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Drugs used to remove sodium and water from the body
Diuretics
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What medicines are used for hypertension?
Diuretics, Alpha adrenergics, beta adrenergic blockers, calcium channel blockers, ACE inhibitors
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Sodium is stored in large quantities in the vascular department of the interstitial compartment...
Potassium must be consumed everyday, stored in intracellular compartment
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Antihypertensive agents are employed to...
lower blood pressure
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Diuretics are employed in patients with...
edema (tissue) or ascites (accumulation of fluid in peritoneal cavity)
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If you have kidney, liver, or lung disease, what issues will all three similiarly have?
Blood pressure issues
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These appear to act by inhibiting sodium and chloride reabsorption in the early portion of the distal tubule?
Thiazide diuretics
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What is the prototype drug for thiazide diuretics?
hydrochlorothiazide
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What is the normal potassium levels in the body?
3.5 - 5.5
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What happens if potassium is too low in the body?
The heart becomes irritable and fibrillates (cardiac arrhythmias), muscle weakness in skeletal and smooth muscles of body
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What if the body has too much potassium?
The heart will stop
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Because the concentration of sodium reaching the distal tubule is higher in patients using thiazide diuretics...
A greater sodium-potassium exchange happens, thus a greater loss of potassium happens
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What is HCTZ?
hydrochlorothiazide
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Furosemide (Lasix) is?
A loop diuretic
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These agents act by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle, reducing the ability of kidneys concentrating urine?
Loop diuretics
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Loop diuretics are considerably more potent than?
Thiazides in promoting sodium and fluid excretion
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Theese are popular agents in treating elderly clients, who may not adequately respond to thiazides (very potent)
Loop diuretics
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These are used in combination with a thiazide or loop diuretic to obtain enhanced diuretic activity?
Potassium-sparing diuretics
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These are used for ICU patients, 15-20 minutes maximum; used in a high concentration in the kidney tubules, which leads to learge amounts of fluid and produces a profound diuretic effect
Osmotic diuretics
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An abnormal increase in arterial blood pressure; complex state caused by renal disease, disease of adrenal gland, etc.
Hypertension
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Blood pressure is generally considered to be dependent on two factors:
cardiac output and peripheral resistance
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Cardiac output is controlled by?
Kidney and heart
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Peripheral resistance is mediated by the?
resistance vessels (such as arterioles)
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What is the blood pressure for Prehypertension?
130-139/85-89
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Stage 1 hypertension?
140-159/90-99
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Stage 2 hypertension?
160-179/100-109
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Stage 3 hypertension?
180/100 or higher
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Centrally acting antiadrenergic agents (brain) are generally...
potent antihypertensive agents with sedation as a major adverse effect
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Methyldopa is believed to replace norepinephrine in adrenergic storage sites, released when the adrenergic neuron is stimulated...
Methyldopa may directly stimulate receptors in the CNS, resulting in dilation of peripheral blood vessels and reduction of blood pressure
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Guanfacine HCL is a centrally acting agent that appears to stimulate alpha-adrenergic receptors...
thereby producing vasodilation and reduction of heart rate
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Peripherally Acting Antiadrenergic Agents...
Prazosin, Terazosin, Doxazosin
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Beta-Adrenergic Blocking Agents (side effect: vasodilation)... these drugs all end in?
-olol
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This drug is only indicated for treatment of sever hypertension that has not responded to safer drugs, generally used with a beta-adrenergic blocking agent?
Minoxidil
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What is the side effect for Angiotensin-Converting Enzyme Inhibitors?
Pt will begin to cough and cannot stop coughing
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All Angiotensin-Converting Enzyme Inhibitors end in?
-pril
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These agents reduce arterial blood pressure at rest and during exercise by dilating peripheral arterioles and reduce peripheral resistance?
Calcium channel blocking agents (used within first 8 hours of a CVA)
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Diazoxide (Hyperstat IV) is only used?
In emergency situations, that need immediate care (hypertensive emergency)
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Patients on hypertension medicine can benefit from?
a sodium-restricted diet
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Muscle cramps, muscle weakness, and change in pulse may indicate?
Potassium deficit
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Patients taking potassium-sparing diuretics are instructed to avoid?
Salt substitutes containing potassium
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Use of thiazide diuretics may result in?
Hyperglycemia
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Who must be especially monitored when taking thiazide diuretics?
Diabetics and those with gout
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Rauwolfia derivatives may produce nasal stufiness and mental depression...
Patients should avoid OTC decongestants with pressor agents
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Observe patients taking beta-adrenergic blocking agents for?
Respiratory difficulties and bradycardia
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Patients taking antihypertensives, especially ACE inhibitors, may decrease...
Libido, and in men, may inhibit erectile ability
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Patients with hypertension should be advised...
- Avoid heavy meals and exercise after meals
- Prevent constipation, straining for bowel movements is dangerous (Elvis)
- OTC drugs should be monitored for pressor substances
- Diets should be rich in potassium and calcium
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Patients taking diuretics and antihypertensive agents should weigh themselves...
3 times a week (3 pound increase is cause for concern)
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Disease characterized by the accumulation of fatty substances on the inner wall of large and medium-sized arteries
Atherosclerosis
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Total cholesterol should be less than?
200
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Hyperlipidemia means?
High fat content in blood
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Cholesterol includes?
- Chylomicrons (largest lipoproteins, carries digested fats from gut into blood stream)
- LDL (carries fat to cells)
- VLDL (carries triglycerides to cells)
- HDL (good cholesterol, carries fats back to liver for metabolism and excretion)
- Total glyceride (complex fat muscles)
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Total good cholesterol (HDL) should be less than?
50
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Most lipids entering the body are chemically bound to a plasma protein called?
Albumin
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Albumin forms chemical compounds known as?
Lipoproteins
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Bile is created in the liver, stored in the?
Gallbladder
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Bile is squirted from gallbladder into gut to?
Digest fats in intestines
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This drug acts by binding to bile acids including glycocholic acid that is the major bile acid in humans in the intestines; resulting in an increase in the conversion of cholesterol to bile acids?
Colesevelam HCl
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These antihyperlipidemic drugs are also called statin drugs?
HMG-CoA Reductase Inhibitors
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This drug increases HDL cholesterol, reducing LDL and VLDL cholesterol, as well as a reduction of triglyceride levels?
HMG-CoA reductase inhibitors
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When is most cholesterol synthesized?
Between midnight and 3 AM
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When should HMG-CoA reductase inhibitors be administered?
Once a day in the evening (bedtime)
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Patients using the HMG-CoA reductase inhibitors should be advised about what adverse effect?
Photosensitivity
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What is the drug of choice for primarily lowering triglycerides and raising HDL?
gemfibrozil (Lopid) and fenofibrate (TriCor)
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Niacin is what vitamin?
Vitamin B3
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This aids in processing of cholesterol; dilates blood vessels, helping patient with hypertension?
Niacin (Nicotinic Acid)
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Bile acids promote absorption of?
Lipids from ingested foods in teh intestines
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Defined as a decrease in circulating red blood cells that is associated with a decrease in hemoglobin concentration?
Anemia
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What is the maximum life span of a RBC?
120 days
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What are some causes of anemia?
- Excessive red blood cell destruction
- Inadequate red blood cell production
- Combination of both
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Absorbic acid is?
Vitamin C
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Most common cause of iron deficiency anemia?
Blood loss, although it may be caused by a dietary deficiency
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If a person has an iron deficiency, esp. a child, they are extremely susceptible to?
Lead poisoning, which can lead to severe neurological disorders
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Who are those at great risk for developing iron anemia?
- Patients with chronic bleeding disorders
- Females on menstration cycle
- Frequent blood donors
- Drugs that cause blood loss
- Pregnant women
- Infants (>1 yr)
- Lactating females
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Treatment of the patient with an iron-deficiency anemia usually involves?
An attempt to correct the cause of the underlying blood loss
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Vitamin B12 deficiency is usually characterized by?
Weakness, sore tongue, and numbing/tingling of the extremities; anorexia, shortness of breath, and jaundice
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Fat soluble vitamins are?
A, D, E, K
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Patients who do not properly absorb Vitamin B12 must generally receive...
IM therapy monthly for the rest of their life; may suffer damage to nervous system if therapy is discontinued
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Folic Acid is a relatively safe drug that only rarely produces adverse effects...
Generally administered for 2-3 weeks before folic acid stores are replenished
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When iron therapy is initiated...
Patients may have their stool become darker (tarry stool)
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What is hyperchlorhydria also known as?
Indigestion, sour stomach, sheartburn, acid stomach
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What is GERD?
Backflow of stomach contents through the lower esophageal sphincter (LES)
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Antacids are used in the treatment of?
GERD (gastroesophageal reflux)
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Alkaline chemical agents used for relief of symptoms associated with hyperacidity and PUD (peptic ulcer disease)?
Antacids
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Antacids do what?
Change pH in stomach from acidic to more basic (lowering acid content)
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When taking antacids, it is important to remember...
- Wait 2 hours to take an anacid after medication has been administered
- Or take an antacid an hour before administering their medicines
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With a tetracycline, an antacid should not be administered...
Within two hours of an oral dose
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Antacids are capable of interacting with...
many other drugs
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Antacids...
- Bind to other drugs
- Increase gsatric pH
- Increase urinary pH
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To minimize the likelihood of interactions between antacids and other drugs, patients should be advised...
To not take other oral medications within 1-2 hours from the time they are taking antacids
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Administration with other drugs or food may reduce the absorption of these agents
Antacids
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With liquid antacid products...
Shake well prior to use
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With Alkaseltzer, it has good antacid use; however, it contains what?
Aspirin, thus do not administer to people with peptic ulcers in stomach
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H1 receptors agonists?
Histamine
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H2 receptors agonists?
Hydrochloric acid
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These are some of the newest agents used to treat hyperacidity, GERD, and the damage caused by these conditions; and take a minimum of 3-4 days to work?
Proton Pump Inhibitors (Nexium, Prilosec, etc)
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How long does it take for the stomach to completely empty?
30-60 minutes
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These are used for short-term duodenal ulcer treatment (up to 8 weeks); they adhere to ulcer, forming an artifical scab, while healing with the proton pump inhibitors and antibiotics?
sucralfate (Carafate)
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Metoclopramide is used for?
Prokinetic agent that is used for a prolonged emptying time (gastroparesis), which is a loss of tone of LES; it increases acetylcholine levels. Its major side effect is extra paramital side effects (tremors, problems with tongue, etc.)
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Synthetic prostaglandin compound reported to decrease gastric acid secretion and possibly exert a protective effect on the mucosal surface of the stomach
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Pancreatic enzymes are required for?
Proper digestion of fats, proteins, and complex carbohydrates
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Lactase Enzyme (LactAid, Lactrase, Dairy Ease) is used for?
People with lactose intolerance; which is usually due to inadequate production of lactase enzyme, an enzyme that breaks down lactose into absorbale monosaccharides, such as glucose.
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Antacids should be administered following?
Meals or a snach
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Avoid the use of aspirin, ibuprofen, and naproxen in patients with?
Peptic ulcer disease
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Avoid simultaneous administration of?
Antacids and antibiotics
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Monitor patients taking cimetidine for?
Diarrhea, dizziness, rash, and confusion
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Emetics?
Are agents used to induce vomiting
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Antiemetics?
are given to prevent and to treat nausea and vomiting
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Nausea and vomiting is usually caused by?
Dopamine levels
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Ipecac syrup is not used in children less than a year old, and...
does not work unless large amounts of water (pref. salt water) is ingested along with it
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Ipecac syrup is contraindicated with?
Activated charcoal
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Both anticholinergic and antihistamine antiemetics can cause anticholinergic side effects, such as...
dry mouth, urinary retention, and blurred vision, not with glaucoma, and even constipation
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Neuroleptic agents are?
Dopamine antagonists
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What is the prototype drug for prokinetic agents?
metoclopramide (Reglan)
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With vertigo, what is it that makes you dizzy?
Eyes are seeing one thing, brain is receiving another message, causing nausea when the brain becomes confused
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The serotonin-blocking agent Zofran is used for?
chemotherapy-related nausea and vomiting
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Emetics are not administered to persons who have swallowed...
corrosive substances or oils or to those who are unconscious
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A condition in which the passage of feces through the lower gastrointestinal (GI) tract is slow or nonexistent?
Constipation
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With cholinergic drugs...
Acetylcholine levels go up, increasing peristalsis for constipation (laxatives)
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With anticholinergic drugs...
acetylcholine levels go down (diarrhea)
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When digestion is hyperactive, colon doesn't absorb enough water, leading to abnormal levels of fluids and electrolytes, causing...
Diarrhea
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Stimulant laxatives increase...
the motility of the GI tract by chemical irritation of the intestinal mucosa or by a more selective action on specific nerves in the intestinal wall
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These type of laxatives draw water through the intestinal wall by osmotic action and thereby increase the fluidity of the stool and stimulate greater inetestinal motility?
Saline laxatives (enemas)
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Retention of an enema is dangerous, thus...
You must go after it and remove with a colon tube
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This cleans out bowels in preparation for surgeries or exam preps such as a colonscopy?
Magnesium citrate
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Bulk forming laxatives must be...
taken with at least 8 ounces of water, and lots of continuous fluid consumption throughout the day
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The most popular intestinal lubricant is...
liquid petrolatum (mineral oil); solid petrolatum is known as petroleum
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Fecal wetting agents (docusate) are useful in cases where many other laxatives would be contraindicated...
e.g. in cardiac and debilitated patients
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Rectal suppositories are usually inserted about...
3 inches
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Avoid stimulant laxatives in the...
elderly
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You can disguise the taste of castor oil with...
fruit juices
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Avoid rushing or distracting patients taking lubricant laxatives...
to avoid aspiration
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Never administer laxatives to patients experiencing...
abdominal pain, nausea, or vomiting unless you have consulted a physician
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Patients taking laxatives must consume at least 6-8 glasses of water...
to avoid dehydration
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With antidiarrheal agents, you must monitor...
fluid intake and output; record information about frequency and nature of stools
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Patients taking paregoric diphenoxylate HCl (Lomotil), difenoxin (Motofen), or loperamide (Imodium) for ....
CNS depression
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Adsorbents should not be taken within...
several hours of taking other oral medications
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Lactobacillus products
must be refridgerated
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