CAPTOPRIL TAB. 25MG.

ANTIHYPERTENSIVE
NURSING CARE
 Blood pressure control
 Monitor signs of hyperk (IRAP, HEP, DM)
 Assess for signs of angioedema
 Control of liver and kidney function

 Administer 1 – 2 hours before or after food

IMPORTANT POINTS FOR NURSING
The role of nursing is basic to assist, advise, advise, serve as support and complement
in the control of this chronic disease, which lasts a lifetime and requires pharmacological
treatment followed by dietary and hygienic recommendations.
a) patient education: modify lifestyles (weight reduction, intake of alcohol, sodium, fats,
coffee and tobacco, avoid stress and perform moderate exercise), with the added
difficulty of the little confidence that patients have in these methods ;
b) inform about the chronicity of the disease and the importance of complying with the
treatment prescribed by the doctor, without interrupting it or varying it without consulting
him;
c) educate according to cultural level; d) involve family members, and e) inform in a
clear and accessible way about the disease (p. e.g., it can be treated, not cured, it can
be asymptomatic and complications may arise) and about the treatment (name of the
drug, what it is used for and what to expect from it, dosage, common side effects: how to
avoid them, when they appear, precautions , interactions with other drugs, how to act if
a dose is forgotten, need for periodic monitoring).
 ALPRAZOLAN TAB.
BENZODIAZEPINE (ANSIOLYTIC)
NURSING INTERVENTION
 Care of vital signs with emphasis on HR
 Orthostatic hypotension
 Orthostatic hypotension
*Check blood pressure at rest and standing, and any changes in pulse. *Instruct
the patient to get up slowly from lying or sitting.
 Observe signs of poisoning
 Ensure the expected therapeutic response
 Instruct the patient not to drive a car or dangerous machinery while taking the
medications.
 Instruct the patient in long-term treatment so that he does not stop taking the
medication abruptly, as this may be life-threatening. Symptoms include
depression, insomnia, increased anxiety, abdominal and muscle pain, tremors,
vomiting, sweating, seizures, and delirium.
 Assess the patient's mood daily.
 Take necessary precautions if potential suicide exists.
 Take the medicine with food and milk.
 Observe adverse reactions
IMPORTANT POINTS FOR NURSING
Give general advice on adequate sleep hygiene: do not sleep during the day, do not
drink stimulating substances (coffee, tea, cola drinks, alcohol) during the afternoon,
avoid noisy or very bright environments at night, avoid heavy dinners, etc
Due to the risk of dependence and tolerance that hypnotics entail, it is recommended to
restrict their use to specific situations and maintain them for as short a time as possible,
as well as withdraw them gradually to avoid the appearance of possible withdrawal
symptoms.

It is important to know that, although infrequent, hypnotics can produce a paradoxical

reaction, that is, produce effects contrary to those expected.
The patient should be warned about the convenience of avoiding alcoholic beverages
due to the combination of effects, as well as advise that extreme care be taken if
dangerous machinery is used or when driving vehicles, since hypnotics increase
response times. and/or reduce alertness.
 EPAMIN TAB.
ANTIEPILEPTIC
NURSING CARE
 Vital signs care
 Monitor serum Epamin concentrations
 Instruct the patient not to consume alcohol or take other medications that
depress the CNS while taking the medications.
 Observe signs of poisoning
 Ensure the expected therapeutic response
 Observe adverse reactions
IMPORTANT POINTS FOR NURSING
We will ensure that the patient understands the introduction/withdrawal pattern of the
drug and the reason for this action, explaining that antiepileptic drugs must be
introduced and withdrawn progressively.
The patient will be informed about the most likely side effects of the drugs they are
taking, which are usually: ataxia, diplopia, nausea, drowsiness and dizziness. Other side
effects that the treatment may cause are: hirsutism, weight gain, amenorrhea and
gingival hypertrophy. The patient should consult us if any side effect appears but without
abandoning the medication.
The affected person should be advised of the need to keep a seizure diary that will
facilitate monitoring of the therapeutic regimen in case of a decrease in seizures and
that in case of worsening or stagnation will help to change the drug. Missed doses, if
any, must be noted in the diary, as well as modifications or the intake of specific drugs
other than antiepileptics, since interactions may occur.
You will be advised, together with the neurologist, to carry out analytical controls every
3-6 months for toxic substances in the blood to monitor the therapeutic levels of the drug
and determine therapeutic compliance.
A rigid daily feeding schedule will not be imposed. An attempt will be made to adapt to
the patient's meal schedule.
Insist on oral hygiene because some drugs to treat epilepsy, such as phenytoin, can
cause gingival hyperplasia.
In case of vomiting, if less than half an hour has passed after taking the drug, the patient
will be advised to repeat the dose.
Insist on the provision of vitamin K and folic acid, since the drugs can reduce their
absorption, and the provision of vitamin D8, especially in older patients or with long-
standing epilepsy, since antiepileptic drugs (AEDs) can reduce their absorption.
absorption and cause osteoporosis.
 CARBAMEZEPINE
ANTICONVULSIVE AND RELAXANT
NURSING CARE
 Monitor vital signs
a) Hypotension, tachycardia, respiratory depression and muscle weakness

 Monitor serum carbamazepine concentrations

 Instruct the patient not to drink alcohol or take other medications that depress the
CNS while taking the medications.
 Sexual dysfunction:
a) Men may report abnormal ejaculation or impotence.
b) Women may experience delay or loss of orgasm.
c) If the side effects become intolerable, it may be necessary to change the
medication to another antidepressant.
IMPORTANT POINTS FOR NURSING
Do not stop the medication abruptly after a long period of use, as withdrawal symptoms
may occur: nausea, vomiting.
Get up slowly from sitting or lying down to prevent a sudden drop in blood pressure.

DIAZEPAN TAB.
BENZODIAZEPINE
NURSING INTERVENTION
 Care of vital signs with emphasis on HR
 Orthostatic hypotension
 Orthostatic hypotension
*Check blood pressure at rest and standing, and any changes in pulse. *Instruct
the patient to get up slowly from lying or sitting.
 Observe signs of poisoning
 Ensure the expected therapeutic response
 Instruct the patient not to drive a car or dangerous machinery while taking the
medications.
 Instruct the patient in long-term treatment so that he does not stop taking the
medication abruptly, as this may be life-threatening. Symptoms include
depression, insomnia, increased anxiety, abdominal and muscle pain, tremors,
vomiting, sweating, seizures, and delirium.
 Assess the patient's mood daily.
 Take necessary precautions if potential suicide exists.
 Take the medicine with food and milk.
 Observe adverse reactions

IMPORTANT POINTS FOR NURSING
Give general advice on adequate sleep hygiene: do not sleep during the day, do not
 drink stimulating substances (coffee, tea, cola drinks, alcohol) during the afternoon,
avoid noisy or very bright environments at night, avoid heavy dinners, etc
Due to the risk of dependence and tolerance that hypnotics entail, it is recommended to
restrict their use to specific situations and maintain them for as short a time as possible,
as well as withdraw them gradually to avoid the appearance of possible withdrawal
symptoms.

It is important to know that, although infrequent, hypnotics can produce a paradoxical

reaction, that is, produce effects contrary to those expected.
The patient should be warned about the convenience of avoiding alcoholic beverages
due to the combination of effects, as well as advise that extreme care be taken if
dangerous machinery is used or when driving vehicles, since hypnotics increase
response times. and/or reduce alertness.
Schatzberg, AF, Cole, JO, & DeBattista, C. (2005). Manual of clinical psychopharmacology (5th ed.).
Washington, DC: American Psychiatric Publishing.

Mary C. Townsend, Fourth Edition, FUNDAMENTALS OF NURSING IN PSYCHIATRY, Fourth Edition,

2011. pp 186-205.

Milvia

THEORETICAL FRAMEWORK

ANTIHYPERTENSIVES

High blood pressure (HTN) is one of the main risk factors for vascular diseases in
developed countries, its importance being known not only in the healthcare field but also in
the general population. It constitutes a problem of great magnitude with clinical, social and
economic implications; and in many countries it is the most frequent cause of medical
consultation and the one that generates the greatest demand for the use of drugs. The
prevalence varies according to the figures taken as pathological, and it is estimated that
15-30% of the adult population has this pathology. Regarding its etiology, it is unknown in
90% of cases, and is identified as essential or primary.

It is a chronic disease, in many cases asymptomatic and with very non-specific

clinical manifestations: occipital headache first thing in the morning, dizziness, abnormal
vision (such as seeing floaters). It affects different target organs and systems (heart,
central nervous system, kidney, peripheral vascular system and retina) and causes
multiple complications (cerebral hemorrhages, thrombosis, aneurysms, renal failure,
ventricular hypertrophy in the heart, increasing the risk of myocardial infarction , etc.), so
its early detection and subsequent control are of great importance. In general, the risk of
developing these diseases increases about three times in patients with HTN.
 ANTIHYPERTENSIVES

They are those drugs indicated in the treatment of HTN, which are classified
according to the blood pressure values proposed by the seventh report of the Joint
National Committee of the United States (table 27-1).

Classification of high blood pressure in adults over 18 years of age

Blood pressure Systolic blood pressure Diastolic blood pressure

classification (mmHg) (mmHg)
Normal* < 120 < 80
Prehypertension 120-139 80-89
Stadium 1 140-159 90-99
Stage 2 > 160 > 100

Classification

Currently, a wide variety of drugs are available, which must be effective and safe,
and their selection will be individualized according to the clinical characteristics of the
patient. The pharmacological mechanisms through which the different drugs act are: a)
reducing blood volume and, therefore, cardiac output and blood pressure; b) decreasing
peripheral resistance through sympathetic inhibition, direct vasodilation or decrease in
vascular reactivity; c) decreasing cardiac output, and d) inhibiting the reninangiotensin
axis. According to this classification, there are seven types of antihypertensive drugs:
diuretics, adrenergic inhibitors (β-blockers, α1-blockers, α/β-blockers), direct vasodilators,
calcium antagonists, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II
receptors (ARA-II) and centrally acting hypotensive agents.

THEORETICAL FRAMEWORK
 BENZODIAZEPINES

Benzodiazepines are fat-soluble substances that, depending on their chemical

structure and the dose used, have different therapeutic effects: anxiolytic, hypnotic,
anticonvulsant and muscle relaxant. It is in low doses when benzodiazepines have
anxiolytic action, being the choice for short-term treatment of GAD.
Regarding the mechanism of action, benzodiazepines act at the level of the limbic
system, more specifically in the hippocampus and amygdala, fixing on a specific location in
the GABA system. This binding is carried out in the GABAA receptor, enhancing it, which
facilitates the flow of chlorine ions towards the neuron, causing it to be inhibited.

Mechanism of action.

They increase the inhibitory effects of GABA, since they facilitate its binding with
GABAA receptors, which are associated with chloride channels. Benzodiazepines bind to
a specific benzodiazepine receptor located in the macromolecular complex formed by the
GABAA receptor and the chloride channel, producing an allosteric modulation that
facilitates the interaction of GABA with its specific binding site, increasing the opening
frequency of the channels. of chlorine activated by it. Not only classic benzodiazepines
bind to this receptor, but also other non-benzodiazepine molecules that act as agonists
(such as zopiclone or zolpidem) or antagonists (such as flumazenil). Furthermore, in this
complex there are other binding sites for barbiturates, picrotoxin, general anesthetics and
steroids, which also modify the opening of the channel in a facilitative or inhibitory way in
response to GABA.(1)

Pharmacokinetics.

They are well absorbed orally, and maximum absorption occurs between 30 and
180 minutes (some do so more quickly than others, depending on the degree of lipid
solubility). By intramuscular route, most have slow and erratic absorption (especially
diazepam and chlordiazepoxide), producing insufficient plasma concentrations and local
irritation due to crystallization of the compound at the injection site. The intravenous route
is used in emergencies, usually anticonvulsants. Another alternative route is the rectal
route, especially in children, through which diazepam solutions are rapidly absorbed.
Benzodiazepines are generally very fat-soluble, which means that many of them gradually
accumulate in body fat, and their distribution is broad, easily crossing the placenta and the
blood-brain barrier.

Adverse effects.

The most common are: drowsiness, sedation, disorientation, ataxia, inability to

coordinate fine movements or respond quickly to stimuli (precautions should be taken
when driving vehicles or operating machinery). Some patients may paradoxically present
increased aggressiveness, irritability and anxiety, even with moderate doses, which may
be a manifestation of withdrawal syndrome (v. later) and is more acute in short-acting
benzodiazepines, whose effect disappears more quickly. In addition, benzodiazepines can
cause anterograde amnesia (forgetting of upcoming events) by interfering with the process
of memory consolidation and storage. (2)

Drug interactions.

They enhance the central nervous system depressant effects of other drugs
(alcohol, barbiturates, antipsychotics, opiates, sedative antihistamines). The interaction
with alcohol is of special importance, due to the danger it poses for drivers, since it can
alter the state of consciousness and the ability to drive. (1)

1. Hurlé MA. Anxiolytic and sedative drugs. In: Flórez J, Armijo JA, Mediavilla A, editors. Human pharmacology.

4th ed. Barcelona: Masson; 2003. p. 579-594.

2. Catalog of pharmaceutical specialties. General Council of Pharmaceutical Colleges, Einsa. Madrid; 2005.