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80 Cards in this Set
- Front
- Back
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ACE Inhibitors
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Lisinopril
Enalapril Quinapril Ramipril Benazepril Fosinopril Captopril |
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ACE Inhibitor Indications
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HTN
CHF MI Diabetic nephropathy |
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ACE Inhibitor MOA
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Inhibit angiotensin converting enzyme (ACE) which normally converts inactive Angiotensin I to active Angiotensin II
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What drug should not be taken with antacids or on an empty stomach?
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Captopril (decreases absorption)
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ACE Inhibitor time to effect
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Onset 1h
Full Effect 2-4 Weeks |
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ACE Inhibitor Side Effects
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Dry, non-productive cough
Angioedema |
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What is angioedema? TX?
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Swelling of mouth, lips, tongue, glottal tissues
Could lead to anaphylaxis Treat with antihistamine-call MD |
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ACE Inhibitor Cautions
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Avoid potassium supplements (ACEI already have K+ sparing effects)
Pregnancy: D (injury and death to fetus) |
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Angiotensin II Receptor Antagonist Examples
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Valsartan
Losartan Irbesartan Losartan Potassium/ HCTZ |
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Angiotensin II Receptor Antagonist Indications
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HTN
CHF Diabetic Nephropathy |
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Angiotensin II Receptor Antagonist MOA
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Blocks Angiotensin II from binding to blood vessel walls and causing vasoconstriction
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Angiotensin II Receptor Antagonist Time to Effect
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Onset 2h
Full Effect 2-4 weeks |
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Angiotensin II Receptor Antagonist Side Effects
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Headache
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Angiotensin II Receptor Antagonist Cautions
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Pregnancy Category C (1st trimester) Category D (2nd and 3rd)
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Diuretic Examples
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Hydrochlorothiazide- Thiazide diuretic
Furosemide- Loop diuretic Sprinolactorne- Potassium-sparing diuretic Triamterene w/ HCTZ- Potassium-sparing diuretic |
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Diuretic Indications
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Edema (due to CHF)
HTN |
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Diuretic MOA
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Decreases water retention by increasing excretion of Na+, K+, Cl-, Mg2+, Ca2+: decrease in fluid leads to decrease in cardiac output and BP (also increase urine output)
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Diuretic Urine Output Levels
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3 Loop Diuretics
2 Thiazide Diuretics 1 Potassium-sparing Diuretics |
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Diuretic Administration
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Take in AM (increases urination)
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Diuretic Time to Effect
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Onset 2h
Full Effect 2-3 weeks |
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Diuretic Side Effects
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Fatigue
Weakness Muscle Cramps Hypotension |
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Diuretic Cautions
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HCTZ in lots of meds - beware of duplications
Monitor electrolyte and fluid impalances periodically May take K+ supplement Pregnancy Category B Not for impaired renal function pts |
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Beta-Blocker Examples
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Atenolol
Metroprolol Tartate Metroprolol Succinate Carvedilol Propranolol |
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Beta-Blocker Indications
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HTN
CHF MI Angina Pectoris Cardiac Arrhythmias Anxiety and Migraine (off label) |
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Beta-Blocker MOA
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Beta-1 adrenergic blocking agents will result in decreased heart rate, cardiac output and BP
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Beta-Blocker Administration
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With food
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Beta-Blocker Time to Effect
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Onset 1h
Full Effects 1-2 weeks |
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Beta-Blocker Side Effects
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Bradycardia, HA, dizziness
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Beta-Blocker Cautions
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Do not discontinue suddenly
Pregnancy Category C Avoid use in asthmatics (may cause attack), diabetics (may mask symptoms of hypoglycemia and tachycardia) |
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Calcium Channel Blocker Examples
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Amlodipine
Verapamil Diltiazem Nifedipine |
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Calcium Channel Blocker Indications
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Angina Pectoris
HTN Cardiac Arrhythmias |
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Calcium Channel Blocker MOA
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Inhibits th influx of calcium ions over cellular membranes resulting in dilation of coronary arteries and arterioles, inhibition of coronary spasms, decrease in BP, decrease in peripheral resistance
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Calcium Channel Blocker Administration
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Empty Stomach
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Calcium Channel Blocker Time to Effect
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Onset 1-2h
Full Effect 1-2 weeks |
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Calcium Channel Blocker Side Effects
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Edema
Flushing Dizziness |
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Calcium Channel Blocker Cautions
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Avoid large quantities of grapefruit juice (inhibits metabolism of drug by decreasing liver enzymes needed to metabolize drug)
Preg Category C |
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Platelet Inhibitor Examples
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Clopidogrel
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Platelet Inhibitor Indications
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Thrombotic Events: Px MI, stroke, PE (Pulmonary Embollus), DVT (Deep Vein Thrombosis)
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Platelet Inhibitor MOA
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Inhibits platelet aggregation by inhibiting ADP binding to its receptor
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Platelet Inhibitor Administration
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With or without food
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Platelet Inhibitor Time to Effect
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Onset 2h
Full Effect 3-7 Days |
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Platelet Inhibitor Side Effects
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URI
Chest Pain HA |
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Platelet Inhibitor Cautions
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Preg Cat B
Increased risk of bleeding |
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Anticoagulant Examples
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Warfarin
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Anticoagulant Indications
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PE (Tx and Px)
Venous Thrombosis (Tx and Px) MI (Px after initial) |
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Anticoagulant MOA
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Interferes with Vit K-dependent clotting factors- leads to decreased coagulation and clotting
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Anticoagulant Administration
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Keep Vit K intake consistent
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Anticoagulant Time to Effect
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Onset 24h
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Anticoagulant Side Effects
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Bleeding
Bruising |
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Anticoagulant Key Counseling Points
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1. Do not stop immediatly (rebound bleeding)
2. Narrow therapeutic index (need to monitor clotting times) 3. Many drug interactions - use APAP for pain relief (no ASA or NSAIDS) |
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Anticoagulant Cautions
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Preg Cat X
Not for use by hemophiliacs, pts with hepatic or renal impairment |
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Antiadrenergic Examples
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Clonidine
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Antiadrenergic Indications
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HTN
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Antiadrenergic MOA
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Stimulates central alpha-adrenergic receptors to inhibit bulbar sympathetic cardioaccelerator and sympathetic vasoconstrictor centers (decrease peripheral resistance, heart rate, and BP)
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Antiadrenergic Administration
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Take with food or milk twice a day
(Change skin site with each placement of transdermal patch q7d) |
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Antiadrenergic Time to Effect
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Onset 30-60 min
BP full effect 2-4h, Stablized in 1 week |
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Antiadrenergic Side Effects
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Dry mouth
Dizzy HA Constipation Fatigue |
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Antiadrenergic Cautions
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Do not discontinue suddenly (rebound)
Avoid decongestants Preg Cat C |
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Nitrate Examples
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Nitroglycerin
Isosorbide Mononitrate Isosorbide Dinitrate |
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Nitrate Indications
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Angina Pectoris
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Nitrate MOA
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Reduction of myocardial oxygen demand through relaxation of vascular smooth muscle - allows more efficient blood flow through myocardium (vasiodilation in heart)
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Nitrate Acute Administration
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Place 1 SL tablet under tongue at onset of chest pain, repeat after 5 minutes if pain persists. After 3 doses, if symptoms persist, call 911
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Nitrate Time to Effect
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Onset 1-3 min
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Nitrate Side Effects
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HA
N/V Dizziness Flushing |
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How should patients store Nitrates?
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Keep SL tabs in original bottle
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Why do patients need to take patch off at night?
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Need a "nitro vaction." It's a pro-drug the liver converts to an active drug - Use up liver enzymes needed if worn all the time -
Need 10-12 hours off patch to make new enzyme |
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Nitrate Cautions
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Preg Category B/C
Do not use with Viagra, Cialis, Levitra - danger of extreme hypotension |
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Alpha-Blocker Examples
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Doxazosin
Terazosin |
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Alpha-Blocker Indications
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HTN,
Benign Prostate Hyperplasia (BPH) |
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Alpha-Blocker MOA
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Selectively blocks alpha-1 adrenergic receptors to cause
1. reduction in systemic vascular resistance (decrease in BP) 2. decrease in muscle tension around bladder neck and prostate to allow increased urine flow |
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Alpha-Blocker Administration
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Take at night - hypotension (first-dose effect)
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Alpha-Blocker Time to Effect
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HTN: 2-3h
BPH: 4-6 weeks |
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Alpha-Blocker Side Effects
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Hypotension (dizzy, drowsy, light headed, HA)
Syncope (fainting)-especially at beginning of therapy |
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Alpha-Blocker Cautions
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Preg Cat C
Screen for prostate cancer first (BPH can be a misdiagnosis of cancer) |
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Antiarrythmic Examples
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Digoxin
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Antiarrythmic Indications
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CHF
cardiac arrhythmias |
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Antiarrythmic MOA
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Inhibits Na+/K+ pump leading to depolarization and an influx of Ca2+ causing an increase in the force and velocity of systolic contractions, a slowing of the heart rate, and a decreased conduction velocity through the AV node (normalized the heart beat)
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Antiarrythmic Time to Effect
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1-2h
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Antiarrythmic Side Effects
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Anorexia
N/V HA Bradycardia |
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Antiarrythmic Cautions
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-Many drug interactions (no cough or cold meds, antacids, laxatives or antidiarrheals
-Do not stop immediately -Narrow therapeutic index: need to monitor blood levels- Toxicity: "halo effect", blurred vision- Older patients who have been on the same dose for many years may develop toxicity problems as their renal function declines -Preg Cat C |
