Drugs Flashcards
Nifedipine
Ca+ channel blocker, only works on arterioles, used with beta blocker to prevent reflex tachycardia
Long-acting preferred for prevention of MI
verapamil
Ca+ channel blocker
works on heart and arterioles
Treats angina, HTN, dysrhythmias
Increases dig rates by 60%- can cause dig toxicity or AV heart block
Amlodipine
Ca+ channel blocker. Similar to nifedipine but without reflex tachycardia risk. Only works on arterioles.
Hydralazine
Vasodilator
Acts on arterioles
Used for essential HTN, hypertensive crisis, HF
Nitroglycerin
Vasodilator
Selective dilation of veins- preload reducer
Sodium Nitroprusside (nitropress)
Vasodilator- arteries and veins
Fastest-acting treatment of hypertensive crisis
Minoxidril
Vasodilator similar to hydralazine (Arteriole)
but more intense
Strong adverse effects
Try hydralazine
Labetalol
beta blocker used to lower blood pressure in eclampsia
Digoxin
Used for heart failure
increases force of contraction, CO
Increases quality of life but not length
toxicity: GI,
ACE & ARB with digoxin
good mix- may be benficial
What offsets potassium loss and blocks aldosterone’s effect?
Spironolactone and elperenone
Quinidine
Class I sodium channel blockers. Delay repolarization and slow conduction. Widen QRS complex and prolong QT interval. Used in supraventricular and ventricular dysrhythmias.
Propranolol
Class II antidysrhythmics. Beta adrenergic blocking agents, used in supraventricular dysrhythmias
Verapamil
Class IV antidysrhythmics
Metformin
PO type II diabetes medication
Inhibits glucose production in the liver
Reduces glucose absorption in the gut
Good for pts who skip meals (no hypoglycemia)
Prevents type II diabetes in patients with risk
Who should not be given metformin?
Pts with severe active liver or kidney disease or alcoholics- could cause lactic acidosis, may be deadly.
Glyburide—type, mechanism, interactions
Type II Diabetes
Sulfonylureas- promotes insulin release.
Major side effect- hypoglycemia
Interactions: Cimetidine- hypoglycemia, beta adrenergic blocking agents- mask signs of hypoglycemia, alcohol (hypoglycemia), NSAIDS (ghypoglycemia)
Repaglinide
Type II Diabetes
Meglitinide
Increases insulin release
May cause hypoglycemia
Rosiglitazone and pioglitazone
Type II Diabetes
Glitazones
Reduce glucose levels by decreasing insulin resistance
Avoid in heart faiure because of fluid retention and pulmonary edema risk!
Sitagliptin
Type II Diabetes
Enhances the actions of incretin hormones
Stimulates matching of insulin release with glucose levels
Canagliflozin
Type II Diabetes
Blocks reabsorption of filtered glucose in the kidney- leads to glucosuria
SE: genital fungal infections, UTI, increases urination
Colesevelam
Bile acid sequestrant used to lower plasma cholesterol
also may help lower blood glucose
Good for lowering blood sugar in pts with high cholesterol and type II diabetes
Diagnostic criteria for DM
FPG 126mg/dL or greater
Glycosylated hemoglobin A1c 6.5 or greater (test indicates serum glucose over the past 3 months)
insulin lispro
short duration, rapid acting
insulin aspart
short duration, rapid acting
insulin glulisine
short duration, rapid actign
regular insulin
short duration, slower acting
NPH insulin
intermediate duration
insulin glargine
long duration- given once a day at night for next day coverage
all day long steady coverage. Might be combined with short acting
insulin detemir
long duration insulin
Sliding scale insulins
regular and short acting, short duration insulin
Which insulins can be mixed?
NPH and any short-acting
Which insulin may be cloudy?
NPH
Where to inject insulin?
SubQ fat in abdomen, thigh acceptable as well
IV infusion of insulin
Short acting insulin may be infused. Regular insulin for operative and NPO patients.
Storage of insulin
Must be refrigerated. Keep out of sunlight and heat.
Unfractionated Heparin
Used for DVT, PE, evolving stroke, open heart surgery, renal dialysis, low-dose postoperatively, in pregnancy
Heparin-induced thrombocytopenia
dropping platelets, DVT or PE while on heparin, ischemia of digits. Treat by discontinuing heparin, switch to a different anticoagulant.
Protamine sulfate
used for heparin OD.
Lab values for heparin
aPTT
Enoxaparin
Low molecular weight heparin
Dosage based on body weight- no aPTT measurement needed
Prevention of DVT, DVT, ischemic stroke, unstable angina, MI
Daltaparin
Low molecular weight heparin
Dosage based on body weight- no aPTT measurement needed
Prevention of DVT, DVT, ischemic stroke, unstable angina, MI
Warfarin
PO anticoagulant- takes several days to work.
Used for long-term prophylaxis of VT and prevention of TE, prevention of clotting in afib.
Vitamin K antagonist- blocks biosynthesis of clotting factors.
Antidote: vitamin K
INR monitoring & prothrombin time - lab values
Dabigatran
Direct thrombin inhibitor
PO drug
Newly approved
Doesn’t require monitoring, same dose for all pts regardless of weight
Rivaroxaban
Binds directly with factor X to prevent clotting
PO, approved in 2011
No lab monitoring required
Aspirin
Antiplatelet drug
Uses: ischemic stroke, TIA, stable angina, coronary stenting, acute MI
Inhibition of cyclooxygenase
Increased risk of GI bleeding
Clopidogrel (Plavix)
Antiplatelet drug
Alternative to aspirin
ADP receptor antagonist
Less intracranial and GI bleeding than aspirin
abiciximab
GP IIb/IIIa inhibitor- “super aspirin”
used for percutaneous procedures with aspirin AND heparin.
Only used IV
Alteplase (tPa)
Thrombolytic drug
Converts plasminogen to plasmin
Given for MI or CV
Must be given within 2 hours of MI!
Major adverse effect- major bleeding, IC bleeding
Blood replacement may be necessary
Minimize concurrent hep, warfarin, dabigitran!
