Medchart 6 Flashcards
What medication is used for heart failure?
Digoxin (Lanoxin/Lanoxicaps)
MOA of Digoxin?
Inhibit Na+K+ATPase pump, normally competes with potassium
- Increase Contractility : Positive intropic
- Less beats : Negative Dromotropic
- Slow heart rate: Negative Chemotropic
Adverse effects of Digoxin
- AV block
- Dysrhythmias
- Anoxeria
- N/V
- Colored vision (yellow)
- Halo vision
What are the Beta adrnergic Antagonists?
Propranolol (Inderal)
Metoprolol (Lopressor/ Toprol)
Atenolol (Tenormin)
What are Propranolol (Inderal)
Metoprolol (Lopressor/ Toprol)
Atenolol (Tenormin) used for?
- Dysrhythmias
- Angina Pectoris
- Protects against MI
MOA of Propranolol (Inderal)
Metoprolol (Lopressor/ Toprol)
Atenolol (Tenormin)
- reduce heart rate and contractility
- lowes myocardial O2 demand
What are the Calcium channel Blockers Dihydropyridines?
Nifedipine (Adalat)
Amlodipine (Norvasc)
Nicardipine (Cardene)
What are Calcium channel Blockers Dihydropyridines used for?
Nifedipine (Adalat)
Amlodipine (Norvasc)
Nicardipine (Cardene)
- Hypertension
- Angina Pectoris
MOA of Calcium channel Blockers Dihydropyridines
- Bind reversibly to closed type calcium channels
- Block calcium channels in vascular smooth muscle
- decrease amount of calcium available for muscle contraction
What are the Calcium channel blockers Nondihydropyridines
Verapamil (Calan)
Diltiazem (Cardizem)
What are Calcium channel blockers Nondihydropyridines used for?
Verapamil (Calan)
Diltiazem (Cardizem)
- Hypertension
- Angina pectoris
- Coronary artery disease
MOA of Calcium channel Blockers Nondihydropyridines
- bind to subunits of L-type calcium channels
- inhibit flow into muscle
- causes vasodilation of peripheral arterioles and reduces contractility of myocardium
Nursing concerns with ALL calcium channel blockers
-Complete History/Exam
-Monitor VS and BP 30 to 60 min before administration
withhold if systolic BP<90 mmHg
-Watch for orthostatic hypotension and chest pain
-Check daily weight, I&O and edema→ HF
-Avoid grapefruit (interact with CYP450)
-Observe for constipation
-Discontinue gradually
-Report palpitation and nausea
-No smoking, alcohol, or breastfeeding
What drug is an ACE inhibitor?
Enalapril (Linsinopril/Catorpil)
What is the ACE inhibitor Enalapril used for?
Hypertension
MOA of Enalapril
- Block RAA system in kidneys decreasing BP
- Reduce conversion to Angiotensin 1 to Angiotensin 2
- Reduce aldosterone effects and increase effectiveness of diuretics
What are adverse effects for Enalapril?
- Hyperkalemia
- persistant cough
- postural hypotension
- angioedema
Nursing concerns for Enalapril
- Protect Kidneys
- ACE inhibitors are cheaper but pts may not be able to tolerate nocturnal cough
What drug is an ARB Inhibitor?
Losartan
What is Losartan used for?
Hypertension
MOA for Losartan
- Block renin-angiotensin-aldosterone system in kidney to decrease BP
- Block effects of Angiotensin 2
- Similar effects of ACE inhibitors
Adverse effects of Losartan
- Hypotension
- Angioedema (rare)
Nursing Concerns for Losartan
Fewer adverse effects than ACE inhibitors because they are more specific
What are the Alpha 2 Agonist
Clonidine (Catapres),
Methyldopa (Aldomet)
What is Clonidine (Catapres),
Methyldopa (Aldomet) used for
Hypertension
MOA for Clonidine (Catapres),
Methyldopa (Aldomet)
- Unknown centrally acting mechanism unrelated to alpha2 receptors
- Reduce sympathetic nerve impulses
Adverse effects for Clonidine (Catapres),
Methyldopa (Aldomet)
- Drowsiness, depression, sedation
- Decreased libido/impotence
- Hepatotoxicity
- Positive coombs test → anemia
What are the Alpha 1 antagnoist drugs?
Prazosin (Minipress)
Doxazosin (Cardura)
What is Prazosin (Minipress)
Doxazosin (Cardura)
used for?
Hypertension
MOA for Prazosin (Minipress)
Doxazosin (Cardura)
- Block Alpha 1 Receptors
- Relax arterial & venous smooth muscle
Adverse effects for Prazosin (Minipress)
Doxazosin (Cardura)
- First dose phenomenon: orthostatic hypotension
- More for alpha 1 antagonists bc they are so potent
- This leads to ↓ blood flow to the brain and syncope (loss of consciousness R/T no blood flow)
- Sexual Dysfunction
- N/V and abdominal cramping
- Incontinence & increased urine frequency
- Depression
- Lethargy
- Vivid Dreams
Direct acting Vasodilator drugs
- Hydralazine (Apresoline)
- Nitroprusside (Nipride): Only for emergencies given through an IV; Continuous Cardiac/Hemodynamic Monitor
What is Hydralazine (Apresoline)
-Nitroprusside (Nipride) used for
Hypertension
MOA for Hydralazine (Apresoline)
-Nitroprusside (Nipride)
- Dilate arterial smooth muscle directly
- Some also affect veins
Adverse effects for Hydralazine (Apresoline)
-Nitroprusside (Nipride)
Can be minimized with beta blockers and diuretics
Reflex tachycardia
Fluid retention
Nursing Concerns for all ANTIHYPERTENSIVE drugs
- Complete Health History and Physical Exam
- BP & Pulse before administering drug
- Beware of Adverse Effects
- EKG/Lab values including electrolytes
- Daily Weight/ I&O to monitor fluid retention
- NO OTC meds or herbal supplement (Drug-Drug Interactions)
- Sedation and Dizziness for Pt. safety
Nursing Concerns for all Diuretics
- Complete health history
- Vital signs, BP and LOC frequently
- Baseline and period determination of electrolytes
- Safety precaution: hypotension and syncope
- Old patients observation
- Readiness to access to bathroom
- Given early in day (prevent nocturia)
- Daily weight, I/O and watch for cerebral, pulmonary edema and swelling
- No breastfeeding
Adverse effects for Diuretics
Electrolyte Imbalances/ Dehydration/ Hypotension
Loop or High Ceiling Diuretic
Furosemide (Lasix)
What is lasix used for
Most often hypetension
MOA for Furosemide (Lasix)
Block Na+, K+, and Cl- reabsorption at ascending loop of Henle
Adverse effect for Furosemide (Lasix)
Ototoxicity
Thiazides Diuretic
Hydrochlorothiazide (HydroDIURIL/ HCTZ)
What is Hydrochlorothiazide (HydroDIURIL/ HCTZ) used for
Most commonly prescribed for Diuretic-Related problems (HF and Hypertension)
MOA for Hydrochlorothiazide (HydroDIURIL/ HCTZ)
- Block Na+ reabsorption at distal tubule
- Results in less water reabsorption
Adverse effects for Hydrochlorothiazide (HydroDIURIL/ HCTZ) used for
- Gout Attacks
- Blood Dyscrasias (overall ↓ in WBC/RBC/Platelets)
Potassium Sparing Diuretic
Spironolactone (Aldactone): Low Effectiveness
MOA for Spironolactone (Aldactone)
- Inhibit action of aldosterone in distal tubule and collecting ducts of nephron
- ↑ Na+, Cl-, and H2O excretion
- K+ Retained
Adverse effects for Spironolactone (Aldactone)
Hyperkalemia (3.5-5.0): Life Threatening Cardiac Dysrhythmias
Osmotic Diuretic
Mannitol (Osmitrol)
What is Mannitol (Osmitrol) used for
- ↑ intracranial and intraocular pressure (surgery/ trauma/ Brain Trauma)
- Renal Failure
MOA for Mannitol (Osmitrol)
- Increase osmolality of the filtrate to pull water from intracellular and interstitial space (surrounding the cells) into vascular space
- Decreased H2O and Na+ through filtration by glomerulus but incapable of being reabsorbed by renal tubule
Adverse effects of Mannitol (Osmitrol)
rebound increase in ICP annd extravasation
Carbonic Anhydrase Inhibitors
Acetazolamide (Diamox)
What is Acetazolamide (Diamox) used for
Glaucoma
MOA for Acetazolamide (Diamox)
- Inhibit Carbon Anhydrase activity in proximal renal tubule
- Cause Increased excretion of Na+ and bicarbonate (Basic)
Adverse effects of Acetazolamide (Diamox)
Metabolic Acidosis
