Tuesday, May 23, 2023

Antihypertensives, immunosuppressants and medications used in palliative care. Cyclosporine. Dexamethasone. Hydrocortisone. Prednisolone. Tamoxifen



Immunosuppressive drugs:

- Azathioprine, cyclosporine

Cytotoxic drugs:

  • Asparagine, Blyomycin, Calcium Folate, Chloramposyl, Clormethine, Cisplatin, Cyclophosphamide, Cetarapine, Dakarpazine, Dactinomycin, Downorubicin, Doxorubicin, Etoposide, Fluorouracil, Levamisol, Merkaptopurine, Methotrexate, Procarbazine, Phenplastin, Fincristine.
  • Hormones and Antihypertensives:
  • Dexamethasone, hydrocortisone, prednisolone, tamoxifen

Palliative care medications:

The World Health Organization (WHO) Expert Committee on the Use of Essential Medicines recommended that all medicines listed in the Bulletin of the World Health Organization "Eradication of Cancer Pain" with the "Guide to Opium Availability", second edition, are essential. The drugs are listed in the relevant sections of the Model List, according to their therapeutic uses, such as analgesics.

Antihypertensive drugs

1- Therapeutic strategy:

It depends on the intensity of the blood pressure, its repercussions and the overall cardiovascular risk.

2- Choice of antihypertensive classes:

The five classes of antihypertensives that have been shown to be effective in cardiovascular prevention may be offered as first-line therapy for uncomplicated essential hypertension.
The five classes of antihypertensives that have been shown to be effective in cardiovascular prevention are:
  • diuretics;
  • beta-blockers;
  • Calcium channel inhibitors, especially dihydropyridines;
  • the converting enzyme inhibitors (IEC);
  • Angiotensin II receptor antagonists (ARAII).
  • When initiating treatment with ACE inhibitors or ARAII, it is recommended to monitor serum potassium and serum creatinine within 7 to 15 days of starting treatment.
  • Daily monoprice should be favored to promote adherence.
  • It is recommended to start with monotherapy, but a fixed combination with first-line AMM may also be offered.
  • In second intention, a dual therapy will be introduced in a period of at least four weeks in case of insufficient tension response.
  • The treatment is set up from the outset in a situation of secondary prevention.
  • There is no convincing demonstration of efficacy in cardiovascular prevention for the following molecules:
  • alphablockers, with a less preventive effect than thiazide diuretics;
  • Central antihypertensives (no large-scale intervention trial).

3- Voltage objectives:

- According to AFSSAPS-HAS recommendations
For all hypertensives, TA <140 mmhg.="" p="">For all elderly subjects (systolic BP), TA <150 mmhg.="" p="">In case of renal insufficiency, proteinuria> 0.5 g / d, TA <130 125="" case="" diabetes="" even="" feasibility="" in="" mmhg="" of="" p="" random="">- Management strategy based on comorbidities.
The factors taken into account are: aging, LVH, coronary insufficiency, arterial disease of the lower limbs (see corresponding specific lessons).