365 - Test 3 Respiratory and Cardiac Flashcards
1
Q
Acetyleysteine (Mucomyst) Classification
A
Mucolytic
2
Q
What does a Mucolytic do?
A
Breaks up the linkages or bonds of Mucoprotein molecules, turning secretions into smaller, more soluble, and less viscous strands. Most effective at PH 7-9.
3
Q
How is Mucomyst administered?
A
Little. Nebulization
4
Q
How is Mucomyst excreted?
A
Lungs and mucus
5
Q
How long does it take for mucomyst to become effective?
A
little as 1 minute, but for maximum effect 5-10 minutes.
6
Q
What are the ADR’s of Mucomyst?
A
Few, some N&V, stomatitis, rhinorrhea, bronchospasm in asthmatics.
7
Q
Special Information for mucomyst
A
Rotten egg odor, wash face after treatment, Oral 72 hour protocal, IV 24 hour protocol,
8
Q
What is the classification for Guaifenesin (robitussin)
A
Expectorant, Bronchomucotropic
9
Q
What is the action of Guaifenesin (Robotussin)?
A
It directly irritates the gastric mucosa which results in neural activation of the bronchial glands, increasing the volume and reducing the viscosity of respiratory secretions. AKA: the gastropulmonary reflex action
10
Q
What are the ADR’s from guaifenesin?
A
Few, occasional GI upset
11
Q
Special information about guaifenesin
A
HYDRATION
12
Q
What classification is Epinephrine?
A
Sympathomimetic (Non-selective), Bronchodilator
13
Q
What is the action of epinephrine?
A
stimulates Alpha, beta 1 and beta 2 receptors. Alpha recemtor medicate vasoconstiction to reduce mucosal edema.
The Beta 1 receptors stimulate heart rate and force of contraction as well as cardiac irritability.
The beta 2 receptors induce bronchial smooth muscle relaxation.
14
Q
How is epinephrine absorbed?
A
usually parenteraly as most of it is destroyed by enzymes, or aerosol which restrict it’s effects to the respiratory tract.
15
Q
What are the side effects of epinephrine?
A
nervousness, insomnia, fear, tremors, tachycardia, palpitations, headache, dyspnea
16
Q
What is the special information for epinephrine?
A
use with CAUTION in patients with coronary artery disease, hypertension, hyperthyroidism, concurrently with MAO inhibitors which will precipitate severe hypertension
17
Q
What classification does Isoproterenol (Isuprel) have?
A
it is a sympathomimetic (non selective BETA stimulating) drug.
18
Q
What is the action of Isoproterenol (Isuprel)?
A
It stimulates both beta 1 and 2 receptors, stumulating heart and causing bronchodilation. This will also cause a decrease in tone and motility of GI and Uterus.
19
Q
How can Isoproterenol (Isuprel) be absorbed?
A
Oral, sublingual, and inhalation, poor parenteral.
20
Q
How long does it take Isoproterenol (Isuprel) take to become effective?
A
peaks in 15 minutes, lasts for 90 minutes
21
Q
What are the ADR’s for Isoproterenol?
A
Tachycardia and palpitation, headache, nausea, tremor, insomnia, becomes less effective with use.
22
Q
What is the special information about Isoproterenol (Isuprel).
A
It’s one of the most powerful bronchodilators.
23
Q
How is Albuterol classified?
A
Bronchodilator, sympathomimetic (selective Beta 2 stimulator)
24
Q
What is the action of albuterol?
A
Beta 2 simulation which causes relaxation of the smooth muscles of the bronchial tree and peripheral vasculature, in high doses it will have some beta 1 action.
25
What is the duration of albuterol?
onset 1 hour, duration is 7.5. half life is 3.5 hours.
26
What are the ADR's for Albuterol
Few, peripheral dilation can cause decreased blood pressure leading to tachycardia, tremors, nervousness, palpitations, dizziness, headache, N&V, anxiety, lethargy, and tinnitus.
27
What is the special information for albuterol?
It lasts longer than epinephrine but has a slower onset, use with caution in diabetics, HTN, cardiac disorders especially dysrhythmias, Long acting B 2 receptor agonists are called LABA's - Salumetrol.
28
What classification is Ipratropium (Atrovent)?
Anticholinergic Bronchodilator
29
What is the action of ipatropium (Atrovent)?
ipatropium blocks cholinergic receptors, reducing bronchial tone and does not seem to affect volume or viscosity of sputum.
30
How is ipatroprium (atrovent) Absorbed?
Inhilation allows for little aborption (Less than 1%) has almost exclusive effect on mouth and airway.
31
What are the ADR's of ipatropium?
few
32
What is the special Information for Ipatropium?
Combivent (Ipatropium and albuterol), and Spiriva (tiopropium and Tudorza (aclininium) - same class.
33
What is the classification for Aminophyline (Theophylline)?
Bronchodilator, Methylated xanthine
34
What is the action for Aminophyline (theophyline)?
It inhibits phosphodiesterae, which allows for an increase CAMP and results in the relaxation of smooth muscle (esp bronchial), stimulates heart, stimulates CNS, and renal excretion. Stimulates the medullary respiratory center.
35
How is aminophylline administerd and what is it's theraputic range?
Oraly, sometimes by IM but it's irritating. 10-20 MCG/ML
36
What are the ADR's for aminophylline?
GI anorexia, N&V ( stimulated vomiting center), , nervousness, insomnia, irritability, headache, severe convulsions and coma, tachycardia, severe hypotension and arrhythmias, urinary frequency.
37
what is the special information about aminophyline?
take with food to reduce GI upset, the half-life is shorter with smokers, know if they smoke.
38
What classification is Cromolyn Sodium (Intal)?
it is a Antiallergic (Histamine inhibitor)
39
What is the action of Cromolyn sodium (intal)?
It inhibits the release of histamine and other mediators of inflamation, stabalizes cytoplasmic membranes of mast cells.
40
What is the absorption for cromolyn?
Inhilation, radpit but only penetrates 10% deep into lung Half life of 80 minutes, maximal drug response may take 2-4 weeks.
41
What is the ADR for cromolyn?
only common one is throat irritation.
42
What is cromolyn used for?
it's used for asthma prophylaxis! not for acute attacks.
43
What forms does cromolyn come in?
metered dose powder inhaler, nasal spray for seasonal allergies, and in an opthalmic solution for eye allergies.
44
What is the special information for cromolyn (intal)?
Teach patients to rinse thier mouth out after use
especailly effective in children with minimal side effects
can prevent an excercise induced asthma attack if given Q15 mintues before exercising.
45
What classification is Zafirlukast (accolate)?
It is aleukotriene receptor antagonist
46
What is the action of Zafirlukast (Acolate)?
It competes for leukotriene receptor sites - blocks inflammatory response (Bronchoconstriction and inflammatory cell infiltration) caused by leukotrienes (proteins found on pollen and irritants).
47
What is the distribution for Zafirlukast?
tablet, peaks in 3 hours, not for acute attacks, half life of 10 hours but may be 2x as long in the elderly.
48
What are the ADR's for Zafirlukast?
GI, headache, elevated liver function tests.
49
What is the special information for Zafirlukast (Accolate)?
Used as a maintenence theraphy for asthma, prophylaxis only and not for accute attacks.
it elevates liver enzymes and can increase warafin concentration and elevated PT,
Administration with ASA cause increased levels of Zafirlukast.
Empty stomach (1hour before meals, or 2 hours after)
50
What is the classification of Beclomethasone (Vanceril)?
Inhaled corticosteroid)
51
What is the mechanism of action of Beclomethasone (Vanceril)?
Exact mechanism isn't understood, but suppresses the formation of antibodies, blocks the enzymes that produce the inflammatory process in tissues.
52
What are the ADR's of Beclomethasone (Vanceril)?
hoarsness, dry mouth, localized thrush infection
53
What is the special infomation for beclomethasone (vanceril)?
teach patient to wash mouth out, may have some systemic steroid effects, there are combination products like advair and Dulera)
54
What is the classification of Dextromethorpan?
It's an antitussive non opiod
55
What is the action of dextromethorpan?
acts centrally to suppress the medullary cough center (elevating the threshold for coughing). NO analgesic or addictive properties.
56
What are the ADR's for dextromethorpan?
Few and infrequent, GI distress and drowsiness
57
What is the special informatin for dextromethorpan?
It's a synthetic opiate derivative devoid of analgesic and repiratory depressant effects, many questions about it's effectiveness now, designated as DM when present with other OTC cough medicines.
58
What is the classification of pseudoephedrine (Sudafed)?
decongestant
59
What the is the action of sudafed?
stimulates alpha and beta adrenergic receptors and triggers release of epinephrine. casues vasoconstriction and cardiac stimulation (may increase BP).
bronchial muscle relaxation is less prominent than with epinephrine
causes reduced uterine activity
is a bit of a stimulant on the medulla and cerebral cortex.
mostly it causes vasoconstriction which with shrink, the mucous membranes causing congestive relief.
60
What are the ADR's for sudafed?
monimal but CV = tachycardia and flushing
61
What is the special informatio for sudafed?
avoid taking at bedtime as stimulation can occur.
62
What is the classification of diphedhydramine (benadryl)?
antihistamine (H1-blocking drug).
63
What is the action of benadryl?
it competes with histamine for it's receptor sites. histamine contracts muscles in bronchi and GI and relaxes others in the fine blood vessels.
it inhibits both vasoconstrictor effects of histamine and the more important vasodilation effects (airway).
Capillary permeability - antagonizes histamine and increases the capillary permeability and formation of edema.
it does not inhibit histamine effects of stimulation of gastric secretion involving the H2 receptors
it inhibits the release of ACH
causes sedation
64
what are the ADR's for benadryl?
CNS sedation, tinnitus, lassitude, blurred vision, diplopia, euphoria, nervousness, insomnia, loss of appetite, NV, epigastic distress and constipation, diarrhea, dry mouth, urinary frequency, palpitations, hypotension, headache, tingling, weakness of hands.
65
What is the special information for benadryl?
do not mix with OH it increases the sedative effects, tolerance can occur, used as an hypnotic with children and adults.
66
VLDL
Produced in liver, deliver triglycerides to adipose tissue and muscle
67
LDL
by product of VLDL metabolism, delivers cholesterol to liver and tissues. want below 100
68
HDL
removes cholesterol, has good protective effect, want in 40-60's
69
What are the non-pharmacologic ways to alter plasma lipoproteins?
Diet, weight loss, exercise, smoking (increases LDL, decreases HDL), DM, hypothyroidism, excessive OH increases risk.
70
Antilipemic drugs
modify lipoproteins, none remove plaque, but can supress production of lipoproteins.
71
What type of classification is Atrovastatin (Lipitor)?
Anti-lipid (HMG - Co-A reductase inhibitor).
72
What is the action of Atrovastatin (Lipitor)?
It inhibits the HMG - CoA reductase, which is the enzyme that catalyzes the rate - limiting step on of cholesterol synthesis. Lowers LDL raises HDL somewhat. Can be given with no regard to food. inhibist cholesterol SYNTHESIS it has no effect on consumption. extremely efectve for fixing liver production levels of LDL. Can prevent cardiovascular events with people that are at high risk.
73
What are the ADRs of atorvastatin (lipitor)
Mild transient GI distrubances, MUSCLE PAIN, rash, headache, sleep disturbances, increase in serum transanimase levels (liver enzymes), peripheral neuropathy, lupus like syndromes, severy Myalgia, Myositis, and MUSCLE weakness, rhabdomylosis,
74
What is the special informaiton with Atrovastatin (lipitor).
Taking with food can reduce GI upset
use cautiously in patients who consume OH regularly or who have a known liver disease.
lifer function tests should be monitored at the beginning of tx and regurlarly thoughout.
drug is contraindicated in pregnancy becasue you need cholesterol for cell membrane and mylen sheath production.
lipitor may enhance the clinical effects of oral anticoagulants
*grapefruit juice inhibits the metabolism of statins and will raise blood levels to toxic amounts.
75
General approach to HTN
Treated with a combination of drugs, object is to reduce BP to <120/80 for most people with the FEWEST side effects.
76
Bloop pressure formula
Blood pressure = Cardiac Output X total peripheral reistance. tx is aimed at affecting at multiple levels. affecting the SNS will have the greatest effect.
77
Strategies to reduce HTN
```
Low salt (<4-5 GM/day), DASH Diet, Potassioum and Calcium lower HTN.
Weight reduction
Aerobic exercise
Reduce Stress
Lower OH
Other meds
SLEEP
```
78
Groups of drugs to treat HTN
```
Those that promote excretion of Salt - diuretics
those that decrease SNS activity
Vasodilators
Calcium Channel blockers
Angiotensin II inhibitors
```
79
Ganglionic Blockers and how they are used?
They work but can have systemic affects and are used when in HTN crisis.
80
What is the most common side effect of HTN medications?
Hypotension (postural).
81
Drugs that interfere with SNS activity (Centrally or Peripherally)
Used for mild to moderate HTN, Good with impaired renal function, usually combined with thiazide diuretics.
82
What classification is Methyldopa (Aldomet)?
It's a SympathoLYTIC antihypertensive, Alpha 2 adrenergic agonist
83
What is the action of methyldopa (aldomet)?
Thought to act on the central mechanism that reduces sympathetic outflow from the medulla thereby reducing the amount of NorE formed resulting in a decreased peripheral resistance. it has little or no affect on cardiac output.
84
What are the ADR's for methyldopa (aldomet)?
Portural/hypotention, sedation, depression, dry mouth, nasal congestion, headache, fever, decreased WBC and platelets, hepatic dysfuntion, sexual dysfuntion.
it can cause Na and H2O retention as a response to the barrow receptors sensing a reduction in BP. often a diuretic is added after treatment.
85
What is the special infomration with methyldopa (aldomet)?
contraindicated in patients with liver disease or a history of major depression.
sometimes it's used for pregnancy induced HTN or when drug OH withdrawal induced HTN.
CNS
86
What is the classification of Prazosin, Minipress)
Antihypertensive, alpha-1 adrenergic antagonist
87
What is the major action of Prazosin (Minipress)
Alpha 1 blocker, it's a major action is competetive blockade of the alpha-1adrenergic receptors. net result is the prevention of the constriction by alpha stimulation. results in vasodilation of arterioles and VEINS, and decreased peripheral resistance. Anti-constriction. some benefit for BPH some relaxation of prostate and bladder-neck smooth muscle (tamulosin, flomax in same family, alpha 1 blocker).
88
What are the ADR's for Prazosin (minipress)
Orthostatic Hypotension, dizziness, syncope, palpitations, tachycardia (compensatory), headache, dry mouth, diarrhea, peripheral edema, urinary urgency, impotence FIRST DOSE response - really sudden drop in BP on first dose - monitor carefully.
89
What classification of drug is Propranolol (Inderal)?
Beta Adrenergic Inhibitor (Beta Blocker) end in olol, can be selective or non selevtive, propranolol is not selevtive
90
What is the action of propranolol, a beta blocker?
It blocks B1 abd B2 adrenergic receptors. antihypertensive actions may be due to decrease the heart rate and decrease the force of contraction.
deprese the renin0angiotensin system.
1) decreased heart rate and force of contraction
2) depress the renin angiotensin system or a central action
3) they are antianginal - reduction of myocardial oxygen consumption.
4) Anti-arrhythmic - Block the B adrenergic effects in the SA node and purkingie fibers.
5) often used to reduce the hearts workload.
6) they prevent reflex tachycardia seen with vasodilators.
91
Absorption propranolol
oral medication, should be taken on an empty stomach, not alsways done.
92
What are the ADR's for Propranolol (Inderal).
Insensity the AV block, CV bradycardie, CHF, AV block, Hypotension, brocnchospasm, blocks beta 2 leading to broncho constriction esp in COPD and asthma. Also nausea, cramps, fatigue, and allergic response and allergic response.
93
What should be checked before administering propranolol?
Apical pulse and BP
94
special information for propranolol?
As an hypertensive it's used with a thiazide diuretic and a vasodilator. Used as an antiarrythmic for supraventricular arrhythmias. DO NOT STOP ABRUPTLY. Smoking will decrease concentration.
use with CAUTION in patients with COPD and ASTHMA, and diabetes (Block manifestation of SNS response in hypoglycemia).
Also used for migraine prophylaxis, panic attacks, benign essential tremor, and PTSD
95
Beta 1 and beta 2 blockers
Inderal (propranolol) and Corgard (nadolol).
96
Beta 1 specific (safer for asthma and lung)
Tenormin (atenolol and Lopressor (Metrop) AKA cardio selective. DON'T INTERFERE WITH AIRWAYS
97
General information about Vasodilators
They SNS will be activated by a reflex action to vasodilators ((increase HR, CO, force of contraction) these can precipitate angina so they're generally combined with something like a beta blocker.
98
What are the two types of vaso dilation
1) selective to arterioles - Hydralazine (Apresoline) whcih will decrease afterload.
2) Affect both arterioles and veins Nitroprusside (Nipride) which are the FASTEST acting hypertensive and will decrease both afterload AND preload.
99
What classification of drug is Hydralazine (Apresoline)?
It is a antihypertensize, direct vasodilator - selective to arterioles.
100
What are the ADR's with Hydralazine (Apresoline)?
Hypotension, headache, palpitations/reflexive tachycardia, anxiety, mild depression, dry mouth, unpleasant taste in mouth, N/V
101
What is the method of action for hydralazine?
thought to have a direct action on blood vessels, to cause arteiolar vasodialation and increase renal blood flow.
102
Special Information for hydralazine?
Used for moderate to severe HTN, , reqires frequent monitoring in the early stages of Tx because of differences in metabolism.
103
Overview of Calcium Channel blockers
Calcium channel blockers cause arteriolar dilatation, they also decrease myocontractility, and block the angio tensin renal system. align them to beta blockers, do it differently but their effects are similar. ALL inhibit the movement of CA across membranes. some affect heart, some blood vessels, some both. Nifedipine really only affects vessels whereas verapamil and diltiazem and nifedipine affect heart.
104
What is the classification of Verapamil (calan, Isoptin)?
it is a calcium antagonist, antianginial, andarrhythmic. (i.e. calcium blocker).
105
What is the action of verapamil?
produces antagonizm of the calcium channels inhibiting flow in heart and blood vessels.
106
What are the effects of Verapamil?
1) arteriolar dilation and resultant lowering of BP
2) increase coronary perfusion
3) SA node causes reduction in heart rate
4) decrease in nodal conduction of AV node
5) inhibition or renin release
107
What are the ADR's associated with verapamil?
Bradycardia, hypotension, severe tachycardia (can be temporary), possible nausea, abdominal discomfort, dizziness, headache, flushing, pruritus, constipation.
108
What is the special information for verapamil?
Contraindicated in AV block and conditions of reduced myocardial contractility, CHF, or hypotension.
diltiazem is similar to verapamil
grapefruit juice may increase levels.
109
What do renin-angio tensin antagonists do?
they inhibit the action of the renin angio tensin aldosterone system ex: captopril, enalapril, lisinppril, or lostartan. ACE inhibitor and angiotensin blockers study together. both work by blocking RAA often first choice for BP managments, also used for CHF
110
What is the classification of lisinopril (prinibil)
Angiotensin II inhibitor ACE inhibitor - prevents production of angiotensin II which is a potent vaso constrictor. ACE is enzyme that allows that conversion
1) reduces vascular tone and direct lowering of BP
2) decreased aldosterone release and less Na retention and therefor less water retention.
111
What are the ADR's for lisinopril
hypotension, rashes, pruritis, COUGH can be an issue becasue by blocking ACE you lead to an increase in bradykinin which leads to cough - dry non irritating cough that doesn't go away. dizzyness, headache, possible HYPERKALEMIA 2-4%, rarely neuytropenia, agranulocytosis. BLACK BOX WARNING for pregnant women they CANNOT go on and result in fetal death. generally a well tolerated medication overall.
112
how is Losartan (Cozaar) classified?
It is an angiotensin II receptor agonist, antihypertensive
113
What is the action of Losartan?
goes to receptors and prevents binding. all will en in artan. smooth muscles of blood vessels, inhibits RAAgoes to receptors and prevents binding. all will en in artan. smooth muscles of blood vessels, inhibits RAA system leading to vasodilation. do not get the cough with this group because there's no increase in bradykinin. system leading to vasodilation. do not get the cough with this group because there's no increase in bradykinin.
114
What are the ADR's with Losartan
dizzyness, insomnia, GI, muscle pain and cramps, occasionally increased LFT's. cough not an issue becasue no increase in bradykinin in lungs.
115
What is the Special information with Losartan
Takes a month to kick in, combined with diuretic (called Hyzaar). BLACK BOX WARNING: do not give to pregnant women it will cause fetal death.
116
What is Angina?
Angina Pectoris – a symptom of transient myocardial ischemia perceived as chest pain or
discomfort.
Generally precipitated by a condition that increases myocardial oxygen demand or decreases oxygen supply (primarily in diseased vessels – but can be in normal ones).
117
Three classes of drugs used to treat.
1. Nitrates – reduce oxygen demand by reducing preload and afterload
2. Beta-blockers – decrease oxygen consumption by decreasing heart
rate, BP, and myocardial contractility
3. Calcium-channel blockers – produce coronary and systemic arterial
vasodilation, reduce afterload, heart rate, and contractility.
A. Nitrate example – Nitroglycerin (comes in oral, chewable,
Sublingual, ointment, inhaled, IV, transmucosal)
B. Beta-blockers – Remember, Blocking Beta-1 causes
decreased HR and contractility. Also decrease reflex
tachycardia caused by other drugs.
C. Calcium-channel blockers – Have many other actions beside
anti-anginal effects. Reduce myocardial oxygen consumption.
118
Classification for Nitroglycerin
Anti Anginal
119
Action of NG
Relaxation of vascular smooth muscle – exact mechanism is unknown. Peripheral resistance is decreased, and venous return to heart is decreased. Net result is decrease in myocardial oxygen
consumption and relief of angina. Note: Studies have shown that vessels in the heart of pts. with CAD do not dilate in response to NTG.
120
ADR NG
ADR: Headache, dizziness, syncope, reflex tachycardia, flushing of skin, hypotension.
121
Special information NG
Concurrent use with sildenafil (Viagra) or similar drugs may cause life-threatening hypotension and cardiac collapse
122
IV. Drugs in Congestive Failure
Goals of therapy – decrease cardiac workload, and improve cardiac performance
Usual causes of heart failure – MI, HTN, CAD, arrhythmias (esp. AF)
Three Classes of Drugs for Therapy:
1) Diuretics – watch for potassium depletion!
2) Vasodilators
a. Nitrates – increase venous pooling
b. Hydralazine and others – dilate arterioles
c. Combined arterial/venous effects – prazosin and nitroprusside
d. ACE inhibitors – produce vasodilatation and suppress aldosterone production
3) Inotropic agents – include cardiac glycosides – digoxin (Lanoxin)
Increase contractility, improve efficiency
Decrease heart rate – better filling.
123
What is the Action of hydrochlorothiazide (HCTZ, Hydrodiuril)?
Inhibition of sodium reabsorption at cortical diluting segment of the nephron, including portions of ascending loop of Henle and mainly distal convoluted tubule. Exact mechanism is unclear. Promotes excretion of Na, Cl, and water. K is also lost.
124
What is the classification of hydrochlorothiazide (HCTZ, Hydrodiuril)
Thiazide diuretic
125
What are the ADR's for hydrochlorothiazide (HCTZ, Hydrodiuril)
Hypokalemia and other electrolyte disturbances. Gastric irritation, anorexia, cramping, constipation, jaundice, headache, vertigo, paresthesias. Allergic manifestations do occur, especially if patient is sensitive to sulfa.Sometimes they increase blood glucose mostly an issue for diabetics. can make you hypotensive. can increase levels of uric acid, not a good choice for gout sufferers
126
What is the special information for hydrochlorothiazide?
It's a derivative of Sulfonamide, so if patient is allergic to sulfa they may have an allergy to HCTZ). mild to moderate diuretic.
127
What is the classification of Furosemide (Lasix)?
Loop diuretic, most effective kind.
128
What is the Action of Furosemide (lasix)?
It inhibits active chloride transport in thick portion of ascending loop of Henle, by doing so passive sodium transport inhibition occurs. This class is the most effective diuretics. Oral onset 30 min and peak in 1-2 hours, IV onset 5 min, peak 30 min, duration 2 hours. so know the onsets for patient care if a patient has a diuretic while waiting for treatment. Lasts about 6 hours in oral form lasts 6 - lasix
129
What are the ADR's for Furosemide?
will lose more lytes, especially K. Nausea, Vomiting, Diarrhea, dermatitis, pruritis, blurring of vision, postural hypotension, hypokalemia, ototoxicity (never more than 4 g/min). HYPOKALEMIA
130
What is the special information for furosemide (lasix)?
1. sulfamide derivative.
2. contraindicated in pregnancy and nursing mothers, and states of anuria.
3. more potent than thiazides (not ideal for treating HTN, but especially good for CHF - and emergency fluid removal like cor pulmonale, pulmonary edema).
4. does promote calcium excretion.
131
What is the classification of spironolactone (Adalctone).
Potassium sparing diuretic (Aldosterone antagonist).
132
What is the action of spirolactone (Aldactone)?
Synthetic steroidal compound which antagonizes effects of aldosterone by competitively binding to the protein that permits K secretion at DCT. produces mild diuresis of NA and water in this way. It is the most mild class of diuretics but works synergystically with other diuretics.
133
What are the ADR's of Spirolactone?
anorexia, NV, diarrhea, occasional headache, drowsiness, ataxia, mental confusion. MOST SERIOUS side affect is HYPERKALEMIA! But in men it can cause gynecomastia and in women breast soreness and menstrual irregularities because it affects hormone production.
134
Special information for Spirolactone?
May be used in combination with other diuretics. Aldactazide + aldactone hydrodiuril (beef up potassium, still lose fluid). Weakest diuretic alone.
135
What classification of drug is Mannitol?
Osmotic diuretic - increase osmolality of whatever's put (Particles in fluid). i
136
What is the action of Mannitol?
Non-electrolytes are filtered by the glomerulus but NOT significantly reabsorbed or metabolized. the high osmolarity also decreases the reabsorption of water. t's a big sugar that draws water wherever it goes. given IV to pull water towards it and when it gets to the kidney it goes through and pulls even more water to it, it draws a lot of water to it. HUGE diuresis. Not reabsorbed - cannot leave the blood stream. Increases osmotic pressure wherever it goes (into vascular compartment).
137
WHat are the ADR's of Mannitol?
Depends on dose? headache, nausea, chills, mild chest pain, electrolyte imbalance.
138
Special information for Mannitol?
should NOT be given to patients with severe CHF, HTN, or chronic edema because it will increase volume in blood stream dangerous to pump. basically increases bp by increasing volume. Used for patients with cerebral edema, after a head injury, pulls fluid out of cerebral tissue, lowers ICP. can use oral form for the eye to keep pressure down in eye like glaucoma. It may crystallize so use a filter when giving it especially when it's cold.
139
What classification is Digoxin
Cardiac Glycoside - Inotropic - strenghents muscle contraction
140
what is the action of Digoxin a cardiac glycoside?
alters sodium potassium transport and an alteration of calcium movement, so it will increase the force of the contraction and slow the heart rate. Especially useful for HF, and Atrial Fibrillation.
Effects:
1. Positive inotropic action (increases strength of contraction)
2. negative Chronotropic action (decreases heart rate).
3. negative dromotropic action (slows conduction velocity).
Indirect actions include intensify effects on vagus nerve which slows heart, has diuretic effect on kidney. some sex steroidal like effects.
141
What are the ADR's of cardiac glycoside (Digoxin)?
Anorexia, NV, diarrhea, headache, visual disturbances, weakness, restlessness, and nervous irritability, gynecomastia. ALMOST EVERY TYPE OF DYSRHYTHMIA CAN BE PRODUCED BY DIGOXIN TOXICITY. perception of color changed, halos around light both are signs of toxicity.
0.25 mcg
digitalizing dose 1-2.5 then maintenance 0.125 mg
142
special information for Digoxin
1. must check apical pulse rate and rhythm before giving drug, remember arrhythmia may be a late sign of toxicity.
2. many drug interactions
a. diuretics lead to potassium loss which leads to DIGOXIN TOXICITY. hypokalemia increases
b. Antacids = interfere with absorption.
c. antidote = digoxin immune FAB
143
What type of drug is potassium chloride (K-dur)
electrolyte
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What is the action of potassium?
It is a major positively chargeds Ion in the intracellular fluid (inside cells) and plays an important role in:
1. muscle contraction
2. conduction of nerve impulse.
3. enzyme action
4. cell membrane function.
Used for prophalaxys with diuretic and digoxin therapy
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ADRs for potassium
Hyperkalemia, with all effects esp cardiac electrical activity. may cause GI pain, distension, abd cramps, diarrhea, weakness, paralysis.
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Special information for potassium?
used for prophylaxis with diuretic therapy. administer with a full glass of water, has unpleasant taste if liquid or elixir.
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Antiarrhythmic agents
dyusthrhythmias arise from two general causes
1. disturbances in automaticity
2. disturbance in conduction.
many drugs are used for antiarrhythmic effects
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What class is quinadine? class 1 a
anti arrhythmic
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action of qunidine
Direct action on cardiac cell membrane. stabilizes cell membranes by preventing ready movement on Na and K across cellular barrier. decreases impulse generation, prolongs refractory period of atria and ventricular fibers, and decreases conduction. it's a stabilizing mechanism on the cardiac cell membrane keeping it from firing readily, reduces refractory period. mainly used for atrial arrhythmia.
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What are the ADR's for quinidine
Diarhhea! NV, tinnitus, vertigo, visual disturbances, thrombocytopenic purpura, rashes, urticaria, hypotension, CV vary to complete heart block and ventricular disorders including ventricular fibrillation.
BIggest problem is CV changes that can be fatal. can cause ventricular
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Special information for quinidine
used with afib, but has activity in the ventricles as well. there are MANY drug interactions with quinidine.
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What classifictaion is the drug Lidocane?
Anti arrhythmic 1B
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Action lidocane
Similar electrophysiologic properties as quinidine. depresses excessive automaticity of ectopic pacemakers (esp. in HIS Purkingie fibers) little effect on atria. really short half life, has to be given as an infusion.
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What are the ADR's for lidocane>
drowsiness, CNS disturbances including agitation, disprientation, muscle twitching, heart block, given in PVC, resp and cardiac arrest can occur
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Special information for lidocane
1. drug of choice in treating ventricular dysrhythmias.
| 2. caution in patients with liver disease (hepatic blood flow affects rate of clearace.
