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96 Cards in this Set

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Factors stimulating release of renin
Decreased blood pressure or sodium level, B-adrenergic agonists, hypokalemia
Physiological effects of renin
Increased BP, positive chronotropic and inotropic, vasoconstriction, incr. release of NE, aldosterone, and stimulation of CNS for thirst
Indications for ACE inhibitors
Tx of mild to moder. htn, vasodilation to treat moderate to severe CHF
Contraindications and s/e of ACE inhibitors
C/I in renal pts.
S/E: hyperkalemia, hypersensitivity, first-dose effect (rapid BP fall)
Nursing implications w/ ACE inhibitors
Monitor BP before and after dose, K levels, incr. HR, change positions slowly, teach orthostatic hypotn, clear throat feeling r/t incr. secretions in throat, best to take on empty stomach, take at same time (AM) qd
ACE inhibitor prototype
captopril (Capoten)
Why give ACE inhibitors w/ diuretics?
Better control of htn and K levels
Angiotensin II Receptor Antagonists
(ARBs)anti-htn, prevents vasoconstriction and fluidretention, does NOT cause chronic cough that ACE inhibitors cause
ARB prototype
losartan (Cozaar)
Extra kidney functions
Produce erythropoietin, renin, prostaglandins, involved in synthesis of Vit. D (absorbs Ca)
Thiazides
incr. Na and H2O excretion at early distal tubules, give with meals to prevent GI irritation.
Prototype for Thiazides
hydrochlorothiazide (hydrodiuril)
S/E of thiazides
hyponatremia, hypovolemia, hypokalemia, HYPERglycemia (dilutional), photosensitivity
Loop diuretics mechanism of action
Inhibit reabsorption of Na and Cl in proximal and distal tubules but mainly in LOOP, can be given IV
Loop diuretic prototype
furosemide (Lasix)
Side effects of loop diuretics
Same as all diuretics, OTOTOXICITY
Potassium sparing diuretics and prototype
Can be given concurrently w/ other diuretics to counteract K loss
Prototype: triamterene (Dyrenium)
Action of K-sparing diuretics
Inhibit Na ion pumps in distal tubule for Na reabsorption
S/E of K-sparing diuretics
Hyperkalemia
Osmotic diuretics
low molecular weight substances that increase plasma osmolarity, glomerular filtration, and tubular fluid retention by remaining in high concentrations in renal tubules. (work in proximal tubule) Inhibits reabsorption
Indications of osmotic diuretics
tx glaucoma, ARF, reduction of increased introaocular pressure (before or after surgery), cerebral swelling w/ trauma
Osmotic diuretic prototype
mannitol (Osmitrol)
Carbonic anhydrase inhibitors action
inhibits carbonic anhydrase->inhibits bicarb reabsorption which alkalizes urine and acidifies blood
Indications for carbonic anhydrase inhibitors
adjunct tx for glaucoma, hydrocephalus, petit mal seizures, tx OD of acidic based drugs like ASA or phenobarbital
S/E and nursing interventions for carbonic anhydrase inhibitors
s/e: hyponatremia, hypokalemia, hypovolemia, METABOLIC ACIDOSIS
Interventions: I&O, daily weights, labs, BP, dizziness, syncope, same time qd (in am)
Prototype for carbonic anhydrase inhibitors
acetazolamide (Diamox)
Causes of essential htn
Heredity, high sodium diet, smoking, type a personality, stress, hx of atherosclerosis
Causes of secondary htn
Pheochromocytoma (tumor of adrenal medulla)
Coarctation of aorta
Cold medications increase BP because...
increasing vasoconstriction to open nasal airway
Prototype for B-blockers
Inderal
Action of Inderal
1. Decrease peripheral resistance
2. Decreases renin activity
3. Resets sensitivity of baroreceptors
C/I for B-Blockers
Cardiac failure, bradycardia, AV conduct. distrubance, Asthma, COPD, diabetics (exacerbates hypoglycemia)
Centrally acting alpha adrenergic agonists mechanisms of action
Work in CNS to lower BP (decr. SNS outflow from brain to CV system). Inhibits cardioacceleration and vasoconstriction centers
Prototype for Centrally acting alpha adrenergic agonist
Catapres (clonidine)
Nursing measures for clonidine
Bradycardia, fatigue, depression. Take at night
Peripherally acting selective A-adrenergic blockers mechanism of action
Selectively block a-adrenergic receptors (postsynaptic) in peripheral vasculature->vasodilation
S/E of peripherally acting selective A-adrenergic blockers
Reflex action causes + chronotropic and inotropic, inc. renin activity (give w/ B-blocker)
Direct acting vasodilators mechanism of action
Directly dilate the arterioles w/out affecting the SNS or adrenergic receptors on smooth muscle cells. Can trigger reflex tachycardia and incr. renin. May require B-blockers
Examples of direct acting vasodilators
hydralazine (Apresoline) and nitroprusside (Nipride)
Nursing interventions w/ hydralazine
Arteriole dilatore, used more for long-term htn mgt. IV or PO, watch for LUPUS and NEURITIS
Nursing interventions w/ Nipride
Arteriole AND veinous dilator, used in ER for sever htn (200/100). Only IV, potent dilator, short durations, thiocyanide is byproduct, given as a continuous drip (not push). Light sensitive
Class of drugs that abolishes unidirectional blocks
Group 1B
Class of drugs that produces bidirectional block
Group 1A, 2, and 4
Class 1A Mechanism of action and example
quinidine (Quinaglute). Given for afib and atrial flutter (superventricular arrhythmias). Slows rate of depolarization, prolongs refractory period
Interventions w/ quinidine
v.s., listen to heart sounds, PO w/o food, IV over 30-60 min.
S/E tinnitus, dizziness, visual disturbances, double vision, diarrhea, n/v
Class 1B Mechanism of Action and example
Example: lidocaine (Xylocaine)
Abolishes unidirectional block (gets impulse through the jello), used for ventricular arrhythmias,
Nursing interventions for class 1B drugs
Give initial IV bolus, then continuous drip on pump, monitor for extravasation, depresses CNS->drowsiness, confusion, hypotn R/T vasodilation
Class 2 Drugs Mechanism of action and example
propranolol (Inderal)

*B-adrenergic blockers. inhibits sympathetic stim. of heart. Tx supraventricular arrhythmias
Class 3 Mechanism of action and example
amiodarone (Cardarone) Blocks K channels->prolonged refractory, vert. arrythmias, use if pt. can't cardiovert, can be proarrhythmic
Class 4 mechanism of Action and example
verapamil (Calan)

Ca channel blocker, prolongs refractory period->depresses myocardium, vasodilation.
Tx: supraventricular arrhythmnias, htn
Nursing interventions for Class 4 drugs
S/E include constipation, hypotn, syncope, and ortho. hypotn.
K removing resins mechanism of action and example
poystyrene sulfonate (Kayexalate)

Bind w/ K (which causes arrhythmias), given orally or as enema. Used when hyperkalemia causing arrhythmias.
S/E: SEVERE DIARRHEA
Organic nitrates mechanism of action
Directly relax vascular smooth muscle, affect both arterial and venous tone->decr. preload->decr. BP->reflex tachycardia. Used to treat angina and CHF
Nursing interventions for Nitro
S/E: ha, then hypotn, bu;rning @ area of application, reflex tachycardia
SL: keep under tongue, if doesn't work in 5 min., use another, up to three. Keep in BROWN JAR, air decomposes drug. Change q6mos.
TD: put one on, take one off, non-hairy area, on in am off at hs
IV: glass bottle, use pump, monitor v.s., rate based on BP titration
Cardiac glycosides action and example
Digoxin
Act through the inhibition of ATPase->accumulation of Na w/in cell->release of lg. quantities of Ca->more irritable->contracts more freq. Incr. SA node sensitivity, negative chronotropic, slows impulse inside heart, sits at AV node longer (little more time for ventricles to fill)
Indications for digoxin
CHF, supraventricular arrhythmias
S/S of digitoxicity
Blurred vision, white halos, chromatopsia (white looks green or yellow), flickering lights, anorexia, n/v, diarrhea, atrial arrhythmias, SA block, bradycardia
Antidote for digoxin
Digoxin Immune Fab (Digibind)
Heparin action at low and high doses
Low: prophylaxis, inhibits Factor X, which begins common pathway
High: inactivates thrombin, prevents conversion of fibrinogen to fibrin, pt. already had TIA, CVA, prevent clot from getting worse
Routes of Hep admin.
IV: immediate action
SC: gradual, longer-acting
NOT IM: erratic absorption and excessive bleedig
Clinical indicator of hep therapy
APTT (activated partial thromboplastin time). Goal is APTT 1.5-2.0 times normal clotting time (30-40 sec)
Oral anticoagulants mechanism of action and prototype
warfarin (Coumadin)
Acts in the LIVER to inhibit the synthesis of active Vit. K clotting factors.
Clinical indicators for coumadin efficacy
PT 18-30 sec.
INR 2.0-3.0
Nursing implications w/ Coumadin
Take same time qd, routine bloodtests, don't change amt. of greens consumed, wait til coumadin therapeutic to take off hep, watch for bleeding, soft bristle tooth brush, electric razor
Drugs that antagonize coumadin
Barbituates and dilantin
Clinical indications for thrombolytic drugs and example
Ex: streptokinase (Streptase)
Dissolve clots, use w/ CVA if symptoms started w/in last 6hrs.
Nursing interventions w/ streptokinase
Given IV, use immediately after reconstituting, pump, don't stick more than once, put sandbags over puncture wound, v.s., bleeding, H and H, clotting time
Antidote to streptokinase
aminocarproic acid (Amicar) given IV or PO
Platelet inhibitors mechanism of action and Ex.
Inhibit plt. aggregation. Ex: ticlopidine (Ticlid) NO ANTIDOTE. Take w/ food
Hemorrheologic agent mechanism of action and example
pentoxifylline (Trental)

Improves microcirculation by incr. flexibility of RBCs
Mechanism of action for bile acid sequestrants and example
cholestyramine (Questran) Inhibits reabsorption of bile-> incr. excretion-> incr. use of cholesterol to make bile->decr. cholesterol. May need to take a laxative and incr. fluids, may decr. fat soluble vitamins
S/E of nicotinic acid and example
Niacin (Nicobid, Vit. B3)
S/E: flushing, take ASA 30 minutes before to prevent flushing
Reductase inhibitors mechanism of action and example
Ex: lovastatin (Mevacor, Zocor, Crestor)
Inhibit enzyme that makes cholesterol. Monitor liver, take w/ meals to decr. GI symptoms, ha
Gompertzian Kinetics
abnormal growth rate in which cells lack the normal regulating factors->continue to multiply pass the critical mass state
Clinical manifestations of bone marrow depression in chemo pt. and drugs given to manage
Neutropenia (give interferon), thrombocytopenia, and anemia (give Epogen or Procrit)
Toxicities other than bone in chemo tx
Stomatitis, n/v, diarrhea, alopecia, reproductive toxicity, hyperuricemia (incr. uric acid prod.)
Subcategories of antimetabolites
*Folic Acid antagonists
*Purine antagonists
*Pyrimidine antagonists
Pyrimidine antagonists mechanism of action and S/E
Fluorouracil (5-FU), inhibits pyrimidine synthesis.
S/E: neurotoxicity (monitor for q in LOC), hyperpigmentation, no significant drug interactions
Subcategories of mitotic inhibitors
Vinca alkaloids
Podophyllotoxins
Taxenes
Vinca alkaloids prototype and mechanism of action
Vincristine (Oncovin)
Interferes w/ microtubule assembly.
Vinca alkaloids s/e and interactions
S/e: neurotoxicity, vesicant
Interactions: Phanytoin, digoxin, Ca channel blockers
Podophyllotoxins prototype and mechanism of action
Etoposide (Vepesid)
Inhibits DNA synthesis so cell doesn't enter mitosis,
S/E and interactions w/ podophyllotoxins
S/E: bone marrow suppression, alopecia, mild peripheral neuropathy, and sever hypersensitivity, teratogenic and mutagenic risks. GIVE B6.

No significant interactions
Prototype and mechanism of action for Taxanes
Paclitaxel (Taxol)

Promotes abnormal formation of spindle fibers during interphase
S/E and interactions w/ taxanes
S/E: bone marrow depression, peripheral neuropathy, cardiotoxicity, severe hypersensitivity, vesicant

Interacts w/ Verapamil, Quinidine, and Ketoconazole
Subcategories of alkylating agents
Nitrogen mustards
Nitrosureas
Alkylator-like agents
Nitrogen mustard prototype and mechanism of action
Cyclophophamide (Cytoxan)
Screws up protein matching in double helix (cross-linking) blocks replication
S/E of nitrogen mustards
Bone marrow depression, hemorrhagic cystitis (blood in urine), alopecia, hepatotoxicity, teratogenic and mutagenic risks. Keep pt. HYDRATED
Prototype and mechanism of action for nitrosureas
carmustine (BCNU)
Causes cross-linking, realily crosses BBB
S/E and interactions w/ Nitrosureas
bone marrow depression, frequent n/v, pulmonary toxicity, hypersensitivity, hyperpigmentation, teratogenic

Interactions: cimetidine, digoxin, and phenytoin
Antitumor antibiotics mechanism for action and prototype and S/E
Doxorubicin (Adriamycin)
Inhibits DNA and RNA synthesis
S/E: irreversible cardiomyopathy, truns urine pink/red, bone marrow depression, alopecia, hyperuricemia, GI disturbances
Use of corticosteroids in CA pts.
Used in conjunction w/ xrt, decreases sxs, gradually taper doses, s/e include F/E imbalances,exacerbation of DM, osteoporosis, peptic ulcers, increased infections
Antiestrogen prototype and mechanism of action
Tamoxifen (Nolvadex)
Blocks estradiol uptake and is effective w/ tumors that contain high conc. of estrogen receptors. Breast CA prevention
Interferons prototype and S/E
Interferon alfa-2a
Assist lymphocytes but don't know how.
S/E: flu-like sx, anorexia, diarrhea, dizziness, bone marrow depression, alopecia, cardiotoxicity, neurotoxicity, hyperuricemia
Antigout drugs
Allopurinol, Colchicine, and Probenecid
Gout
Results from inappropriate uric acid metabolism from overproduction or underexcretion of uric acid.