-
Lasix is the most common Loop Diuretic, what are its pharmacokinetics?
- PO, IV, or IM.
- IV is for critical situations
- Hepatic Metabolism, and Renal excretion
-
What is the function of a Loop Diuretic?
- Lowers BP by reducing blood volume and promoting vasodilation.
- **this diuretic promotes the MOST volume because its action of blocking Na and Chloride reabsorption is in the loop of henle.
- AFFECTS THE PRELOAD
-
What are the 3 types of Diuretics?
Loops, Thiazides, and K Sparings
-
What special consideration does Nitro indictate?
Must be kept in the dark to prevent light exposure from desinigrating the medication and the med should be discontinued slowly.
-
What meds interact with Nitro?
- BP meds
- Viagra
- Beta Blockers (Verapamil, Diltiazem)
- Hypotensive Drugs
-
Adverse effects of Nitro include:
flusing, headache, reflex tachycardia, decreased BP, hypotension, dizziness
-
Nitro is used to treat:
CAD and Angina
-
What are the pharmacokinetics of Nitro?
- Not PO
- given transdermal (patch good for 12 hrs), sublingual, buccal, and spray (x3 max)
-
What is the mechanism of action of Nitroglycerin(Nitro)?
Dilation of the veins and vascular smooth muscle to decrease O2 demand, and pressure on veins (decreases chest pain)
-
What type of medication is Nitroglycerin?
Organic Nitrate
-
What medications interact with Hydralazine?
- Beta Blokcers help protect against the reflex tachycardia
- Diuretics prevent Na and water retension and expansion of BV
- BP meds will intensify
- Antihypertensive meds need monitoring
-
What are some adverse effects of Hydralazine?
- Reflex Tachycardia
- Increase of Blood volume
- Headache
- Dizziness
- Lupus-like syndrome
- Fatigue
-
What is Hydralazine use for:
- HTN
- Hypertensive crisis *first drug of choice for emergency
- HF
-
Explain the pharmacokinetics of Hydralazine.
- Absorbed PO and parenteral which is faster.
- Inactivated by metabolic process: Acetylation. The pace is genetically determined; those that acetylate slow have higher blood levels of the drug which can result in undesirable effects.
-
Hydralazine works to decrease BP by:
Dilation of the arteries that results from direct action of the vascular smooth muscle
-
What type of medication is Hydralazine?
This is a vasodilator
-
Beta Blockers common end with:
LOL
-
Beta Blockers are contraindicated in pts with:
- Asthma
- Diabetes (caution- can mask the signs of hypoglycemia)
- Sick sinus syndrome
- HF
- COPD
- or 2nd-3rd degree Heart Block
-
What are some adverse effects of Beta Blockers?
- Sometimes blockade of the B1 cells can cause: brady cardia, and decreased AV conduction
- Blockade of B2 cells promotes Vasoconstriction.
- Common side effects:
- insomnia
- depression
- bizarre dreams
- sexual disfunction
- dizziness
-
What is the therapeutic use of Beta Blockers?
- Anginal Pectoris (stable)
- NOT Vasopactic angina
-
Beta blockers work by:
- Blocking primarity B1 cardiac cells, and also some B2 pulmonary cells
- (Causing decreased contractility, and decreased respiratory rate)
-
What are some examples of Beta Blocker medications?
- Propranolol
- Metoprolol
- Antenolol
-
Can a pregnant woman take any ARB medications?
No, can cause fetal harm
-
Calcium Channel Blockers are contraindicated in pts wtih:
Heart Block
-
What are some things that should be monitored as a nurse with a pt taking a Calcium Channel Blocker medication?
- Monitor the BP
- and Administer this med on an empty stomach.
-
What are the therapeutic uses of Calcium Channel Blockers?
- Cardiac Dysrhthmias
- Angina Pectoris
- Essential Hypertension
- Sometimes Migranes
-
What are the adverse effects of Diltiazem?
- Dizziness
- flushing
- exacerbation of cardiac dysfunction
- sick sinus syndrome
- HF
- Less constipation than verapamil
-
What are the adverse effects of Verapamil?
- Facial Flushing
- headache
- dizziness
- Edema of the feet and ankles
- Constipation
-
What medications interact with Verapamil and Diltiazem?
Digoxin (risk of AV block is increased) and Beta Blockers (risk of excessive cardio suppression)
-
What are the two main Calcium Channle Blockers?
Verapamil, and Diltiazem
-
How do Calcium Channel Blockers work?
Block calcium channels in the heart and the blood vessels; reduces HR, increases coronary perfusion, dilation of arteries, decreased AV nodal conduction, decreases the force of contraction
-
What does a Calcium channel blocker typically end in?
DIPINE
-
Can you take antihypersensitive drugs with ARBs?
No, they interact
-
What are some adverse effects of ARBs?
- Angioedema
- Fetal Harm
- Renal Failure
-
What are the therapeutic uses of ARBs?
- HTN
- HF
- Nephropathy
- MI
- Stroke prevention
-
What are some examples of ARB medications?
- Valsartan
- Candesartan
- Irbesartan
- Olmeasartan
- Iosartan
-
What are the pharmacokinetics of ARBs?
PO with or without food; metabolized in the liver, excreted in the kidneys
-
What are the therapeutic uses of ACE Inhibitors?
- HTN
- HF
- L Ventricular dysfunction
- Nephropathy
- MI
- Prevention of death in pts with high risk for cardiovascular evetns.
-
What is the Mechanism of action of an ARB?
Blocking the actions of Angiotensin II; causing a dilaton of the arterioles & veins (decreasing BP) which decrease the release of aldosterone.
-
What do ARBs commonly end in?
SARTAN
-
What do ACE Inhibitors commonly end in?
PRIL
-
What are some things that you want to monitor as a nurse with a pt taking ACE Inhibitors?
- Monitor the WBC, K level, and BP
- *educate on eating low K foods and avoiding OTC drugs
-
Can Lotensin or Enalapril be given to a pregnant woman?
No, ACE Inhibitors pose fetal injury.
-
What are some adverse effects of ACE Inhibitors?
- Dry cough
- Hyperkalemia
- Renal Failure
- Angioedema
- First dose Hypertension
-
Nearly all ACE Inhibitors are PO with food, but what are the two that need to be given 1hr before meals?
Meoxipril, and Captopril
-
What are some examples of ACE Inhibitor Drugs?
- Lotensin
- Enalapril
- Enalaprilat
- Catopril
- Lisinopril
- Moexiprol
-
What is the Mechanism of Action of an ACE Inhibitor?
Blocking of Angiotensin I to Angiotensin II; this decreases aldosterone and kinase and increases bradykinin. Overall, vessels dilate (decreasing BP), and blood volume degreases.
-
Niacin is used for:
Hypercholesterolema, decreases LDL & Tryglycerides, increases HDL
-
SPecail considerations for pts taking streptokinase:
- NOT for pregnant women
- NOT for pts with ischemic stroke in last 3 months; or intracranial hemorrhage prior, or internal bleeding. Should be given within 3 hrs of onset.
-
Streptokinase adverse effects:
- Bleeding
- Antibody production causing allergy or neutralization to med
- hypotension
- fever
-
Streptokinase uses:
- Acute MI
- DVT
- Massive pulmonary embolism
-
How can streptokinase be given administered?
IV infusion, or infusion into the coronary artery
-
Streptokinase works by:
indirect mechanism: binds to plasminogen to form the active complex then converts to plasmin- plasmin digests clots and clotting factors
-
Streptokinase is what kind of drug?
A Thrombolytic drug "clott buster"
-
Pletal medications Interactions include:
Omeprazole, grapefruit, sertraline, erythromycin, ketocanazole, fluoxetine
-
Pletal adverse effects:
- headache
- diarrhea
- preipheral edema
-
Platel (cilostazol) uses:
Intermittent claudication (arterial insuficiency)
-
Pletals mechanism of action is what?
- anti-platelet:
- inhibits platelets and vasodilates. Suppresses by inhibiting PDE3
-
-
Ticlid (ticlopidine) , an antiplatelet drug, works similar to which other antiplatelet drug?
Plavix
-
Plavix medication interactions and side effects:
- Side effects: GI, same as aspirin
- Interactions: Prilosec and drugs that promote bleeding
-
Plavix uses:
Prevention of stroke, stenosis of coronary stens and MI
-
Plavix can be taken with or without food?
Either way is fine
-
Plavix (clopidogrel), an antiplatelet drug, works by:
blocking ADP receptors on the platelets, preventing the formation of platelets
-
Aspirin adverse effects:
- GI bleeding
- Peptic ulcer disease
- Increased risk of hemmorrhagic stroke
-
Aspirin uses:
- CAD- to keep injured vessel from clotting up
- MI
- Chronci stable angina
-
Aspirin inhibits platelet formation by:
causing irreversible inhibition of cyclooxygenase; and inhibiting synthesis of prostacyclin
-
The 4 Antiplatelet drugs that we are studying include:
- Aspirin
- Plavix
- Ticlid
- Pletal
-
Special implimentations when taking warfarin:
- monitor INR, PT< and CBC
- For Atrial fibrilation or stroke- pts INR should be 2-3
- For valve replacement INR shoud be 2.5-3.5
-
Interactions with Warfarin include:
- NSAIDs
- Sulfa drugs
- Heparin
- Bactrim
- Vitamin K
- Contraceptives
-
Warfarin uses include:
- Long term prophylaxis of thrombosis
- DVT
- ATRIAL FIBRILATION
- pulmonary embolism
- reduces risk of MI
-
Warfarin is excreted in the :
urine and feces
-
Warfarin, aka coumadin, works by:
- suppressing coagulation by producing clotting factors VII, IX, X, and prothrombin.
- It is a vitamin K agonist
-
Can enoxaparin be taken by a pregnant woman?
Yes; drug of choice of anti-coagulants
-
Enoxaprin antidote is same as regualr heparin which is:
Protamine sulfate
-
Lovenox is used for:
- DVT prevention following surgery
- prevention of ischemic complication swith unstable angina
- prophylaxis
-
Enoxaprin (Lovenox) can only be given what way?
SubQ
-
Enoxaparin (Lovenox) works by what mechanism:
Inactivates Xa factor, this is a low molecular heparin
-
Heparin is contraindicated in pts :
- Post of
- Low platelet count
- lumbar puncture
- bleeding disorders
-
Interactions with Heparin:
- Protamin Sulfate- antidote for overdose
- NSAIDs - promotion of bleeding
- Depakene
- Thrombolytics
-
Adverse effects of Heparin:
- Hemmorrhage
- Haparin induced thrombocytopenia
- Hypersensitivity rxns
- Long term treatment can cause osteoporosis
-
Heparin Uses:
- can be used during pregnancy- (preferred)
- Pulmonary edema
- DVT
- renal dyalisis
- Acute MI
- Venous thrombosis (post-op)
-
Heparin pharmacokinetics:
- IV (fast) or SubQ- NO PO
- hepatic metabolism, excreted in the kidney
-
Heparin works by:
inactivating thrombin and factor Xa which causes suppression of fibrin (no clott without fibrin)
-
3 types of Anti-coagulants medications are:
- Heparin
- Enoxaparin (lovenox)
- Warfarin (Coumadin)
-
Ezetimibe is not recommended in pts with:
Liver impairment; or the elderly
-
Ezetimibe works better when combine with what meds?
Statins
-
Ezetimibe adverse effects:
- myopathy
- Hepatitis
- Pancreatitis
- Thrombocytopenia
- NOT for pregnanty women
-
Ezetimibe (Zetia) works as a what? How does it work?
- -Cholesterol reducer
- -works by: inhibiting absorption of cholesterol; works on the brush border of the small intestine
-
What drugs interact with Fibrates
- WARFARIN- risk of bleeding
- Statins- increase risk of myopathy
-
What can high tryglyceride levels cause damage to?
The Pancreas
-
What are adverse effects of Fibrates?
- Rash
- GI upstet
- Gall stones
- myopathy
- liver injury
-
What are the therapeutic uses of Fibrates?
- High trygliceride levles
- Needing to raise HDL
-
Fibrates work to:
- Lower tyrglyceride levels by breaddown of lipoproteins from tissues, removes them from the plasma.
- Interacts with PPAR alpha receptor in the liver and adipose tissue
-
What are some examples of Fibrate medications?
- Gemfibrozil (lopid)
- Fenofibrate (tricor)
-
What can you take with Niacin to releave the flushing and itching?
Aspirin
-
Interactions of Niacin with other drugs include:
- Slo-niacin is most likely to cause liver damage
- Consult Dr. before taking with STATINS
-
What are some adverse effects of Niacin?
- Bodily flushing
- Itching
- GI upset
- Gouty
- Arthrits
-
Nicotinic acid is also known as:
Niacin, or Vitamin B3
-
Bile Acid sequestrants are contraindicated in pts with:
Intestinal problems, crones, or colitis
-
What are drugs that interfere with Bile acid sequestrants?
- Thiazides diuretics
- Digoxin
- Warfarin
- Some antibiotics
- GRAPEFRUIT, and other gas producing foods
- Antacids
-
What are some adverse effects of Bile sequestrants?
- GAS
- constipation
- bloating
- indegestion
- decrease in uptake of fat-soluble vitamins
-
Bile sequestrant uses:
Treats Hypercholesterolemia in conjuction with diet and exercise
-
Bile acid sequestrant pharmacokinetics:
- Works only in INTESTINE
- excreted through kidneys
- Can not be broken down in GI or by digestive enzymes
-
Bile sequestrants work by:
forming insoluble solids in the intestine preventing reabsorption of bile acids and accelerates their excretion- reducing LDL
-
What is an example of a Bile Sequestrant medication?
Colesevelam
-
What would you want to measure as a nurse with a pt taking lipitor?
- Monitor ASD, ALT labs
- watch for signs of muscle pain
- watch LDL levels- normal <120, if chronically ill pt can be <100
- Teaching: omega 3, fish, exercise, diet
-
HMGCOA adverse effects:
- NOT for pregnanty women
- Hepatoxic
- Muscle Myopathy/Rhabdomyolysis
- Kidney Failure
- Cramps
- Constipation
-
Uses of HMGCOA's include:
- Hyperlipidemia
- Hypercholesterolemia
- CAD
- MI
-
Pharmacokinetics of HMGCOAs?
- PO, take at night because liver produces cholesterol then
- Metabolized in liver- Hepatoxic
-
How do HMGCoA's work?
decreases LDL and Increases HDL by inhibiting the HMG-CoA enzyme which inhibits VLDL which causes LDL to lower
-
What do HMG-CoA's commonly end in?
STATIN
-
What are some examples of HMG-CoA drugs?
-
What are the 5 types of cholesterol reducing drugs?
- HMG-CoA inhibitors
- Bile Acid Sequestrants
- Nicotinic Acid
- Fibrates
- Ezetimibe
-
What do you watch for as a nurse with a pt taking digoxin?
- Watch HR, and level of drug closely
- Labs- the OPTIMAL RANGE IS: 0.5-0.8
-
What meds interact with Digoxin?
- Thiazides, and loop diuretics
- ACE inhibitors
- ARBs
- Sympathomimetics- act on heart ot increase force of contraction
- Quinidine- this is an anti dysrhythmic that can cause increased digoxin levels
- VERAPAMIL- can significantly increase plasma levles- could also counter act the benefits
-
What are the adverse effects of Digoxin?
- Decreased sypathetic tone
- Increased urine production
- decreased renin release causing decreased blood volume
- ventricular fib
- visual disterbances
- nausea/vomitting
- fatiuge
-
What are the pharmacokinetics of Digoxin?
- PO- meals high in bran can decrease absorption
- Distributed widely and across placenta
- Excretion in kidneys after liver metabolism which is minimal
-
Explain the mechanism of action of Digoxin.
- Inhibits sodium, potassium, and ATPase- promoting Ca accumulation within the myocytes and facilitates the interaction of myocardial contractile proteins: actin and myosin.
- They exert positive inotropic action on the heart ; increasing force of ventricular contraction- increasing cardiac output.
-
What type of medication is Digoxin?
Cardiac Glycoside
-
Drugs that interact with Spironolactone:
- ACE Inhibitors
- ARBs
- Aldosterone antagonists- because of hyperkalemia promotion
- ***NOT to be taken with K supplement.
-
What is the mechanism of action of spironolactone?
- Blocks aldosterone action in the kidneys.
- *Small degree of diuresis so the hypotensive effects are modest.
-
What is the main K Sparing Diuretic?
Sprionolactone
-
Give some examples of K rich foods?
Bananas, citris fruits
-
Thiazides interact with what meds?
- NSAIDs, K sparing diuretics, Digoxin.
- Caution in pts with diabetes!
-
Adverse effects of thiazides include:
- Hypokalemia
- Dehydration
- Hyperglycemia
- Hyperuricemia
-
Uses of thiazides include:
HTN and Edema
-
What is the action of a thiazide diuretic?
Blocks tha Na reabsorption in the DCT in the kidney by two mechanisms: reducing blood volume and by reducing the arterial resistance
-
What is an example of a Thiazide diuretic?
Hydrocholorthiazide, chlorthalidone
-
What are special considerations of Loop diuretics?
- Best time to take this med is in the morning
- Usually takes a K supplement with this because of the loss of K with the Na.
-
Medications that interfere with loop diuretics include:
- Digoxin
- Ototoxic drugs
- K sparing drugs
-
Loop diuretics must be cautioned in pts with:
Diabetes!
-
The adverse effects of loop diuretics include:
- Hypokalemia
- Dehydration
- Hyperglycemia
- Hyperuricemia
- Hearing Loss
-
What are the therapeutic uses for all diuretics?
- HTN
- Edema
- - CHF (primarity spironolactone)
|
|
