Pharm Drug Cards

–Neutral fats
–90% of all lipids in the body

–Helps with plasma membrane building

–Most commonly called cholesterol
–Widely known to cause atherosclerosis

–Transports cholesterol out of tissues
–AKA good cholesterol

–Transport cholesterol into the tissues–AKA bad cholesterol

–Precursor of LDL
–Primary carrier of triglycerides in the blood

•Pr: atorvastatin (Lipitor)
•Action: interferes with the synthesis of cholesterol in the liver
•Use: ↓LDL, VLDL, triglyceride levels; ↑HDL
•Adverse effects: HA, fatigue, muscle or joint pain, and heartburn

•Pr: cholestyramine (Questran)
•Action: binds with bile acids in the GI tractto increase excretion of cholesterol in the stool
•Use: ↓LDL levels
•Adverse effects: more SE than statins; GI c/o’s; bloating, constipation, steatorrhea

•Pr: niacin (B complex vitamin)
•Action: ↓ VLDL level, ∴↓ LDL level
•Use: ↓ VLDL, triglyceride levels; ↑ HDL
•Adverse effects: more SE than statins; flushing (take ASA), hot flashes, N/D, excess gas, hepatotoxicity. Can raise blood glucose in diabetics.

•Pr: gemfibrozil (Lopid)
•Action: unknown, but it ↓ VLDL and ∴ triglycerides, and ↑ HDL
•Use: severe hypertryglyceridemia
•Adverse effects: GI distress, watch for bleeding with clients on anticoagulants

•Pr: ezetimibe (Zetia)
•Action: inhibits the absorption of cholesterol
•Use: modest reduction of LDL
•Adverse effects: none

•Assessment
•Nursing Diagnosis–Knowledge deficit regarding condition–Ineffective regimen management–Risk for bleeding
•Planning: the client will:
•Implementation

Cardiovascular Disease (CVD)

Hypertension: Classified into Three Categories

Goals and Drug Selection of Antihypertensives
•Goal of antihypertensive therapy
•A single drug begins anti-HTN therapy
•Stepped care
•Hypotension (orthostatic) can be caused by ANY drug that alters the BP

•Pr: hydrochlorothiazide (Hydrodiuril)
•Action: increase urine output to reduce blood volume to reduce resistance
•Use: mild to moderate HTN
•Adverse effects: electrolyte imbalances, especially potassium

•Pr; nifedipine (Procardia)
•Action: prevents Ca from entering muscle, relaxing arterioles (vasodilates)
•Use: hypertension and angina
•Adverse effects: dizziness, HA, flushing, reflex tachycardia. Can become toxic with grapefruit juice (causes greater absorption, causing a greater response.)

•Pr; enalapril (Vasotec)
•Action: ACE inhibitors block angiotensin I→II (powerful vasoconstrictor). Also, it decreases reabsorption of Na causing increased urine excretion
•Use: HTN, HF, and MI
•Adverse effects: persistent cough, orthostatic hypotension, angioedema

•Pr: losartan potassium (Cozaar)
•Action: blocks angiotensin receptors in arterial smooth muscle (after II is formed)
•Use: HTN
•Adverse effects: hypotension

•Pr: doxazosin (Cardura)
•Action: blocks affects of sympathetic nervous system leading to vasodilation
•Use: HTN
•Adverse effects: orthostatic hypotension, nausea, bradycardia, dry mouth
•SE are predictable fight or flight

•Pr: hydralazine (Apresoline)
•Action: cause vasodilation by direct relaxation of arterial smooth muscle
•Use: severe hypertension and hypertension crisis (2 minute half life)
•Adverse effects: reflex tachycardia, sodium and fluid retention

•Diuretics–Electrolyte labs, daily weight
•Ca Channel Blockers
•ACE Inhibitors
•Adrenergic Blockers
•Direct Vasodilators

•Prototype; lisinopril (Prinivil, Zestril)
•Action; enhances excretion of Na & water
•Use; lowers BP and peripheral resistance
•Adverse effects; first-dose hypotension, cough, hyperkalemia, RF6djm6Diuretics

•Prototype; furosemide (Lasix)
•Action; to increase urine excretion, reducing blood volume (peripheral resistance) and cardiac workload
•Use; reduce edema and pulmonary congestion
•Adverse effects; dehydration, electrolyte imbalance, hypotension, ototoxicity

•Prototype; metoprolol (Lopressor, Toprol XL)
•Action; slows the heart rate and ↓ BP resulting in ↓ cardiac workload
•Use; to reduce symptoms of HF and slow progression of disease
•Adverse effects; fluid retention, worsening of HF, fatigue hypotension, bradycardia, heart block

•Prototype; isosorbide dinitrate (Isordil)
•Action; Directly relax blood vessels and ↓BP resulting in ↓preload, and ↓workload
•Use; to lower BP, especially for those who cannot take ACE Inhibitors
•Adverse effects; reflex tachycardia, orthostatic hypotension

•Prototype; digoxin (Lanoxin)
•Actions; a more forceful, slow heart beat
•Use; increase the contractility or strength of myocardial contraction
•Adverse effects; Narrow margin of safety, dysrhythmias, digitalis toxicity, visual #s

•Prototype; milrinone (Primacor)
•Action; positive inotrope, blocks enzyme phosphodiesterase in cardiac and smooth muscle, and ↑ contractility
•Use; a short-term therapy for HF
•Adverse effects; Very toxic, hypokalemia, hypotension, supra and ventricular dysrhythmias11djm11Nursing

•Prototype drug:nitroglycerin (Nitrostat)
•Action:potent coronary artery vasodilator
•Use:for lowering myocardial oxygen demand
•Adverse effects:hypotension, dizziness, blurred vision, dry mouth, headache17djm17Beta

•Prototype drug:atenolol (Tenormin)
•Action:slows rate and reduces contractility to reduce cardiac workload
•Use:for prophylaxis of chronic angina
•Adverse effects:hypotension, dizziness, fatigue during exercise18djm18Calcium

•Prototype drug:diltiazem (Cardizem)
•Action:relax coronary arteries (dilate) to reduce cardiac workload
•Use:for lowering blood pressure
•Adverse effects:hypotension, bradycardia, heart failure, constipation

•Prototype drug:reteplase (Retavase)
•Action:to dissolve clots obstructing coronary arteries
•Use:for restoring circulation to myocardium
•Adverse effects:excessive bleeding21djm21Other

•Prototype drug:procainamide (Pronestyl)
•Action:Blocks Na channels, therefore slowing conduction of stimulus
•Use:to correct atrial and ventricular dysrhythmias
•Adverse effects:can create new dysrhythmias or worsen existing ones–Lupus effect, NV, abdominal pain, headache–High doses can produce CNS effects29djm29Beta

•Prototype drug:propranolol (Inderal)
•Action:to block beta receptors, which ↓HR, conduction velocity& automaticity
•Use:atrial dysrhythmias associated with HF
•Adverse effects:bradycardia, hypotension with dizziness and fainting–Bronchospasms, hypoglycemia, diminished libido

•Prototype drug:amiodarone (Cordarone)
•Action:blocks potassium channels in myocardial cells, which prolongs duration (refractory period) of action potential (slows)
•Use:to treat resistant ventricular tachycardia, atrial dysrhythmias with HF
•Adverse effects:blurred vision, pneumonia-like syndrome, bradycardia, hypotension–Can create new dysrhythmias or worsen existing ones–Restricted use because of serious SE

•Prototype drug:verapamil (Calan)
•Action:to block calcium-ion channels, which reduces automaticity of the SA node and slows impulse through AV node
•Use:to treat supraventricular tachycardia
•Adverse effects:bradycardia, hypotension, headache

•Prototype drugs:heparin (parenteral) and warfarin (Coumadin) (po) (LMWH: low molecular weight heparins)
•Action:to inhibit platelet aggregation (“clumping”) to ↓formation or enlargement of clots (do not “thin” blood)
•Use:to prevent thrombi from forming or enlarging, prevent formation of clots in veins, treat thromboembolic disorders
•Adverse effects:abnormal bleeding

•Prototype drug:(ADP receptor blocker) clopidogrel (Plavix)
•Action:platelets do not aggregate (clot)
•Use:to prevent thrombi formation after a stroke (CVA) or myocardial infarction (MI)
•Adverse effects:abnormal bleeding

•Prototype drug:aminocaproic acid (Amicar)
•Action:to prevent fibrin from dissolving clots
•Use:To promote formation of clots by preventing and treating excessive bleeding from surgical sites, therefore shortens bleeding time
•Adverse effects:May cause hyper-coagulation (clots) with concurrent use of estrogens and oral contraceptives45Nursing

•Prototype drug: erythropoietin, epoetin alpha (Epogen, Procrit)
•Action: hormone secreted by kidneys, sends message to bone marrow to increase erythrocyte production
•Use: treatment of anemia
•Adverse effects: hypertension, seizures
•Nursing cons: HTN, thromboembolism, H/H

•Prototype drug: filgrastim (Neupogen)
•Action: to increase neutrophil production
•Use: chemo, organ transplant, AIDS complications, severe bacterial infections
•Adverse effects: bone pain, allergies, thrombocytopenia
•Nursing cons: WBC levels, not given within 24 hours of chemo. Report dyspnea, tachycardia, and low BP

•Pr: oprelvekin (Neumega): only drug in this class
•Action: Stimulates thrombopoeitin to increase production of platelets
•Use: chemo pts with thrombocytopenia
•Adverse effects: fluid retention
•Nursing cons: do not give within 24 hours of chemo

•Prototype drug: cyanocobalamin (Crystamine, vitamin B12, others)
•Action: to replace vitamin B12
•Use: treatment of vitamin B12 deficiency
•Adverse effects: diarrhea, hypokalemia, rash, anaphylaxis
•Nursing cons: stools may be dark green or black

•Prototype drug:ferrous sulfate (Feosol)
•Action:to supplement iron needed by body
•Use:to treat iron deficiency
•Adverse effects:–Nausea, heartburn, constipation, dark stools
•Nursing cons: give 1 hour before or 2 hours after a meal, take as directed since excessive doses can be toxic

•Prototype drug: normal serum albumin (Albuminar, Albutein)
•Action: to maintain plasma osmotic pressure and transport substances through blood
•Use: restoration of plasma volume and blood proteins
•Adverse effects: allergies and protein overload

•Pr: norepinephrine (Levaterenol, Levophed)
•Action: to act directly on alpha-adrenergic receptors to raise blood pressure; also has positive inotropic effects
•Use: treat acute shock and cardiac arrest
•Adverse effects: tachycardia, bradycardia, and hypertension

•Prototype drug: dopamine (Dopastat, Inotropin)
•Action: is dose dependent; low doses = dopaminergic effect, high doses = beta-adrenergic effect
•Use: to treat septic and cardiogenic shock
•Adverse effects: dysrhythmias, hypertension, gangrene

•Prototype drug: epinephrine (Adrenalin)
•Action: for use as nonselective adrenergic agonist
•Use: to treat anaphylaxis, shock, cardiac arrest
•Adverse effects: hypertension and dysrhythmias

•Prototype; furosemide (Lasix)
•Action: Block reabsorption of Na in loop
•Uses: treat HTN, Moderate to severe fluid retention from HF, hepatic cirrhosis, RF
•Adverse effects: rapid, large excretion of urine, dehydration and electrolyte imbalances, ototoxicity

•Prototype; chlorothiazide (Diuril)
•Action: Block reabsorption of sodium, in distal tubule, increasing urine excretion
•Uses: Mild to moderate hypertension
•Adverse effects: Dehydration, orthostatic hypotension, hypokalemia

•Prototype: spironolactone (Aldactone)
•Action: blocks aldosterone by not reabsorbing Na (and water) and not excreting K
•Use: mild diuresis in HF
•Adverse effects: hyperkalemia

•Prototype; dextran 40
•Action: raise oncotic pressure of blood, therefore pulling water and expanding plasma volume within minutes
•Use: fluid replacement for hypovolemia D/T hemorrhage, surgery, severe burns
•Adverse effects: hypersensitivity reactions fluid overload, HTN

•Prototype; Sodium chloride (NaCl)
•Major electrolyte in ECF
•Connected to water balance: water travels toward or with Na
•Regulation of Na output is important function of kidneys
•Hypernatremia: Na level > 145 mEq/L
•Hyponatremia: Na level < 135 mEq/L

•Prototype; potassium chloride
•Most abundant electrolyte in ICF
•Renal excretion closely linked with that of sodium
•Hyperkalemia: K level > 5 mEq/L
•Hypokalemia: K level < 3.5 mEq/L

•Prototype; potassium chloride
•Most abundant electrolyte in ICF
•Renal excretion closely linked with that of sodium
•Hyperkalemia: K level > 5 mEq/L
•Hypokalemia: K level < 3.5 mEq/L

•Prototype; ammonium chloride•Alkalosis develops at pH values > 7.45•Symptoms; nervousness, hyper reflexes, convulsions: slow, shallow respirations to retain CO2•Causes;–Respiratory: hyperventilation (asthma, anxiety)–Metabolic: prolonged constipation, excess sodium bicarbonate, potassium depleting diuretics, severe vomiting