PHARMACY PRACTICE II

PREPARED BY: Ph. Hisham A. Razzak

Academic year: Sem. I- 2023/2024
Topics to be covered
• Different CVD and their management
• Endocrine diseases and their management
• CNS diseases and their management
• Types of pain and their management
Diseases related to Cardiovascular system
Hypertension

Ischemic heart diseases (angina, Myocardial infarction)

Hyperlipidemia

Arrhythmia
Hypertension
Hypertension: high blood pressure (BP). ↑ blood in vessels is too high
(140/90 mmHg or higher).
It is common but can be serious if not treated.
People with high BP may not feel symptoms.
The only way to know is to get your blood pressure checked
Primary - 95% Primary - 5%
Hypertension when BP ≥ 140/90 mmHg WHO
Diagnosis
BP checked by using sphygmomanometer.
After the age of 40 regular checking of BP is recommended.
https://theconversation.com/how-to-manage-your-blood-pressure-in-isolation-135958
NICE GUIDELINES
Aim of treatment

I. The goal of hypertension treatment is to lower high blood

pressure

II. protect important organs, like the brain, heart, and kidneys
from damage.
Selective of antihypertensive drug
₁ Level of blood pressure

₂ Presence of risk factors for CVD and target organ damage

₃ Coexisting disease

Antihypertensive Drug
Diuretics
Diuretics ↑ the output of water and sodium. Uses:
1. Relieving edema (cardiac, renal, or hepatic diseases).
2. Treatment of hypertension alone or in combination (antiHT)
They are classified in this into:
Thiazide and related diuretics
Loop diuretics
Potassium-sparing diuretics
Osmotic diuretics
Carbonic anhydrase inhibitors
 Moderately potent
Thiazide and related diuretics diuretics

1.↑ Na+ excretion in urine by inhibiting its reabsorption in the kidney

tubules.
2.Chronic use → hypokalemia and hyperglycemia.
3.Interfere with urate excretion → hyperuricemia.
4.Example : Hydrochlorothiazide

Note: Have antidiuretic effect in patients with nephrogenic diabetes insipidus.

Indications
1. Hypertension
2. Mild cardiac failure,
3. Mild edema due to renal or hepatic disease,
4. Some cases of nephrogenic diabetes insipidus.
Contraindications
• Renal and hepatic impairment, pregnancy, hyperuricemia, severe
hypokalaemia.
Caution:
• diabetes, gout, breastfeeding, elderly.
Side effects
1. Hypokalemia, minimized by:
A. Intermittent use of the drug,
B. Increasing dietary intake of potassium,
C. Simultaneous use of potassium-sparing diuretic.
2. Hyperuricemia, aggravation of diabetes, allergic rashes, lipid
levels disturbance, thrombocytopenia, postural hypotension,
impotence (reversible).
 Counselling tips- Thiazide
• It's usual to take once a day, in the morning. To avoid waking up in the
night to go to the toilet.
• Take medicine same time every day.
• Monitor BP and pulse before and after the administration.
• Monitor laboratory tests before and regularly during treatment. i.e.,
electrolytes (especially K++), Bd glucose, BUN, and serum uric acid levels.
• Swallow the tablets whole with a drink of water.
• If forget to take it, take the forgotten dose as soon as remember. However, if
remember before late afternoon, skip the missed dose and take the next dose
at the usual time.
BUN= Blood Urea Nitrogen
 Highly potent
Loop diuretics diuretics

1. ↑ Na+, and water output.

2. Hypokalemia, hypotension, and severe dehydration may result
from the unguarded use of loop diuretics.
3. Orally = effect after 1 hr. , IV = effect after 10 min.
4. Hearing loss when prolonged use or during concomitant use
with aminoglycosides.

Should be administered
during the day to avoid
disturbing the patient’s
sleep
Frusemide
Indications:
Oedema associated with left ventricular failure, CHF, and oliguria
due to renal failure.
Contraindications:
Hypovolaemia, anuria, renal failure.
Caution:
Hypotension; dehydration; pregnancy; breast-feeding; prostatic
enlargement.
 Hypokalaemia if furosemide is
Frusemide used with digoxin.
Hypokalaemia ↑ risk of digoxin
toxicity.
S/E:
Hyponatraemia, hypokalaemia, hypomagnesemia; hypotension; GI
disturbances. ↑ excretion of calcium.
Tinnitus and deafness may result from chronic use or with rapid
parenteral administration.

Na+,
K+,
Mg+₂
Counselling tips – Frusemide
• Do not take furosemide after 4 pm, to avoid waking in the night to go
to the toilet.
• It starts to work within 1 hour. Most people need to use toilet about 30
minutes after taking it, and again within a few hours.
• It can take a few weeks to take full effect.
• If experience any ear problems, contact the doctor immediately.
• Avoid driving during the first few days of treatment.
Counselling tips – Frusemide
• It's usual to take once a day, in the morning. To avoid waking up in the
night to go to the toilet.
• Take medicine same time every day.
• Monitor BP and pulse before and during treatment.
• Monitor laboratory tests before and regularly during treatment. i.e.,
electrolytes (especially K), Na and Mg.
• Swallow the tablets whole with a drink of water.
• If forget to take it, take the forgotten dose as soon as remember.
However, if remember before late afternoon, skip the missed dose and
take the next dose at the usual time.
 Weak diuretics,
Potassium-sparing diuretics (PSD) retain K++

1.Their action is in part aldosterone dependent. Examples:

a) Spironolactone (an aldosterone antagonist), used in
hyperaldosteronism (Conn’s syndrome).
b) Amiloride (not affecting aldosterone).
2.Combined with thiazides or loop diuretics to avoid
hypokalemia.

Potassium-Sparing Diuretics +
ACEIs → severe hyperkalemia
Spironolactone Have an anti-androgen effect =
gynaecomastia

Indications: Oedema, nephrotic syndrome, primary hyper-

aldosteronism
C/I: Elderly; hepatic and renal impairment;
Caution: pregnancy; breastfeeding; hyperkalaemia; Addison’s
disease (adrenal gland hypofunction).
S/E: GI disturbances; gynaecomastia; menstrual disturbances;
headache; hyperkalaemia; blood disorders.
NOTE: Amiloride same but NOT used in aldosteronism.
Counselling tips- spironolactone
1. Usually taken o.d. in the morning. If taking bid, take the second dose
before 4 p.m.
2. Blood tests while taking the drug make sure potassium levels are
stable.
3. Taken with food, to help stop feeling or being sick.
4. Do not have low-sodium salt. Because they contain high potassium.
5. Try to limit other food and drink that contain high potassium, i.e.,
bananas, avocados, pulses, nuts, and salmon.
Osmotic diuretics
They ↑ solute in the renal tubule → ↑ urine volume.

Uses:
1. To ↓ intracranial or intraocular pressure.
2. To induce diuresis in acute drug poisoning.

Example: Mannitol
Mannitol Given only in hospital under
medical observation

Indications: Intracranial/ intraocular hypertension, cerebral edema,

to induce diuresis in acute poisoning.

C/I: pulmonary edema, congestive heart failure.

Caution: renal impairment; avoid extravasation (causes

inflammation thrombophlebitis). Monitor urine output and
electrolyte balance.
S/E: chills, fever
 Weak diuretics
Carbonic anhydrase inhibitors
• It is a carbonic anhydrase inhibitor, also it has a weak diuretic
effect.
• Mainly used to treat glaucoma. ↓aqueous humor production
by inhibition of the carbonic anhydrase enzyme.
• Example: Acetazolamide, administered orally or by
injection.
Hypersensitivity!
Sulphonamide derivative.
Acetazolamide

Indications: Reduce intraocular pressure in glaucoma.

C/I: Electrolyte disturbances; severe hepatic/renal impairment;

sulphonamide sensitivity

Cautions: Avoid prolonged use; elderly; pregnancy; breastfeeding,

pulmonary obstruction.

S/E: taste disturbances, paraesthesia, flushing, headache, fatigue,

depression, metabolic acidosis and electrolyte disturbances, blood
disorders, skin disorders.
The end