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89 Cards in this Set
- Front
- Back
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Nurses responsibilites
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1. administer drugs
2. asses drug effects 3. interventions to make drug regimen more tolerable/effective 4. client/ family teaching 5. policies, procedures, laws |
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Framework of Drug Information requires knowledge of...
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1. anatomy, physiology & pathophysiology
2. drug standards/guidelines 3. major drug categories 4. client as unique human being with consideration for holistic nature |
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Plant/ Herbal products
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1. codeine and morphine (poppy seed plant)
2. digitalis products (foxglove) 3. alfalfa: arthritis pain- topical or oral 4. aloe: burns & wounds- topical 5. ginger: nausea/ motion sickness 6. ginkgo: cognitive functioning- vasodilator: increase blood flow to brain, not used with aspirin |
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Animal sources
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1. insulin: pancreas of cows & pigs
2. thyroid drugs: thyroid & hypothalamus tissue 3. growth hormones |
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Inorganic compounds
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1. aluminum: antacid- gastric acidity
2. flouride: dental cavities & osteoporosis 3. iron: anemias 4. gold: rheumatoid arthritis |
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Synthetic sources
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1. patterned after drugs made from plants/animals
2. production of chemicals that are therapeutic 3. enhance effectiveness example: Marional (comes from marijuana for cancer patients, nausea and appitite) |
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Preclinical Trials
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- tested on lab animals
- determine if presumed effects exist - evaluate adverse effects |
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Reasons for drugs being discarded- Preclinical trials
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1. lack therapeutic activity
2. too toxic 3. highly teratogenic 4. small safety margins |
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Phase 1 Studies
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- healthy human volunteers
- emphasis on safety - tightly controlled -special concerns women, minorities, and children |
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Reasons drugs are discarded- Phase 1 studies
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1. lack therapeutic effects
2. adverse effects unaccept. 3. highly teratogenic 4. too toxic |
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Phase 2 Studies
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- drugs tried in patients who have the disease the drug is meant to treat
- informed benefits & risks - emphasis on effectiveness |
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Reason for drug discard- Phase 2 studies
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1. less effective than anticipated
2. too toxic 3. unaccept. adverse effects 4. low benefit to risk ratio 5. no more effective than similar drugs |
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Phase 3 Studies
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- used in vast clinical market
- 5 to 6 years or longer - info collected and provided to drug comp. and FDA -widely used, unexpected adverse effects may occur |
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Phase 4 Ongoing Evaluation
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-prescribers expect to report unexpected effects to FDA
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Nurse's role in drug approval
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1. informed concent (literacy level, glasses, hearing)
2. administering drugs in clinical phases 3. client/family teaching 4. can work for FDA 5. research 6. help clients find trials |
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Generic name
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original destination drug was given when the company applied for approval process
(acetaminophen) |
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Brand (trade) name
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approved drug given a name by pharmaceutical company who developed it
(Tylenol) |
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Chemical name
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name that reflect the chemical structure of the drug
(n-acetyl-para-aminophenol) |
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Federal Food, Drug, and Cosmetic Act
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mandates tests for drug toxicity, means for drug recall, gave FDA enforcement power
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Durham-Humphrey Amendment
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tightened control of certain drugs, certain drugs needed to be labeled & need prescription to be distributed
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Kafauver-Harris Act
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tightened control over quality of drugs
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Controlled Substance Act
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defined drug abuse, classified with potenital risk for abuse
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Orphan Drug Act
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drugs that have been discovered but not finanically viable b/c they have limited market or narrow margin. provided company w/ incentives
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OTC drugs
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- previously a prescription
- drugs used so long w/o adverse effects - OTC can: 1. mask signs and symptoms 2. drug interactions: interfere w/ drug therapy 3. serious overdoses |
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Pharmacodynamics
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how drugs affect the body
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Pharmacokinetics
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how body acts to the drug
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Drug Actions of pharmacodynamics
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-replace or substitute missing chemicals (insulin)
-increase or stimulate: certain cellular activities -depress or slow: cellular activities, discharges in central nervous system -interfere w/ fuction of foreign cells: invading microorganisms |
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Agonist
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drugs that interact directly w/ receptor sites to cause same activity that natural chemicals would at this site, stimulate receptor
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Antagonist
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acts to prevent breakdown of natural chemicals stimulating receptor sites, bind to receptor & prevent response from occuring
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Selective Toxicity
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-ability of drug to attack
- attack systems only found in foreign cells (penicillin-bacteria) -anti-neoplasms (cancer cells-bone marrow, hair, gi cells) |
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Passive transport- pharmacokinetics
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-diffusion
-major way drugs absorb in body -high concentration to low -no cellular energy required |
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Active transport
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-process uses energy to move molecule across cell membrane
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Filtration
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-movement through pores in cell membrane
- down concentration gradient - result of pulling of plasma proteins |
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Factors to consider
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1. route of administration
2. timing 3. critical concentration: amount of drug needed for therapeutic effects 4. half-life: time it takes for amt. of drug to decrease 1/2 of peak level |
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Absorption- Oral administration
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-most frequent used route
-non-invasive -less expensive -safest -barriers: acid, food, pathology (previous illness effect absorption of meds) |
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Factors affecting absorption
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1. perfusion: of blood to area
2. fat content: subcut. tissue 3. temp: of muscle/tissue (vasoconstriction= warm; vasodilation= cold) 4. first-pass effect: breakdown of drug in liver immediately after absorption |
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Factors affecting distribution
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1. lipid solubility: many drugs bound w/ protein & lipid soluble
2. perfusion of area: decreased blood flow to effected areas 3. cardiac output 4. binding to plasma proteins |
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Factors influencing body's response to a drug
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-weight
-age -gender -physiological -pathological: different diseases, g.i., BP -genetic: lack enzymes for metabolizing -immunological: allergies -psychological:attitude |
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Factors influencing body's response to a drug cont.
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-environment: light, temp, noise
-tolerance -cumulation: excessive doses, accumulation, toxicity -drug to drug: 2 drugs adverse effects on each other -drug to food -drug to lab tests: some drugs alter lab results |
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Nurse's role on toxic effects of drugs
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-anticipate
-prevent -assess: sign/symptoms -document: baseline vitals for any changes |
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Primary adverse effects
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-an extension of drug's desired effect
-most common -result of simple overdose -diuretic=electrolyte imbalance |
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Secondary adverse effects
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-wide variety of effects in addition to what is desired
-antihistamine aids in breating, can cause drowsniness, can't drive on it |
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Hypersensitivity adverse effects
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-excessive response to primary & secondary effects
-allergic reactions -toxic effects if can't secrete |
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Anaphylactic reaction
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-antibody reacts w/ site
-histamine released -swelling, bronchospasms, repiratory stress |
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Stomatitis
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inflammation of mucous membranes, swollen gums and tongue
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Superinfections
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several kinds of drugs that disturb normal flora of body, usually controlled by organisms (fever, diarrhea, black hairy tongue)
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Blood dyscrasia
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bone marrow supression by drug effects, cell death occurs (fever, sore throat, low BCC)
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Drug Induced Tissue and Organ Damage
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1. alterations in glucose metabolism- hypo/hyperglycemia
2. electrolyte imbalance: low potassium levels increase= slow HR, cramps decrease= low BP & urine output 3. neurological effects 4. g.i. disturbances 5. teratogenicity |
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Antibiotics
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bacterial infections
(penicillin, sulfonamides) |
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Antivirals
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prevent & treat influenza, herpes, HIV, and AIDS
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Antifungals
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range from athlete's foot to life-threatening mycosil (fungus) infections
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Antoprotozols
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include anti-maleria drugs
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Anthelmintics
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treat local and systemic infections (helminthes=worms)
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Aminoglycosides
(major classes of antibiotics) |
powerful antibiotics used to treat serious infections (gentamycin, streptomycin)
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Fluroquinolones
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(cipro) relatively new, broad spectrum, made synthetically, mild adverse drug affects
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Marcolides
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penicillin allergies
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Penicillins
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first antibiotic used for clinical use
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Sulfonamides & Tetracylcines
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not commonly used, widespread resistance
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Hypersensitivity reactions
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past reactions (rash, hives, couldn't breathe)
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Superinfections
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destruction of normal flora that invades tissue
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Nephrotoxicity
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kidney damage, frequently w/drugs metabolized in renals
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GI Toxicity
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nausea, vomitting, diarrhea, upset stomach
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Neurotoxicity
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damage to nerve tissue, 8th cranial nerve- most common damage, dizziness, loss of hearing
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Corticosteroids
(anti-inflammatory agents) |
block inflammatory & immune systems, used topically to produce a local anti-inflammatory effect w/o adverse effects
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Antihistamines
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block release of histamine in initiation of inflammatory response
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Salicylates
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-blocks inflammatory response
-fever & pain reducer -inhibits synthesis of prostaglandins -acts on hypothalamus -inhibits platelet aggrevation -produces analegesic effect (mild-moderate pain) |
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Salicylates
pharmacokinetics & cautions |
-readily absorbed in stomach
-crosses placenta/ breastmilk -bleeding abnorm.= platelet (prevent strokes, MI's) -upcoming surgeries (bleeding) -pregnancy -impaired renal function |
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Salicylates
adverse effects |
1. G.I. (nausea, heartburn..)
2. bleeding 3. cultural (blacks have decreased sensitivity to pain, increased doses) 4. salicylism: dizziness, ringing in ears, confusion 5. hypernea: labored rapid breathing, tachypnea |
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Non-steriodal anti-inflammatory drugs
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-most common (ibuprofin)
- doesn't prevent strokes, MI -readily available in G.I. -metabolized in liver -excreted in urine -in breastmilk |
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Non-steriodal anti-inflammatory drugs
cautions |
1.allergy to salicyates
2. cardiovascular, hypertension, peptic ulcers 3. g.i. bleeds 4. pregnancy 5. renal function |
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Acetaminophen
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-pain and fever
-readily absorbed in g.i tract -metabolized in liver -excreted in urine -crosses placenta/breastmilk |
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Acetaminophen cautions
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-allergy to acetaminophen
-pregnancy -chronic alcoholism -hepatic dysfunction |
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Cardiovascular disease
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-includes all conditions affecting heart & blood vessels
- #1 cause of death in US -peripheral vascular disease, coronary artery disease, etc. |
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Hyptertension
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-high BP, more than 2 readings
-most common cardiovascular -blacks highest rate -#1 killer of women |
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Prehypertension
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120-139 /
80-89 |
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Stage 1 hypertension
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140-159 /
90-99 |
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Stage 2 hypertension
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160 or above /
100 or above |
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Blood pressure control
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1. heart rate
2. stroke volume (amount of blood pumped out of ventricle w/ each heart beat) 3. total peripheral resistance: resistance to muscular arteries to blood being pumped through |
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Step 1: Lifestyle modifications
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-weight reduction
-smoking cessation -moderate alcohol intake -reduction of salt in diet -increase physical activity |
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Step 2: Inadequate response
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-continue lifestyle modifications
-medication initiated: 1. diuretic or beta blocker: decrase sodium, HR 2. ACE inhibitor, calcium channel blocker |
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Step 3: Inadequate response
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-increase drug dose
-substitute another drug -add 2nd drug from another class |
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Step 4: Inadequate response
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-add 2nd or 3rd agent or diuretic
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Calcium channel blockers
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-prevent calcium into cardiac and smooth muscle cells
-interferes with cell's ability to contracts leading to loss of smooth muscle -vasodilation -decreased peripheral resistance (decrease BP, cardiac workload, mycardial oxygen consumption) |
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ACE inhibitors
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-block conversion of angiotension I to angiotension II
-decreased BP, aldosterone secretion, serum sodium & flud -increases serum potassium |
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Vasodilators
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-emergency, life-threatening hypertension
-relaxation of vascular smooth muscle - decreased BP, peripheral resistance -oral renin inhibitors |
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Calcium channel blockers adverse effects
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-headache
-anxiety -g.i. disturbances -bradycardia: slow HR |
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ACE inhibitors adverse effects
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-nausea/ vomitting
-change in taste perception -dry persistant cough |
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Vasodilators adverse effects
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-hypotension
-orthostatic hypotension -dizziness -fatigue |
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Thromboembolic disorders
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-decreased blood flow or total occlusion of the blood vessel
-predispose to the formation of clots -example: CAD (narrowing of coronary arteries caused by damage to the epithelial lining in these vessels) |
