CVS Prescriptions- I

1) Mild Hypertension:
Information:
• A: ACEI/ARB
• B: B-blockers
• C: CCB
• D: Diuretics
 Model prescription:
For Young patient
• Rx:
• Tab. Enalapril 10 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up BP
measurement after 15 days
For older patient
• Rx:
• Tab. Hydrochlorthiazide 25 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up BP
measurement after 15 days
Advice:
• Weight reduction: Attain and maintain BMI <25 kg/m2
• Dietary salt reduction: <6 g NaCl/d
• Adapt DASH-type dietary plan: Diet rich in fruits, vegetables,
and low-fat dairy products with reduced content of saturated and
total fat
• Moderation of alcohol consumption: For those who drink
alcohol, consume 2 drinks/day in men and 1 drink/day in women
• Physical activity: Regular aerobic activity, e.g., brisk walking for
30 min/d
 Alternatives:

Rx:
• Tab. Amlodipine 5 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days.
Follow up BP measurement after 15 days
2) Moderate Hypertension:
Information:
• BP measurement between 160- 179 mmHg systolic or 100- 109 mmHg
diastolic
Model prescription:
Rx:
• Tab. Enalapril 10 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days.

• Tab. Hydrochlorthiazide 25 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up BP
measurement after 15 days
 Alternatives
Rx:
• Tab. Amlodipine 5 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up
BP measurement after 15 days

• Tab. Hydrochlorthiazide 25 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up
BP measurement after 15 days
 3) Severe Hypertension:
Information: BP measurement ≥180 mmHg systolic or ≥110 mmHg diastolic
Model prescription:
Rx:
• Tab. Enalapril 10 mg
• Supply 15 Tablets
• Direction: one tablet to be taken once a day for 15 days.

• Tab. Amlodipine 5 mg
• Supply 15 Tablets
• Direction: one tablet to be taken once a day for 15 days.

• Tab. Hydrochlorthiazide 25 mg
• Supply 15 Tablets
• Direction: one tablet to be taken once a day for 15 days. Follow up BP measurement
after 15 days
Stepped-care approach

• Initially, treatment is started with a small dose of a single drug.

The dose is gradually increased till the desired BP level (<140
mmHg systolic and <90 mmHg diastolic) is achieved without
undue ADR or the maximum recommended dose is reached. At
that point, another drug is substituted or added, if needed.
4) Hypertensive encephalopathy with diastolic BP >
130 mmHg:
Information:

• Hypertensive encephalopathy is a classic feature of malignant hypertension

• Its clinical presentation consists of severe headache, mental confusion, and
apprehension. Blurred vision, nausea and vomiting, and focal neurologic
deficits are common
• If untreated, the syndrome may progress over a period of 12–48 hours to
convulsions, stupor, coma, and even death.
• This should be treated in a hospital ICU with facilities for invasive BP
monitoring. In their absence, IV antihypertensives should be avoided.
• Patient should be treated in a strictly supine position to avoid orthostatic
complications.
 Model prescription:
Rx:
Inj. Sodium nitroprusside in IV infusion pump
• Direction: Initial 0.3 (µg/kg)/min; increase the rate gradually; usual 2–
4 (µg/kg)/min; maximum 10 (µg/kg)/min for 10 min
OR
Inj. Labetalol 20 mg/4 ml vial
• Supply 15 vials
• Direction: 20 mg over 10 min IV bolus, then 40–80 mg at 10-min
intervals up to 300 mg total dose
[ Labetalol is the drug of choice in hypertensive crisis in pregnancy.]
• Inj. Nicardipine 25mg/10ml vial
• Supply such one vial
• Direction: initially 5 mg/hour i.v infusion, increase rate as
needed upto 15mg/hour

Caution with IV antihypertensive:

• Immediate fall of BP can cause severe brain damage and
hypotension.
• The initial reduction in DBP should be about 20%; further
reduction of 10% every 2-4 hours till DBP reaches 100 mmHg
 5) Isolated systolic hypertension
Information:
• Systolic BP ≥ 140 mmHg and diastolic BP < 90 mmHg
• It is very resistant to treat as it does not respond well to usual antihypertensive
drugs.
• However, Trials indicate superiority of Calcium channel blockers in this setting.

Model prescription:
Rx:
• Tab. Amlodipine 5 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up BP
measurement after 15 days
6) Hypertension with Diabetes Mellitus :

Information:
• Goal of blood pressure < 130/80 mmHg
• Thiazides and beta-blockers have diabetogenic potential, so not preferred
unless in combination with ACEIs/ARBs.
• ACEIs/ARBs and CCBs are preferred agents.
• ACEIs and ARBs have been shown to improve insulin action and ameliorate the
adverse effects of diuretics on glucose metabolism. Compared with amlodipine
(a calcium antagonist), valsartan (an ARB) has been shown to reduce the risk of
developing diabetes in high-risk hypertensive patients.
• ACEIs and ARBs decrease intraglomerular pressure and proteinuria and may
retard the rate of progression of renal insufficiency in diabetic nephropathy
 Model prescription:
• Rx:
• Tab. Enalapril 10 mg
• Supply 15 Tablets
• Direction: one tablet to be taken once a day for 15 days.

• Tab. Amlodipine 5 mg
• Supply 15 Tablets
• Direction: one tablet to be taken once a day for 15 days.
7) Anginal Hypertension:
Information:

• ACEIs reduce morbidity and mortality rates in post-myocardial

infarction patients.
• ACEIs provide better coronary protection than do calcium channel
blockers,
• Whereas calcium channel blockers provide more stroke protection
than do either ACEIs or beta blockers.
• Beta-blockers are cardioprotective. They reduce frequency of angina
attacks. They also decrease the incidence of MI in these patients.
 Model prescription:
• Rx:
• Tab. Enalapril 10 mg
• Supply 15 Tablets
• Direction: one tablet to be taken once a day for 15 days.

• Tab. Atenolol 50 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days.
Follow up BP measurement after 15 days
 8) Pregnancy Induced Hypertension:
Information:
• Methyldopa is effective, and is safe for the mother and the baby; it is the
preferred antihypertensive drug in pregnant women.

• Labetalol is safe in the third trimester of pregnancy.

• Nifedipine can be used safely.

• Thiazide diuretics and ACEIs are teratogenic in nature, so they are avoided
during pregnancy.

• ACEIs are associated with oligohydramnios and neonatal renal failure.

ACEIs/ARBs are absolutely contraindicated during pregnancy.
Rx:
• Tab. Methyldopa 250 mg
• Supply 15 tablets
• Direction: One tablet to be taken 2 times in a day for 5 days. Follow up BP
measurement and dose adjustment after 5 days

In case of hypertensive emergency i.e. preeclampsia, eclampsia

Rx:
• Inj. Labetalol 20 mg/4 ml vial
• Supply 15 vials
• Direction: 20 mg over 2 min IV bolus, then 40–80 mg at 10-min intervals up to 300 mg
total dose
[ Labetalol is the drug of choice in hypertensive crisis in pregnancy.]
• [Inj. Hydralazine can also be given]
• Inj Magnesium sulfate 2 gm slow IV infusion to prevent and treat eclamptic seizures
9) Hypertension with Bronchial Asthma:
Information:
• Beta-blockers are contraindicated because of broncho-constriction effect.
• CCBs are preferred as they leads to smooth muscle relaxation. Thiazides
can also be given safely.

Model prescription:
• Rx:
• Tab. Amlodipine 5 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up BP
measurement after 15 days
OR
Rx:
• Tab. Hydrochlorthiazide 25 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days.
Follow up BP measurement after 15 days
10) Essential hypertension with chronic congestive
heart failure:

Information:

• Diuretics are the drug of choice as they also relieve the symptoms of CHF.
• ACEIs/ARBs and beta-blockers prevent the progression of disease and
reduce morbidity and mortality in patient with CHF.
• However, beta-blockers should be avoided in severe decompensated heart
failure because of cardiodepressant effect.
 Model prescription:
Rx:
• Tab. Enalapril 10 mg
• Supply 15 Tablets
• Direction: one tablet to be taken once a day for 15 days.

• Tab. Hydrochlorthiazide 25 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up
BP measurement after 15 days
11) Migraine with Hypertension:
Information:
• Beta-blockers are the preferred drug as they are also effective for
prophylaxis of migraine.
• CCBs can also be used.

Model prescription:
Rx:
• Tab. Atenolol 50 mg
• Supply 15 Tablets
• Direction: one tablet to be taken in the morning for 15 days. Follow up BP
measurement after 15 days
Thank You