Drug cards Flashcards
HMG-CoA Reductase Inhibitors/Statins AKA Lipid Lower Agent Mechanism of Action:
Inhibits HMG-CoA reductase (which is the enzyme responsible for catalyzing an early step in the synthesis of cholesterol).
HMG-CoA Reductase Inhibitors/Statins AKA Lipid Lower Agent Indications
Management of hypercholesterolemia and mixed dyslipidemia; primary prevention of coronary heart disease (MI, Stroke, angina) in pt. w/ increased total and LDL and HDL cholesterol.
HMG-CoA Reductase Inhibitors/Statins AKA Lipid Lower Agent contraindications
Pregnancy, liver disease, or elevation of liver enzymes
HMG-CoA Reductase Inhibitors/Statins AKA Lipid Lower AgentAdverse Effects:
Adverse Effects: Insomnia, HA, weakness, Angioneurotic edema (aka Quincke’s edema and it causes rapid swelling edema of the dermis; sub cut; and mucosa), chest pain, abdominal cramps, rhabdomyolysis, which the breakdown of muscle tissue that releases a damaging protein into the blood (if muscle tenderness develops during therapy w/ CPK levels raised it is an indicator for rhabdomyolysis).
Alpha 2 Receptor Agonist/stimulant mechanism of action
Drug example: Clonidine (Catapress)
Stimulate alpha 2-adrenergeic receptors in the brain. The alpha 2-adrenergeic receptors are unique in that receptor stimulation reduces sympathetic outflow, from the CNS, resulting in a lack of norepinephrine production, reducing BP.
- stimulation of alpha 2-adrenergic receptors also effects the kidneys, reducing the activity of renin
Alpha 2 Receptor agonist/stimulant Indications:
Primarily for Tx of HTN; either alone or in combination w/other antihypertensives
Contraindications for Alpha 2 Receptor agonists/stimulant
acute heat failure, MAOI, peptic ulcers, beta blockers (nonselective= carvedilol), liver and kidney disease
Adverse Effects: reflex tachycardia, orthostatic hypotension, 1st dose syncope,
Bradycardia w/reflex tachycardia, orthostatic hypotension (postural & post exercise), 1st dose syncope,, dry mouth, drowsiness, dizziness, depression, edema, constipation, sexual dysfunction.
- HA, sleep disturbances, nausea, rash, palpitations
- The abrupt discontinuation of these drugs can result in REBOUND HTN
Nonselective blocking drugs are commonly associated with?
Bronchoconstriction as well as metabolic inhibition of glycogenolysis in the liver
Any change in the dosing regimen for cardiovascular medications should be undertaken gradually and with appropriate patient monitoring and follow-up, why is this?
Abrupt dosage changes of cardiovascular medications, either up or down, can be especially hazardous for the patient. Some drugs can cause disruptions in blood count as well as in serum electrolyte levels and renal function. Periodic monitoring of WBC count, serum potassium, sodium, and creatinine levels is necessary
Adrenergic drugs Interactions
Adrenergic drugs can cause additive CNS depression when taken with alcohol, benzos, opioids
Alpha 2-Adrenergic receptor stimulator (Agonist)
Drug: Clonidine
- not typically 1st line antihypertensives, use associated with high incidence of unwanted AEs such as orthostatic hypotension, fatigue, and dizziness
- adjunct drugs in Tx of HTN after others have failed or may be used in conjunction w/other antihypertensives such as diuretics
- MOA: decrease BP, useful in management of opioid withdrawal
- better safety profile & available in several dosage formulations (topical & oral)
- when patch used, remove old patch
- do not discontinue abruptly=rebound HTN
Calcium channel blockers for Tx of HTN
Effectiveness in treating HTN related to ability to cause smooth muscle relaxation by blocking the binding of calcium to its receptors preventing contraction
- due to effectiveness & safety they are on the list of 1st line drugs for Tx of HTN
- sometimes used in Tx of Raynaud’s disease & migraine HA
- used in combo with other drugs
Adrenergic Antagonists Metoprolol (Lopressor) Mechanism of Action
BETA BLOCKER> blocks stimulation of beta 1-adrenergic receptors
Adrenergic Antagonists Metoprolol (Lopressor) Indications
HTN, Prevention of MI and decrease mortality in clients w/ recent MI, Management of stable symptomatic CHF
Adrenergic Antagonists Metoprolol (Lopressor) contraindications
Systolic heart failure, caution w/ pt. w/ bronchial asthma, Diabetes
-with any adrenergic drugs: known drug allergy, acute heart failure, concurrent use of MAOIs, peptic ulcer, sever liver & kidney disease
Adrenergic Antagonists Metoprolol (Lopressor) Adverse Effects
Fatigue, drowsiness, bradycardia w/reflex tachycardia, CHF, pulmonary edema, diarrhea, postural and postexercise hypotension, dry mouth, dizziness, depression, edema, constipation, sexual dysfunction
Adrenergic Antagonists Metoprolol (Lopressor) interactions
Diuretics and antihypertensive and CCBs (additive effects), Insulin or oral diabetic drugs (hypoglycemic effects).
In patients taking alpha blockers there is a high incidence of?
Orthostatic hypotension
More info on Metoprolol: used for the?
prophylactic treatment of angina, decreases mortality in pt. who have recently has an MI
Ace inhibitors Drug: Lisinopril (Zestril) MAO Half life Indication Contraindications Adverse effects Patient teaching
- Mechanism of action: Inhibits angiotensin converting enzyme
- Long half life & long duration of action so can be given orally once a day
- Indication: Hypertension, heart failure, & acute MI
- Contraindications: drug allergy & pregnancy (all ACE inhibitors have detrimental effects on neonate & unborn fetus)
- Adverse effects: Hyperkalemia, nonproductive dry cough, & decrease renal function
- Patient teaching: Do Not abruptly stop any heart failure medications. Most pt. are encouraged to avoid using antacids 2 hours before or after medication administration
Angiotensin Converting Enzyme Inhibitors (ACE)
Lisinopril (Zestril): Used for?
HTN and heart failure, and MI; Pregnancy C drug for women in 1st trimester; Category D for women in 3rd trimester; Hyperkalemia, dry cough, and decrease renal function may occur with use
Angiotensin Converting Enzyme Inhibitors (ACE) Enalapril (Vasotec) is/
The only ACE inhibitor that is available in PO and parenteral form, IV is great for pt. who cannot swallow and it does not require cardiac monitoring; the oral form of enalapril differs from captopril in that pts. Must have a functioning liver for the drug to be converted into its active from; also great for pt. chances of survival after an MI
Angiotensin Converting Enzyme Inhibitors (ACE) Captopril (Capoten)
preventing the left ventricular dilation and dysfunction that can arise in the acute period after an MI and can improve a pt. chance of survival. Can also reduce the risk of heart failure, and has the shortest half-life of all ACE drugs. Must be given 3 or 4 times a day.
Ace inhibitor Mechanism of Action
Inhibits angiotensin-converting enzyme, and renin-angiotensin- aldosterone system (decreases the amount of aldosterone [the bodies salt] in the blood stream = BP lowered
Ace inhibitor Indications
Antihypertensive, may be used in combination with other drugs (diuretics) to treat heart failure
- due to their ability to decrease SVR & preload, they can stop the progression of left ventricular infarction (MI) known as ventricular remodeling
- decrease morbidity and mortality in pt’s w/heart failure
- protective effect on kidneys because they reduce glomerular filtration pressure (drug of choice for diabetics)
- reduce proteinuria
Ace inhibitors Contraindications
Previous reaction of angioedema (laryngeal swelling) with ACE use, pt. w/ a baseline K+ level of 5 mEq/L or higher( ACE inhibitors promote K+ reabsorption, and Na excretion), Lactating women, children, pt. w/ bilateral renal artery stenosis
Ace inhibitors Adverse Effects
Fatigue, Dizzy, Angioedema (can be fatal), 1st dose hypotensive effect (extreme decrease in BP), Hyperkalemia, dry non productive cough, loss of taste, renal impairment
In patients with severe heart failure whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors may cause?
Acute renal failure
ACE Inhibitors promote what in the kidneys?
Potassium resorption in the kidney, although they promote sodium excretion. For this reason, serum potassium levels must be monitored regularly
ACE Inhibitors Toxicity Management of OD
Signs and symptoms are hypotension, treatment are symptomatic: administer IV fluids to expand blood volume, and hemodialysis is effective to remove captopril and Lisinopril
ACE Inhibitors Drug/ Food Interactions
- NSAIDs=decrease antihypertensive effects, can also predispose pt. to develop acute renal failure
- other hypertensives or diuretics=hypotensive effects; -Lithium with ACE inhibitors=lithium toxicity
- K+ supplements or K+ sparring diuretics=hyperkalemia
Assessment for ACE inhibitors
- BP (immediately before initial and subsequent doses
- Apical pulse
- respiratory status (because of AE of dry, hacking, chronic cough
- serum K+, sodium, chloride levels
- baseline cardiac functioning tests
- CBC before and during therapy due to AE of neutropenia & other blood disorders
- weaning is recommended to avoid rebound HTN
- impaired taste can last 2-3 months after discontinuation
- educate it takes several weeks to see therapeutic effects & don’t take K+ supplements
Adverse effects of ARBs
Chest pain, fatigue, hypoglycemia, diarrhea, UTI, anemia, and weakness
-Hyperkalemia & cough less likely to occur compared to ACE
Toxicity & management of ARBs
overdose manifest as hypotension & tachycardia; bradycardia occurs less often
-Tx: symptomatic & supportive includes administration of IV fluid to expand blood volume
What happens with doxazosin a alpha 1 blocker
A first dose orthostatic hypotension may occur w/in 2-6 hours so carefully assess BP (supine and standing) & measure corresponding pulse rates before the first dose and 2-6 hours afterward, as well as with any subsequent increase in dosage
When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs?
Alpha blockers such as doxazosin (Cardura) because these drugs are associated with first-dose syncope so, to avoid injury, advise patient to remain supine for first dose. More than likely they will be prescribed to be given at bedtime to allow pt to sleep
-it may take up to 4-6 weeks for drug to achieve therapeutic effect
