Orthostatic reaction

Orthostatic reactions is defined as a symptomatic fall in blood pressure and it is measured by a fall in systolic blood pressure by >20 mmHg or to below 90 after three minutes of standing up after lying down (The Consensus Committee 1996). Orthostatic hypotension is estimated to prevail in 18-28% of the population over 65 and in public health surveys as many as 25% of persons over 80 years experienced symptoms related to low blood pressure and orthostatic reactions (Colledge et al. 1994, Brignole 1998). 

Many different drug classes have shown to cause hypotension and orthostatic reactions and drugs for cardiovascular conditions, psychoactive medicines and polypharmacy, can all have this side effect (Box 5.15). Among the most frequently used drugs in the elderly are diuretics, ACE-inhibitors, angiotensin II antagonists, calcium channel blockers and antidepressants. 

Syncope occurred in a hypertensive 48-year-old man who took oral chloroquine sulfate (total 600 mg base) while also taking amlodipine 5 mg/day (44). Chloroquine and amlodipine both cause vasodilatation, perhaps by release of nitric oxide, and the syncope in this case was probably due to a synergistic mechanism. Malaria itself can also provoke orthostatic reactions, which may be why syncope is not a reported adverse effect of chloroquine. However, in this patient malaria had been excluded. 

Alfuzosin (91) is a prazosin-like hypotensive adrenergic a-1 receptor blocker with the special structural feature that two carbons have been excised conceptually from the piperazine ring normally present in this series. Following the usual sequence for this series, reaction of 4-amino-2-chloro-7-dimethoxyquinazoline (89) with the tetrahydro-2-furyl amide of 3-methylaminopropyla-mine (90) gives alfuzosin (91) [25], Alfuzosin is claimed to cause less orthostatic hypotention (dizziness or fainting upon sudden rising) than prazosin. 

Adverse reactions of amantadine include gastrointestinal upset with nausea and vomiting, anorexia, asthenia (weakness, loss of strength), constipation, depression, visual disturbances, psychosis, urinary retention, and orthostatic hypotension. 

Discuss ways to promote an optimal response to therapy, how to manage common adverse reactions, nursing actions that may be taken to minimize orthostatic or postural hypotension, and important points to keep in mind when educating patients about the use of adrenergic blocking drugs. 

The most common serious adverse reactions to amantadine are orthostatic hypotension, depression, congestive heart failure, psychosis, urinary retention, convulsions, leukopenia, and neutropenia Less serious reactions include hallucinations, confusion, anxiety, anorexia, nausea, and constipation. Adverse reactions with selegiline include nausea, hallucinations, confusion, depression, loss of balance, and dizziness. 

The adverse reactions most often associated with the administration of the COMT inhibitors include disorientation, confusion, light-headedness, dizziness, dyskinesias, hyperkinesias, nausea, vomiting, hallucinations, and fever. Other adverse reactions are orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious and possibly fatal adverse reaction that can occur with the administration of tolcapone is liver failure... 

Risk for Injury related to parkinsonism, adverse drug reactions (dizziness, light-headedness, orthostatic hypotension, loss of balance)... 

Sedation and dry mouth are the most common adverse reactions seen with the use of TCAs. Tolerance to these effects develops with continued use. Orthostatic hypotension can occur with the administration of the TCAs. Orthostatic hypotension is a drop in blood pressure of 20 to 30 points when a person changes position, such as going from a lying position to a standing position. Mental confusion, lethargy, disorientation, rash, nausea, vomiting, constipation, urinary retention, visual disturbances, photosensitivity, and nasal congestion also may be seen. Sexual dysfunction may occur with administration of clomipramine. 

Orthostatic hypotension is a common adverse reaction seen with the administration of the MAOIs. Other common adverse reactions include dizziness, vertigo, nausea, constipation, dry mouth, diarrhea, headache, and overactivity. 

Some adverse reactions, such as dry mouth, episodes of orthostatic hypotension, and drowsiness, may need to be tolerated because drug therapy must continue. Nursing interventions to relieve some of these reactions may include offering frequent sips of water, assisting the patient out of the bed or chair, and supervising all ambulatory activities. 

Electrolyte imbalances, anorexia, nausea, vomiting, dizziness, rash, photosensitivity reactions, postural or orthostatic hypotension, glycosuria Electrolyte imbalances, anorexia, nausea, vomiting, fever, chills, anxiety, confusion, hematologic changes me as bumetanide... 

Adverse effects. Fatigue, orthostatic hypotension, extrapyramidal Parkin-son-like symptoms (p. 88), cutaneous reactions, hepatic damage, immune-hemolytic anemia... 

Adverse reactions associated with loop diuretics include nausea vomiting diarrhea gastric irritation headache fatigue dizziness thrombocytopenia rash orthostatic hypotension hyperuricemia hyperglycemia electrolyte imbalance (decreased chloride, potassium and sodium) dehydration. 

Adverse reactions occurring in 3% or more of patients include nausea, dizziness, lightheadedness, fainting, abdominal pain, confusion, hallucinations, depression, loss of balance, insomnia, orthostatic hypotension, increased akinetic involuntary movements, agitation, arrhythmias, bradykinesia, chorea, delusions, hypertension, new or increased angina pectoris, syncope, and dry mouth. 

Adverse reactions occurring in 3% of patients include nausea dizziness lightheadedness insomnia depression anxiety irritability hallucinations confusion anorexia dry mouth constipation ataxia livedo reticularis peripheral edema orthostatic hypotension headache. 

Orthostatic hypotension, somnolence, UTI, viral infection Serious Reactions... 

Orthostatic hypotension, headache, GI disturbances, photosensitivity Serious Reactions... 

Advanced Parkinson s disease (53%-17%) Orthostatic hypotension, extrapyramidal reactions, insomnia, dizziness, hallucinations Occasional... 

Confusion, increased intraocular pressure, orthostatic hypotension, tachycardia Serious Reactions... 

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