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121 Cards in this Set
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Adenosine
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natural constituent of muscle tissue
Action slows AV node conduction Indication PSVT (paraoxsysmal supraventricular tachycardia) SE chest pain |
Paroxysmal supraventricular tachycardia (PSVT) is an occasional rapid heart rate. "Paroxysmal" means from time to time.
ormally, the chambers of the heart (atria and ventricles) contract in a coordinated manner. The contractions are caused by an electrical signal that begins in an area of the heart called the sinoatrial node (also called the sinus node or SA node). The signal moves through the upper heart chambers (the atria) and tells the atria to contract. PSVT starts with events taking place above the lower heart chambers (ventricles). PSVT can be initiated in the SA node, in the upper heart chambers (atria), in the atrial conduction pathways, or other areas. PSVT can occur with digitalis toxicity and conditions such as Wolff-Parkinson-White syndrome. |
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What is different about adenosine delivery compared to other meds?
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Must infuse it very fast over 3 seconds
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Albuterol
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Beta 2 Agonist
– Onset of action: 5-30 minutes – No anti-inflammatory capabilities • Adverse effects – Hyperglycemia: Patients with DM only • B2 receptors in liver glycogen glucose – Tremor/nervousness/possible cardiac dysrhythmias • Long-acting: Not first line agent. May risk of asthma-related death if not used properly. • Oral: Can cause cardiac symptoms (angina, dystrhythmias) – Use with caution – Used for long term maintenance only |
Beta 2 Agonists
• Mechanism of action: relaxes bronchiolar smooth muscle – Inhaled/Oral – Usually no systemic effects • Warning: if dose too high, loses selectivity and can cause systemic effects – Fast relief, also used for long-term maintenance • Long-acting: Salmeterol BID inhaled –Maintenance drug ONLY. |
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Your jogging partner who has asthma
begins wheezing. You recommend: |
Albuterol
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Alpha-1 adrengergic blockers
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Peripheral-acting Alpha Adrenergic Blocker
• Prototype: doxazosin (Cardura) • Action – Blocks alpha1 receptors (alpha1 stimulation = vasoconstriction), result is vasodilation and lowered peripheral vascular resistance – Less cardiac effects because no beta action – Can cause orthostatic hypotension in first dose or with dosage increases – relaxes urinary sphincter tone |
• Indications
– Used as Step II drugs because of SE or in patients with hyperlipidemia • SE – Weakness, GI sx, stuffy nose, edema of the lower extremities, HA, syncope(暈厥), SOB • Education – “first-dose hypotensive reaction”—instruct to avoid rapid postural changes – Effects may not be achieved for 4-6 weeks – May relax bladder sphincter too much |
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Alpha-1 adrengergic blockers use for two condition
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These drugs, called alpha blockers for short, are used for two main purposes: to treat high blood pressure (hypertension) and to treat benign prostatic hyperplasia (BPH), a condition that affects men and is characterized by an enlarged prostate gland.
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Amiodarone
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Amiodarone is an antiarrhythmic medication that affects the rhythm of heartbeats.Amiodarone is for use only in life-threatening situations
Potassium Channel Blockers (Delay Repolarization) Action prolongs action potential, increases the refractory period in all cardiac tissues decreased automaticity, prolonged AV conduction, blocks sodium, potassium, and calcium channels Indication life-threatening ventricular dysrhythmias |
SE
pulmonary fibrosis, thyrotoxicosis (hyperthyroid) blue-gray skin color Drug-drug interactions with other antidysrhythmics, can cause tachydysrhythmias and life threat rhythms |
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Angiotensin converting enzyme inhibitor (ACE-I)
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Prototype: lisinopril
•Indications –Essential HTN with normal renal function –Often used with a thiazide or loop diuretic •counteracts K retention of ACE –HF: used with digoxin and diuretics –Diabetes •For renal protection even without HTN |
SE
– Hyperkalemia – Dry cough (occurs in about 1/3 of patients)Angioedema, hypotension • Drug-drug interactions – additive effect with other antihypertensives |
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Angiotension Converting Enzyme (ACE) Inhibitors
•Action |
–Completely blocks the angiotensin I converting enzyme
–Prevents the production of angiotensin II which is a powerful vasoconstrictor –Decreases vascular tone –Absence of aldosterone release leads to excretion of fluid –Renal protective in diabetics |
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Def vascular tone
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Vascular tone is a medical term used to describe the diameter and tone of a blood vessel when the vessel is fully dilated. Under normal conditions, all blood vessels experience at least a mild degree of contraction of the smooth muscles of the vessel. These contractions are used to determine vascular tone. When this tone is normal, the blood vessels are considered to be functioning at optimal levels. When these contractions become abnormal, vascular health may become compromised, requiring a trip to a medical professional for proper diagnosis and treatment.
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ACE Inhibitors
• Education |
– Full effects not seen for several weeks
– Taste impairment disappears in 2-3 weeks – Cough not indicative of lung disease – Do not use in renal artery stenosis – Do not use K supplements or susbstances containing large amounts of K (i.e., salt substitutes, low-sodium milk) – Do not use with pregnancy (no blood to fetus) |
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What electrolyte can elevate with Ace
Inhibitor Use? |
Potassium
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Antacids and iron
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antacids decrease iron absorption.
Your stomach acid level or pH determines how much iron you will absorb. To work like it should, your stomach acid should have a pH of 1.0 - 3.0 and not much higher. When the pH of your stomach increases above 3.0, your stomach acidic action is decreasing. On the pH scale, a pH of 7.0 is a neutral value and this is the pH of water. Higher pH numbers are considered alkaline. |
Acidic stomach has better profile
– Take with OJ – Better taken on empty stomach, but this increases gastritis risk • Do not take with coffee, tea, eggs or whole grain breads or will lose about 1/3 |
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Antidysrhythmics
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All antidysrhythmics have the potential to worsen the dysrhythmia or create a new one
EKG is the only way to assess if the drug is effective Close monitoring of all systems is important, not just the CV system All patients taking antidysrhythmics should take their HR for 1 full minute before dose Medications falling out of favor |
fast sodium channel blockers
beta blockers potassium channel blockers calcium antagonists |
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Aspirin action
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Antiplatelet Agents,
Action blocks enzyme necessary to create the stickiness of the vessel walls so it inhibits platelet aggregation, permanently alters the platelet one 325 mg tablet can double bleeding time for up to 7 days--it takes that long to make new platelets |
Indications
Prophylaxis of MI in patients with angina or hx of MI ( ? If effective in women) one a day (81mg) even used in ED when question of MI (2 tabs) Prophylaxis of recurrent TIAs/CVA(Cerebrovascular disease) (325mg) does not appear to be effective in men harmful if hemorraghic stroke has occurred |
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what is TIA
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A transient ischemic attack (TIA) is a transient stroke that lasts only a few minutes. It occurs when the blood supply to part of the brain is briefly interrupted. TIA symptoms, which usually occur suddenly, are similar to those of stroke but do not last as long. Most symptoms of a TIA disappear within an hour, although they may persist for up to 24 hours. Symptoms can include: numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes;
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what is hemorrhage stroke
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Hemorrhage is the medical term for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms).
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Atropine
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action is anticholinergic effect, blocks vagal stimulation and increases HR (increases conduction thru the AV node)
indication is bradycardia |
This medication is used to decrease saliva and phlegm and to control stomach/intestinal spasms. This medication works by blocking the actions of a certain natural substance (acetylcholine) that your body makes.
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Beta Blockers: 2 receptors and actions
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anti-hypertensive
Receptors – Beta1—referred to as cardioselective because they block receptors in the heart – Beta2—primarily in smooth muscle & lungs • Action (blockade of beta1) – Decreases HR, conduction, contractility, and cardiac output – Inhibits renin release by the kidney – Reduces myocardial oxygen demand – Decreases peripheral vascular resistance which lowers BP |
Action (blockade of beta2)
– Bronchoconstriction • Patients with asthma, CHF, emphysema at risk – Should use cardioselective agent – Masks symptoms of acute hypoglycemia and hyperthyroidism • Ok to use if not brittle DM • Safety during pregnancy – Most are category C |
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Beta 2 Agonists action
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Beta 2 Agonists
• Mechanism of action: relaxes bronchiolar smooth muscle – Inhaled/Oral – Usually no systemic effects • Warning: if dose too high, loses selectivity and can cause systemic effects – Fast relief, also used for long-term maintenance • Long-acting: Salmeterol BID inhaled –Maintenance drug ONLY. |
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Beta Blocker indication
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Indications
ventricular dysrhythmias shown to be particularly effective with post-MI dysrhythmias HTN Hyperanxiety (stage fright) Also hyperthyroid (racing heart) |
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Beta Blocker SE
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Both selective and nonselective agents
–Negative chronotrope –Negative inotrope –Negative dromotrope •All result in lower CO •Lower CO = drop in BP |
Education
–Don’t alter the drug regimen •consistently take with food or without food –No OTC decongestants and cough and cold meds with pseudoephedrine/phenylprine –How to avoid orthostatic hypotension –Weight and diet management –Check pulse: if < 45,don’t give –Monitor for signs of depression –Should be on one post MI! |
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Histamine stimulation to H1 and H2, Type 1 hypertensive
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Histamine binds to H1, H2 receptors
• H1 stimulation – Vasodilation of venules/arterioles (i.e., face) – capillary permeability secondary to capillary endothelial contraction – Bronchoconstriction – Other: itching and pain d/t sensory receptors, secretion of mucus • H2 Stimulation – Secretion of gastric acid |
Type I hypersensitivity/Anaphalyxis reactions
– Allergen + IgE crossbridgesmast cell/basophil degranulationrelease of histamine – Anaphylaxis – Angioedema – Urticaria (hives) – Rhinitis • Inflammation of nasal mucosa/swelling/congestion • Sneezing, itching and watery eyes • Seasonal or perennial, allergens |
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Hydrocholorthiazide (HCTZ) action
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action
–Inhibits Na and Cl reabsorption in early distal tubule –May increase serum levels of Ca, Glu, and uric acid –Reduces plasma and extracellular fluid –Has direct action on peripheral vessels to decrease peripheral resistance Moderate increases in urine output –Normal 1 ml/min, thiazides 3 ml/min •Inhibits release of insulin, raises sugar –Increase in cholesterol and TG levels |
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Hydrocholorthiazide (HCTZ) indication
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•Indications
–Essential hypertension –Chronic edema (CHF, cirrhosis, renal failure) –Treatment of hypercalcemia |
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Hydrocholorthiazide (HCTZ) SE
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SE
–Hyponatremia and hypovolemia –Polyuria –Oliguria in the renal compromised patient –Hypokalemia (up to ½ of long-term users have sx at some point) •Most serious effect is cardiac dysrhythmia –Increased risk of digitalis toxicity |
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Hydrocholorthiazide education
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Education
– Supplement K in diet • dried fruits • OJ • Banana • Limited use of salt substitutes (KCL not NACL) – Need monitoring of BP, lipid levels – Drug may make patients feel tired • drink more non-sugar, non-caffeine fluids |
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Hydrocholorthiazide contraindication and drug-drug interaction
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Thiazides
•Contraindications –Renal disease, gout, diabetes, hyperlipidemia –Pregnant women •Drug-drug interactions –Drugs that affect the same electrolytes or minerals –Digoxin (K shifting impacts this) |
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Iodine 131 therapy
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I-131 for RF ablation of thyroid in hyperthyroidism.
you will become radioactive after having been given the treatment and will emit radiation you will be required to remain within 'the radionuclide treatment suite' (RNR) until you are advised that it is safe to leave. This consists of a side room, shower / bath and toilet. You will excrete a considerable amount of radioactive iodine in urine, faeces, sweat, saliva and nasal mucous and it is therefore very important that these substances are not allowed to 'contaminate' other people, or areas outside the RNR. You may ONLY use the toilet, shower and washing facilities WITHIN the radionuclide suite. |
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Radio frequency ablation (RFA)
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Radio frequency ablation (RFA) is a medical procedure where part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from the high frequency alternating current to treat a medical disorder. An important advantage of RF current (over previously used low frequency AC or pulses of DC) is that it does not directly stimulate nerves or heart muscle and can therefore often be used without the need for general anesthetic.
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Isoniazid action , ADME, and SE
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Action
–Causes cell wall disruption, bactericidal •ADME –Metabolized in liver •SE –GI distress, hepatitis |
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isoniazid drug-drug interactions, and monitoring
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Drug-drug interactions
–Daily use of ETOH increases risk of liver toxicity –Decreases serum levels of ketoconazole, not recommended to combine with INH •Monitoring –Most cases of isoniazid hepatotoxicity are mild (ie, asymptomatic with < 3-fold elevation of serum aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) and commonly resolve despite continued therapy with isoniazid. However, a small number of adult patients taking isoniazid develop severe hepatitis that may progress to liver failure and death if the drug is not stopped promptly. –Sputum cultures periodically –Need ophthalmologic exam if vision changes |
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Lovastatin indication and SE
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Indications
primary hyperlipidemia which does not respond to diet alone SE few: HA, GI disturbances, myalgia (can progress to muscle damage drug induced liver dysfunction (use with care in presence of liver disease or chronic alcoholism) |
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Cholesterol Synthesis Inhibitors prototype
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Lovastatin
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Lovstatin effect
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Prototype: lovastatin (Mevacor)
Effect most effective drugs to lower LDL inhibits critical enzyme in formation of cholesterol (HMG-CoA) thus decreasing total cholesterol, LDL, and triglycerides while also increasing HDL |
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Which food/dietary supplement is not allowed to be taken with statins?
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grapefruit juice
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Lovastatin drug-drug interactions and toxicity
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Drug-drug interactions
-Grapefruit juice (increase release of other drugs) Toxicity increased risk if taken with gemfibrozil or niacin |
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Low molecular weight heparin prototype, action and indication
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Prototype: enoxaparin (Lovenox)
Action inactivates factor Xa Indication prevention of DVT post-op (hip, abd, knee) treatment of established DVT unstable angina |
No need to monitor. Start dose according to pt's weight. however people extremely overweight won't be able to take this drug.
also pt with bad Kidney can't take it while pt with bad kidney can take Heparin> |
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Low molecular weight heparin SE, implications
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SE
local erythema, pain, hematoma at injection site Implications no need to check aPTT ( no protein binding) patient can be self-taught injection pre-loaded syringes This and regular heparin NOT IM Nasty hematomas(a localized collection of blood outside the blood vessels,usually in liquid form within the tissue. ) |
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Why might LMWH be used over UFH(heparin)?
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no blood monitoring (aptt)
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Mannitol action
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Prototype: mannitol
•Action—potent osmotic –Stays inside tubule –Large size pulls water and solutes into tubular fluid (chemically inert) –Kidneys reabsorb less Na, Cl, and water in an effort to equalize the concentration, but not significant shifts of electrolytes |
especially for Pt with cranial edema. However, don't use on PT with cranial bleeding
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Mannitol nursing implicaitons
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Nursing Implications
–Crystallization in solution is common—need to warm –IV line filter and filter needles –Use an indwelling catheter with a urometer to measure hourly urine output (therapy is based on accurate I & O) •For ALL Diuretics—empty foley prior to dose! –Effect lasts about 6-8 hours |
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How should the RN warm up the glass
bottle of Mannitol? |
In a hot water bath
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Organic Nitrate Vasodilators
•Prototype: and action |
Organic Nitrate Vasodilators
•Prototype: nitroglycerin (NTG) –used in both short and long term treatment –cheap and effective |
Action
–vasodilates vessels in the periphery thereby decreases workload of the heart –Dilates coronary arteries improving blood flow –does not dilate plaque covered, damaged vessels –comes in metered tablets, sprays, ointments |
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Nitroglycerin ADME and effect
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ADME
–oral: Time-released with heavy first pass effect; not good for emergent needs •Nitrobid. Isosorbide has similar action –oral mucous membranes (sl): quick (minutes) –ointment: slow release, 30-60 min, messy –transdermal patches for sustained release longer term effects |
Effects
–Dilation of peripheral vessels by relaxing smooth muscle lining of vessels. •Decreases afterload –Decreases the amount of blood returning to the heart (preload) –Reflex tachycardia •anytime BP falls, sympathetic activity occurs |
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Nitroglycerin indication
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Indications: angina
–Emergent CP: SL tablet, wait 5 min; if pain continues, can repeat with second and third dose. If CP continues after second dose, call 911 (used to be 3 doses) –Allow to dissolve slowly, don’t eat, drink, or smoke. Patient should feel tingling sensation under tongue, if not present the drug may have lost its potency. |
IV: for emergent use following an MI or severe refractory angina
–IV NTG binds with PVC, need to use special tubing and glass bottle •glass bottles need vented spike on tubing!! –Must run through pump –Close monitoring of BP –High falls risk |
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Nitroglycerin long term use and toxicity
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•Long term use
–ointment: measured length, apply to hairless surface and cover with plastic –transdermal patch: •don’t soak in water •rotate placement •12 hr on and 12 hr off •Nurses wear gloves |
Toxicity
– dose dependent hypotension and reflex tachycardia – nitro has a very short half-life so is gone quickly – Tx: vasopressors (but not epinephrine) and O2 |
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Nitroglycerin nursing implication
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Stored in airtight light resistant (brown) glass bottles
or air tight aluminum sprays – Can’t set out in pill boxes • Need ready access--several bottles • Bottles “expire” 6 months after opened • HA is normal; if none --isn’t working • Expect orthostatic hypotension • Handle patches and ointments with gloves |
Try to avoid angina triggers
• Drugs are also temperature sensitive – Keep out of hot cars or pants pockets • Spray meters are “more expensive” – Last longer than bottles – Bottles are ‘expired’ if open more than 6 months |
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Oral iron supplements some fact and absorption
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Actually very hard to absorb
• Small daily amounts better than big doses – Use of iron skillet beneficial • Near daily use needed • Must be “aged” to leech iron onto food – Fell out of favor with advent of steel & Al • Food sources – See Davis Drug guide list – Its not just red meat |
Absorption
• Much passes out giving stool dark brown to black color – Same color as if old blood in the stool • Upset stomach and constipation frequent complaints – If gastritis from another source (ulcers, ETOH) can worsen it |
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iron food source
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Iron from vegetables, fruits, grains, and supplements is harder for the body to absorb. These sources include:
Dried fruits prunes raisins apricots Legumes lima beans soybeans dried beans and peas kidney beans Seeds almonds Brazil nuts Vegetables broccoli spinach kale collards asparagus dandelion greens Whole grains wheat millet oats brown rice |
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Iron supplement things to watch for
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Liquid forms can stain teeth
– Do not chew • Easy for children to OD • Iron overload can present like anemia s/s – Fatigue, aches • Will make rheumatoid arthritis worse • Patients can have hemochromatosis Sometimes is given IV – The solution is BLACK!! |
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Pravastatin
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Pravastatin is used together with lifestyle changes (diet, weight-loss, exercise) to reduce the amount of cholesterol (a fat-like substance) and other fatty substances in the blood. Pravastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body.
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Prazosin
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Prazosin is used alone or in combination with other medications to treat high blood pressure. Prazosin is in a class of medications called alpha-blockers. It works by relaxing the blood vessels so that blood can flow more easily through the body.
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Home > Drugs and Supplements > Prazosin
Printer friendly viewPrint Bookmark and Share AHFS Consumer Medication Information [Internet]. Prazosin(pra' zoe sin) Last Revision: September 1, 2010. Why is this medication prescribed? Prazosin is used alone or in combination with other medications to treat high blood pressure. Prazosin is in a class of medications called alpha-blockers. It works by relaxing the blood vessels so that blood can flow more easily through the body. How should this medicine be used? Prazosin comes as a capsule to take by mouth. It usually is taken two or three times a day at evenly spaced intervals. The first time taking prazosin, you should take it before you go to bed. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take prazosin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of prazosin and gradually increase your dose. Prazosin controls high blood pressure but does not cure it. Continue to take prazosin even if you feel well. Do not stop taking prazosin without talking to your doctor. Other uses for this medicine Prazosin is also used to treat benign prostatic hyperplasia (BPH, noncancerous enlargement of the prostate), congestive heart failure, pheochromocytoma (adrenal gland tumor), sleep problems associated with post-traumatic stress disorder (PTSD; an anxiety disorder in people who experience or witness a traumatic, life-threatening event), and Raynaud's disease (condition where the fingers and toes change skin color from white to blue to red when exposed to hot or cold temperatures). Talk to your doctor about the possible risks of using this medication for your condition. |
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Propranolol action and SE
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Beta blocker
action: Action (non-selective) – Decreases cardiac contractility (negative inotropic effect) which drops arterial pressure and inhibits renin release – Especially useful in HTN with tachycardia, angina – More selective beta blockers can help avoid most significant SE • More likely to see atenolol or metoprolol in clinical |
SE
•SE follow this: –Bradycardia, fatigue, drowsiness, anxiety, difficulty breathing, GI sx, impotence, cold hands and feet, depression (?) –If have CHF can make it worse if use cardioselective; non-selective better like carvedilol •Drug-drug interaction –Blocks action of sympathomimetics (epi) |
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important thing for beta blocker
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Don’t stop! Don’t run out!
•Rebound hypertension •When body has HTN meds on board and they are suddenly stopped –Massive sympathetic “rescue” causes rapid HR and high BP |
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Propranolol
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Beta blocker
Prototype: propranolol (Inderal) • Action (non-selective) – Decreases cardiac contractility (negative inotropic effect) which drops arterial pressure and inhibits renin release – Especially useful in HTN with tachycardia, angina – More selective beta blockers can help avoid most significant SE • More likely to see atenolol or metoprolol in clinical |
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Beta Blockers
• Indications |
Beta Blockers
• Indications – Chronic angina, HTN – Treat cardiac dysrhythmias – **Prevent a second MI – Treat vascular HA – Tremors – Anxiety |
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protamine sulfate
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antidote for Heparin
Toxicity If aPTT too prolonged >> can bleed to death stop administering and give antidote: protamine sulfate (has a strong positive charge which binds with heparin’s negative charge) |
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Pyrazinamide
• Action ADME and SE |
Pyrazinamide
• Action – Bacteriostatic or bactericidal depending on dose • ADME – Need to maintain fluid intake of 2500 ml daily – Metabolized in liver • SE – Arthralgia r/t hyperuricemia, jaundice |
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Questran
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Bile Acid Sequestrants
Prototype: cholestyramine (Questran) Effects sequesters or binds with the bile so it cannot be reabsorbed excreted in feces body responds by making more cholesterol and bile than before loss is greater than gain so decreases cholesterol. |
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Questran ADME and Indication
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To treat TB
ADME works solely in the GI tract, is not absorbed comes in powder or bar form--must mix with juice or semi-solid as it tastes bad Indications hyperlipidemia, elevated LDLs adjunctive therapy in dig overdose, affects absorption and reabsorption of dig |
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Rifampin Action, ADME and SE
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Rifampin
•Action –Broad-spectrum bactericidal, blocks RNA •ADME –Well absorbed orally, widely distributed, lipid soluble so can also reach intracellular bacteria –Metabolized in liver •SE –GI distress, flu-like symptoms |
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Rifampin drug-drug interactions and Education
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Drug-drug interactions
–Daily use of ETOH increases hepatotoxicityrisk –Decreases levels of steroids, anticoagulants, dig, Dilantin, some antihypertensives, theophylline, methadone, hypoglycemic agents –Causes subtherapeuticlevels of HIV protease inhibitors –Increases risk of hepatotoxicitywith INH |
Education
–Take drug on empty stomach, full glass of water –Reddish brown discoloration of body fluids, will stain contact lenses –Need to use alternative forms of contraception other than OCPs –No ETOH! |
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Spironolactone • Action
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Hypertension and Edema
Potassium-sparing Diuretics • Prototype: spironolactone (Aldactone) • Action – Block action of aldosterone in the distal tubule, promotes Na and water excretion – Low potency, similar to thiazides – Allows K to remain in system – Triamterene directly blocks the Na/K exchange channel in the distal nephron |
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Spironolactone indication, SE, drug-drug interactions, OD, Education
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Indications
– Prevention and treatment of hypokalemia – Hypertension and edema especially in liver failure and adrenal disease issues – Used in combo with HCTZ to counteract K loss • SE like other diuretics • Chemically like steroid hormone – More likely to see gynecomastia, menstrual irregularities, impotence, hirsuitism |
Drug-drug interactions
– Drugs that decrease K excretion • ACE inhibitors, salt substitutes, K supplements, some antibiotics like potassium penicillin – Spironolactone increases t ½ of digoxin – Decreases effects of anticoagulants • dose needs to be adjusted • OD – Hypovolemia, hypotension • Education – unlike other diuretics don’t push K+ foods |
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Salmeterol actions
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Beta 2 Agonists (asthma)
• Mechanism of action: relaxes bronchiolar smooth muscle – Inhaled/Oral – Usually no systemic effects • Warning: if dose too high, loses selectivity and can cause systemic effects – Fast relief, also used for long-term maintenance • Long-acting: Salmeterol BID inhaled –Maintenance drug ONLY. |
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Statins
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lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver.
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Many different brands
Those mixed with other anti-lipemics more likely to have issues Stronger the statin the more risks Risks run in families ? If water soluble statin (pravachol) has less risk Lipitor (atorvastatin) is now generic!!! |
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Beclomethasone inhaler action, administration, SE
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Glucocorticoids
•Beclomethosone/Flovent –Suppression of Inflammation •secretion of inflammatory mediators •infiltration of inflammatory cells •edema of airway mucosa –Prophalyxis, give on fixed schedule –First line agents for maintenance |
Administration
–Use spacer –Gargle/rinse afterwards –Best if used with B2 agonist: B2 opens airways, better penetration of glucocorticoid •Side Effects –Adrenal suppression, bone loss –Oral candidiasis |
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Clonidine action, indications, SE, Drug-drug interaction, OD and Note
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Central-acting Sympatholytics
• Prototype: clonidine (Catapres) • Action – Decreases sympathetic outflow from brain to periphery, generalized decrease in sympathetic tone (alpha2 receptors)—lowers CO, HR, peripheral resistance • Indications – Used in moderate hypertension • SE – Same as general ones plus high risk for rebound HTN if drug abruptly withdrawn |
Drug-drug interaction
– Use with beta blocker counteracts effects and can lead to severe hypertension • OD – Severe hypotension – Can affect alpha1 receptors and lead to severe hypertensive crisis • NOTE: Class drug methyldopa (Aldomet) preference drug in pregnancy |
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Desmopressin ( DDAVP) action, indicaiton, dose form and SE
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Posterior Pituitary Replacement
•Prototype: Desmopressin acetate (DDAVP) –Note: vasopressin also available. Called Pitressin---don’t confuse with Pitocin •Action: synthetic vasopressin (ADH) analog; enables kidneys to concentrate urine if problem is with pituitary; can also stop bleeding in hemophilia |
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Diabetes insipidus (DI)
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Diabetes insipidus (DI) is a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, with reduction of fluid intake having no effect on the concentration of the urine.
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Indications: Neurogenic Diabetes Insipidus (DI) and enuresis
–not effective in DI with renal cause •Dose Forms: oral, SC, IV and nasal inhaler •SE: HTN, flushing, water retention, rhinitis, nausea |
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Digoxin action, ADME, •Pharmacological effects and •Indications
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Digitalis (Cardiac Glucosides)
•Prototype: digoxin (Lanoxin) •Action –positive inotrope, negative chronotrope and negative dromotrope –potent, small doses (0.125 or 0.25 mg/day) •ADME –oral, IM, or IV administration •formulation greatly affects absorption –t 1/2 is 36 hrs –narrow therapeutic range: 0.5-0.8 mg/mL |
•Pharmacological effects
–increases cardiac contractility –decreases electrical conduction rate –indirectly decreases HR and increases sodium and water excretion •Indications –HF –atrial fibrillation or other supraventricular dysrhythmia when ventricular rate too rapid |
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Digioxin way to give dose and SE
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Digitalization (loading)
•Need to get on board to therapeutic dose –gradual vs rapid digitalization •Higher doses at first; then typical doses –Can do IV or po –Dose depends on body weight •Rapidly done for acute problems –0.5 STAT, then 0.25 q6h X 2 –Then standard dose 6 hours later and qd •Elders: prefer to do gradually |
SE
–cardiac: bradycardia, AV block, other rhythm disturbances –GI: n/v, anorexia –vision: green/ yellow tint to white objects, halos around lights (usually not tiltoxic) |
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Digioxin therapeutic watch out
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Digoxin
• Therapy monitoring is important – periodic drug levels – electrolyte levels • Important not to get K alterations – if change in generic formulation, may need dose adjustment – assessment of heart rate prior to dosing • MUST take apical pulse – Hold drug if <45 |
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What is a pulse deficit?
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Difference between
apical and radial |
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digoxin Toxicity and Drug-drug interactions
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Toxicity
– early: n/v, vision changes – late: dysrhythmias due to progressive heart block • May be fast as if need more medication! – Treatment: • Hold doses • Immune Fab ( Digibind) binds with molecule and then is excreted by kidney. As more tissue molecules are released into the bloodstream (diffusion), more binding takes place – onset 1 min, t 1/2 15-20 hr • Hasten elimination by binding (charcoal, cholestyramine) |
Drug-drug interactions
– drugs that reduce absorption or decrease fxn • antacids, laxatives, cholesterol-lowering agents, ACE/ARB – drugs that depress cardiac function • beta blockers, calcium channel blockers – hypokalemia • the most common cause of dig overdose • even therapeutic levels may be too high if K is low • most common offender is diuretic use |
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digoxin nursing consideration
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• Cardiac function
– watch HR, dysrhythmias • Electrolyte imbalances – hypokalemia and hypomagnesemia increase risk of toxicity – hyperkalemia and hypercalcemia may produce dysrhythmias • Renal insufficiency patients – decreases excretion of dig; easier toxic • Female patients |
• Monitor effect of other drugs containing
sodium or potassium, use of diuretics • Check heart rate: – Need to take apical pulse for 1 full minute prior to administering drug – Okay to give with food but not if meal has high fiber content--best if 1 hr ac or 2 hr pc |
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Diphenhydramine(Benadryl)
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Antihistamines
•1stGeneration: Diphenhydramine(Benadryl) |
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Diphenhydramine(Benadryl) nursing consideration
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Nursing Considerations
–Caution: Anti-cholinergic side effects, use with caution in patients with glaucoma, hyperthyroidism (tachycardia), HTN or BPH/urinary retention –Sedation: do not take with ETOH, no driving |
–No H2 (gastric) actions
–Not useful for non-allergic rhinitis –Not useful for asthma –Children: some become hyperactive—unpredicatable –Drug interactions: CNS effects with ETOH, hypnotics, anti-psychotics, anxiolytics, narcotics •anticholinergiceffects: antipsychotics, TCAs, atropine –In anaphalyxis: give epinephrine first, then antihistamine later |
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Diuretics
general action |
Diuretics
•Why do they work for HTN? –Increase the amount of sodium and chloride excreted by the kidneys –Decrease circulating volume •reducing volume in plasma & extracellular fluid –Lower Na seems to decrease sensitivity of vessels to sympathetic stimulation •Can be used alone or with other agents |
Diuretics
•Major site of action is the kidney nephron •All interfere with reabsorption in the tubules of the kidney. •Because Na is so prevalent in dietary intake, Potassium is the electrolyte of greatest fluctuation that we must monitor •Also affect Ca, glucose, and uric acid. |
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Diuretics
•Four major classifications |
Diuretics
•Four major classifications –Osmotic (mannitol) –Loop (furosemide) –Thiazide (hydrochlorothiazide) –Potassium sparing (spironolactone, triamterene) |
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Epogen
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RBC production
• Epoetin alfa ( Epogen or Procrit) – Darbepoetin- longer t1/2 • Stimulates production of RBC • Mimics natural hormone from the kidney • Must have the regular building blocks there to work – Iron, folic acid, B 12 |
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Epogen Who Needs It?
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Who Needs It?
• Anemia of Chronic renal failure – Added at the end of dialysis • Chemotherapy induced anemia – IF not involving the bone marrow • Planned surgical interventions in those with chronic anemia |
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Why do athletes illegally use EPO?
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1. Increase 02 carrying
capacity |
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Ethambutol action, ADME, and SE
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• Action
– Bacteriostatic, effective only against actively dividing mycobacteria • ADME – Metabolized in liver • SE – Optic and peripheral neuritis, decreased ability to see red and green, elevated uric acid levels |
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furosemide action, ADME, SE
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Loop Diuretics
• Prototype: furosemide (Lasix) • Action – Inhibit reabsorption of Na and chloride in the ascending loop of Henle – Similar to thiazides but more intense • Greater peak increase in urine output • Faster acting • Increase Ca excretion • Less effect on lipids • Parenteral use • Can use with low GFR |
ADME
– Fairly well absorbed, peak 1-2 hr; IV effect within 5 minutes • Indications – Significant edema (CHF, cirrhosis, renal disease) – Hypertension • SE – Postural hypotension, blurred vision, HA, GI distress, anorexia, anxiety, confusion, ototoxicity, photosensitivity |
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Furosemide
• Drug-drug interaction OD and education |
Furosemide
• Drug-drug interaction – Digoxin, lithium • increase risk of ototoxicity – NSAIDs antagonize diuretic effects • OD – Hypovolemia, hypotension – Electrolyte imbalances • Education – Postural hypotension – Dietary counseling re: foods rich in potassium – More likely to need K supplements – Avoid sun – Alert to hearing loss – May need higher dose if placed on NSAID |
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What is step therapy Resp
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Step Approach to Asthma
• Step 1 (Mild) – SABA(short acting Beta 2 agonist), if used more than 2x/wk consider step 2. • Step 2 (Mild persistent) – Low-dose steroid inhaler daily. An LT antagonist or methylxanthine are alternatives for pts over 12 years of age. SABA inhaler for acute symptom control. • Step 3 (Moderate) – Intermediate-dose ICS( inhale crotecoid steroid) or low dose ICS with LABA. SABA inhaler for acute symptom control. • Step 4 (Moderate) – Medium dose ICS+ LABA (long acting beta 2 agonist) inhaler. SABA inhaler for acute symptom control. • Step 5 – High dose ICS and LABA • Step 6 – Addition of an oral steroid (2 mg/kg/day not to exceed 60 mg/day) used daily. |
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Concept of rescue inhalers
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cardiovascular (CV) considerations of respiratory meds
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How to administer inhaled meds
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MDI technique: Open mouth technique
Remove the cap from the MDI and shake it well. Hold the MDI by placing your index finger on top of the metal canister and thumb on the bottom of the plastic mouthpiece. Tilt your head back slightly, open your mouth wide, and place the MDI about 2 inches in front of your mouth. As you begin to breathe in slowly through your mouth, press down on the metal canister one time. Continue to breathe in slowly and as deeply as you can. Hold your breath for at least 10 seconds to allow the medication to deposit in the airways. Wait at least one minute and repeat the above steps. Follow the dosage prescribed by your doctor. Replace the cap on your MDI when you are finished. If you are using a corticosteroid MDI, gargle and rinse your mouth with water or mouthwash after each use. Technique for MDI with spacer A spacer is a chamber that attaches to the MDI and holds the burst of medication. This makes taking the MDI easier and helps get the medication into the lungs better. A MDI may sometimes be used without a spacer. Your health care provider will decide if this is appropriate for you. Remove the cap from the MDI and spacer device. Shake well. Insert the MDI into the open end of the spacer (opposite the mouthpiece). Place the mouthpiece of the spacer between your teeth and seal your lips tightly around it. Breathe out completely. Press the canister once. Breathe in slowly and completely through your mouth. If you hear a horn-like sound, you are breathing too quickly and need to slow down. Hold your breath for at least 10 seconds to allow the medication to deposit in the lungs. Wait at least one minute and repeat the above steps. Some MDIs require more than 2 puffs. Follow the dosage ordered by your doctor. Replace the cap on your MDI when done. If you are using a corticosteroid MDI, gargle and rinse your mouth with water or mouthwash after each use. |
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How and when to take supplements with what type of education.
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Be open and unbiased
Educate selves about herbal medicines in general, including SE and interactions Warn patients about experimenting, risk of SE if mix with RX Use is safest if PCP aware Encourage patients to purchase standardized products from a single company –Use only recommended dosagesAre cancerHerb-Drug Interactions Encourage patients to be open about all medication they may be taking If patients are known to have adverse drug reactions, warn them that they have a higher risk of side effects from herbs as well Elderly, pregnant women, and children have an increased risk of interactions and SE Some herbs are unsafe during pregnancy Like RX meds herbs have SE too |
Research implies strongly that getting them from foods is more effective
–It might not just be the vitamin, but associated other chemicals in the food source that give them their propertiesTwo |
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Regulations and labels supplements
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Not regulations as drugs and labels,
Labels are off a lot of time Unregulated and not required to have accurate info on the labels |
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Implications of drugs both short and long term (steroids, thyroid etc)
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Short term: 7 days (steroid), taper
Thyroid Long term, thyroid too little or too much, when we remove we may remove too much |
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S/S of aldosterone imbalances
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Too much aldosterone: increase fluid , increase BP,
Too little aldosterone, lower BP indication: addison's disease |
Mineralcorticoids
•Aldosterone is the main hormone •Action –Stimulates reabsorption of Na+ •Release triggered by BP, blood volume, Na+ levels –Keeps K+ in balance |
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Precautions with I 131 therapy
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Radiation precaution
stay away from children, preganant women |
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watch out: Diuretics
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Potassium level
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Osmotics (Mannitol) watch out
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Pt's I/O
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Thiazides watch out
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BP
Lipid Levels (because Thiazide increase in cholesterol and TG levels) |
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Dysrythmias
watch out |
EKG
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Hyperlipidemias
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C-reactive Protein
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watch out Digioxin
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Drug Levels
Electrolytes (K alterations) Apical HR PRIOR to Admin |
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Heparin watch out
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aPTT
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LMW Heparin watch out
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none
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Warfarin watch out
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Prothrombin (PT)/INR (q 2-4 weeks or so)
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DDAVP watch out
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Monitor Fluid Balance
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Thyroid Therapy watch out
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TSH Levels
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Isoniazid watch out
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AST/ALT Monthly (liver enzymes)
Sputum Cultures Opthalmologic Exam (if vision changes) |
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Thrombolytic Therapy watch out
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EKG
Monitor for Subtle Bleeding (change in LOC, pink urine, tarry stools, joints for swelling) |
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So which drug works where in the heart to do what?
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Heart Failure:
1. Improve Cardiac Contractability - glycosides & ace inhibitors or ARBs 2. Decrease Preload - diuretics 3. Decrease Afterload - vasodilators 4. Ventricular Restructuring and Rate Control - Beta Blocker |
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Different between low and unfractionated heparins and warfarin; how and when they are used and precautions
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Unfractionated heparins compared to heparins
no need to check aPTT ( no protein binding) patient can be self-taught injection pre-loaded syringes more expensive not suit for big person not for pt with bad kidney This and regular heparin NOT IM Nasty hematomas |
Heparin vs. Coumadin
Route Parenteral Oral Duration < 4 hr 2-5 days Labs APTT PT/INR Antidote ProtamineSulfate Vitamin K (Aqua- Mephyton) |
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Anginal meds use and precautions, patient education
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nitroglycerin (NTG)
–used in both short and long term treatment –cheap and effective Stored in airtight light resistant (brown) glass bottles or air tight aluminum sprays – Can’t set out in pill boxes • Need ready access--several bottles • Bottles “expire” 6 months after opened • HA is normal; if none --isn’t working • Expect orthostatic hypotension • Handle patches and ointments with gloves |
• Try to avoid angina triggers
• Drugs are also temperature sensitive – Keep out of hot cars or pants pockets • Spray meters are “more expensive” – Last longer than bottles – Bottles are ‘expired’ if open more than 6 months |
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Anti-lipid therapy and patient education
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Initial- Depends on risk
lifestyle modification for 3-6 months reduce daily intake of fat, cholesterol, calories reduce alcohol intake if high stop smoking, worsens lipid abnormalities exercise for weight reduction, fitness, mental attitude Reduce lipid elevating drugs thiazides, estrogens |
AGENT
Have been shown to reduce progression of atherosclerosis and improve morbidity in patients at risk Main types bile acid sequestrants cholesterol synthesis inhibitors HMG-CoA inhibitors (statins) |
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Concepts of antirhythmic drug care and nursing implications,
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What labs need to be watched with different meds? ( HTN, anticoags, diuretics, lipids etc)
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HTN: soldium?
Diuretic:potassium Anticoag: heparin: aPTT, waffarin, PT/INR Lipid: ?liver, CK muscle break down |
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How can you tell if a med is working or toxic?
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Clinical sysmpton:
If you see the result Absence of clinical problem |
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Patient education for HTN drugs
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Compliance (Often difficult)
–Symptomless, feel cured, perceive SE as worse than HTN –Expense –Drug switching to find the right agent(s) •One thing does not work –Usually needs combination of approaches •Needs concordance of patient |
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HTN drugs
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Antihypertensives
–Beta adrenergic blockers –Calcium channel blockers –Angiotension converting enzyme inhibitors (ACE and ARBs) –Diuretics –Sympatholytic drugs –Acute anti-hypertensives –Direct-acting vasodilators –Direct renin inhibitors |
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Some chronic medical conditions help direct which antihypertensive agent is used or not used.
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See P508
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What to do if BP is too high or too low
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What’s pt lifestyle, are they taking persistantely
Their fluid level, |
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Concept of rescue inhalers
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anbutel
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