 mg PO tid. Do not exceed 450 mg/day. Use in conjunction with diuretic and digitalis therapy. Left ventricular dysfunction after MI: 50 mg PO tid, starting as early as 3 days post MI. Initial dose of 6.25 mg, then 12.5 mg tid, increasing slowly to 50 mg tid. Diabetic nephropathy: 25 mg PO tid

Cystinuria: Initial dose: 25 mg orally 2 to 3 times a day one hour before meals. Initial doses may be titrated as tolerated approximately every 1 to 2 weeks to reduce the degree of cystinuria. Limited data have shown significant reductions in the urinary excretion of cystine after daily doses of captopril of 150 mg.

Usual Pediatric Dose for Congestive Heart Failure Note: Dosage must be titrated according to patient response; use lowest effective dose; lower doses should be used in patients who are sodium and water depleted due to diuretic therapy. Premature neonates and term neonates less than or equal to 7 days of age: Initial: 0.01 mg/kg/dose every 8 to 12 hours; titrate dose Term neonates greater than 7 days of age: Initial: 0.05 to 0.1 mg/kg/dose every 8 to 24 hours; titrate dose upward to maximum of 0.5 mg/kg/dose given every 6 to 24 hours

Infants: Initial: 0.15 to 0.3 mg/kg/dose; titrate dose upward to maximum of 6 mg/kg/day in 1 to 4 divided doses; usual required dose: 2.5 to 6 mg/kg/day Children: Initial: 0.3 to 0.5 mg/kg/dose; titrate upward to a maximum dose of 6 mg/kg/day in 2 to 4 divided doses Older children: Initial: 6.25 to 12.5 mg/dose every 12 to 24 hours; titrate upward to maximum of 6 mg/kg/day in 2 to 4 divided doses Adolescents to adults: Initial: 12.5 to 25 mg/dose given every 8 to 12 hours; increase by 25 mg/dose at 1 to 2 week intervals based on patient response Maximum dose: 450 mg/day; usual dosage range for hypertension Usual Pediatric Dose for Diabetic Nephropathy Note: Dosage must be titrated according to patient response; use lowest effective dose; lower doses should be used in patients who are sodium and water depleted due to diuretic therapy.

Premature neonates and term neonates less than or equal to 7 days of age: Initial: 0.01 mg/kg/dose every 8 to 12 hours; titrate dose Term neonates greater than 7 days of age: Initial: 0.05 to 0.1 mg/kg/dose every 8 to 24 hours; titrate dose upward to maximum of 0.5 mg/kg/dose given every 6 to 24 hours Infants: Initial: 0.15 to 0.3 mg/kg/dose; titrate dose upward to maximum of 6 mg/kg/day in 1 to 4 divided doses; usual required dose: 2.5 to 6 mg/kg/day

Children: Initial: 0.3 to 0.5 mg/kg/dose; titrate upward to a maximum dose of 6 mg/kg/day in 2 to 4 divided doses Older children: Initial: 6.25 to 12.5 mg/dose every 12 to 24 hours; titrate upward to maximum of 6 mg/kg/day in 2 to 4 divided doses Adolescents to adults: Initial: 12.5 to 25 mg/dose given every 8 to 12 hours; increase by 25 mg/dose at 1 to 2 week intervals based on patient response Maximum dose: 450 mg/day; usual dosage range for hypertension Usual Pediatric Dose for Hypertension Note: Dosage must be titrated according to patient response; use lowest effective dose; lower doses should be used in patients who are sodium and water depleted due to diuretic therapy. Premature neonates and term neonates less than or equal to 7 days of age: Initial: 0.01 mg/kg/dose every 8 to 12 hours; titrate dose Term neonates greater than 7 days of age: Initial: 0.05 to 0.1 mg/kg/dose every 8 to 24 hours; titrate dose upward to maximum of 0.5 mg/kg/dose given every 6 to 24 hours Infants: Initial: 0.15 to 0.3 mg/kg/dose; titrate dose upward to maximum of 6 mg/kg/day in 1 to 4 divided doses; usual required dose: 2.5 to 6 mg/kg/day

Children: Initial: 0.3 to 0.5 mg/kg/dose; titrate upward to a maximum dose of 6 mg/kg/day in 2 to 4 divided doses Older children: Initial: 6.25 to 12.5 mg/dose every 12 to 24 hours; titrate upward to maximum of 6 mg/kg/day in 2 to 4 divided doses

Adolescents to adults: Initial: 12.5 to 25 mg/dose given every 8 to 12 hours; increase by 25 mg/dose at 1 to 2 week intervals based on patient response Maximum dose: 450 mg/day; usual dosage range for hypertension

Indications Used for treating high blood pressure, heart failure, and for preventing kidney failure due to high blood pressure and diabetes. Contraindications and cautions Contraindicated with allergy to captopril, history of angiodema. Use cautiously with impaired renal function; CHF; salt or volume depletion, lactation, pregnancy. Side effects: CV: Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in salt- or volume-depleted patients Dermatologic: Rash, pruritus,pemphigoid-like reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity, alopecia GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic jaundice,

hepatocellular injury, anorexia, constipation GU: Proteinuri a, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Hematologic: Neutropenia, pancytopenia Other: Cough, malaise, dry mouth, lymphadenopathy Interactions agranulocytosis, thrombocytopenia, hemolytic anemia,

Interactions Drug-drug Increased risk of hypersensitivity reactions with allopurinol

Decreased antihypertensive effects with indomethacin Increased captopril effects with probenecid Drug-food Decreased absorption of captopril with food Drug-lab test False-positive test for urine acetone Pharmacokinetics Onset: 15 mins. or less Peak: 6090 mins. Nursing Responsibilities 1. Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. (for patients treated with hypertension) 2. For patients treated with CHF, monitor weight and assess patient routinely for resolution of fluid overload. Signs of fluid overload are: peripheral edema, rales or crackles, dyspnea, weight gain and jugular vein distention. 3. The nurse should keep in mind that Captopril may cause false-positive result for urine acetone. 4. The drug should be administered 1 hour before or 2 hours after meals. It may be crushed if the patient has difficulty swallowing. 5. Keep this medication in the container it came in, tightly closed, and out of reach of children. 6. Store it at room temperature and away from excess heat and moisture (not in the bathroom). 7. Throw away any medication that is outdated or no longer needed. 8. Inform the patient that Captopril tablets may have a slight sulfur odor (like rotten eggs). 9. Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light-headedness or dizziness occurs, consult your health care provider. 10. Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will interact with ACE inhibitors. Consult your health care provider. 11. Instruct the patient to notify the physician immediately when the following manifestations are experienced:

chest pain swelling of the face, eyes, lips, tongue, arms, or legs difficulty breathing or swallowing

fainting rash

Source: http://www.scribd.com/thenursingcorner/d/17469373-Captopril-Drug-Study http://www.drugs.com/dosage/captopril.html

Generic Name: CARBOCISTEINE Brand Name: Novicof, Loviscol

General action: Mucolytic

Specific action: Reduces the viscosity of bronchial secretions and facilitate expectoration.

Available forms: Drops: 50 mg/ml Syrup: 100mg/5ml Capsule: 500mg

Dosages: Capsule: Adult: 250mg 2 caps, 500mg 1 cap TID Suspension: Adult 15ml; Pedia: 6-12yrs: 5ml, 2-5 yrs: 1.25-2.5 ml Syrup: 6-12yrs: 10ml2-5 yrs: 2.5ml Drops: 12-24mos: 1.25ml, 9-11mos: 1ml, 6-8mos:0.75ml, 3-5mos: .50ml, <3mos: 0.25ml All doses 3-4x/ day Indication:

Acute/chronic disorders of the upper & lower respiratory tract associated with the secretion & formation of excessive and viscid mucus. Contraindication: It should be used with caution in elderly patients with severe respiratory insufficiency or in asthmatic patients. Active peptic ulcer Carbocisteine should not be used with antitussives (cough suppressants) or medicines that dry up bronchial secretions.

Side effects: Nausea, Headache, vomiting, anorexia, gastric discomfort, diarrhea, GI bleeding Nursing Responsibilities: Assess cough: type, frequency, character Advice medical consultation for persistent cough of more than 7 days Advice patient to avoid smoking Suggest sugarless lozenges to decrease throat irritation and cough It should be taken with food

Source: www.scribd.com/doc/6774377/Drug-Study