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80 Cards in this Set

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ACE Inhibitors
Lisinopril
Enalapril
Quinapril
Ramipril
Benazepril
Fosinopril
Captopril
ACE Inhibitor Indications
HTN
CHF
MI
Diabetic nephropathy
ACE Inhibitor MOA
Inhibit angiotensin converting enzyme (ACE) which normally converts inactive Angiotensin I to active Angiotensin II
What drug should not be taken with antacids or on an empty stomach?
Captopril (decreases absorption)
ACE Inhibitor time to effect
Onset 1h
Full Effect 2-4 Weeks
ACE Inhibitor Side Effects
Dry, non-productive cough
Angioedema
What is angioedema? TX?
Swelling of mouth, lips, tongue, glottal tissues
Could lead to anaphylaxis
Treat with antihistamine-call MD
ACE Inhibitor Cautions
Avoid potassium supplements (ACEI already have K+ sparing effects)
Pregnancy: D (injury and death to fetus)
Angiotensin II Receptor Antagonist Examples
Valsartan
Losartan
Irbesartan
Losartan Potassium/ HCTZ
Angiotensin II Receptor Antagonist Indications
HTN
CHF
Diabetic Nephropathy
Angiotensin II Receptor Antagonist MOA
Blocks Angiotensin II from binding to blood vessel walls and causing vasoconstriction
Angiotensin II Receptor Antagonist Time to Effect
Onset 2h
Full Effect 2-4 weeks
Angiotensin II Receptor Antagonist Side Effects
Headache
Angiotensin II Receptor Antagonist Cautions
Pregnancy Category C (1st trimester) Category D (2nd and 3rd)
Diuretic Examples
Hydrochlorothiazide- Thiazide diuretic
Furosemide- Loop diuretic
Sprinolactorne- Potassium-sparing diuretic
Triamterene w/ HCTZ- Potassium-sparing diuretic
Diuretic Indications
Edema (due to CHF)
HTN
Diuretic MOA
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)
Diuretic Urine Output Levels
3 Loop Diuretics
2 Thiazide Diuretics
1 Potassium-sparing Diuretics
Diuretic Administration
Take in AM (increases urination)
Diuretic Time to Effect
Onset 2h
Full Effect 2-3 weeks
Diuretic Side Effects
Fatigue
Weakness
Muscle Cramps
Hypotension
Diuretic Cautions
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
Beta-Blocker Examples
Atenolol
Metroprolol Tartate
Metroprolol Succinate
Carvedilol
Propranolol
Beta-Blocker Indications
HTN
CHF
MI
Angina Pectoris
Cardiac Arrhythmias
Anxiety and Migraine (off label)
Beta-Blocker MOA
Beta-1 adrenergic blocking agents will result in decreased heart rate, cardiac output and BP
Beta-Blocker Administration
With food
Beta-Blocker Time to Effect
Onset 1h
Full Effects 1-2 weeks
Beta-Blocker Side Effects
Bradycardia, HA, dizziness
Beta-Blocker Cautions
Do not discontinue suddenly
Pregnancy Category C
Avoid use in asthmatics (may cause attack), diabetics (may mask symptoms of hypoglycemia and tachycardia)
Calcium Channel Blocker Examples
Amlodipine
Verapamil
Diltiazem
Nifedipine
Calcium Channel Blocker Indications
Angina Pectoris
HTN
Cardiac Arrhythmias
Calcium Channel Blocker MOA
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
Calcium Channel Blocker Administration
Empty Stomach
Calcium Channel Blocker Time to Effect
Onset 1-2h
Full Effect 1-2 weeks
Calcium Channel Blocker Side Effects
Edema
Flushing
Dizziness
Calcium Channel Blocker Cautions
Avoid large quantities of grapefruit juice (inhibits metabolism of drug by decreasing liver enzymes needed to metabolize drug)

Preg Category C
Platelet Inhibitor Examples
Clopidogrel
Platelet Inhibitor Indications
Thrombotic Events: Px MI, stroke, PE (Pulmonary Embollus), DVT (Deep Vein Thrombosis)
Platelet Inhibitor MOA
Inhibits platelet aggregation by inhibiting ADP binding to its receptor
Platelet Inhibitor Administration
With or without food
Platelet Inhibitor Time to Effect
Onset 2h
Full Effect 3-7 Days
Platelet Inhibitor Side Effects
URI
Chest Pain
HA
Platelet Inhibitor Cautions
Preg Cat B
Increased risk of bleeding
Anticoagulant Examples
Warfarin
Anticoagulant Indications
PE (Tx and Px)
Venous Thrombosis (Tx and Px)
MI (Px after initial)
Anticoagulant MOA
Interferes with Vit K-dependent clotting factors- leads to decreased coagulation and clotting
Anticoagulant Administration
Keep Vit K intake consistent
Anticoagulant Time to Effect
Onset 24h
Anticoagulant Side Effects
Bleeding
Bruising
Anticoagulant Key Counseling Points
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)
Anticoagulant Cautions
Preg Cat X
Not for use by hemophiliacs, pts with hepatic or renal impairment
Antiadrenergic Examples
Clonidine
Antiadrenergic Indications
HTN
Antiadrenergic MOA
Stimulates central alpha-adrenergic receptors to inhibit bulbar sympathetic cardioaccelerator and sympathetic vasoconstrictor centers (decrease peripheral resistance, heart rate, and BP)
Antiadrenergic Administration
Take with food or milk twice a day
(Change skin site with each placement of transdermal patch q7d)
Antiadrenergic Time to Effect
Onset 30-60 min
BP full effect 2-4h, Stablized in 1 week
Antiadrenergic Side Effects
Dry mouth
Dizzy
HA
Constipation
Fatigue
Antiadrenergic Cautions
Do not discontinue suddenly (rebound)
Avoid decongestants
Preg Cat C
Nitrate Examples
Nitroglycerin
Isosorbide Mononitrate Isosorbide Dinitrate
Nitrate Indications
Angina Pectoris
Nitrate MOA
Reduction of myocardial oxygen demand through relaxation of vascular smooth muscle - allows more efficient blood flow through myocardium (vasiodilation in heart)
Nitrate Acute Administration
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
Nitrate Time to Effect
Onset 1-3 min
Nitrate Side Effects
HA
N/V
Dizziness
Flushing
How should patients store Nitrates?
Keep SL tabs in original bottle
Why do patients need to take patch off at night?
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
Nitrate Cautions
Preg Category B/C
Do not use with Viagra, Cialis, Levitra - danger of extreme hypotension
Alpha-Blocker Examples
Doxazosin
Terazosin
Alpha-Blocker Indications
HTN,
Benign Prostate Hyperplasia (BPH)
Alpha-Blocker MOA
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
Alpha-Blocker Administration
Take at night - hypotension (first-dose effect)
Alpha-Blocker Time to Effect
HTN: 2-3h
BPH: 4-6 weeks
Alpha-Blocker Side Effects
Hypotension (dizzy, drowsy, light headed, HA)
Syncope (fainting)-especially at beginning of therapy
Alpha-Blocker Cautions
Preg Cat C
Screen for prostate cancer first (BPH can be a misdiagnosis of cancer)
Antiarrythmic Examples
Digoxin
Antiarrythmic Indications
CHF
cardiac arrhythmias
Antiarrythmic MOA
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)
Antiarrythmic Time to Effect
1-2h
Antiarrythmic Side Effects
Anorexia
N/V
HA
Bradycardia
Antiarrythmic Cautions
-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