Lasix is the most common Loop Diuretic, what are its pharmacokinetics?
PO, IV, or IM.IV is for critical situationsHepatic 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 medsViagraBeta 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 POgiven 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 tachycardiaDiuretics prevent Na and water retension and expansion of BVBP meds will intensifyAntihypertensive meds need monitoring
What are some adverse effects of Hydralazine?
Reflex TachycardiaIncrease of Blood volumeHeadacheDizzinessLupus-like syndromeFatigue
What is Hydralazine use for:
HTNHypertensive crisis *first drug of choice for emergencyHF
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:
AsthmaDiabetes (caution- can mask the signs of hypoglycemia)Sick sinus syndromeHFCOPDor 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 conductionBlockade of B2 cells promotes Vasoconstriction. Common side effects: insomniadepressionbizarre dreamssexual disfunctiondizziness
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?
PropranololMetoprololAntenolol
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 BPand Administer this med on an empty stomach.
What are the therapeutic uses of Calcium Channel Blockers?
Cardiac DysrhthmiasAngina PectorisEssential HypertensionSometimes Migranes
What are the adverse effects of Diltiazem?
Dizzinessflushingexacerbation of cardiac dysfunctionsick sinus syndromeHFLess constipation than verapamil
What are the adverse effects of Verapamil?
Facial FlushingheadachedizzinessEdema of the feet and anklesConstipation
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?
AngioedemaFetal HarmRenal Failure
What are the therapeutic uses of ARBs?
HTNHFNephropathyMIStroke prevention
What are some examples of ARB medications?
ValsartanCandesartanIrbesartanOlmeasartanIosartan
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?
HTNHFL Ventricular dysfunctionNephropathyMIPrevention 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 coughHyperkalemiaRenal FailureAngioedemaFirst 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?
LotensinEnalaprilEnalaprilatCatoprilLisinoprilMoexiprol
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 womenNOT 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:
BleedingAntibody production causing allergy or neutralization to medhypotensionfever
Streptokinase uses:
Acute MIDVTMassive 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:
headachediarrheapreipheral 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 adverse effects:
NeutropeneaTTPGI upset
Ticlid (ticlopidine) , an antiplatelet drug, works similar to which other antiplatelet drug?
Plavix
Plavix medication interactions and side effects:
Side effects: GI, same as aspirinInteractions: 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 bleedingPeptic ulcer diseaseIncreased risk of hemmorrhagic stroke
Aspirin uses:
CAD- to keep injured vessel from clotting upMIChronci 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:
AspirinPlavixTiclidPletal
Special implimentations when taking warfarin:
monitor INR, PT< and CBCFor Atrial fibrilation or stroke- pts INR should be 2-3For valve replacement INR shoud be 2.5-3.5
Interactions with Warfarin include:
NSAIDsSulfa drugsHeparinBactrimVitamin KContraceptives
Warfarin uses include:
Long term prophylaxis of thrombosisDVTATRIAL FIBRILATIONpulmonary embolismreduces 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 surgeryprevention of ischemic complication swith unstable anginaprophylaxis
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 ofLow platelet countlumbar puncturebleeding disorders
Interactions with Heparin:
Protamin Sulfate- antidote for overdoseNSAIDs - promotion of bleedingDepakeneThrombolytics
Adverse effects of Heparin:
HemmorrhageHaparin induced thrombocytopeniaHypersensitivity rxnsLong term treatment can cause osteoporosis
Heparin Uses:
can be used during pregnancy- (preferred) Pulmonary edemaDVTrenal dyalisisAcute MIVenous thrombosis (post-op)
Heparin pharmacokinetics:
IV (fast) or SubQ- NO POhepatic 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:
HeparinEnoxaparin (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:
myopathyHepatitisPancreatitisThrombocytopeniaNOT 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 bleedingStatins- increase risk of myopathy
What can high tryglyceride levels cause damage to?
The Pancreas
What are adverse effects of Fibrates?
RashGI upstetGall stonesmyopathyliver injury
What are the therapeutic uses of Fibrates?
High trygliceride levlesNeeding 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 damageConsult Dr. before taking with STATINS
What are some adverse effects of Niacin?
Bodily flushingItchingGI upsetGoutyArthrits
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 diureticsDigoxinWarfarinSome antibioticsGRAPEFRUIT, and other gas producing foodsAntacids
What are some adverse effects of Bile sequestrants?
GASconstipationbloatingindegestiondecrease in uptake of fat-soluble vitamins
Bile sequestrant uses:
Treats Hypercholesterolemia in conjuction with diet and exercise
Bile acid sequestrant pharmacokinetics:
Works only in INTESTINEexcreted through kidneysCan 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 labswatch for signs of muscle painwatch LDL levels- normal <120, if chronically ill pt can be <100Teaching: omega 3, fish, exercise, diet
HMGCOA adverse effects:
NOT for pregnanty womenHepatoxicMuscle Myopathy/RhabdomyolysisKidney FailureCrampsConstipation
Uses of HMGCOA's include:
HyperlipidemiaHypercholesterolemiaCADMI
Pharmacokinetics of HMGCOAs?
PO, take at night because liver produces cholesterol thenMetabolized 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?
ZocorLipitor
What are the 5 types of cholesterol reducing drugs?
HMG-CoA inhibitorsBile Acid SequestrantsNicotinic AcidFibratesEzetimibe
What do you watch for as a nurse with a pt taking digoxin?
Watch HR, and level of drug closelyLabs- the OPTIMAL RANGE IS: 0.5-0.8
What meds interact with Digoxin?
Thiazides, and loop diureticsACE inhibitorsARBsSympathomimetics- act on heart ot increase force of contractionQuinidine- this is an anti dysrhythmic that can cause increased digoxin levelsVERAPAMIL- can significantly increase plasma levles- could also counter act the benefits
What are the adverse effects of Digoxin?
Decreased sypathetic toneIncreased urine productiondecreased renin release causing decreased blood volumeventricular fibvisual disterbancesnausea/vomittingfatiuge
What are the pharmacokinetics of Digoxin?
PO- meals high in bran can decrease absorptionDistributed widely and across placentaExcretion 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 InhibitorsARBsAldosterone 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:
HypokalemiaDehydrationHyperglycemiaHyperuricemia
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 morningUsually takes a K supplement with this because of the loss of K with the Na.
Medications that interfere with loop diuretics include:
DigoxinOtotoxic drugsK sparing drugs
Loop diuretics must be cautioned in pts with:
Diabetes!
The adverse effects of loop diuretics include:
HypokalemiaDehydrationHyperglycemiaHyperuricemiaHearing Loss
What are the therapeutic uses for all diuretics?
HTNEdema- CHF (primarity spironolactone)