LIPID LOWERING AGENTS/LOWER RESP DRUGS Flashcards
LIPID LOW. AGENTS ACROSS LIFESPAN
Children: typically due to genetics
1st: dietary measures first
2nd: fibrates and HMG - CoA inhibitors (statins)
Pregnancy: bile acid sequestrants
HMG-CoA reductase inhibitors
Statins
Statins (drug names)
“Statin”
-atorvastatin
-lovastatin
-pravastatin
Statins (therapeutic actions)
-HMG-CoA reductase (an enzyme) is needed to synthesize cholesterol in the liver
-if this enzyme is blocked, serum cholesterol and LDL decrease since the liver can’t produce cholesterol
-increases HDL levels too
Statins (indications)
-treats elevated cholesterol, triglycerides and LDL
Statins (caution and interactions)
-renal impairment (can be worsened if rhabdomyolysis occurs)
-impaired endocrine function
-interactions with antibiotics, antifungals, immunosuppressants (increased adverse effects) grapefruit juice (toxicity) and St. John’s wort (statin effectiveness decrease)
Common adverse effects of statins
-GI system: flatulence and abdominal pain
-Liver: elevated liver enzymes (ALT/AST) and acute liver failure
-muscle soreness and aches
-iu
Rhabdomyolysis
Breakdown of muscles which releases waste products that can injure the glomerulus and result in acute renal failure
Implementation of statins
-administer at bedtime
-monetary cholesterol, LDL and LFTs
STATins
-sore muscles
-toxic liver
-avoid grapefruit in St. John’s wort
-take at night
Bile acid sequestrants (drug names)
“Chole-“ or “Cole-“
-cholestyramine
-colestipol
-colesevelam
Bile acid sequestrants (therapeutic actions)
-binds bile acids in the intestine, allows excretion in feces instead of reabsorption
- my definition: helps lower cholesterol by binding to bile acids in the intestines, preventing them from being absorbed in the blood
Bile acid sequestrants (indications)
-Hypercholesterolemia: high cholesterol and high LDLs
-pruritis associated with partial biliary obstruction
Bile acid sequestrants (contraindications)
-complete biliary obstruction; abnormal intestinal function
Bile acid sequestrants (caution and interactions)
- Caution: pregnancy
-interactions with malabsorption of fat soluble vitamins
-affects absorption of other oral drugs
Common adverse effects of bile acid sequestrants
-Direct G.I. irritation: including nausea and constipation
-vitamin A D Eand K deficiencies (increased bleeding times)
Implementation of Bile acid sequestrants
-powder drugs need to be mixed in liquid
-tablets swallowed hole only
-Give drug in the morning
-administer other oral drugs one hour before or 4-6 hours after bile acid sequestrants
Cholesterol absorption inhibitors
Ezetimibe
Cholesterol absorption inhibitors (therapeutic actions)
-works in small intestine to decrease the absorption of dietary cholesterol
-Less cholesterol is circulated to the liver
-Liver clears more cholesterol from the blood, which results in less circulating cholesterol
-decrees total cholesterol levels, LDL‘s, and triglycerides
Why do we give Cholesterol absorption inhibitors
For hypercholesterolemia
Cholesterol absorption inhibitors (cautions and interactions)
-Caution: liver disease
-Interaction with cyclosporine (increased risk of ezetimibe toxicity)
Common adverse effects of Cholesterol absorption inhibitors
- GI: abdominal pain and diarrhea
-possible blood in the urine
Cholesterol absorption inhibitors implementation
-Monitor labs before enduring therapy
Proprotein Convertase Subtilism/Kexin type 9 inhibitors (PCSK9) DRUG NAMES
“-ocumab”
-alirocumab
-evolocumab
Proprotein Convertase Subtilism/Kexin type 9 inhibitors (therapeutic actions)
-monoclonal antibodies prevent PCSK9 enzymes from attaching to the LDL receptors on the liver cell
-This allows for LDLs to attach those liver cells and be metabolized (removed from the blood)
-decreases LDL levels and total cholesterol
Proprotein Convertase Subtilism/Kexin type 9 inhibitors (indications/why do we give it?)
-Treatment of hypercholesterolemia
-Used with a statin drug or alone if statins can’t be taken
Proprotein Convertase Subtilism/Kexin type 9 inhibitors (interactions)
None/unknown
Proprotein Convertase Subtilism/Kexin type 9 inhibitors (adverse effects)
-Risk of infection
-injection site reactions
Fibrates
-fenofibrate
-gemfibrozil
-fenofibric acid
Vitamin B3
Niacin
Why do we give fibrates and or vitamin B3?
-for patients with hypercholesterolemia
-it helps lower triglycerides and LDL
-increases HDL
Lower respiratory tract
-Is where gas exchange occurs
-includes bronchial tree and alveoli
What sort of things occur in the lower respiratory tract?
-asthma
-COPD
-Pneumonia
-Respiratory distress syndrome (neonates)
-adult respiratory distress syndrome
Lower respiratory tract
Life span: children
Used frequently in children
-Long acting inhaled steroid
-short acting beta2 agonist (SABA)
-Leukotriene receptor antagonist
Treatment changes as as child grows
Prevention
-avoidance of allergens, smoke, crowds, and dusty areas
Xanthines (drug names)
-caffeine
-theophylline
also called methylxanthines
-narrow margin of safety
-Interact with many drugs
-Numerous adverse effects
-reserved for when other drugs don’t work or critical situation in ICU
Xanthines (therapeutic actions)
-Direct effect on the smooth muscles of the respiratory tract, both in the bronchi and in the blood vessels
-exact MOA is not known
Xanthines (indications/why do we give it?)
-Symptomatic, relief or prevention of asthma and COPD
-Reversal of broncospasm
Xanthines (caution and interactions)
Caution
-G.I. problems
-Heart disease
-Renal hepatic disease
-alcoholism
-hyperthyroidism
-interactions include any drug metabolized in the liver that has the potential to interact with with xanthines
-substances in cigarettes
Xanthines (common adverse effects)
-G.I. issues
-Cardiac
-central nervous system
-severe toxicity: seizures, life-threatening, arrhythmias, hypotension, coma.
Implementation of xanthines
-Administer with food or milk to relieve G.I. upset
-switch from IV to oral as soon as possible
Sympathomimetics (drug names)
“-terol”
“-proterenol”
-levalbuterol
-salmeterol
-albuterol (inhaler)
-formoterol
-isoproterenol
-metaproterenol
Epinephrine (drug of choice in bronchospasm)
Sympathomimetics (therapeutic actions)
-beta 2 selective adrenergic agonists
-dilates bronchi
-Increases respiratory rate
-Increases depth of respirations
-SABA/LABA
Sympathomimetics (indications/why do we give it?)
-acute asthma attack
-bronco spasm
-Prevention of exercise induced asthma
-Maintenance medication for chronic respiratory diseases
Sympathomimetics (cautions and interactions)
Caution
-Conditions that would be aggravated by SNS stimulation
-Depends on the severity of the underlying condition
-interactions with beta blockers, other drugs that increase blood pressure or heart rate, substances, and cigarettes.
Sympathomimetics (common adverse effects)
- bronchospasm (sometimes it causes the thing it’s supposed to prevent)
-Sympathomimetic stimulation: CNS stimulation, G.I. upset, cardiac (arrhythmias, hypertension, sweating, pallor, flushing)
Sympathomimetics implementation
-take 30 to 60 minutes before exercise
Anticholinergics (drug names)
“Tropium”
-IPratropium
-tiotropium
“Clidinium”
-aclidinium
-umeclidinium
Anticholinergics (therapeutic actions)
- blocks the vagal effect leading to relaxation of smooth muscle and bronchi (broncodilation)
Anticholinergics (indications/why do we give it?)
-Maintenance treatment of COPD
Anticholinergics (contraindications)
-acute bronchospasm requiring immediate intervention
Anticholinergics (caution and interactions)
Caution
-any condition aggravated by the Anticholinergic effects
Interactions with other anticholinergics
Anticholinergics (common adverse effects)
- dry mouth, hoarseness, sore throat
-dizzy, headache, fatigue, nervous, palpitations, and urinary retention
-paradoxical bronchoconstriction
Anticholinergics implementation
-void prior to medication administration
-Humidification and hydration
Anticholinergics TIP
-can’t see
-can’t pee
-Can’t spit
-can’t shit
Inhaled steroids (drug names)
“One”
-beclomethasone
-fluticasone
-triamcinolone
“Esonide”
-budesonide
-ciclesonide
Inhaled steroids (therapeutic actions)
-Decreases the inflammatory response in the airways
-takes 2 to 3 weeks to be effective
Inhaled steroids (indication/why do we get it?)
-Prevention and treatment of asthma
-Maintenance treatment of COPD
Inhaled steroids (indication/why do we get it?)
-Prevention and treatment of asthma
-Maintenance treatment of COPD
Inhaled steroids(contraindications)
- not an emergency drug for an acute asthma attack
Inhaled steroids (cautions and interactions)
Caution
- active respiratory infection
No known interaction
Common adverse effects of inhaled steroids
- sore throat/hoarseness
-coughing, dry mouth
-fungal infections
Inhaled steroids implementations
- rinse mouth after using inhaler
-Monitor for respiratory infection signs
Leukotriene Receptor antagonist (drug names)
“-lukast”
-zafirlukast
-montelukast
Leukotriene Receptor antagonist (therapeutic actions)
-Lock receptors for the production of leukotrienes
-they don’t have an immediate effect
-takes one to two weeks to reach full effect
Leukotriene Receptor antagonist (indications/why do we give it?)
-long-term asthma treatment
Leukotriene Receptor antagonist (contraindications)
-Allergy or acute asthma attack
Leukotriene Receptor antagonist (caution and interactions)
caution
-hepatic impairment
-there are several interactions. You must check before you administer.
Leukotriene Receptor antagonist ( common adverse effects)
- flu like symptoms
-CNS: headache, dizzy
-G.I. upset
Black box warning
-neuropsychiatric effects, including aggressive behavior, depression/suicide, hallucinations (behavioral changes are especially seen in children)
Leukotriene Receptor antagonist implementation
-not for use in acute asthma attack. Long-term asthma treatment only.
Lung surfactants (drug names)
“Actant”
-beractant
-calfactant
-lucinactant
-poractant
Lung surfactants (therapeutic actions)
-replace the surfactant that is missing in the lungs of neonates with RDS
-Begins to work immediately
Leukotriene Receptor antagonist (why do we give it?)
-to treat respiratory distress syndrome, and premature infants, and help them breathe
Implementation of lung surfactants
- Monitor continuously
-Ensure to placement before administering
-suction before administering but wait two hours after administering to suction again
