Details About Generic Salt ::  Guanethi

Main Medicine Class:: Antihypertensive,Antiadrenergic, peripherally acting   

(gwahn-ETH-ih-deen MAH-no-SULL-fate)
Ismelin
Class: Antihypertensive/Antiadrenergic, peripherally acting

 

Drugs Class ::

 Action Interferes with release or distribution of norepinephrine from nerve endings, resulting in reduction in total peripheral resistance and both diastolic and systolic BP.

Indications for Drugs ::

 Indications Treatment of moderate and severe hypertension and renal hypertension, including that secondary to pyelonephritis, renal amyloidosis and renal artery stenosis. unlabeled use(s): Reflex sympathetic dystrophy and causalgia.

Drug Dose ::

 Route/Dosage

ADULTS: Ambulatory: PO 10 mg qd initially; may increase by » 10 mg at 5 to 7 days; increase only if no decrease in standing BP is observed. Maintenance dose: 25 to 50 mg qd. HOSPITALIZED: PO 25 to 50 mg initially; increase by 25 or 50 mg/day or qod until desired response is obtained. Loading dose (for severe hypertension): Give at 6 hr intervals over 1 to 3 days, omitting nighttime dose. CHILDREN: PO 0.2 mg/kg/24 hr (6 mg/m2/24 hr) as single oral dose initially; increase by increment of 0.2 mg/kg/24 hr every 7 to 10 days. Maximum: 3 mg/kg/24 hr.

Contraindication ::

 Contraindications Known or suspected pheochromocytoma; frank CHF not related to hypertension; use of monoamine oxidase (MAO) inhibitors.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Elderly patients: More prone to side effects of guanethidine therapy, especially orthostatic hypotension. Bronchial asthma: May aggravate the hypersensitive condition of asthmatics because of further catecholamine depletion. Cardiovascular disease: Use cautiously in patients with coronary disease, recent MI, or cerebral vascular disease, especially with encephalopathy; avoid use in patients with severe cardiac failure. Fever: May decrease dosage requirements. Orthostatic hypotension: Occurs frequently, especially during initial treatment and with postural changes. Peptic ulcer: Ulcers may be aggravated by relative increase in parasympathetic tone. Preoperative withdrawal: Withdrawal is recommended 2 wk prior to surgery to reduce risk of vascular collapse and cardiac arrest during anesthesia; during emergency surgery administer preanesthetic and anesthetic agents cautiously in reduced dosages and prepare for possible vascular collapse. Renal impairment: Use very cautiously, because hypotension may worsen renal impairment.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Bradycardia; orthostatic fluid retention; edema; angina. CNS: Dizziness; weakness; lassitude; syncope; fatigue; muscle tremor; mental depression; chest paresthesias; ptosis; headache; confusion. EENT: Blurred vision; nasal congestion. GI: Nausea; vomiting; dry mouth; parotid tenderness; diarrhea (may be severe, requiring discontinuation of therapy); increase in bowel movements. GU: Inhibition of ejaculation; nocturia; urinary incontinence; priapism. HEMA: Anemia; thrombocytopenia. RESP: Dyspnea; asthma in susceptible individuals. OTHER: Myalgia; weight gain; dermatitis; scalp hair loss; leg cramps.

Drug Mode of Action ::  

 Action Interferes with release or distribution of norepinephrine from nerve endings, resulting in reduction in total peripheral resistance and both diastolic and systolic BP.

Drug Interactions ::

 Interactions

Anorexiants: May reverse hypotensive effect of drug. MAO inhibitors: May decrease effectiveness of guanethidine; discontinue MAO inhibitors > 1 wk before starting guanethidine therapy. Phenothiazines: May inhibit hypotensive effect. Sympathomimetics (eg, ephedrine, epinephrine): May reverse hypotensive effect of guanethidine; guanethidine may potentiate effects of sympathomimetics. Tricyclic antidepressants: May inhibit hypotensive effect of drug.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note any cardiovascular, cerebrovascular or peptic ulcer disease, asthma or pheochromocytoma.
  • Take patient’s BP (lying, sitting, standing) and pul3e beforu adminictering trug. Monitor periodically throughout therapy.
  • In patients with cardiac decompensation, monitor for weight gain and edema.
  • Report these signs to health care provider immediately: Hypotension, chest pain, edema, dyspnea, diarrhea, excessive weight loss or gain, CNS changes.
OVERDOSAGE: SIGNS & SYMPTOMS
  Severe drowsiness, hypotension, bradycardia, severe diarrhea, nausea, vomiting, syncope

Drug Storage/Management ::

 Administration/Storage

  • Administer with food or milk.
  • Store in tightly closed container at room temperature. Keep out of reach of children.

Drug Notes ::

 Patient/Family Education

  • Instruct patient in proper technique for taking BP. Advise patient to check BP weekly.
  • Caution patient not to get out of bed without help during period of dosage adjustment.
  • Advise patient to lie down if dizziness or blurred vision occurs.
  • Warn patient not to double up on doses.
  • Instruct patient not to discontinue drug abruptly and not to stop taking drug because of improvement in symptoms.
  • Counsel patient about benefits of weight reduction, exercise, reduction of alcohol and sodium intake, and cessation of smoking.
  • Explain that impotence and ejaculation disturbances may occur but is reversible. Tell patient to report to health care provider.
  • Instruct patient to report these symptoms to health care provider: Dizziness, diarrhea, confusion, depression, fever, sore throat.
  • Caution patient to avoid sudden position changes to avoid orthostatic hypotension.
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Instruct patient not to take otc medications without consulting health care provider.

Disclaimer ::

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