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428 Cards in this Set
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Meds for hypertension |
Diuretics ACE inhibitors ARBS Beta blockers CA channel blockers |
5 |
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What do diuretics do? |
Inc urination and dec fluid volume
Mobilize fluid to treat HTN, heart failure, Nephrotic Syndrome, and liver cirrhosis
JNC8 first line treatment for HTN |
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How do diuretics work? |
Produce diuresis by decreasing reabsorption of Na and water in kidney tubules |
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How do diuretics work? |
Produce diuresis by decreasing reabsorption of Na and water in kidney tubules |
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Side effects of diuretics |
Hypovolemia
Acid Base disturbances
Electrolyte imbalances (K*, Mg*, Na, Cl) |
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Loop diuretics: Action |
Works in the Loop of Henle to inhibit electrolyte reabsorption
Temp inc in renal blood flow without inc in GFR
Works best of all diuretics in or w urine output <30ml/hr
Very strong, useful for rapid diuresis
Esp helpful in renally impaired or bc of site of action |
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furosemide (Lasix) |
Loop diuretic |
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Loop diuretic examples |
furosemide (Lasix)*
bumetanide torsemide (Demadex) |
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Loop diuretic examples |
furosemide (Lasix)*
bumetanide torsemide (Demadex) |
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Loop diuretics: Uses |
CHF Hepatic disease Renal disease Pulmonary edema HTN refract to thiazides Ascites Oliguria (100-400 cc in 24hrs) |
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Loop diuretics: ADRs |
Fluid and electrolyte imbalance Hearing loss/deafness - rapid IV
*Deliver IVP Lasix at 20-40 mg/min |
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Loop diuretics: ADRs |
Fluid and electrolyte imbalance Hearing loss/deafness - rapid IV
*Deliver IVP Lasix at 20-40 mg/min |
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Loop diuretics: Interactions |
Aminoglycosides antibiotics (gentamicin): Hearing loss |
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Loop diuretics: Patient teaching |
Take in morning
Watch for signs and symptoms of hypokalemia (loop diuretics are potassium wasting) |
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Loop diuretics: lifespan |
Do not use in pregnant or breastfeeding women, dangerous to mother and baby
Caution in elderly (may have reduced albumin binding, reduced renal function) |
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Hypokalemia: effects |
Slow bowel Dysrhythmia Muscle weakness Dizziness Thirst Mental confusion |
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Hypokalemia: effects |
Slow bowel Dysrhythmia Muscle weakness Dizziness Thirst Mental confusion |
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Hyperkalemia: effects |
Weakness Paralysis Ventricular fibrillation Death |
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Potassium goal level |
3.5-5.0 mEq/L |
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Potassium goal level |
3.5-5.0 mEq/L |
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Hypokalemia Tx |
Replace with K+, 10mEq as IVPB in 50cc D5W over 1 hour **do not push**
May replace moderate losses w oral dose |
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Potassium goal level |
3.5-5.0 mEq/L |
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Hypokalemia Tx |
Replace with K+, 10mEq as IVPB in 50cc D5W over 1 hour **do not push**
May replace moderate losses w oral dose |
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Hyperkalemia Tx |
Excess removed via insulin and glucose infusion in emergency, pushing K+ to cells
Can be removed via sodium polystyrene sulfonate (Kayexalate), remains in intestines where it absorbs K+ and forms complex of resin and K+, excreted in feces
Mild elevation - low K+ diet |
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Thiazide diuretics: action |
Inc excretion of sodium chloride, water, and potassium
Acts on distal tubule to inhibit Na absorption (not as strong as loop)
Anti hypertensive - dec PVR Initial drop in cardiac output and blood volume Chronic dec in PVR |
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hydrochlorothiazide (HCTZ, HydroDiuril) |
Thiazide diuretic |
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Thiazide diuretics: Uses |
HTN, HF Edema of early renal disease Cirrhosis
#1 for HTN
Works best if u/o still >30cc/hr (Still pretty good renal function and GFR)
1 month to see full effect
Inc effectiveness of other HTN meds by 30-50% |
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Thiazide diuretics: Uses |
HTN, HF Edema of early renal disease Cirrhosis
#1 for HTN
Works best if u/o still >30cc/hr (Still pretty good renal function and GFR)
1 month to see full effect
Inc effectiveness of other HTN meds by 30-50% |
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Thiazide diuretics: ADRs |
Electrolyte disturbances (hypo) K, Mg, Na, Cl
Inc fasting blood glucose levels
Elevated BUN
Hyperuricemia
Inc serum cholesterol, triglycerides, LDL (helps to give K sparing diuretic with)
K+ wasting diuretic |
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Thiazide diuretics: Uses |
HTN, HF Edema of early renal disease Cirrhosis
#1 for HTN
Works best if u/o still >30cc/hr (Still pretty good renal function and GFR)
1 month to see full effect Inc effectiveness of other HTN meds by 30-50% |
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Thiazide diuretics: ADRs |
Electrolyte disturbances (hypo) K, Mg, Na, Cl
Inc fasting blood glucose levels
Elevated BUN
Hyperuricemia
Inc serum cholesterol, triglycerides, LDL (helps to give K sparing diuretic with)
K+ wasting diuretic |
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Thiazide diuretics: interactions |
Digoxin Lithium NSAIDs |
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Thiazide diuretics- Teaching |
Diet Timing (morning) Take w meals to avoid GI upset |
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Potassium sparing diuretics- uses |
Counteract potassium loss with diuretics i.e. Thiazides
Edema
HTN |
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spironolactone (Aldactone) |
Potassium sparing diuretic
Non selective blocker, blocks aldosterone and indirectly affects sodium uptake and potassium secretion
Aldosterone antagonist
Blockage of aldosterone in kidney and CV areas lead to poss effects like improved CV structure and function
Uses- HTN, edema, HF, hyperaldosteronism, acne, PCOS |
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spironolactone (Aldactone) |
Potassium sparing diuretic
Non selective blocker, blocks aldosterone and indirectly affects sodium uptake and potassium secretion
Aldosterone antagonist
Blockage of aldosterone in kidney and CV areas lead to poss effects like improved CV structure and function
Uses- HTN, edema, HF, hyperaldosteronism, acne, PCOS |
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triamterone (Dyrenium) |
Potassium sparing diuretic
Directly inhibits sodium uptake and potassium secretion
HTN, edema |
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spironolactone (Aldactone) |
Potassium sparing diuretic
Non selective blocker, blocks aldosterone and indirectly affects sodium uptake and potassium secretion
Aldosterone antagonist
Blockage of aldosterone in kidney and CV areas lead to poss effects like improved CV structure and function
Uses- HTN, edema, HF, hyperaldosteronism, acne, PCOS |
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triamterone (Dyrenium) |
Potassium sparing diuretic
Directly inhibits sodium uptake and potassium secretion
HTN, edema |
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amiloride (Midamor) |
Potassium sparing diuretic
Blocks sodium-potassium exchange in distal nephron
Used to counteract potassium loss caused by more powerful diuretics
ADR hyperkalemia
Interactions - ACE inhibitors, other drugs w hyperkalemia |
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spironolactone (Aldactone) |
Potassium sparing diuretic
Non selective blocker, blocks aldosterone and indirectly affects sodium uptake and potassium secretion
Aldosterone antagonist
Blockage of aldosterone in kidney and CV areas lead to poss effects like improved CV structure and function
Uses- HTN, edema, HF, hyperaldosteronism, acne, PCOS |
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triamterone (Dyrenium) |
Potassium sparing diuretic
Directly inhibits sodium uptake and potassium secretion
HTN, edema |
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amiloride (Midamor) |
Potassium sparing diuretic
Blocks sodium-potassium exchange in distal nephron
Used to counteract potassium loss caused by more powerful diuretics
ADR hyperkalemia
Interactions - ACE inhibitors, other drugs w hyperkalemia |
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Potassium sparing diuretics ADRs |
Hyperkalemia |
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spironolactone (Aldactone) |
Potassium sparing diuretic
Non selective blocker, blocks aldosterone and indirectly affects sodium uptake and potassium secretion
Aldosterone antagonist
Blockage of aldosterone in kidney and CV areas lead to poss effects like improved CV structure and function
Uses- HTN, edema, HF, hyperaldosteronism, acne, PCOS |
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triamterone (Dyrenium) |
Potassium sparing diuretic
Directly inhibits sodium uptake and potassium secretion
HTN, edema |
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amiloride (Midamor) |
Potassium sparing diuretic
Blocks sodium-potassium exchange in distal nephron
Used to counteract potassium loss caused by more powerful diuretics
ADR hyperkalemia
Interactions - ACE inhibitors, other drugs w hyperkalemia |
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Potassium sparing diuretics ADRs |
Hyperkalemia |
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Potassium sparing diuretics- teaching |
Avoid diet high in potassium (salt subs)
Timing - can give am or pm, prolonged effect |
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spironolactone (Aldactone) |
Potassium sparing diuretic
Non selective blocker, blocks aldosterone and indirectly affects sodium uptake and potassium secretion
Aldosterone antagonist
Blockage of aldosterone in kidney and CV areas lead to poss effects like improved CV structure and function
Uses- HTN, edema, HF, hyperaldosteronism, acne, PCOS |
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triamterone (Dyrenium) |
Potassium sparing diuretic
Directly inhibits sodium uptake and potassium secretion
HTN, edema |
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amiloride (Midamor) |
Potassium sparing diuretic
Blocks sodium-potassium exchange in distal nephron
Used to counteract potassium loss caused by more powerful diuretics
ADR hyperkalemia
Interactions - ACE inhibitors, other drugs w hyperkalemia |
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Potassium sparing diuretics ADRs |
Hyperkalemia |
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Potassium sparing diuretics- teaching |
Avoid diet high in potassium (salt subs)
Timing - can give am or pm, prolonged effect |
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Osmotic diuretics- causes |
Causes osmotic gradient Water moves from extravascular to intravascular |
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spironolactone (Aldactone) |
Potassium sparing diuretic
Non selective blocker, blocks aldosterone and indirectly affects sodium uptake and potassium secretion
Aldosterone antagonist
Blockage of aldosterone in kidney and CV areas lead to poss effects like improved CV structure and function
Uses- HTN, edema, HF, hyperaldosteronism, acne, PCOS |
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triamterone (Dyrenium) |
Potassium sparing diuretic
Directly inhibits sodium uptake and potassium secretion
HTN, edema |
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amiloride (Midamor) |
Potassium sparing diuretic
Blocks sodium-potassium exchange in distal nephron
Used to counteract potassium loss caused by more powerful diuretics
ADR hyperkalemia
Interactions - ACE inhibitors, other drugs w hyperkalemia |
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Potassium sparing diuretics ADRs |
Hyperkalemia |
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Potassium sparing diuretics- teaching |
Avoid diet high in potassium (salt subs)
Timing - can give am or pm, prolonged effect |
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Osmotic diuretics- causes |
Causes osmotic gradient Water moves from extravascular to intravascular |
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Osmotic diuretics- Uses |
Relief of oliguria
Tx of inc intracranial pressure Tx of inc intraocular pressure |
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mannitol (Osmitrol) |
Osmotic diuretic
ADRs: Edema, caution in CHF patient Headache Nausea/vomiting Fluid and electrolyte imbalance
Can crystallize out of solution in low temps |
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Adverse effects and toxicity - osmotic diuretics |
ADRs Hypokalemia Hyponatremia
Toxicity Crystalluria and nephrolithiasis Hearing loss/deafness |
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Patient monitoring for diuretics |
Daily weight (same time) Intake and output Edema BP (may need orthostatic) Lung sounds |
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ACE inhibitors - Action |
Block conversion of angiotensin 1 to angiotensin 2 (powerful vasoconstrictor) |
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ACE inhibitors - Action |
Block conversion of angiotensin 1 to angiotensin 2 (powerful vasoconstrictor) |
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ACE inhibitors - uses |
Mild to moderate HTN
Vasodilator tx for HF
May be used w diuretics
Diabetic prophylactic against renal failure
Reverse damage in coronary vessel wall and kidney
Prevent ventricular remodeling |
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ACE inhibitors med endings |
pril |
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ACE inhibitors med endings |
pril |
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captopril (Capoten) |
ACE inhibitor |
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ACE inhibitors med endings |
pril |
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captopril (Capoten) |
ACE inhibitor |
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lisinopril (Prinivil, Zestril) |
ACE inhibitor |
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ACE inhibitors - ADRs |
Dry hacking cough (bradykinin accumulation)
1st dose effect (significant drop in BP)
Hyperkalemia (if taking K products)
Severe renal insufficiency (bilateral renal stenosis or only 1 kidney) - Contraindicated
Fetal harm
Angioedema - 1% of population dev lg wheals on tongue, pharynx, and glottis - Discontinue |
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Angiotensin 2 Antagonists (ARBS) - causes |
Block action of angiotensin 2 (ACE inhibitor blocks production of angiotensin 2)
Block vasoconstriction and aldosterone producing effects of angiotensin 2 at receptor sites (vascular smooth muscle, adrenal glands)
Block binding of angiotensin 2 to angiotensin receptors |
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Angiotensin 2 Antagonists (ARBS) - causes |
Block action of angiotensin 2 (ACE inhibitor blocks production of angiotensin 2)
Block vasoconstriction and aldosterone producing effects of angiotensin 2 at receptor sites (vascular smooth muscle, adrenal glands)
Block binding of angiotensin 2 to angiotensin receptors |
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ARBs - uses |
HTN HF diabetic nephropathy Myocardial infarction Stroke prevention |
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ARB med endings |
sartan |
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ARB med endings |
sartan |
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losartan (Cozaar) |
ARBs (Angiotensin 2 antagonist) |
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ARBs - ADRs |
Angioedema Renal failure Teratogenic
More expensive than ACE 1, newer, no cough. |
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eplerenone (Inspra) |
Aldosterone antagonist |
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Aldosterone antagonist - causes |
Selectively blocks aldosterone receptors
Kidneys: Excretion of sodium and water, retention of potassium |
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Aldosterone antagonist - causes |
Selectively blocks aldosterone receptors
Kidneys: Excretion of sodium and water, retention of potassium |
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Aldosterone antagonist - uses |
HTN HF |
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Aldosterone antagonist - causes |
Selectively blocks aldosterone receptors
Kidneys: Excretion of sodium and water, retention of potassium |
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Aldosterone antagonist - uses |
HTN HF |
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Aldosterone antagonist- caution |
Hyperkalemia |
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Ca Channel blockers - actions |
Blocks slow Ca channels preventing Ca from entering cell - dec contraction of smooth muscle tissue, vasodilation results, dec PVR
Does not act on veins |
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Ca Channel blockers - actions |
Blocks slow Ca channels preventing Ca from entering cell - dec contraction of smooth muscle tissue, vasodilation results, dec PVR
Does not act on veins |
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Ca Channel blockers - uses |
HTN (inc AA& isolated HTN)
Cardiac arrhythmias (slows ventricular HR)
Angina pectoris (causes vasodilation) |
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Ca Channel blockers - actions |
Blocks slow Ca channels preventing Ca from entering cell - dec contraction of smooth muscle tissue, vasodilation results, dec PVR
Does not act on veins |
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Ca Channel blockers - uses |
HTN (inc AA& isolated systolic HTN)
Cardiac arrhythmias (slows ventricular HR)
Angina pectoris (causes vasodilation)
Elderly and African Americans (esp w diuretics)
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Ca Channel blockers - ADRs |
Common- constipation (blocks smooth muscle in intestine)
Other- dizziness, flushing, headache, edema of ankles and feet, bradycardia in susceptible pts |
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nifedipine (Procardia) |
Ca channel blocker
Vascular smooth muscle only |
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verapamil (Calan, Isoptin) |
Ca channel blocker
Heart and vascular smooth muscle |
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verapamil (Calan, Isoptin) |
Ca channel blocker
Heart and vascular smooth muscle |
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diltiazem (Cardizem) |
Ca channel blocker
Heart and vascular smooth muscle |
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What do Ca channel blocker names have in common? |
Generic may end in dipine
Trade may have Ca or Cardi |
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Ca channel blocker and reflex tachycardia |
Reflective inc in HR to counteract lower BP
Verapamil and diltiazem oppose this reflex by suppressing heart conduction
Nifedipine doesn't work on the heart, no opposition to reflex tachycardia. |
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Beta Adrenergic Blockers - action |
Compete with epinephrine for beta receptor sites, inhibiting response to beta adrenergic stimuli
Beta 1 blockers (heart) - dec HR, dec myocardial contractility, dec CO
Beta 2 blockers (lung) - ADR- inc bronchospasm
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Beta Adrenergic Blockers - action |
Compete with epinephrine for beta receptor sites, inhibiting response to beta adrenergic stimuli
Beta 1 blockers (heart) - dec HR, dec myocardial contractility, dec CO
Beta 2 blockers (lung) - ADR- inc bronchospasm
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Beta Adrenergic Blockers - uses |
HF HTN post MI |
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Selective Beta Blockers |
Atenolol (Tenormin) Metoprolol (Lopressor)
High doses can also block beta2
Best for PTs with asthma (beta2 bronchoconstriction) |
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Selective Beta Blockers |
Atenolol (Tenormin) Metoprolol (Lopressor)
High doses can also block beta2
Best for PTs with asthma (beta2 bronchoconstriction) |
A.M. |
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Atenolol (Tenormin) |
Beta Adrenergic Blocker - Selective |
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Metoprolol (Lopressor) |
Beta Adrenergic Blockers - Selective |
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Metoprolol (Lopressor) |
Beta Adrenergic Blockers - Selective |
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Non selective Beta Blockers |
carvedilol (Coreg) propranolol (Inderal) sotalol (Betapace) |
CPS |
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Metoprolol (Lopressor) |
Beta Adrenergic Blockers - Selective |
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Non selective Beta Blockers |
carvedilol (Coreg) propranolol (Inderal) sotalol (Betapace) |
CPS |
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carvedilol (Coreg) |
Beta Adrenergic Blockers - Non selective |
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Metoprolol (Lopressor) |
Beta Adrenergic Blockers - Selective |
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Non selective Beta Blockers |
carvedilol (Coreg) propranolol (Inderal) sotalol (Betapace) |
CPS |
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carvedilol (Coreg) |
Beta Adrenergic Blockers - Non selective |
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propranolol (Inderal) |
Beta Adrenergic Blockers - Non selective
Class 2 antiarrythmic |
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sotalol (Betapace) |
Beta Adrenergic Blockers - Non selective
Class 3 antiarrythmic |
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Beta Adrenergic Blockers - properties |
Relief of anxiety
Little volume retention
Antianginal
Antiarrythmic
Post MI protection
Reverse left ventricular hypertrophic |
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Beta Adrenergic Blockers - ADRs |
Bronchospasm Can mask hypoglycemia Fluid retention to HF Impotence Cold extremities Inc triglycerides Dec HDL Exercise intolerance
Do not use w asthma PT Caution w DM |
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Vasodilators - action |
Act on peripheral blood vessels
Dec BP Inc HR, CO, force of contraction
Sometimes given w Beta Blockers to dec ADRs |
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Vasodilators - uses |
HTN HF Angina MI |
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Vasodilators - uses |
HTN HF Angina MI |
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Vasodilators- cautions |
Ok to use in kids and pregnancy, caution: pregnancy category C No data for breastfeeding
Caution in elderly- falls |
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Vasodilators - uses |
HTN HF Angina MI |
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Vasodilators- cautions |
Ok to use in kids and pregnancy, caution: pregnancy category C No data for breastfeeding
Caution in elderly- falls |
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hydralazine (Apresoline) |
Vasodilators - arteriole dilation |
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Vasodilators - uses |
HTN HF Angina MI |
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Vasodilators- cautions |
Ok to use in kids and pregnancy, caution: pregnancy category C No data for breastfeeding
Caution in elderly- falls |
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hydralazine (Apresoline) |
Vasodilators - arteriole dilation |
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Vasodilators - arteriole dilation : uses |
HTN HTN crisis (parenterally) HF |
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Vasodilators - uses |
HTN HF Angina MI |
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Vasodilators- cautions |
Ok to use in kids and pregnancy, caution: pregnancy category C No data for breastfeeding
Caution in elderly- falls |
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hydralazine (Apresoline) |
Vasodilators - arteriole dilation |
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Vasodilators - arteriole dilation : uses |
HTN HTN crisis (parenterally) HF |
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Vasodilators - arteriole dilation - Action |
Dec peripheral resistance by dilation of arterioles Dec BP Dec afterload |
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Vasodilators - uses |
HTN HF Angina MI |
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Vasodilators- cautions |
Ok to use in kids and pregnancy, caution: pregnancy category C No data for breastfeeding
Caution in elderly- falls |
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hydralazine (Apresoline) |
Vasodilators - arteriole dilation |
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Vasodilators - arteriole dilation : uses |
HTN HTN crisis (parenterally) HF |
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Vasodilators - arteriole dilation - Action |
Dec peripheral resistance by dilation of arterioles Dec BP Dec afterload |
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Vasodilators - arteriole dilation - ADRs |
Reflex tachycardia
Salt and water retention
HF
Drug induced systemic lupus (slow acetylators, med build up) |
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minoxidil (Loniten, Rogaine) |
Vasodilators - arteriole dilation
Similar but more intense than hydralazine
Severe HTN unresponsive to other drugs
ADR: hypertrichosis |
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diazoxide (Hyperstat IV) |
Vasodilators - arteriole dilation
Reserved for HTN emergency |
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sodium nitroprusside (Nipride) |
Vasodilator - Mixed arterial and venous |
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sodium nitroprusside (Nipride) |
Vasodilator - Mixed arterial and venous
DOC reduce BP hypertensive crisis |
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Vasodilator - Mixed arterial and venous - Action |
Act directly on arteries and veins
Rapid reduction of BP in hypertensive crisis (DOC)
BP returns to pretreatment level minutes after IV stopped
Metabolized to cyanide - measure thiocyanate levels (Caution prolonged use) |
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clonidine (Catapres) |
Centrally acting Sympathetic Nervous System Inhibitor |
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Centrally acting Sympathetic Nervous System Inhibitor - Action |
Dec sympathetic tone, peripheral vasodilation
Dec sympathetic outflow to heart, kidneys, and blood vessels Decreased BP, PVR, HR No change in CO |
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Centrally acting Sympathetic Nervous System Inhibitor - Action |
Dec sympathetic tone, peripheral vasodilation
Dec sympathetic outflow to heart, kidneys, and blood vessels Decreased BP, PVR, HR No change in CO |
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Centrally acting Sympathetic Nervous System Inhibitor - Uses |
Mild to moderate HTN
Lower sitting and standing BP Often comb w diuretic Not first line, other drugs better w fewer ADRs |
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Centrally acting Sympathetic Nervous System Inhibitor - ADRs |
CNS - drowsiness, inability to concentrate, depression Dry mouth Impotence, dec libido Orthostatic hypotension Raynaud's phenomenon |
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prazosin (Minipress) |
Alpha adrenergic Blockers |
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Alpha adrenergic Blockers - action |
Sympatholytic
Dec PVR Dec CO |
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Alpha adrenergic Blockers - action |
Sympatholytic
Dec PVR Dec CO |
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Alpha adrenergic Blockers - uses |
Mild to moderate HTN
Reduces preload and afterload Benign prostatic hypertrophy |
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Alpha adrenergic Blockers - action |
Sympatholytic
Dec PVR Dec CO |
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Alpha adrenergic Blockers - uses |
Mild to moderate HTN
Reduces preload and afterload Benign prostatic hypertrophy |
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Alpha adrenergic Blockers - ADRs |
Orthostatic hypotension (give at bedtime)
Resistance/tolerance over time
Sodium and fluid retention (renin response to dec BP) |
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Anti hypertensives - Patient and Family Teaching |
Continue taking meds even when feeling better Meds control, not cure HTN Abrupt Withdrawal- rebound HTN
Compliance w additional interventions
Proper technique for monitoring BP, when to report
Watch weight gain and report
Change position slowly
Avoid ephedrine based products (cough suppressants, decongestants) |
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Drug classes for heart failure |
Beta blockers (carvedilol, metoprolol)
Diuretics (esp thiazide and loop)
Renin inhibitors (ACE &ARBs) Cardiac remodeling Hemodynamic benefits |
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digoxin (Lanoxin) |
Cardiac glycoside
Safer, rapid onset, short duration compared to digitoxin
Pos inotrope (inc contraction) Neg chronitropic (Dec HR) |
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digoxin (Lanoxin) |
Cardiac glycoside
Safer, rapid onset, short duration compared to digitoxin
Pos inotrope (inc contraction) Neg chronitropic (Dec HR) |
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Digoxin- uses |
CHF - systolic (inability to pump)
Dysthymia
Slow conduction via AV node 2nd line |
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Digoxin - cardiac effects |
Pos inotropic - inc contraction
Neg chronotropic - dec HR
Neg dromotropic - dec elect imp |
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Digoxin precautions |
Bradycardia
Monitor serum electrolytes (K, Mg, Ca) Hypokalemia, hypomagnesemia, hypercalcemia |
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Digoxin toxicity signs |
Dyspnea Inc weight Edema Wheezes, crackles in lungs Dec HR Dec U/O |
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dopamine (Intropin) |
Positive inotropic HR drug
For shock- inc BP, CO, U/O
Activate beta 1 - inc contraction Activate kidney dopamine receptors, inc renal perfusion
High doses activate alpha 1 receptors- inc vascular resistance, dec CO |
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Dopamine receptor action |
Low dose- inc U/O
Med dose- inc U/O, inc CO
High dose- renal vasoconstriction, dec U/O, inc BP (clue too high) |
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Ejection Fraction |
% of heart volume pumped w each contraction
70% norm 40% risk for dysthymia |
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|
Class 1a antiarrythmics - action |
Blocks sodium channels - slows
Slows conduction velocity in atria and ventricles
Delays heart repolarization |
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|
Class 1a antiarrythmics - meds |
quinidine (sulfate, gluconate)
procainamide (Pronestyl) |
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Class 1a antiarrythmics - meds |
quinidine (sulfate, gluconate)
procainamide (Pronestyl) |
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|
quinidine (sulfate, gluconate) |
Class 1a antiarrythmics |
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Class 1a antiarrythmics - meds |
quinidine (sulfate, gluconate)
procainamide (Pronestyl) |
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quinidine (sulfate, gluconate) |
Class 1a antiarrythmics |
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procainamide (Pronestyl) |
Class 1a antiarrythmic |
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|
|
quinidine - ADRs |
Diarrhea (can become severe)
Cinchonism (tinnitus, vertigo, visual disturbance, hearing loss, confusion
Cardiac toxicity
Can be used short or long term
Sustained VT, atrial fibrillation, atrial flutter |
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|
procainamide- precautions |
Measure CBC w first therapy- leukocytes, neutrophils, and platelets may drop
If ANA elevated for prolonged use, may lead to SLE |
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|
Class 1b antiarrythmics - action |
Block sodium influx - slows conduction
Accelerate repolarization phase |
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lidocaine (Xylocaine) |
Class 1b antiarrythmics
Treats acute and chronic conditions
Ventricular dysthymia |
|
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Lidocaine administration |
Loading dose - IV push 50mg/min
Continuous infusion 1-4mg/min
Do not give IV lidocaine with preservative |
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Lidocaine ADRs |
Parasthesia - numbness bilaterally
Numbness
Agitation
Disorientation
All temp and due to anesthetic properties |
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|
Class 1c antiarrythmics - action |
Blocks sodium channels - slows
Depress sinus node, prolonged conduction |
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propofanone (Rythmol) |
Class 1c antiarrythmic
May make arrhythmia worth May dec cardiac contractility, exacerbate HF |
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Class 2 antiarrythmics - action |
Exert Beta blockade - slows
Rapid ventricular response
Slight dec resting HR Dec exercise tachycardia |
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Class 2 antiarrythmics - ADRs |
(Propranolol)
Too much blockage - sinus arrest, CHF
Bronchospasm (beta 2 blockade)
Blocks SA node - hypotension from dec CO |
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Class 3 antiarrythmics- action |
Slows - delays repolarization
These meds are not interchangeable |
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|
amiodarone (Cordarone) |
Class 3 antiarrythmic
DOC for VT |
|
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|
Class 3 antiarrythmics- uses |
Ventricular dysthymia (IV)
Chronic cardiac arrhythmia (oral) |
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|
Class 3 antiarrythmics - ADRs |
IV - bradycardia and hypotension
Oral - highly toxic Corneal micro deposits Blue gray skin discoloration Pulmonary infiltrates and fibrosis (irreversible, serious) |
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|
sotalol (Betapace) ADRs |
Hypokalemia- dysthymias Bradycardia, HF, bronchospasm |
|
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Class 4 antiarrythmics - action |
Inhibit transmembrane flow of calcium ions - slows |
|
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|
Class 4 antiarrythmics - action |
Inhibit transmembrane flow of calcium ions - slows |
|
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|
Class 4 antiarrythmics - ADRs |
Bradycardia, HF |
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|
Class 4 antiarrythmics - action |
Inhibit transmembrane flow of calcium ions - slows |
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|
Class 4 antiarrythmics - ADRs |
Bradycardia, HF |
|
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verapamil (Calan, Isoptin) |
Class 4 antiarrythmic |
|
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|
adenosine (Adenocard) - action |
Inhibits effect of catecholamine stimulation
Slows condition through AV node |
|
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|
adenosine (Adenocard) - uses |
Anti arrhythmic
Pharmacological stress test - coronary artery vasodilation, can see perfusion defects |
|
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|
adenosine (Adenocard) administration |
Over 1-2 seconds, close to heart as possible through IV tubing
Short half life |
|
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|
adenosine (Adenocard) administration |
Over 1-2 seconds, close to heart as possible through IV tubing
Short half life |
|
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|
adenosine (Adenocard) - ADRs |
Chest pain Impending doom Asystole the possibility heart rhythm |
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|
Lipid goals |
Total cholesterol (fasting) <200mg/dl
LDL <100mg/dl
HDL >40mg/dl
TG <150mg/dl |
|
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|
Metabolic syndrome |
Inc waist circumference Inc triglycerides (>150) Low HDL Inc FBG (>110) or dx DM Inc BP |
|
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|
Metabolic syndrome |
Inc waist circumference Inc triglycerides (>150) Low HDL Inc FBG (>110) or dx DM Inc BP |
|
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|
Statins long name |
HMG CoA Reductase Inhibitors |
|
|
|
Metabolic syndrome |
Inc waist circumference Inc triglycerides (>150) Low HDL Inc FBG (>110) or dx DM Inc BP |
|
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|
Statins long name |
HMG CoA Reductase Inhibitors |
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|
lovastatin (Mevacor) |
Statin HMG CoA Reductase Inhibitors |
|
|
|
Metabolic syndrome |
Inc waist circumference Inc triglycerides (>150) Low HDL Inc FBG (>110) or dx DM Inc BP |
|
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|
Statins long name |
HMG CoA Reductase Inhibitors |
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|
lovastatin (Mevacor) |
Statin HMG CoA Reductase Inhibitors |
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simvastatin (Zocor) |
Statin HMG CoA Reductase Inhibitors |
|
|
|
Metabolic syndrome |
Inc waist circumference Inc triglycerides (>150) Low HDL Inc FBG (>110) or dx DM Inc BP |
|
|
|
Statins long name |
HMG CoA Reductase Inhibitors |
|
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lovastatin (Mevacor) |
Statin HMG CoA Reductase Inhibitors |
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simvastatin (Zocor) |
Statin HMG CoA Reductase Inhibitors |
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atorvastatin (Lipitor) |
Statin HMG CoA Reductase Inhibitors |
|
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|
Statin HMG CoA Reductase Inhibitors - Action |
Best at decreasing LDL (25-63%)
Liver removes more LDL from the body
Dec triglycerides
Inc HDL
Dec total mortality and mortality due to CAD
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Statin HMG CoA Reductase Inhibitors - Administration |
Give at night
Avoid grapefruit juice (inhibits CYP3A4 enzyme, inc amt of statin)
Macrolides and and anti fungals (azoles) inc statin level |
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|
|
Statin HMG CoA Reductase Inhibitors - ADRs |
GI - dyspepsia, ab pain, constipation, diarrhea
Myopathy and rhandomyolysis (PT report unusual muscle aches, teach CPK levels)
Hepatotoxicity (low incidence) -measure liver enzymes at start of therapy and 6-12 mo after
Pregnancy category X |
|
|
|
PCSK9 inhibitors- action |
Lowers LDL significantly
Statins are better at decreasing mortality |
|
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|
Nicotinic Acid (Niaspan, Niacin, Vitamin B3) - action |
Inhibit VLDL production in the liver
Dec LDL 5-25% Dec HDL 15-35% Dec triglycerides 20-50%
Vitamin niacin much lower dose (25mg vs 1-3G) |
|
|
|
Nicotinic Acid (Niaspan, Niacin, Vitamin B3) - action |
Inhibit VLDL production in the liver
Dec LDL 5-25% Dec HDL 15-35% Dec triglycerides 20-50%
Vitamin niacin much lower dose (25mg vs 1-3G) |
|
|
|
Nicotinic Acid (Niaspan) - ADRs |
Flushing and warmth 15-60 min after dose Take on full stomach or take aspirin 325mg 30 min before dose
Inc risk of hepatotoxicity (dark urine, dec appetite, yellowing)
Hyperglycemia (caution)
Gouty arthritis |
|
|
|
Bile Acid Sequestrants - action |
Exchange resins- bond w bile in intestine
LDL dec 20% first month
5-20% inc in VLDL, usually transient, caution if high at start
Used alone or combo w statin |
|
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|
Nicotinic Acid (Niaspan, Niacin, Vitamin B3) - action |
Inhibit VLDL production in the liver
Dec LDL 5-25% Dec HDL 15-35% Dec triglycerides 20-50%
Vitamin niacin much lower dose (25mg vs 1-3G) |
|
|
|
Nicotinic Acid (Niaspan) - ADRs |
Flushing and warmth 15-60 min after dose Take on full stomach or take aspirin 325mg 30 min before dose
Inc risk of hepatotoxicity (dark urine, dec appetite, yellowing)
Hyperglycemia (caution)
Gouty arthritis |
|
|
|
Bile Acid Sequestrants - action |
Exchange resins- bond w bile in intestine
LDL dec 20% first month
5-20% inc in VLDL, usually transient, caution if high at start
Used alone or combo w statin |
|
|
|
colesevelam (Welchol) |
Bile Acid Sequestrants |
|
|
|
Nicotinic Acid (Niaspan, Niacin, Vitamin B3) - action |
Inhibit VLDL production in the liver
Dec LDL 5-25% Dec HDL 15-35% Dec triglycerides 20-50%
Vitamin niacin much lower dose (25mg vs 1-3G) |
|
|
|
Nicotinic Acid (Niaspan) - ADRs |
Flushing and warmth 15-60 min after dose Take on full stomach or take aspirin 325mg 30 min before dose
Inc risk of hepatotoxicity (dark urine, dec appetite, yellowing)
Hyperglycemia (caution)
Gouty arthritis |
|
|
|
Bile Acid Sequestrants - action |
Exchange resins- bond w bile in intestine
LDL dec 20% first month
5-20% inc in VLDL, usually transient, caution if high at start
Used alone or combo w statin |
|
|
|
colesevelam (Welchol) |
Bile Acid Sequestrants |
|
|
|
Bile Acid Sequestrants - ADRs |
Constipation, bloating, flatulence, nausea
Med tastes bad - noncompliance |
|
|
|
Nicotinic Acid (Niaspan, Niacin, Vitamin B3) - action |
Inhibit VLDL production in the liver
Dec LDL 5-25% Dec HDL 15-35% Dec triglycerides 20-50%
Vitamin niacin much lower dose (25mg vs 1-3G) |
|
|
|
Nicotinic Acid (Niaspan) - ADRs |
Flushing and warmth 15-60 min after dose Take on full stomach or take aspirin 325mg 30 min before dose
Inc risk of hepatotoxicity (dark urine, dec appetite, yellowing)
Hyperglycemia (caution)
Gouty arthritis |
|
|
|
Bile Acid Sequestrants - action |
Exchange resins- bond w bile in intestine
LDL dec 20% first month
5-20% inc in VLDL, usually transient, caution if high at start
Used alone or combo w statin |
|
|
|
colesevelam (Welchol) |
Bile Acid Sequestrants |
|
|
|
Bile Acid Sequestrants - ADRs |
Constipation, bloating, flatulence, nausea
Med tastes bad - noncompliance |
|
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|
Bile Acid Sequestrants - implications |
Teach PT how to mix
Take 1 hour before or 4-6 hours after other drugs to avoid interactions |
|
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|
Fibric Acid Derivatives- action |
Best for DM (high triglycerides)
Lower triglycerides 40-55%
Inc HDL 6-10%
Does not lower LDL |
|
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|
Fibric Acid Derivatives- action |
Best for DM (high triglycerides)
Lower triglycerides 40-55%
Inc HDL 6-10%
Does not lower LDL |
|
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|
gemfibrozil (Lopid) |
Fibric Acid Derivative |
|
|
|
Fibric Acid Derivatives- ADRs |
Rashes general GI complaints, gallstones, intolerance of fried foods |
|
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|
Fibric Acid Derivatives- ADRs |
Rashes general GI complaints, gallstones, intolerance of fried foods |
|
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|
Fibric Acid Derivatives- interactions |
High risk of myositis w statins
Warfarin displaced by gemfibrozil - inc anticoagulation |
|
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|
ezetimibe (Zetia) |
Cholesterol absorption inhibitor |
|
|
|
ezetimibe (Zetia) |
Cholesterol absorption inhibitor |
|
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|
Cholesterol absorption inhibitor - action |
Good for decreasing cholesterol as adjunct to diet modifications
Use w statin for more effective lipid control |
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|
Angina - stable |
Chronic, exertional
Cause - CAD (inc O2 demand, poor O2 supply)
Tx- dec O2 demand - nitrates, beta blockers, Ca channel blockers.
Can't effect O2 supply as CAD will not allow vasodilation. |
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|
Angina - Unstable |
Medical emergency
Cause - severe CAD w vasospasm, thrombi development/blockage
Tx- nitrates, beta blockers, Ca channel blockers, O2, morphine, anti platelets (ASA) |
|
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|
Angina - Unstable |
Medical emergency
Cause - severe CAD w vasospasm, thrombi development/blockage
Tx- nitrates, beta blockers, Ca channel blockers, O2, morphine, anti platelets (ASA) |
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|
Nitrates: Nitroglycerin- action |
Directly relaxes smooth muscle, causing vasodilation
Dec venous tone, pooling in peripheral veins, dec venous return, dec preload, dec SV
Dec myocardial oxygen consumption (exertion also angina) Inc oxygen supply (unstable angina) by preventing spasm
Anti platelet and antithrombotic effects |
|
|
|
Nitrates- ADRs |
Pounding HA (most common, treat w acetaminophen)
Orthostatic hypotension
Reflex tachycardia
Flushing
Tolerance develops to nitroglycerin induced vasodilation, provide drug free interval |
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|
nitroglycerin SL tablets (Nitrostat) |
Acute nitrate therapy - angina |
|
|
|
nitroglycerin SL tablets (Nitrostat) |
Acute nitrate therapy - angina |
|
|
|
nitroglycerin IV (Tridil, Nitro-BID IV) |
Acute nitrate therapy - angina |
|
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|
Nitroglycerin sustained release (Nitro-BID) |
Chronic nitrate angina therapy |
|
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|
Nitroglycerin sustained release (Nitro-BID) |
Chronic nitrate angina therapy |
|
|
|
Nitroglycerin transdermal patches (Nitro-Dur) |
Chronic therapy
Nitrate for angina |
|
|
|
Isosorbide mononitrate (Imdur, ISMO) |
Prophylactic nitrate for chronic stable angina |
|
|
|
Beta blockers - antianginal |
Stable angina, not vasospastic Dec HR and O2 demands |
|
|
|
Beta blockers - antianginal |
Stable angina, not vasospastic Dec HR and O2 demands |
|
|
|
Ca channel blockers- antianginal |
Helpful for both stable (dec O2 demands) and vasospastic (dilates coronary arteries) |
|
|
|
Angina - PT and family teaching |
Sit down and use meds at first sign of attack
Relief in 5 min, if not: repeat in 5-10 min (don't take more than 3 doses)
Call or go to ER if not relieved by first tablet
Keep tabs in original container and away from heat
Replace tabs every 24 months (label bottle w date of opening)
Take aspirin |
|
|
|
Drugs for thromboembolic disorders |
Anticoagulants- heparin and warfarin (suppress fibrin formation - venous)
Anti platelets- aspirin and tirofibran (inhibit platelet aggregation - arterial)
Thrombolytics - alteplase, streptokinase (break up fibrin, dissolve thrombi) |
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|
Heparin - action |
Acts in the first 3 steps of clotting cascade, inactivated thrombin and factor Xa |
|
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|
Heparin - action |
Acts in the first 3 steps of clotting cascade, inactivated thrombin and factor Xa |
|
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|
Heparin - uses |
Rapid anticoagulation (DVT, PE)
After several days, PT converted to oral anticoagulant
Low molecular weight heparin used to prevent thromboembolism after surgery (less risk than traditional heparin, less lab monitoring, safe to use at home) |
|
|
|
Heparin - ADRs |
Bleeding, hemorrhage (progressively falling platelet count)
Heparin induced thrombocytopenia (inc resistance to anticoagulation effect) |
|
|
|
Heparin - ADRs |
Bleeding, hemorrhage (progressively falling platelet count)
Heparin induced thrombocytopenia (inc resistance to anticoagulation effect) |
|
|
|
Heparin - monitoring |
aPTT Control: 40 seconds
Goal: aPTT 1.5-2.0 times control
Antidote: protamine sulfate |
|
|
|
enoxaparin (Lovenox) |
Low molecular weight heparin |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
Low molecular weight heparin - uses |
Used at home No monitoring, safer 1st line Tx for DVT prevention (surgery, MI)
Other: pregnancy, PE, open heart and dialysis machinery |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
Low molecular weight heparin - uses |
Used at home No monitoring, safer 1st line Tx for DVT prevention (surgery, MI)
Other: pregnancy, PE, open heart and dialysis machinery |
|
|
|
warfarin (Coumadin) - action |
Anticoagulant
Inhibition of blood clotting by interfering w hepatic synthesis of vitamin K dependent clotting factors |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
Low molecular weight heparin - uses |
Used at home No monitoring, safer 1st line Tx for DVT prevention (surgery, MI)
Other: pregnancy, PE, open heart and dialysis machinery |
|
|
|
warfarin (Coumadin) - action |
Anticoagulant
Inhibition of blood clotting by interfering w hepatic synthesis of vitamin K dependent clotting factors |
|
|
|
Warfarin - uses |
Prophylactic: TIAs, recurrent MI
Long term anticoagulation- prevention of DVT, PE, thrombus from heart valves, and in A fib. |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
Low molecular weight heparin - uses |
Used at home No monitoring, safer 1st line Tx for DVT prevention (surgery, MI)
Other: pregnancy, PE, open heart and dialysis machinery |
|
|
|
warfarin (Coumadin) - action |
Anticoagulant
Inhibition of blood clotting by interfering w hepatic synthesis of vitamin K dependent clotting factors |
|
|
|
Warfarin - uses |
Prophylactic: TIAs, recurrent MI
Long term anticoagulation- prevention of DVT, PE, thrombus from heart valves, and in A fib. |
|
|
|
Warfarin - ADR |
Bleeding |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
Low molecular weight heparin - uses |
Used at home No monitoring, safer 1st line Tx for DVT prevention (surgery, MI)
Other: pregnancy, PE, open heart and dialysis machinery |
|
|
|
warfarin (Coumadin) - action |
Anticoagulant
Inhibition of blood clotting by interfering w hepatic synthesis of vitamin K dependent clotting factors |
|
|
|
Warfarin - uses |
Prophylactic: TIAs, recurrent MI
Long term anticoagulation- prevention of DVT, PE, thrombus from heart valves, and in A fib. |
|
|
|
Warfarin - ADR |
Bleeding |
|
|
|
Warfarin - interactions |
Protein binding (ASA) |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
Low molecular weight heparin - uses |
Used at home No monitoring, safer 1st line Tx for DVT prevention (surgery, MI)
Other: pregnancy, PE, open heart and dialysis machinery |
|
|
|
warfarin (Coumadin) - action |
Anticoagulant
Inhibition of blood clotting by interfering w hepatic synthesis of vitamin K dependent clotting factors |
|
|
|
Warfarin - uses |
Prophylactic: TIAs, recurrent MI
Long term anticoagulation- prevention of DVT, PE, thrombus from heart valves, and in A fib. |
|
|
|
Warfarin - ADR |
Bleeding |
|
|
|
Warfarin - interactions |
Protein binding (ASA) |
|
|
|
Warfarin - antidote |
Vitamin K |
|
|
|
dalteparin (Fragmin) |
Low molecular weight heparin |
|
|
|
Low molecular weight heparin - uses |
Used at home No monitoring, safer 1st line Tx for DVT prevention (surgery, MI)
Other: pregnancy, PE, open heart and dialysis machinery |
|
|
|
warfarin (Coumadin) - action |
Anticoagulant
Inhibition of blood clotting by interfering w hepatic synthesis of vitamin K dependent clotting factors |
|
|
|
Warfarin - uses |
Prophylactic: TIAs, recurrent MI
Long term anticoagulation- prevention of DVT, PE, thrombus from heart valves, and in A fib.
Not useful in emergencies |
|
|
|
Warfarin - ADR |
Bleeding |
|
|
|
Warfarin - interactions |
Protein binding (ASA) |
|
|
|
Warfarin - antidote |
Vitamin K |
|
|
|
Warfarin - monitoring |
Prothrombin time (PT), control is 12 seconds
INR goal 2-3 most, 3-4.5 some.
Goals: INR 2-3x normal for most 3-4.5 normal in some |
|
|
|
dabigatran (Pradaxa) |
Direct reversible inhibitor of thrombin |
|
|
|
dabigatran (Pradaxa) |
Direct reversible inhibitor of thrombin |
|
|
|
dabigatran (Pradaxa) - action |
Inhibits free thrombin and thrombin in clots |
|
|
|
dabigatran (Pradaxa) |
Direct reversible inhibitor of thrombin |
|
|
|
dabigatran (Pradaxa) - action |
Inhibits free thrombin and thrombin in clots |
|
|
|
dabigatran (Pradaxa) - advantages over warfarin |
Rapid onset
No need to monitor blood for anticoagulation levels
Few food drug interactions
Lower risk for major bleeding, risk for generalized bleeding (warfarin favored bc of this)
Same dose regardless of age or weight
Used for a fib, post op prevent |
|
|
|
dabigatran (Pradaxa) |
Direct reversible inhibitor of thrombin |
|
|
|
dabigatran (Pradaxa) - action |
Inhibits free thrombin and thrombin in clots |
|
|
|
dabigatran (Pradaxa) - advantages over warfarin |
Rapid onset
No need to monitor blood for anticoagulation levels
Few food drug interactions
Lower risk for major bleeding, risk for generalized bleeding (warfarin favored bc of this)
Same dose regardless of age or weight
Used for a fib, post op prevent |
|
|
|
dabigatran (Pradaxa) - ADRs |
Bleeding (no antidote)
GI - abdominal pain, diarrhea, dyspepsia |
|
|
|
Rivaroxaban (Xarelto) |
Direct factor Xa inhibitors Anti thrombotic: inhibits production of thrombin
Advantages over warfarin- same as Pradaxa
Interacts w several meds
Renally impaired and pregnant- extreme caution only
Hepatic- avoid |
|
|
|
apixaban (Eliquis) |
Selective inhibitor of factor Xa
Prevention of stroke and systemic embolism in PTs w non valvular a fib
Bleeding risk, less than warfarin |
|
|
|
Drugs affecting thrombus formation - patient teaching |
Consistent intake of vitamin K foods (warfarin)
Avoid IM injections
Soft toothbrush Electric razor
Avoid injurious activities
Pressure at IV sites
Avoid ASA, NSAIDs, and alcohol
Carry ID of med regimen |
|
|
|
Aspirin (ASA) |
anti platelet agent
Low dose - 325 mg or less |
|
|
|
Aspirin (ASA) |
anti platelet agent
Low dose - 325 mg or less |
|
|
|
Antiplatelet agents - uses |
Ischemic stroke TIA Chronic stable angina Unstable angina Coronary stenting Acute MI Previous MI Primary prevention of MI
Interfere w platelets ability to adhere to each other |
|
|
|
clopidogrel (Plavix) |
Anti platelet agent
Used post stent to prevent blockage
(Fewer hemorrhage risks than Ticlid) |
|
|
|
clopidogrel (Plavix) |
Anti platelet agent
Used post stent to prevent blockage
(Fewer hemorrhage risks than Ticlid) |
|
|
|
abciximab (ReoPro) |
Anti platelet agent
Super aspirin, expensive, IV, short term in high risk acute coronary event, and stent placement. |
|
|
|
Thrombolytic agents IV - use |
Acute coronary thrombosis (MI) DVT Massive PE
Prompt tx (2-6 hrs) in MI, remove clots |
|
|
|
Thrombolytic agents IV - use |
Acute coronary thrombosis (MI) DVT Massive PE
Prompt tx (2-6 hrs) in MI, remove clots |
|
|
|
Thrombolytic agents IV - med ending |
-ase |
|
|
|
Thrombolytic agents IV - use |
Acute coronary thrombosis (MI) DVT Massive PE
Prompt tx (2-6 hrs) in MI, remove clots |
|
|
|
Thrombolytic agents IV - med ending |
-ase |
|
|
|
streptokinase (Kabikinase, Streptase) |
Thrombolytic Agent IV
1st available Digests clots and degrades clotting factors High risk of bleeding May have allergy |
|
|
|
alteplase (Tissue plasminogen activator, t-PA) |
Thrombolytic Agent IV
Expensive Less risk of allergic reaction than streptokinase Higher risk of intercranial bleeding |
|
|
|
Thrombolytics - contraindications |
Can cause bleeding at recently healed sites. Avoid if clots are new, risk of bleeding would be very high and dangerous
Active bleeding Aortic dissection Ischemic stroke in past 3 mo -(okay for acute stroke) Cerebral neoplasm Hx of intracranial hemorrhage Cerebral vascular disease (aneurysm) |
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Thrombolytics - contraindications |
Can cause bleeding at recently healed sites. Avoid if clots are new, risk of bleeding would be very high and dangerous
Active bleeding Aortic dissection Ischemic stroke in past 3 mo -(okay for acute stroke) Cerebral neoplasm Hx of intracranial hemorrhage Cerebral vascular disease (aneurysm) |
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Colony stimulating factors |
Hematopoietic Leukopoietic Thrombopoietic
Cause generation of new blood cells by stimulating stem cells in bone marrow |
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epoetin alfa (Erythropoietin, Epogen) |
Hematopoietic growth factor
Sub cutaneous injection or IV |
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epoetin alfa (Erythropoietin, Epogen) |
Hematopoietic growth factor
Sub cutaneous injection or IV |
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Hematopoietic growth factor - use |
Stimulate red blood cell growth
Chemo induced anemia
Anemia of chronic renal failure
Anemia of HIV therapy |
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epoetin alfa (Erythropoietin, Epogen) |
Hematopoietic growth factor
Sub cutaneous injection or IV |
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Hematopoietic growth factor - use |
Stimulate red blood cell growth
Chemo induced anemia
Anemia of chronic renal failure
Anemia of HIV therapy |
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Hematopoietic growth factor - ADRs |
HTN In CRF HTN, meds may need adjust |
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filgrastim (Neupogen) |
Leukopoietic growth factor
IV or subcutaneous injection |
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filgrastim (Neupogen) |
Leukopoietic growth factor
IV or subcutaneous injection |
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Leukopoietic growth factor - use |
Elevates neutrophil count in cancer patients or others w neutropenia
Reduces risk of infection
Very expensive |
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oprelvekin (Interlukin-11) |
Thrombopoietic growth factor
Subcutaneous injection |
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oprelvekin (Interlukin-11) |
Thrombopoietic growth factor
Subcutaneous injection |
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Thrombopoietic growth factor- use |
Stimulate platelet production in chemo PTs w low count |
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Calcium supplements (ADR) |
Bioavailability
Calcium carbonate (Tums, Rolaids) Calcium citrate (Citrical)
ADR - hypercalcemia (affects GI, renal (stones), CNS)
Vitamin D inc absorption of Ca May need to supplement children and elderly |
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calcitonin salmon (Calcimar) - use |
Established post menopausal osteoporosis Suppress bone reabsorption
Nasal spray or injection |
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calcitonin salmon (Calcimar) - use |
Established post menopausal osteoporosis Suppress bone reabsorption
Nasal spray or injection |
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alendronate (Fosamax) |
Biophosphate |
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calcitonin salmon (Calcimar) - use |
Established post menopausal osteoporosis Suppress bone reabsorption
Nasal spray or injection |
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alendronate (Fosamax) |
Biophosphate |
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Biophosphonate - use |
Help dec reabsorption of bone
Post menopause Paget's Steroids |
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calcitonin salmon (Calcimar) - use |
Established post menopausal osteoporosis Suppress bone reabsorption
Nasal spray or injection |
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alendronate (Fosamax) |
Biophosphate |
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Biophosphonate - use |
Help dec reabsorption of bone
Post menopause (at risk) Paget's Steroids |
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Biophosphonate - precautions |
Esophageal erosion
Poor absorption with any food
Must take with full glass water
Must remain upright 30 min Empty stomach, no food 30 min |
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raloxifene (Evista) |
Selective estrogen receptor modulator (SERM) |
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raloxifene (Evista) |
Selective estrogen receptor modulator (SERM) |
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Selective estrogen receptor modulator (SERM) - use |
Estrogen/anti estrogen (depending on tissue)
Encourage estrogen in bone Block estrogen in breast - cancer management
Protect bone, act against breast cancer |
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raloxifene (Evista) |
Selective estrogen receptor modulator (SERM) |
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Selective estrogen receptor modulator (SERM) - use |
Estrogen/anti estrogen (depending on tissue)
Encourage estrogen in bone Block estrogen in breast - cancer management
Protect bone, act against breast cancer |
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Selective estrogen receptor modulator (SERM) - cautions |
ADR- venous thrombosis
Caution- prolonged immobilization
Pregnancy category X
Hot flashes |
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teriparatide (Forteo) |
Dec bone reabsorption Inc bone formation
Only drug that does this
Sub q injection |
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Drug classes to treat bronchial obstruction |
Anti inflammatory
Bronchodilators
(Inhalers, PO, IV) |
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albuterol (Proventil, Ventolin) |
Bronchodilator Beta 2 agonist (sympathomimetic)
Acute, inhaled |
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albuterol (Proventil, Ventolin) |
Bronchodilator Beta 2 agonist (sympathomimetic)
Acute, inhaled |
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salmeterol (Serevent) |
Bronchodilator Beta 2 agonist (sympathomimetic)
Chronic, inhaled |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - precautions |
CV disease (inc myocardial oxygen demand and arrhythmia via stimulation of Beta 1 receptors) |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - precautions |
CV disease (inc myocardial oxygen demand and arrhythmia via stimulation of Beta 1 receptors) |
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Bronchodilator agents - ADRs |
Tachycardia Palpitations Inc BP Anxiety Agitation Tremors (go away w time) |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - precautions |
CV disease (inc myocardial oxygen demand and arrhythmia via stimulation of Beta 1 receptors) |
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Bronchodilator agents - ADRs |
Tachycardia Palpitations Inc BP Anxiety Agitation Tremors (go away w time) |
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beclomethasone (Beclovent, Vanceril) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - precautions |
CV disease (inc myocardial oxygen demand and arrhythmia via stimulation of Beta 1 receptors) |
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Bronchodilator agents - ADRs |
Tachycardia Palpitations Inc BP Anxiety Agitation Tremors (go away w time) |
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beclomethasone (Beclovent, Vanceril) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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budesonide (Pulmicort) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - precautions |
CV disease (inc myocardial oxygen demand and arrhythmia via stimulation of Beta 1 receptors) |
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Bronchodilator agents - ADRs |
Tachycardia Palpitations Inc BP Anxiety Agitation Tremors (go away w time) |
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beclomethasone (Beclovent, Vanceril) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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budesonide (Pulmicort) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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triamcinolone (Azmacort) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - precautions |
CV disease (inc myocardial oxygen demand and arrhythmia via stimulation of Beta 1 receptors) |
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Bronchodilator agents - ADRs |
Tachycardia Palpitations Inc BP Anxiety Agitation Tremors (go away w time) |
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beclomethasone (Beclovent, Vanceril) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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budesonide (Pulmicort) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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triamcinolone (Azmacort) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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Inhaled corticosteroids - action
|
Suppress inflammatory response in lung
Dec edema, stabilizing capillary membranes and dec leakage
Inc beta receptor responsiveness to sympathomimetic bronchodilators
Promote mucokinesis by inc mucociliary activity and water content of airway secretions |
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Bronchodilator agents - action |
Inc production of cAMP, relaxes bronchial smooth muscle |
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Bronchodilator agents - precautions |
CV disease (inc myocardial oxygen demand and arrhythmia via stimulation of Beta 1 receptors) |
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Bronchodilator agents - ADRs |
Tachycardia Palpitations Inc BP Anxiety Agitation Tremors (go away w time) |
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beclomethasone (Beclovent, Vanceril) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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budesonide (Pulmicort) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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triamcinolone (Azmacort) |
Inhaled corticosteroids Anti inflammatory agent Glucocorticoid |
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Inhaled corticosteroids - action
|
Suppress inflammatory response in lung
Dec edema, stabilizing capillary membranes and dec leakage
Inc beta receptor responsiveness to sympathomimetic bronchodilators
Promote mucokinesis by inc mucociliary activity and water content of airway secretions |
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Inhaled corticosteroids - uses |
Maintenance therapy for PTs w asthma, chronic bronchitis, COPD, cystic fibrosis
Systemic corticosteroids occasionally required
Not for acute bronchospasm |
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Inhaled corticosteroids - adverse effects |
Oral fungal infections (rinse mouth out after each use)
Systemic absorption and toxicity if used over long time in heavy users
Inhaler SE minimal
Adrenal insufficiency if oral corticosteroids DC abruptly |
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fluticasone and salmetrol (Advair diskus) |
Combination glucocorticoid and long acting beta 2 agonist
Common tx for ppl who need glucocorticoid and long acting Beta 2 agonist |
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nedocromil (Tilade) |
Mast cell stabilizer |
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nedocromil (Tilade) |
Mast cell stabilizer |
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Mast cell stabilizer - action |
Prevent mast cell degranulation, limit inflammation
Prevent airway inflammation
Require over 3 weeks daily dosing
ADRs minimal ( dry mouth, irritated throat, unpleasant taste, HA)
Not for acute steady but dec frequency and intensity of attacks |
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theophylline (Theo-Dur) |
Methylxanthine Agent
Oral agent |
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Methylxanthine Agent - actions |
Phosphodiesterase inhibitor (enzyme that destroys cAMP) |
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Methylxanthine Agent - actions |
Phosphodiesterase inhibitor (enzyme that destroys cAMP) |
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Methylxanthine Agent - ADRs |
Nervousness Insomnia hA Nausea |
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Methylxanthine Agent - toxicity |
Serum levels ideal 8-39mcg/mL
Toxic levels - tremor, agitation, nausea, HA, seizures, death
Narrow therapeutic index
Mostly replaced w inhalers |
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Leukotriene Receptor Antagonists - action |
Treats bronchial obstruction
Antagonize effects of leukotrienes which mediate: -airway edema -smooth muscle construction -altered cellular activity
Dec inflammatory process Dec frequency and severity of acute asthma attacks
Oral agents, adjuncts to glucocorticoids |
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Leukotriene Receptor Antagonists - action |
Treats bronchial obstruction
Antagonize effects of leukotrienes which mediate: -airway edema -smooth muscle construction -altered cellular activity
Dec inflammatory process Dec frequency and severity of acute asthma attacks
Oral agents, adjuncts to glucocorticoids |
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Leukotriene Receptor Antagonists - uses |
Long term control of asthma (w glucocorticoids)
May gradually dec dose of inhaled corticosteroids
Not effective against acute asthma attacks |
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Acute asthma therapy |
albulerol (inhaled) Max air (inhaled) |
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Acute asthma therapy |
albulerol (inhaled) Max air (inhaled) |
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monteleukast (Singular) |
Leukotriene Receptor Antagonist |
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ipratropium bromide (Atrovent) |
Anticholinergic agent
Treats bronchial obstruction
Useful in COPD patients |
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Bronchial obstruction agents - patient teaching |
Correct administration
Force fluids (2000-3000ml/day)
Limit caffeine containing drinks and food (tremors)
ER plan
Use bronchodilators before corticosteroids |
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