Drug Name Generic Name: CLONIDINE HYDROCHLO RIDE Brand Name: Catapres, Catapres-TTS, Dixaril , Duraclon Classificatio n: Cardiovascula

r agent; central-acting Antihypertens ive; Analgesic

Action Centrally acting Antiadrenergic derivative. Stimulates alpha2adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys.

Indication Step 2 drug in stepped-care approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain. Contraindicatio n: Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa, scleroderma, SLE

Dose Hypertension Adult: PO 0.1 mg b.i.d. or t.i.d., may increase by 0.1 0.2 mg/d until desired response is achieved (max: 2.4 mg/d) Transdermal 0.1 mg patch once q7d, may increase by 0.1 mg q12 wk Geriatric: PO Start with 0.1 mg once daily Child: PO 510 mcg/kg/d divided q812h, may increase to 525 mcg/kg/d divided q6h (max: 0.9 mg/d) Severe Pain Adult: Epidural start infusion at 30 mcg/h and titrate to response. Use rates >40 mcg/h with caution Child: Epidural start infusion at 0.5 mcg/kg/h and titrate to response ADDH Child: PO 5 mcg/kg/d in 4 divided doses (average dose, 0.150.2 mg/d) Transdermal 0.20.3 mg/d q57d

Nursing Responsibilities Assessment & Drug Effects Monitor BR closely. Determine positional changes (supine, sitting, standing).With epidural administration; frequently monitor BP and HR. Hypotension is a common side effect that may require intervention. Monitor BP closely whenever a drug is added to or withdrawn from therapeutic regimen. Monitor I&O during period of dosage adjustment. Report change in I&O ratio or change in voiding pattern. Determine weight daily. Patients not receiving a concomitant diuretic agent may gain weight, particularly during first 3 or 4 d of therapy, because of marked sodium and water retention. Supervise closely patients with history of mental depression, as they may be subject to further depressive

episodes.

Drug Name Generic Name: AMLODIPINE Brand Name: Norvasc Classification : Antihypertensi ves; Calcium channel blockers

Action Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in the inhibition of excitation contraction coupling and subsequent contraction. Therapeutic effects: Systemic vasodilation resulting in the decreased blood pressure. Coronary vasodilation resulting in

Indication Alone or with other agents in the management of hypertension, angina pectoris and vasospastic angina. Contraindicatio n: Hypersensitivity. Blood pressure less than 90 mmHg. Use cautiously in: sever hepatic impairment, history of CHF, aortic stenosis.

Dose Oral: 2.5g/tab Once a day Side Effects: CNS: headache, dizziness, fatigue CV: peripheral edema, angina, bradycardia, hypotension, palpitations GI gingival hyperplasia, nausea DERM: flushing

Nursing Responsibilities Assessment & Drug Effects Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy.

Monitor ECG during prolonged therapy. Monitor intake and output ratios and daily weight.

Assess for signs of CHF (peripheral edema, rales/crackles, dyspnea, weight gain and jugular venous distention.

decreased frequency and severity attacks of angina.

*Lab test considerations: Total serum calcium are not affected by calcium channel blocker.

Drug Name Generic Name: Pregabalin Brand Name: Lyrica Classificati on: Anti Epileptic

Action The mechanism of action of pregabalin is unknown. Pregabalin binds to calcium channels on nerves and may modify the release of neurotransmitt ers (chemicals that nerves use to communicate with each other).

Indication Pregabalin is used to control seizures and to treat fibromyalgia. It is also used to treat pain caused by nerve damage in people with diabetes (diabetic neuropathy) or herpes zoster (post-herpetic neuralgia). Contraindicati on: Hypersensitivity.

Dose Postherpetic neuralgia Initial : 150 mg/day in divided doses. Usual: 150-300 mg/day in divided doses. Max: 600 mg/day in divded doses. Adjunct in partial seizures 150-600 mg/day in divided doses. Max: 600 mg/day. Fibromyalgia Initial: 150 mg/day, up to 300 mg/day after 1 wk if needed and then 450 mg/day if still needed. Generalised anxiety disorderInitial: 150 mg/day. Increase slowly if needed. Max: 600 mg/day. Side Effects: Dizziness, drowsiness, visual disturbance (including blurred vision, diplopia), ataxia, dysarthria, tremor, lethargy,

Nursing Responsibilities Assessment & Drug Effects Pregabalin therapy should be stopped gradually over at least 1 week to decrease risk of seizure activity and avoid unpleasant symptoms such as diarrhea, headache, insomnia, and nausea. If patient has evidence of hypersensitivity(red skin, urticaria, rash, dyspnea, facial swelling, wheezing), stop drug at once, notify prescriber, and give supportive care. Monitor patient closely for adverse reactions. Notify prescriber if significant

Reducing communication between nerves may contribute to pregabalin's effect on pain and seizures.

Pregnancy, lactation. Driving or working with machines, or do other dangerous activities.

memory impairment, euphoria, wt gain, constipation, dry mouth, peripheral edema, depression, confusion, agitation, hallucinations, myoclonus, hypoaesthesia, hyperaesthesia, tachycardia, excessive salivation, sweating, flushing, rash, muscle cramp, myalgia, arthralgia, urinary incontinence, dysuria, thrombocytopenia, neutropenia, 1st heart block, hypotension, hypertension, pancreatitis, dysphagia, oliguria, rhabdomyolysis.

adverse reactions persist. Monitor patient closely for evidence of suicidal thinking or behavior, especially when therapy starts or dosage changes. PATIENT TEACHING Warn against stopping pregabalin abruptly. Urge patient to avoid hazardous activities until she knows how drug affects her.