Captopril
• Generic Name: Captopril
• Trade Name: Capoten
• Class: Angiotensin-Converting Enzyme (ACE) Inhibitor
• Mechanism of Action: Captopril inhibits the angiotensin-
converting enzyme, preventing the conversion of angiotensin I to
angiotensin II. This leads to vasodilation, reduced aldosterone
secretion, and decreased blood pressure.
• Therapeutic Uses:
1. Hypertension management
2. Congestive heart failure treatment
3. Improving survival post-myocardial infarction
4. Diabetic nephropathy
• Important Drug-Drug Interactions:
1. Diuretics: Enhanced hypotensive effect.
2. Potassium-sparing diuretics or supplements: Increased
risk of hyperkalemia.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs): May
reduce antihypertensive effect.
4. Lithium: Increased serum lithium levels and potential
toxicity.
• Adverse Effects:
• Hypotension
• Cough
• Hyperkalemia
• Renal impairment
• Precautions and Contraindications:
• Contraindications: History of angioedema related to previous
ACE inhibitor treatment, pregnancy.
• Precautions: Monitor renal function and serum potassium
levels; caution in patients with renal impairment or collagen
vascular disease.
• Doses, Dosage Forms, and Routes of Administration:
• Dosage Forms: Oral tablets.
• Initial Dose: 6.25–12.5 mg two to three times daily.
• Maintenance Dose: Adjusted based on response; typical range
is 25–150 mg per day in divided doses.
• Patient Counseling:
• Advise on the possibility of dizziness, especially after the first
dose; recommend rising slowly from sitting or lying positions.
• Inform about the potential for a persistent dry cough.
• Emphasize the importance of regular blood tests to monitor
kidney function and electrolytes.
• Advise against the use of potassium supplements or salt
substitutes containing potassium without medical consultation.
Hydrocortisone
• Generic Name: Hydrocortisone
• Trade Names: Cortef, Solu-Cortef
• Class: Corticosteroid
• Mechanism of Action: Hydrocortisone mimics the action of
cortisol, modulating the immune response, reducing
inflammation, and influencing metabolic processes.
• Therapeutic Uses:
1. Adrenal insufficiency
2. Inflammatory and allergic conditions
3. Autoimmune disorders
4. Certain cancers
5. Dermatologic diseases
• Important Drug-Drug Interactions:
• NSAIDs: Increased risk of gastrointestinal ulceration.
• Vaccines: Reduced efficacy of live vaccines; increased risk of
infection.
• Diuretics: Enhanced hypokalemia with non-potassium-sparing
diuretics.
• Antidiabetic agents: May require dose adjustments due to
hyperglycemic effects.
• Adverse Effects:
• Hyperglycemia
• Increased susceptibility to infections
• Osteoporosis with long-term use
• Hypertension
• Cushingoid appearance (moon face, buffalo hump)
• Precautions and Contraindications:
• Contraindications: Systemic fungal infections, known
hypersensitivity.
• Precautions: Use with caution in patients with diabetes,
hypertension, peptic ulcer disease, or osteoporosis.
• Doses, Dosage Forms, and Routes of Administration:
• Dosage Forms: Oral tablets, injectable solutions, topical
creams/ointments.
• Oral Dose: Varies widely; for adrenal insufficiency, typically 15–
30 mg per day in divided doses.
• IV Dose: In acute settings, 100–500 mg every 2–6 hours as
needed.
• Patient Counseling:
• Advise taking oral doses with food to minimize gastrointestinal
discomfort.
• Discuss potential side effects, including mood changes and
increased appetite.
• Inform about increased susceptibility to infections; advise
avoiding exposure to contagious diseases.
Dopamine
Generic Name: Dopamine
Trade Name: Intropin
Class
• Adrenergic Agonist
• Inotropic Agent
Mechanism of Action
• Dopamine acts on dopaminergic receptors and adrenergic
receptors (beta-1 and alpha-1) in a dose-dependent manner:
• Low doses (0.5–2 mcg/kg/min): Stimulates dopaminergic
receptors, leading to vasodilation and increased renal perfusion.
• Moderate doses (2–10 mcg/kg/min): Stimulates beta-1
adrenergic receptors, increasing cardiac output and heart rate.
• High doses (>10 mcg/kg/min): Stimulates alpha-1 adrenergic
receptors, causing vasoconstriction and increased systemic
vascular resistance.
Therapeutic Uses
• Treatment of shock (e.g., cardiogenic, septic shock) to improve
hemodynamic stability.
• Acute heart failure management to enhance cardiac output.
• Treatment of severe hypotension unresponsive to fluid
resuscitation.
Important Drug-Drug Interactions
• MAO inhibitors (e.g., phenelzine): May prolong and intensify
the effects of dopamine.
• Beta-blockers: May antagonize the cardiac effects of dopamine.
• General anesthetics: Can increase the risk of arrhythmias.
• Diuretics: Can enhance the renal vasodilation effects at low
doses.
Adverse Effects
• Tachycardia
• Arrhythmias
• Hypertension (at high doses)
• Peripheral vasoconstriction
• Nausea and vomiting
• Tissue necrosis and ischemia if extravasation occurs
Precautions and Contraindications
• Contraindications:
• Patients with pheochromocytoma.
• Patients with uncorrected tachyarrhythmias or ventricular
fibrillation.
• Precautions:
• Monitor infusion site closely; use a central line if possible to
avoid extravasation.
• Use cautiously in patients with hypovolemia; correct volume
status before administration.
• Careful titration is required to avoid excessive vasoconstriction
or cardiac workload.
Doses, Dosage Forms, and Routes of Administration
1. Dosage Forms:
• Injectable solution (commonly in concentrations of 40 mg/mL,
80 mg/mL, or 160 mg/mL).
2. Routes of Administration:
• Intravenous infusion.
3. Dosage:
• Low dose (renal dose): 0.5–2 mcg/kg/min IV.
• Moderate dose (cardiac dose): 2–10 mcg/kg/min IV.
• High dose (pressor dose): >10 mcg/kg/min IV.
• Maximum dose: Usually not recommended beyond 50
mcg/kg/min due to risk of excessive vasoconstriction and
ischemia.
Patient Counseling
• Explain that dopamine is used in critical care settings to stabilize
blood pressure and improve organ perfusion.
• Inform caregivers about the need for close monitoring during
therapy (e.g., blood pressure, heart rate, urine output).
• Emphasize the importance of promptly reporting signs of
infusion site pain or swelling to avoid extravasation injuries.
References :
1. Lexicomp
2. UpToDate
3. Micromedex
4. World Health Organization
(WHO)
5. Centers for Disease Control and
Prevention (CDC)
