Pharmacology For Nurses - Ch 22-31

Front 1

Definition: VLDL

Back 1

Triglyceride-carrying particle that is converted to LDL in the liver.

Front 2

Definition: LDL

Back 2

Lipid-carrying particle that contains relatively low amounts of protein and high amounts of cholesterol; considered to be "bad" cholesterol. Carries cholesterol away from liver to tissues for use (makes plasma membrane components or steroid) or storage (can cause plaque build-up)

Front 3

Definition: HDL

Back 3

High-density lipoprotein (HDL) Lipid-carrying particle in the blood that contains high amounts of protein and lower amounts of cholesterol; considered to be "good" cholesterol. Carries cholesterol away from tissues to liver for removal.

Front 4

Definition: Reverse cholesterol transport

Back 4

The process by which cholesterol is transported away from body tissues to the liver by HDL.

Front 5

Definition: Rhabdomyolysis

Back 5

Breakdown of muscle fibers usually due to muscle trauma or ischemia. Caused by statins. Can lead to toxicity due to cell contents in blood.

Front 6

Mechanism of Action: HMG-CoA reductase or Statin

Back 6

Statins inhibit HMG-CoA reductase, a critical enzyme in the biosynthesis of cholesterol. These agents are safe and effective for most patients and are drugs of choice in reducing blood lipid levels.

Front 7

Mechanism of Action: Bile Acid Resin

Back 7

The bile acid resins bind bile and cholesterol and accelerate their excretion. These agents can reduce cholesterol and LDL levels but are not drugs of choice due to their frequent adverse effects.

Front 8

Classes of drugs used for dyslipidemia (abnormal lipid levels)

Back 8

Statins
Bile Acid Resins
Niacin
Fibric Acid Agents
Cholesterol Absorption Inhibitors

Front 9

How do lipids travel in the blood?

Back 9

As lipoproteins.
lipid + aproprotein.

Front 10

Mechanism of Action: Nicotinic Acid or Niacin

Back 10

Nicotinic acid can be effective at lowering LDL cholesterol when given in large amounts. It is not a drug of first choice, but is sometimes combined in smaller doses with other lipid-lowering agents such as the statins.

Front 11

Mechanism of Action: Fibric Acid Agents

Back 11

Fibric acid agents lower triglyceride levels but have little effect on LDL. They are not drugs of choice because of their potential side effects.

Front 12

Mechanism of Action: ezetimibe (Zetia)

Back 12

ezetimibe acts by inhibiting the absorption of cholesterol across the small intestine. Its role in treating hyperlipidemia is in combination with statins to achieve an additive reduction in LDL cholesterol.

Front 13

STATINS:
Prototype
Side Effects
Contraindications
Interactions
Things to Know

Back 13

Prototype: atorvastatin (Lipitor)
Side/Adverse effects: myalgia, rhabdomyolsis, GI complaints, possible liver damage
Contraindications: Arthritis, serious liver disease, pregnancy
Interactions:grapefruit inhibits metabolism of drug, ^ risk of myositis when taken with niacin or fibric acid agents
Things to know: Take with food, 2wk onset, goal is to reduce risk of MI and stroke.

Front 14

BILE ACID RESINS:
Prototype
Side Effects
Contraindications
Interactions

Back 14

Prototype drug: cholestyramine (Questran)
Adverse effects: GI tract only- such as bloating and constipation
Contraindications: biliary obstruction
Interactions: Can bind other drugs, increasing potential for drug interactions (digoxin, penicillins, thyroid hormones, thiazide diuretics.
Things to Know: Do not give with food/or other drugs. May have to supplement Vitamins B, D, E, K, zinc, folic acid to avoid nutrient depletion. Mix with liquid. Other drugs +2hrs before or 4hrs after admin.

Front 15

FIBRIC ACID AGENTS:
Prototype
Side Effects
Contraindications
Interactions
Things to Know

Back 15

Prototype drug: gemfibrozil (Lopid)
Side Effects: dyspepsia, diarrhea, nausea, cramps,increases likelihood of gallstones, affects liver function
Contraindications: hepatic impairment, renal dysfunction, gallbladder disease
Interactions: potentiates anticoagulants and antidiabetics, not for use with statins
Things to Know: watch for bleeding with clients on anticoagulants (thins the blood), may decrease blood counts, Hgb, Fatty foods decrease efficacy. Take with a meal.

Front 16

NIACIN:
Prototype
Side Effects
Contraindications
Interactions

Back 16

Prototype drug: niacin
Adverse effects: flushing, hot flashes, hepatotoxicity and gout possible, raise blood glucose
Contraindications: Diabetes, impaired liver function, menopausal women.
Interactions:
Things to Know: Often give aspirin prior to administering will reduce hot flash effects, use in combination with other drugs

Front 17

ZETIA:
Side Effects
Contraindications
Interactions

Back 17

Prototype drug: ezetimibe (Zetia)
Primary use: modest reduction in LDL
Adverse effects: No serious side effects
Use along with a statin

Front 18

Combination drug that includes statin and ezetimibe.

Back 18

Vytorin- combination drug – p. 292

Front 19

List of Drugs: Statins

Back 19

REMEMBER "STATIN"
*atorvastatin (Lipitor)
fluvastatin (Lescol)
Lovastatin (Mevacor)
pitavastatin (Livalo)
pracastatin (Pravachol)
rsouvastatin (Crestor)
simvastatin (Zocor)

Front 20

List of Drugs: Bile Acid Resins

Back 20

*cholestyramine (Questran)
colesevelam (Welchol)
colestipol (Colestid)

Front 21

Lifestyle Changes for lowering lipid levels.

Back 21

Monitor blood-lipid levels
Maintain weight; exercise
Reduce dietary saturated fats and cholesterol
Increase soluble fiber in diet
Reduce or eliminate tobacco use
Use of plant sterols and stanols
Be culturally aware of dietary habits*

Front 22

List of Drugs: Fibric Acid Agents

Back 22

REMEMBER "FIB"
clofibrate (Atromid-S)
fenofribrate (Tricor)
fenofibric acid (Triplix)
*gemfibrozil (Lopid)

Front 23

Most common form of Cardiovascular Disease

Back 23

Hypertension (HTN)

Front 24

Stages of Hypertension

Back 24

Prehypertension - 120-139 / 80-89
Stage I- 140-159 / 90-99
Stage II- 160 + / 100 +

Front 25

Three factors affecting blood pressure.

Back 25

Cardiac Output
Blood Volume
Peripheral Resistance

Front 26

Effects of HTN on organs.

Back 26

Brain: TIA, CVA
Heart: Heart Failure
Kidney: Renal failure
Retina: Visual impairment/blindness

Front 27

NonPharm methods of controlling HTN.

Back 27

Limit alcohol usage
Restrict sodium consumption
Reduce saturated fat and cholesterol; increase fresh fruit and vegetable intake
Increase physical activity
Discontinue tobacco use
Reduce stress
Maintain optimum weight

Front 28

Types of Drugs used to treat Hypertension and which HTN factor they correct.

Back 28

Diuretics- Blood Volume
Calcium Channel Blockers- Cardiac Output
ACE Inhibitors- Blood Volume and Cardiac Output
Angiotensin Receptor Blockers (ARB's)- Blood Volume and Cardiac Output
Beta-Blockers- Cardiac Output
Alpha1 Blockers - Peripheral Resistance
Alpha2 Agonists - Cardiac Output and Peripheral Resistance
Direct Vasodilators- Peripheral Resistance

Front 29

Three types of Diuretics.

Back 29

Thiazide
Potassium-sparing
Loop

Front 30

Mechanism of Action: Diuretics

Back 30

Reduce blood volume by urinary excretion of water and electrolytes.

Front 31

Adverse effects of Diuretics.

Back 31

Thiazide: hydrochlorothiazide (Microzide).
loss of potassium, increase blood-glucose and uric-acid levels

Postassium –sparing: spironolactone (Aldactone)
not a potent diuretic, Gynecomastia and hirsutism, hyperkalemia

Loop diuretics: furosemide (lasix)
most potent, hypokalemia, Hypotension

Hearing loss (these drugs are ototoxic)

Front 32

Mechanism of Action: Calcium Channel Blockers

Back 32

Block calcium ion channels; cause vasodilation, decreasing B/P

Front 33

Mechanism of Action: ACE Inhibitors

Back 33

Block effects of angiotensin II, lowering peripheral resistance and decreasing blood volume

Front 34

Mechanism of Action: Angiotensin Receptor Blockers

Back 34

Block angiotensin receptors in arterial smooth muscle and adrenal glands. Dilate arterioles and increase sodium excretion.

Front 35

Mechanism of action: Beta Blockers

Back 35

Decrease heart rate and contractility; blockade beta1-receptors in juxtaglomerular apparatus

Front 36

Mechanism of action: Alpha1 Blockers

Back 36

Block sympathetic receptors in arterioles leading to vasodilation

Front 37

Mechanism of action: Direct Vasodilators

Back 37

Cause vasodilation by direct relaxation of arterial smooth muscle

Front 38

Definition: Heart Failure

Back 38

Inability of ventricles to pump enough blood for body’s needs
Weakening of heart muscle due to aging or disease

Front 39

S&S with Left Sided HF

Back 39

Blood backs up into lungs
Cough and shortness of breath result

Front 40

S&S with Right Sided HF

Back 40

Causes peripheral edema and organ engorgement

Front 41

Goal of Pharmacotherapy in HF

Back 41

Slow heart rate
Increase contractility
Reduce heart workload
*Affect Cardiac Output

Front 42

Types of Drugs used to treat HF

Back 42

ACE Inhibitors
Diuretics
Cardiac Glycosides
Beta-Adrenergic Blockers
Vasodilators
Phosphodiesterase Inhibitors

Front 43

Definition: Coronary Artery Disease (CAD)

Back 43

Develops when your coronary arteries become damaged or diseased. Cholesterol-containing deposits are usually to blame for coronary artery disease.
Diminished blood flow may cause chest pain (angina) or shortness of breath. A complete blockage can cause a heart attack.

Front 44

Definition and Characteristics: Angina Pectoris

Back 44

Acute chest pain due to insufficient O2 to myocardium.
Steady, intense pain in anterior chest, Pain radiating to left shoulder, left arm, spine, jaw
Pallor, dyspnea, diaphoresis
Tachycardia, elevated blood pressure
Pain diminishes with physical rest and/or stress reduction discomfort subsides in 5 to 10 minutes.

Front 45

Definition: Myocardial Infarction (MI)

Back 45

Occurs when a blood clot blocks the flow of blood through a coronary artery. Interrupted blood flow can damage or destroy myocytes within 20 min.

Front 46

Types of Drugs used for Angina.

Back 46

Nitrates
Beta Blockers
Calcium Channel Blockers

Front 47

Types of Drugs used for MI

Back 47

Thrombolytics
Opiods for pain

Front 48

Anti-platelet Drugs

Back 48

ASA-low dose
Plavix

Front 49

Mechanism of Action: Alpha2 Agonists

Back 49

Decrease outflow of sympathetic nerve impulses from CNS to heart and arterioles. Remember: Centrally Acting

Front 50

Anticoagulant Drugs

Back 50

Heparin
Coumadin
Lovenox

Front 51

Types of Drugs for Dysrhythmias

Back 51

Sodium Channel Blockers Class I
Beta Blockers Class II
Potassium Channel Blockers Class III
Calcium Channel Blockers Class IV
Others: digoxin and adenosine

Front 52

NonPharm methods to treat Dysrhythmias

Back 52

Cardioversion and defibrillation
Electrical shock stops all electrical impulses in heart and allows SA node to regain control

Front 53

Side effects of this antihypertensive agent includes tachycardia, angina, reversible lupus-like syndrome
? propranolol (Inderal)
? mecamylamine (Inversine)
? hydralazine (Apresoline)
? diazoxide (Hyperstat)

Back 53

hydralazine (Apresoline)
see page 321

Front 54

Calcium channel blocker: vasodilation, less likely to have direct cardiac effects:
? nifedipine (Procardia, Adalat)
? diltiazem (Cardiazem)
? verapamil (Calan, Isoptin, Verelan)
? hydrochlorothiazide (Microzide)

Back 54

nifedipine (Procardia, Adalat)
Non-selective. see page 307

Front 55

A patient presents with a blood pressure of 160/110 mm Hg. The patient has a history of coronary vascular disease, resulting in angina, but has no evidence of congestive heart failure. The patient also has asthma and has been treated mainly using terbutaline (Brethine)by aerosol inhalation, Propranolol (Inderal) was prescribed to manage essential hypertension. Was this action appropriate?
? Propranolol (Inderal) is appropriate because it will reduce heart rate and cardiac output. It is an effective antihypertensive agent
? Propranolol (Inderal) is inappropriate because it is only useful in mild hypertension; a better drug would be minoxidil or hydralazine because they are more effective in lowering blood pressure
? Propranolol (Inderal) is appropriate because it is an effective, low-cost antihypertensive. It will augment the effects of terbutaline, an additional benefit
? Propranolol (Inderal) is inappropriate because its use is contraindicated in a patient with asthma.

Back 55

Propranolol (Inderal) is inappropriate because its use is contraindicated in a patient with asthma.
See page 364

Front 56

Vasoconstriction, aldosterone secretion, and renin release suppression occur upon activation of the renin-angiotensin-aldosterone system. How would captopril (Capoten) affect these responses?
? blocks all three
? blocks only vasoconstriction
? blocks all except vasoconstriction
? no effect

Back 56

blocks all three
see pg 310-311

Front 57

An elderly male patient has essential hypertension, congestive heart failure, and type I insulin-dependent diabetes. His congestive failure developed secondary to coronary vascular disease associated with hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this patient?
? chlorothiazide (Diuril)
? captopril (Capoten)
? propranolol (Inderal)
? metoprolol (Lopressor)

Back 57

captopril (Capoten)
Rationale: Beta blockers are contraindicated in congestive heart failure, since beta-blockade reduces myocardial contractility; Beta-blockers are also contraindicated in diabetic patients because these drugs block symptoms of hypoglycemia. Beta-blockers also increase serum lipids.Thiazide diuretics worsen control of hyperglycemia and hyperlipidemia--they tend to increase serum triglycerides and LDL cholesterol.

Front 58

Optimal levels of Lipids.

Back 58

HDL >60
LDL<100
Triglycerides <150

Front 59

Things to report when taking Lipid-lowering drugs.

Back 59

Statins: numbness, tingling, muscle tenderness/pain, effects that hinder ADL's
Bile Acid: severe nausea, heartburn, constipation, straining with stools, tarry stools, yellowing of sclera or skin
Niacin: flank, joint, stomach pain, yellowing
Fibric Acid: unusual bleeding/bruising, RUQ pain, muscles cramps, stool color change
INSTRUCT PT TO RETURN PERIODICALLY FOR LAB WORK.

Front 60

List of Drugs: Thiazide Diuretics

Back 60

chlorothiazide (Diuril)
*hydrochlorothiazide (Microzide)
methylclothiazide (Enduron)
cholrthalidone (Hygroton)
metolazone (Zaroxolyn)
indapamide (Lozol)

Front 61

List of Drugs: K Sparing Diuretics

Back 61

amiloride (Midamor)
eplerenone (Inspra)
spironolactone (Aldactone)
triamterene (Dyrenium)

Front 62

List of Drugs: Loop Diuretics

Back 62

REMEMBER "IDE"
bumetanide (Bumex)
furosemide (Lasix)
torsemide (Demadex)

Front 63

List of Drugs: Calcium Channel Blockers

Back 63

Selective: REMEMBER "PINE"
amlodipine (Norvasc)
felodipine (Plendil)
isradipine (DynaCirc)
*nifedipine (Procardia)
nisoldipine (Nisocor)

Non-Selective:
diltiazem (Cardizem, Dilacor)
verapamil (Clan, Isoptin, Verelan)

Front 64

List of Drugs: ACE Inhibitors

Back 64

REMEMBER "PRIL"
benazepril (Lotensin)
captopril (Capoten)
*enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Prinivil, Zestril)
moxexipril (Univasc)
quinapril (Accupril)
ramipril (Altace)
trandolapril (Mavik)

Front 65

List of Drugs: ARB's

Back 65

REMEMBER "TAN"
candesartan (Atacand)
eprosartan (Teveten)
irbesartan (Avapro)
losartan (Cozaar)
olmesartan (Benicar)
relmisartan (Micardis)
valsartan (Diovan)

Front 66

List of Drugs: Beta Blockers

Back 66

REMEMBER "OLOL"
Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol (Kerlone, Betoptic)
Bisoprolol (Zebeta)
Metoprolol (Lopressor, Toprol).
nadolol (Corgard)
pindolol (Visken)
propranolol (Inderal)
timolol (Timoptic)

Front 67

List of Drugs: Alpha 1 Blockers

Back 67

REMEMBER "ZOSIN"
*dozazosin (Cardura)
prazosin (Minipress)
terazosin (Hytrin)

Front 68

List of Drugs: Alpha 2 Agonists

Back 68

clondine (Catapres)
methyldopa (Aldomet)

Front 69

List of Drugs: Adrenergic Neuron Blockers

Back 69

reserpine (Serpasil)

Front 70

List of Drugs: Direct Vasodilators

Back 70

hydralazine (Apresoline)
nitroprusside (Nitropress)
minoxidil (Loniten)

Front 71

Control center for blood pressure regulation.

Back 71

Vasomotor center.
Baroreceptors and chemoreceptors in aorta and internal carotid.
Renin-Angiotensin system.