( e h - P L E H
- r e h - n o n e )
Hyperkalemia, diarrhea, abdominal pain, diz-ziness, coughing, fatigue, flu-like symptoms.
Hyperkalemia is the primary risk; can result in de-
creased renal function and serious, sometimes fa-
tal arrhythmias. GI:
Diarrhea, abdominal pain.
Pregnancy Category: B
Mastodynia in males, abnormal vaginal
bleeding, gynecomastia (males). Miscellaneous:
Dizziness, coughing, fatigue, flu-like symptoms.
LABORATORY TEST CONSIDERATIONS
(1) Hypertension, alone or in combination withother antihypertensive drugs. (2) Improve survival
e ALT, BUN, uric acid, serum creatinine. Hypo-
of stable clients with left ventricular systolic dys-
natremia, hypercholesterolemia, albuminuria, hy-
function (ejection fraction of 40% or less) and
clinical evidence of CHF after an acute MI. Inves-
Alone or in combination with an angio-
/ e Risk of hyperkalemia
tensin-converting enzyme inhibitor for reducing
Angiotensin II antagonists
/ e Risk of hyperkale-
left ventricular hypertrophy. As adjunctive therapy
in diabetic hypertension with microalbuminuria.
CYP3A4 inhibitors (itraconazole, ketoconazole)
Up to a 5-fold increase in eplerenone exposureLithium
/ Potential lithium toxicity; monitor se-
Binds to the mineralocorticoid receptor and
/ Potential a antihypertensive effect and
blocks binding of aldosterone. Aldosterone in-
creases BP through induction of sodium reabsorp-
h St. John’s wort
/ About a 30% a in eplere-
tion and other mechanisms. Thus, by blocking
aldosterone binding, sodium is not reabsorbedand BP decreases.
Peak plasma levels:
About 1.5 hr. Steady state:
Reached in 2 days. Absorption not affected by
food. Metabolized primarily via CYP3A4 in theliver. About two-thirds excreted in the urine and
one-third in the feces. t1/2, terminal:
4–6 hr. Plas-
ma protein binding:
50 mg once daily. If inadequate
response, increase dose to 50 mg twice a
Serum potassium greater than 5.5 mEq/L at initi-
ation, type 2 diabetes with microalbuminuria, se-
rum creatinine greater than 2 mg/dL in males or
30 mL/min. Also, clients concurrently taking po-
tassium supplements, potassium-sparing diuretics
(e.g., amiloride, spironolactone, triamterene), or
Left ventricular systolic dysfunction and clinical
strong inhibitors of CYP3A4 drugs (clarithromy-
evidence of conjestive heart failure after an
cin, ketoconazole, itraconazole, nefazodone, nelfi-
navir, ritonavir, troleandomycin). Lactation.
25 mg once daily; titrate to tar-
get dose of 50 mg once daily, preferable
Safety and efficacy not determined in children.
um. Less than 5 mEq/L potassium:
nine >2.0 mg/dL in males or >1.8 mg/dL in
day to 25 mg daily to 50 mg daily; Se-
Assess BP, serum K+, renal and LFTs, and for
rum potassium from 5–5.4 mEq/L:
DM. With post-MI heart failure, note LV ejec-
Maintain dosage; no adjustment; Se-
tion fraction and systolic dysfunction.
rum potassium, 5.5–5.9 mEq/L:
Take as directed with or without food. Do not
take supplements containing potassium.
holding the drug; Serum potassium, 6
mEq/L or greater:
Avoid activities that require mental alertness
until drug effects realized. Sit or lie down if
experiencing dizziness or lightheadedness
when standing. Keep log of BP and HR.
Continue lifestyle changes that help control
BP, i.e., maintain healthy diet and limit intake
Dosage adjustment is not necessary for mild
of caffeine, avoid alcohol, salt substitutes, or
to moderate hepatic dysfunction. Should notbe used in those with severe hepatic dysfunc-
high Na+ and high K+ foods, perform regular
exercise, maintain weight, and stop smoking.
Store from 15–30°C (59–86°F).
Avoid OTC meds and ETOH.
Keep all F/U to assess response, labs, and
Note reasons for therapy, symptom character-
List drugs prescribed to ensure none interact.
With HTN, avoid drug use in type 2 diabetes
with microalbuminuria, and if serum creati-
Islamic Transitional State of Afghanistan Central and Provincial Ministry of Health Public Administration Staff Capacity Building Plan MOH Public Health Administration Staff Table of Contents (i) Acknowledgements . 3 (ii) Acronyms . 4 1. Introduction. 5 2. The Process . 6 3. The Outcome. 7 4. The Costs . 8 5. Annexes. 11 5.1 Terms of Reference PHACBWG. 11 5.2 Master Skill Set List. 15
Abstract Tai Chi Chuan has traditionally been used and is still practised by millionsof Chinese people, especially the elderly as an exercise and therapeutic tool. Since theadvent of Traditional Chinese Medicine in the west, there has been an increasinginterest in its potential health benefits by an increasing number of health professionals,including doctors, nurses, physiotherapists and occup