PHARM: DRUGS and LECTURE Chapter 22 and 23

Therapeutic Class: Antihyperlipidemic

Pharmacologic Class: HMG-CoA Reductase inhibitor

Mechanism of Action: Acts by inhibiting HMG-CoA reductase. Liver makes less cholesterol and creates more LDL receptors, decreases the amount of LDL in the blood

• Administration Alerts: Administer with food to reduce GI upset, may be taken anytime of day, OTC niacin can cause an increased risk for rhabdomyolysis

Adverse effects: Headache, GI upset(cramping, diarrhea, constipation), liver damage, rhabdomyolysis

• Contraindications: patients with liver disease, prior hyersensitivity, unexplained persistent elevation of transamines

• Therapeutic Class: Antihyperlipdiemic
• Pharmacologic Class: Bile Acid Resin
• Mechanism of Action: binds with bile acids (containing cholesterol) in an insoluble complex that is excreted in the feces
• Administration Alerts: mix thoroughly with liquid; drink immediately to avoid GI obstruction/irritation, give other drugs 2 hours before, or 4 hours after chlestyramine
• Adverse effects: constipation, bloating, gas, nausea
• Contraindications: patients with total biliary obstruction, prior hypersensitivity

• Therapeutic Class: Antihyperlipidemic
• Pharmacologic Class: Fibric Acid agent
• Mechanism of Action: UNKNOWN :up to 50% reduction in VLDL
• Administration Alerts: administer with meals to reduce GI distress
• Adverse effects: may increase likelihood of gallstones, may affect liver function, dyspepsia, diarrhea, nausea, cramping,
• Contraindications: hepatic impairment, severe renal dysfunction, pre-exisitng gall baldder disease, prior sensitivity

• Therapeutic Class: Drug for hypertension and edema
• Pharmacologic Class: Thiazide Diuretic
• Mechanism of Action: acts on the kidney tubule to decrease the reabsorption of Sodium(sent to the urine). Water flows with the sodium. Blood volume decreases and blood pressure falls
• Administration Alerts: administer early in the day to prevent nocturia
• Adverse effects: electrolyte imbalances due to loss of K+ and Na+, increase K+ intake as precaution, may precipitate gout attacks
• Contraindications: anuria

• Therapeutic Class: Drug for hypertension and angina
• Pharmacologic Class: Calcium Channel Blocker
• Mechanism of Action:Selectively blocks calcium channels in myocardial and vascular smooth muscle. Results in less oxygen utilization by the heart, increases Cardiac Output, decreases blood pressure
• Administration Alerts: DO NOT administer immediate-release formulation if MI is suspected or within 2 weeks after a confirmed MI
• Adverse effects: related to vasodilation: headache, dizziness, peripheral edema, flushing, reflex tachycardia
• Contraindications: prior hypersensitivity

Therapeutic Class: Drug for hypertension and heart failure

Pharmacologic Class: ACE (angiotensin-converting enzyme) inhibitor

Mechanism of Action: reduces angiotensis II and aldosterone levels to produce significant reduction in blood pressure

• Administration Alerts: may produce first-dose phenomenon (profound hypotension which may result in syncope)
• Adverse Effects: may cause hyperkalemia, orthostatic hypertension, headache, dizziness, angioedeme, neutropenia, aranulocytosis

Contraindications: prior hypersensitivity, pregnancy, lactation

• Therapeutic Class: Drug for hypertension and BPH
• Pharmacologic Class: Alpha-1-adrenergic blocker
• Mechanism of Action: dilates arteries and veins by blocking alpha-1 receptors in vascular smooth muscle
• Administration Alerts: monitor for profounf hypotension and possible syncope (first-dose phenomenon)
• Adverse Effects: orthostatic hypotension, dizziness, headache
• Contraindications: prior hypersensitivity to alpha blockers

• Therapeutic Class: Drug for hypertension and heart failure
• Pharmacologic Class: Direct-acting vasodilator
• Mechanism of Action: direct vaso-dilation of arterial smooth muscle (no affect on veins)

Administration Alerts: abrupt withdrawal may cause rebound hypertension and anxiety

Adverse Effects: headache, reflex tachycardia, palpitations, flushing, nausea, diarrhea. Rarely: a lupus-like syndrome that could persist for 6 months or longer, sodium and fluid retention

Contraindications: patients with angina, rheumatic heart disease, MI, tachycardia, lupus

A fat-like substance that is found in certain foods and is also produced in the body by the liver

HDL-high density lipoprotein

LDL- low density lipoprotein

VLDL-Very low density lipoprotein

main consituent of animal fat, serve as energy source and transporter of dietary fat

An increae in the amount of lipids in body that can start to cause problems

transfer cholesterol from liver to tissues and organs

extra is placed in storage on lining of blood vessels and can cause plaques to build up, which can lead to coronary artery disease

hardening of the arteries

lipids get into vascular endothelium white blood cells try to clear them. WBC release growth factors that promote plaque formation, plaques block the artery which becomes rigid and can't constrict and dilate normally

Interacts with macrolide anitbiotics, azole antifungals, and immunosupressant agents. These should be avoided because they interfere with statin metabolism. Increase risk of rhabdomyolysis

risk factors for atherosclerosis: High BP, overweight, smoking, family history, high LDLs, diabetes

they have smaller LDL paticles that can be more penetrating and damaging to arteries.

assess liver function (liver function test): more liver enzymes means the liver is being damaged.

perform tests before treatment begins, and after 6-12 weeks

perform tests when there is a dose increase

lipitor is an adjunct to a low cholesterol diet not a replacement

cholesterol biosynthesis is higher at night

tetracyclines, digitalis, penicillins, thyroid hormone, thiazide diuretics: bile acid binding agents bind with these and decrease their absorption

fats and fat soluble vitamins A,D,E,K--important to monitor for deficiency of vitamins A and D

tell patient to take drugs before meals, bile sequestrant powders must be mixed with water or fruit juice, bile acid sequestrants decrease the ability of the body to absorb numerous drugs, long term use may increase bleeding tendency from hyperprothrombinemia(caused by Vitamin K deficiency)

take before meals, drink plenty of fluids and increase bull in diet to reduce constipation, serum cholesterol levels should be checked, other drugs should be taken 1 hour before or 4-6 hours after

It decreases the hepatic triglyceride production by reducing VLDL synthesis, inhibiting peripheral lipolysis(breakdown of fat). It interferes with the synthesis of LDL and VLDL.

inflammation of blood vessels

CNS--chills/fatigue, vasculitis, blurred vision, cataracts, abdominal pain, epigastric pain anemia, leukopenia

monitor serum triglycerides and cholesterol levels as appropriate, reveiw CBC and liver function test periodically, caution to avoid hazardous activities until CNS effects are known

it reduces teh production of triglycerides therefore interfereing with changing from VLDL to the LDL. It also causes a rise ih HDL.

FLUSHING and HOT FLASHES in almost EVERY CLIENT, variety of intestinal effects (nausea, excess gas, diarrhea), not prescribed for patients with diabetes because it can raise fasting glucose levels, can get OTC, but should not be used to decrease lipids with consulting a doctor

consistent elevation of systemic arterial blood pressure normal =120/80

TIA-transient ischemic attack, heart failure, renal failure, visula impairments/blindness, CVA(cerebral vascular accident)

cardiac output (volume pump per minute), blood volume (fluid loss, fluid retention), peripheral resistance (sympathetic nervous system, renin/angiotensin, increase in blood viscosity)

heart must work harder to pump blood to organs and tissues (fluid can back up into the lungs), adversely affect the vascular system (decrease blood flow to brain and vital organs

diuretics, calcium channel blockers, drugs affecting the renin/angiotensin system, adrenergic antagonist, centrally acting agents, direct vaso-dilators, beta-adrenergic blockers

indicated in the presence of fluid retention, treatment of heart failure/CHF, hypertension. They enhance renal excretion of NA+ and water

reduce blood volume, reduce peripheral edema, and reduce pulmonary or systemic congestion

work to move large volumes of fluid and work quickly especially if given by IV. (lasix) They are K+ losing drugs--need to monitor potassium levels

thiazide diuretics are K+ losing and spironalactones are K+sparing. It is less effective diuretic but helps to spare K+

K+ loss (hypokalemia) when using lasix and thiazide diuretics, hyperkalemia. Both hyper and hypokalemia can cause dysrhythmias, dehydration, and electorlyte imbalance

monitor labs, strict intake and output, weigh patient daily, monitor for dysrythmias and hypokalemia

used for patients where heart needs rest, reduces the amount of calcium that enters the muscle cells in the coronary walls, muscle spasms can be prevented. some decrease the workload in the heart by decreasing vascular resistance and increasing coronary blood flow, some lower the heart rate, reduce myocardial oxygen demand

treat and prevent unstable angina, hypertension, prevent and control tachycardia, treat post MI complications

When starting and stopping theray should be tapered over 7-14 days, urge patient to take exactly what is prescribed even if feeling well, should measure pulse rate and BP regularly/call provider if it falls below accepted level

begin with lowest dose and gradually increase, always take BP prior to administration, ACE inhibitors are often taken with diuretics to reduce BP, all can be taken with meals except: captopril and moexipril, monitor for first dose phenomenon--give normal saline(NS) to increase volume

hypotension, hyperkalemia( when taking with K+sparing diuretics), angioedema (swelling of tissue below surface of skin), cough, dizziness, headache.

• AVOID: K+sparing diuretics
• DO NOT give to patients in renal failure
• MONITOR: ECG, intake/output

Aliskirin (Tekturnal)--acts on renin to inhibit conversion of angiotensin into angiotensin I, take PO, side effects same as ACE inhibitors but to lesser extent, approved only for the treatment of hypertension

completely inhibits alpha-1 adrenergic receptors in sympathetic nervous system causing peripheral dilation and reduced peripheral vascular resistance. It is given for benign prostatic hyperplasia(enlarged prostate) and hypertension. Decreases BP especially when patient stands.

bronchoconstriction and bradycardia--use caustiously with asthmatics, rebound HTN, angina, MI--if stopped abruptly

orthostatic hypotension, dizziness, nausea, drymouth, impotence

teach client to take own pulse and blood pressure, monitor cardiac response, compliance is a major problem, encourage discussion of sexuality as related to drugs, warn not to stop taking abruptly, grapefruit and antacids may impair affects of some hypertensive drugs