Generic name: Captopril Brand name: Apo-Capto, capoten, Novo-captopril, Nu-capto Classification: ACE inhibitor, Antihypertensive Mode of Action:

Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action. Indication: Treatment of hypertension alone or in combination with thiazide-type diuretics Treatment of CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis Treatment of diabetic nephropathy Treatment of left ventricular dysfunction after MI Unlabeled uses: Management of hypertensive crises; treatment of rheumatoid arthritis; diagnosis of anatomic renal artery stenosis, hypertension related to scleroderma renal crisis; diagnosis of primary aldosteronism, idiopathic edema; Bartter's syndrome; Raynaud's syndrome Contraindication: Contraindicated with allergy to captopril, history of angiodema, second or third trimester of pregnancy. Use cautiously with impaired renal function; CHF; salt or volume depletion, lactation. Adverse effects CV: Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in salt- or volume-depleted patients Dermatologic: Rash, pruritus, scalded mouth sensation, pemphigoid-like reaction, exfoliative dermatitis, alopecia, photosensitivity

 GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Hematologic: Neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia, pancytopenia Other: Cough, malaise, dry mouth, lymphadenopathy Dosages ADULTS Hypertension: 25 mg PO bid or tid; if satisfactory response is not noted within 12 wk, increase dosage to 50 mg bidtid; usual range is 25150 mg bidtid PO with a mild thiazide diuretic. Do not exceed 450 mg/day. CHF: 6.2512.5 mg PO tid in patients who may be salt or volume depleted. Usual initial dose, 25 mg PO tid; maintenance dose, 50100 mg PO tid. Do not exceed 450 mg/day. Use in conjunction with diuretic and digitalis therapy. Left ventricular dysfunction after MI: 50 mg PO tid, starting as early as 3 days post-MI. Initial dose of 6.25 mg, then 12.5 mg tid, increasing slowly to 50 mg tid. Diabetic nephropathy: 25 mg PO tid. Nursing Responsibilty Take drug 1 hour before meals; do not take with food. Do not stop without consulting your health care provider. Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if light-headedness or dizziness occurs, consult your health care provider. Severe fetal damage can occur if captopril is taken during pregnancy. Use of contraceptives is advised; if pregnancy should occur, stop drug and notify your health care provider.

 Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will interact with ACE inhibitors. Consult your health care provider. You may experience these side effects: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth sores (frequent mouth care may help); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few days; change position slowly, and limit your activities to those that do not require alertness and precision). Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.

Generic name: Citicoline Brand name: Zynapse Drug Class: Neuroprotective CNS Drugs & Agents for ADHD Indication: Treatment of cerebrovascular accident in acute and recovery phase, symptoms and signs of cerebral insufficiency eg, dizziness, memory loss, poor concentration, disorientation, recent cranial trauma and their sequelae. Therapeutic Action: Pharmacology: Somazine contains as its single active component, cytidine-5diphosphate choline. CDP-choline is a biologic product. It is found in the body and takes part in the biosynthesis of phospholipids which integrate into the structures of the nervous system especially in the membranes of the neurons. The formation of phospholipids is needed for the re-structuring of cell membranes by the damaged neurons.

Citicoline is an interneuronal communication enhancer. It increases the neurotransmission levels because it favors the synthesis and production speed of dopamine in the striatum, acting then as a dopaminergic agonist thru the inhibition of tyrosine-hydroxylase. Citicoline acts as a presynaptic cholinergic agent which favors the synthesis of acetylcholine. It also decreases the release of serotonin. Citicoline improves neuronal metabolism in those cases where there is a neuronal deterioration due to degenerative, toxic or ischemic cause. The cause of poor neuronal metabolism is brought about by a decrease in neuronal activity which makes the astrocytes swell. Swelling is due to electrolyte imbalance. Active neurons release potassium ions. These are taken up by astrocytes (K+ buffers) and distributed to regions with less K+. When neuronal activity decreases, less K+ is released, astrocytes take up Na+ instead of K+. The hydrated Na+ is larger than the hydrated K+ and so the astrocyte swells. Improvement of neurometabolism is demonstrated by citicoline's ability of restoring the activity of mitochondrial ATPase and of membranal Na+/K+ ATPase. Citicoline also increases glucose incorporation aside from metabolism while at the same time decreasing lactate accumulation in the brain. Citicoline makes the neurons more active, causing the astrocytes to loosen their grip on the capillaries, thus improving microcirculation. By virtue of this action, citicoline has an indirect effect on microcirculation. It has the ability to slightly increase cerebral blood flow and exerts an anti-aggregation effect on platelets. Dosage: Ordered dose: 1 grm. IV q 12 hrs. / 5 ml TID Contraindication: Patients with parasympathetic hypertonia. Caution: Somazine must not be administered along with medicaments containing meclophenoxate. Interaction: Somazine potentiates the effects of L-dopa. Incompatibilities: Somazine must not be administered with products containing meclofenoxate (clophenoxate)

Side Effects: Gastrointestinal disorders. Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, or rash, Low blood pressure (faintness, dizziness), Slow or fast heart beat, Headache, Nausea, vomiting, or diarrhea (loose BMs)

Catapres, Catapres-TTS, Dixaril , Duraclon Action: Centrally acting antiadrenergic derivative. Stimulates alpha2-adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys.. Classifications: cardiovascular agent; central-acting antihypertensive; analgesic Indication: Step 2 drug in stepped-care approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain.