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Pharmacology > Module 3 Lipid-Lowering Agents, Diuretic Agents, Appendix C Ophthalmic Agents > Flashcards

Module 3 Lipid-Lowering Agents, Diuretic Agents, Appendix C Ophthalmic Agents Flashcards

1
Q

What do lipid-lowering agents treat?

A

Coronary artery disease

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2
Q

List coronary artery disease modifiable risk factors

A
  • Cigarette smoking (nicotine)
  • sedentary lifestyle
  • high stress levels
    -Hypertension
    -Obesity
  • diabetes
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3
Q

List coronary artery disease non-modifiable risk factors

A
  1. Genetics: family history, onset under 55 years old
  2. Age: incidence increased with age
  3. Sex at birth:
    - males> pre-menopausal female
    - males = post-menopausal female
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4
Q

List The Different lipoproteins

A
  1. Low-density lipoproteins
  2. High-density lipoproteins
  3. Cholesterol
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5
Q

Where are lipoproteins produced?

A

Liver

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6
Q

Define low-density lipoproteins (LDL)

A
  • Tightly packed cholesterol, triglycerides, and lipids
  • carried by proteins with the purpose to be broken down for energy or stored for future energy
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7
Q

Define high-density lipoproteins (HDL)

A
  • loosely packed lipids
  • used for energy and to pick up the leftovers of the LDL breakdown process (fats and cholesterol)
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8
Q

Define cholesterol

A

-Precursor to steroid hormones (sex and adrenal cortical hormones) and cell membrane formation and maintenance
- necessary for normal function

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9
Q

Where does cholesterol come from?

A
  1. Through diet
  2. Through fat metabolism / biotransformation
  3. Body makes it if there isn’t enough taken in through diet
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10
Q

HMG-CoA

A
  • Hydroxymethylglutaryl - coenzyme A
  • enzyme responsible for cellular synthesis of cholesterol
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11
Q

Define hyperlipidemia

A

Increased level of lipids in the blood

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12
Q

Hyperlipidemia causes

A
  1. Excess dietary intake
  2. Genetic alternations in fat metabolism
    - hypercholesterolemia
    - hypertriglyceridemia
    - alterations in LDL and HDL concentrations
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13
Q

How should children lower lipid levels

A
  1. Dietary measures and changes
  2. Fibrates and HMG-CoA inhibitors (statins)
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14
Q

How should adults lower lipid levels?

A
  1. Lifestyle changes
  2. HMG-CoA reducteuse inhibitors (statins)
    - not in pregnancy
  3. Pregnancy: bile acid sequestants
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15
Q

How should older adults lower lipid levels?

A
  1. Lifestyle changes first
  2. Lower dose HMG-CoA (statins)
  3. Higher incidence of adverse effects
    - monitor renal and hepatic labs
    - monitor for muscle pain
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16
Q

List The Different lipid-lowering agents

A

1.HMG-CoA inhibitors (statins)
2. Bile acid sequestrants
3. Cholesterol absorption inhibitors
4.PCSK9 inhibitors
5. Fibrates
6. Vitamin B3
7. Omega 3 fatty acids

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17
Q

List the bile acid sequestants

A
  1. “Chole” or “Cole”
  2. Cholestyramine
  3. Colestipol
  4. Colesevelam
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18
Q

What is the action of bile acid sequestrants

A

Binds bile acids in the intestine, allows excretion in feces instead of reabsorption

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19
Q

What are indications for bile acid sequestants

A
  1. Hypercholesterolemia
    - high cholesterol
    -High LDLs
  2. Pruritis associated with partial biliary obstruction
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20
Q

What are contraindications and cautions of bile acid sequestrants

A
  1. Absolute: allergy
  2. Relative: complete biliary obstruction, abnormal intestinal functioning
  3. Caution: pregnancy
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21
Q

What are adverse effects of bile acid sequestrants

A
  1. Direct GI irritation
  2. Nausea
  3. Constipation
  4. Vitamin A, D, E, K deficiencies
  5. Caution: pregnancy
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22
Q

What are drug-drug interactions of bile acid sequestrants

A
  1. Malabsorption of fat-soluble vitamins
  2. Affect absorption of other oral drugs
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23
Q

What would be included in the assessment of bile acid sequestants

A
  1. History
    - allergy, pregnancy, lactation
    - impaired intestinal function/obstruction
  2. Physical
    -Skin, GI system
  3. Labs: cholesterol, lipid levels
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24
Q

What are implementations for bile acid sequestrants

A
  1. Powdered drugs must be mixed in liquid
  2. Tablets cannot be cut, chewed or crushed
  3. Give the drug before meals
  4. Administer other oral meds 1 hour before or 4 to 6 hours after bile acid sequestrants
  5. Arranged for a bowel program as appropriate
  6. Comfort and safety measures for adverse effects
  7. Provide through patient teaching
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25
Q

What are nursing conclusions for bile acid sequestrants

A
  1. Impaired comfort
  2. Constipation
  3. Injury risk
  4. Knowledge deficit
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26
Q

What should be included in evaluation of bile acid sequestants

A
  1. Evaluate response to drug
  2. Evaluate the effectiveness of the teaching plan
  3. Evaluate the effectiveness of comfort and safety measures
  4. Evaluate the compliance with the regimen
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27
Q

HMG-CoA reductase inhibitors are also known as?

A

Statins

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28
Q

List examples of statins

A

“Astatin”
1. Atorvastatin
2. Lovastatin
3. Pravastatin
4. Rosuvastatin
5. Simvastatin

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29
Q

What is the action of statins?

A
  1. Blocks HMG-CoA reductase enzyme
    - decreases serum cholesterol and LDL due to liver not producing cholesterol
    2.HDL level increases
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30
Q

What are the indications of statins

A
  1. Treats elevated cholesterol, triglycerides and LDL
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31
Q

What are the contraindications of statins

A
  1. Absolute: allergy and pregnancy
  2. Relative: liver disease
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32
Q

What are the cautions of statins

A
  1. Renal impairment
    - can worsen if rhabdomyolysis occurs
  2. Impaired endocrine function
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33
Q

What are the adverse effects of statins?

A
  1. GI system: flatulence, abdominal pain
  2. Liver: elevated liver enzymes and acute liver failure
  3. Muscle soreness, cramps, aches
    - rhabdomyolysis: breakdown of muscles which releases waste products that can injure the glomerulus and result in acute renal failure
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34
Q

What are the drug interactions of statins

A
  1. Antibiotics, antifungals, immunosuppressants
    - May increase drug levels of the statin; increased adverse effects
  2. Grapefruit juice
    - increased risk of toxicity
  3. St. John’s wort
    - Decreased statin effectiveness
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35
Q

What is included in the assessment of statins

A
  1. History
    - allergy, pregnancy, lactation, liver disease, impaired endocrine function, renal impairment
  2. Physical
    - abdomen: bowel sounds and elimination patterns
  3. Labs
    - renal and hepatic functions: lipid levels
    - possible pregnancy test
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36
Q

What is considered in the nursing conclusion of statins

A
  1. Knowledge deficit related to drug therapy
  2. Impaired comfort related to myalgia
  3. Injury risk related to liver and renal effects
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37
Q

What are examples of implementation with statins

A
  1. Administer at bedtime
  2. Monitor serum cholesterol, LDLs, LFTs
  3. Lifestyle modifications
  4. Withold in any acute medical condition
  5. Use of barrier contraception for those of childbearing age
  6. Provide thorough patient teaching
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38
Q

What is included in the evaluation of statins

A
  1. Evaluate response to drug
  2. Effectiveness of teaching plan
  3. Effectiveness of comfort and safety measures
  4. Compliance with the regimen
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39
Q

Statin memory technique “STAT”

A
  1. S- sore muscles
  2. T- toxic liver (ALT/AST)
  3. A- avoid grapefruit juice and St. John’s Wort
  4. T- take at night
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40
Q

What is the cholesterol absorption inhibitor discussed?

A

Ezetimibe

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41
Q

What is the action of cholesterol absorbtion inhibitors?

A
  1. Works in small intestine to decrease absorption of dietary cholesterol
  2. Less cholesterol is circulated to the liver
  3. Liver clears more cholesterol from the blood which results in less circulating cholesterol
  4. Decreases total cholesterol level, LDLs, and triglycerides
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42
Q

What is the indication for cholesterol absorption inhibitors?

A

Hypercholesterolemia

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43
Q

What are the contraindications of cholesterol absorption inhibitors?

A

Allergies (hypersensitivity)

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44
Q

What are the cautions of cholesterol absorption inhibitors?

A

Liver disease

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45
Q

What are the adverse effects of cholesterol absorption inhibitors?

A
  1. GI: abdominal pain and diarrhea
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46
Q

What drug has interactions with cholesterol absorption inhibitors?

A
  1. Cyclosporine: increased risk of ezetimibe toxicity
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47
Q

What is included in the assessment of cholesterol absorption inhibitors?

A
  1. History: allergy, pregnancy/lactation, liver disease
  2. Physical: abdomen: BS and elimination patterns
  3. Labs: cholesterol, lipids, LFTs
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48
Q

What is included in the nursing conclusions of cholesterol absorption inhibitors?.

A
  1. Impaired comfort
  2. Knowledge deficit
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49
Q

What is included in the implementation of cholesterol absorption inhibitors?

A
  1. Monitor labs before and during therapy
  2. Lifestyle changes
  3. Comfort and safety measures
  4. Provide thorough patient teaching
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50
Q

What is included in the evaluation of cholesterol absorption inhibitors?

A
  1. Response to drug
  2. Effectiveness of the teaching plan
  3. Effectiveness of comfort and safety measures
  4. Compliance with the regimen
51
Q

List the proprotein convertase subtilisin discussed

A
  1. ” - ocumab”
  2. Alirocumab
  3. Evolocumab
52
Q

What are proprotein convertase subtilisin also known as?

A

Kevin type 9 (PCSK9) inhibitors

53
Q

What is the action of (PCSK9) inhibitors

A
  1. Monoclonal antibodies prevent PCSK9 enzymes from attaching to the LDL receptors on the liver cell
  2. This allows LDLs to attach to those liver cells and be metabolized (removed from the blood)
  3. Decreases LDL levels and total cholesterol
54
Q

What are the indications of (PCSK9) inhibitors

A
  1. Treatment of hypercholesterolemia
  2. Used with a statin drug or alone if statins cannot be taken
55
Q

What are the absolute contraindications of (PCSK9) inhibitors

56
Q

What are the adverse effects of (PCSK9) inhibitors

A
  1. Risk of infection
  2. Injection site reactions
57
Q

What drugs do (PCSK9) inhibitors interact with?

A
  1. None/unknown
58
Q

What is included in the assessment of (PCSK9) inhibitors?

A
  1. History: allergy, pregnancy and lactation
  2. Physical:
    - skin at intended injection site
    - vital signs and lung sounds
    3: Labs - cholesterol, lipids
59
Q

What is included in the nursing conclusions of (PCSK9) inhibitors

A
  1. Impaired comfort
  2. Infection risk
  3. Impaired skin integrity
  4. Knowledge deficit
60
Q

What is included in implementation of (PCSK9) inhibitors?

A
  1. Monitor labs periodically
  2. Encourage lifestyle changes
  3. Provide comfort and safety measures
  4. Provide thorough patient teaching
61
Q

What is included in the evaluation of (PCSK9) inhibitors?

A
  1. Response to drug
  2. Effectiveness of teaching plan
  3. Effectiveness of comfort and safety measures
  4. Compliance with the regimen
62
Q

What two lipid lowering agents share the same indications and actions?

A
  1. Fibrates
  2. Vitamin B3
63
Q

List the examples of fibrates discussed

A
  1. Fenofibrate
  2. Gemfibrozil
  3. Fenofibric acid
64
Q

What is an example of Vitamin B3

65
Q

What are the indications of fibrates and vitamin B3

A

Hypercholesterolemia

66
Q

What are the actions of fibrates and Vitamin B3

A
  1. Lowers triglycerides and LDL
  2. Increases HDL
67
Q

What are examples of omega-3 fatty acids

A
  1. Omega-3-acid ethyl esters
  2. Omega-3-carboxylic acids
68
Q

What are the indications and action of omega-3 fatty acids?

A
  1. Indication: hypertriglyceridemia
  2. Action: lowers triglycerides
69
Q

What are the indications of fibrates, vitamin B3, and omega-3 fatty acids?

A
  1. No response to strict dietary modification, exercise, and lifestyle changes with the use of one lipid - lowering agent
  2. Unable to tolerate higher doses of the monotherapy drug
70
Q

What are the goals of fibrates, vitamin B3, and omega-3 fatty acids?

A
  1. Lower cholesterol and LDL levels
71
Q

What are the adverse effects of fibrates, vitamin B3, and omega-3 fatty acids?

A
  1. Increased risk of side effects including rhabdomyolysis
72
Q

What are the actions of diuretic agents?

A
  1. Increase urine volume
  2. Increase sodium excretion
  3. Prevent fluid retention
73
Q

What are the indications of diuretic agents?

A
  1. Edema related to congestive heart failure
  2. Acute pulmonary edema
  3. Liver disease
  4. Renal disease
  5. Hypertension
  6. Hyperkalemia
74
Q

What are The Different classes of diuretics?

A
  1. Thiazide and thiazide-like diuetics
  2. Loop diuretics
  3. Carbonic anhydrase inhibitors
  4. Potassium-sparing diuretics
  5. Osmotic diuretics
75
Q

What is important information regarding children taking diuretics?

A
  1. Can take thiazides, loop, and spironolactones
  2. Have rapid drug effects and adverse effects
  3. Monitor closely especially for fluid and electrolyte balances
76
Q

What is important information regarding adults taking diuretics?

A
  1. Emphasize patient education
  2. Take daily weights
  3. Be aware of fluid loss situations
  4. Adequate oral fluid intake
  5. Do not use in lactation
  6. Only allow women who are pregnant to take diuretics if the benefits outweigh the risk in pregnancy
77
Q

What is important information regarding older adults taking diuretics?

A
  1. Possibility of underlying renal and hepatic impairment
  2. Monitor fluid and electrolyte balance closely
  3. Maintain oral fluid intake and activity
  4. Avoid excessive salt
78
Q

List the thiazide and thiazide like diuretics

A
  1. Hydrochlorothiazide
  2. Chlorothiazide
  3. Chlorthalidone
79
Q

What is the mechanism of action for thiazide diuretics

A
  1. Action is to block the chloride pump
  2. Keep chloride and the sodium in the tubule to be excreted in the urine, preventing the reabsorption of both in the vascular system
80
Q

What are the indications of thiazide diuretics?

A
  1. Edema associated with chronic heart failure, liver, or renal disease
  2. Hypertension
81
Q

What are the contraindications of thiazide diuretics?

A
  1. Absolute:
    - allergy
  2. Relative:
    - allergy to sulfonamides
    - hypovolemia
    - severe renal disease
82
Q

What are the cautions of thiazide diuretics?

A
  1. Lupus
  2. Liver disease
  3. Diabetes or glucose tolerance abnormalities
83
Q

What are the adverse effects of thiazide diuretics?

A
  1. Electrolyte and glucose imbalances
    - hypokalemia
    - hypercalcemia
    - hyperglycemia
  2. Fluid loss
    - dizziness
    -Weakness
    - fatigue
  3. alkanized urine
    - bladder infections
84
Q

What are the drug-drug interactions of thiazide diuretics?

A
  1. Digoxin
    - increased risk of digoxin toxicity related to potassium changes
  2. Antidiabetic agents
    - may need adjustment of antidiabetic agent
  3. Lithium
    - increased risk of lithium toxicity
    - monitor levels closely
85
Q

List loop diuretics

A
  1. Bumetanide
  2. Furosemide
  3. Torsemide
86
Q

What are the actions of loop diuretics?

A
  1. Blocks the chloride pump which blocks sodium and chloride reabsorption into circulation
  2. Large amount of sodium and chloride rich urine is excreted
  3. Significant diuresis
  4. Works quickly
87
Q

What are the indications of loop diuretics?

A
  1. Heart failure
  2. Pulmonary edema
  3. Edema related to heart failure, renal disease, and liver disease
  4. Hypertension
88
Q

What are the contraindications of loop diuretics?

A
  1. Absolute:
    - allergy
  2. Relative:
    - electrolyte depletion
    - severe renal failure
    - liver failure
89
Q

What are the cautions of loop diuretics?

A
  1. Lupus
  2. Hyperglycemia
90
Q

What are the adverse effects of loop diuretics?

A
  1. Hypocalcemia
  2. Hypokalemia
  3. Hyperglycemia
  4. Ototoxicity
  5. Hypotension and dizziness
91
Q

What are the drug-drug interactions of loop diuretics?

A
  1. Amino glycosides or cisplatin
    - increased risk of ototoxicity
  2. Anticoagulants
    -increased effects of anticoagulants
  3. Digoxin
    - increased risk of digoxin related to potassium changes
  4. Antidiabetic agents
    - may need adjustment of antidiabetic agents
  5. Lithium
    - increased risk of lithium toxicity
    - monitor levels closely
  6. Indomethacin, ibuprofen, salicylates, NSAIDs
    - decreases effect of diuretic
92
Q

List the carbonic anhydrase inhibitors

A
  1. “-Amide”
  2. Acetazolamide
93
Q

What are the actions of carbonic anhydrase inhibitors?

A
  1. Blocks the effects of carbonic anhydrase
    - slows down the movement of hydrogen ions
  2. More sodium and bicarbonate are lost in the urine
94
Q

What are the indications of carbonic anhydrase inhibitors?

A
  1. Adjuncts to other diuretics
  2. Glaucoma
95
Q

What are the contraindications of carbonic anhydrase inhibitors?

A
  1. Absolute: allergy
  2. Relative: allergy to sulfonamides or thiazides
96
Q

What are the cautions of carbonic anhydrase inhibitors?

A
  1. Renal or hepatic disease
  2. Adrenocortical insufficiency
  3. Respiratory acidosis
97
Q

What are the adverse effects of carbonic anhydrase inhibitors?

A
  1. Metabolic acidosis
  2. Hypokalemia
  3. CNS effects
    - paresthesias of extremities
    - confusion
    - drowsiness
98
Q

What are the drug-drug interactions of carbonic anhydrase inhibitors?

99
Q

List the potassium-sparing diuretics

A
  1. Spironolactone
  2. Triamterene
100
Q

What are the actions of potassium-sparing diuretics?

A
  1. Loss of sodium with the retention of potassium
  2. Spironolactone
    - aldosterone antagonist: blocks aldosterone in the distal tubule which results in the excretion of sodium
  3. Triamterene:
    - block potassium secretion through the tubule (so retaining putassium), this means we are excreting sodium
101
Q

What are the indications of potassium-sparing diuretics?

A
  1. Adjuncts with thiazides or loop diuretics
  2. For those who need a diuretic but are at the risk of hypokalemia
  3. Hyperaldosteronism
102
Q

What are the contraindications of potassium-sparing diuretics?

A
  1. Absolute:
    -allergy
  2. Relative:
    - hyperkalemia
    -Severe renal disease
103
Q

What are the drug-drug interactions of potassium-sparing diuretics?

104
Q

What are the adverse effects of potassium-sparing diuretics?

A
  1. Hyperkalemia
    M - muscle weakness
    U - urine: oliguria, anuria
    R - respiratory distress
    D - decreased cardiac contractility
    E - ECG changes
    R - reflexes: hyperreflexia, areflexia
  2. Androgen effects
    - gynecomastia
    - Irregular menses
    - hirsutism
    - deepening of the voice
105
Q

List osmotic diuretics discussed?

106
Q

What are the actions of osmotic diuretics?

A
  1. Pulls water into the renal tubule without sodium loss
  2. Pulls fluid from extra vascular space into the intravascular space
    - only administered IV
107
Q

What are the indications of osmotic diuretics?

A
  1. Increased ICP ( intracranial pressure)
  2. Increased renal failure due to shock, drug overdose, or trauma
  3. Decrease IOP before eye surgery or in acute glaucoma attacks
108
Q

What are the contraindications of osmotic diuretics?

A
  1. Pre-existing severe renal disease
  2. Pulmonary congestion and edema
  3. Intracranial bleeding
  4. Dehydration
  5. Heart failure
109
Q

What are the adverse effects of osmotic diuretics?

A

Related to the sudden drop in fluid levels
1. Fluid and electrolyte imbalance
2. Nausea and vomiting
3. Hypotension
4. Light-headedness
5. Confusion
6. Headache
7. Heart failure
8. Pulmonary edema

110
Q

What is included in the assessment of diuretic agents?

A
  1. History
    - allergies, pregnancy, lactation
    - fluid and electrolyte disturbances; hyperglycemia
    - contraindications or cautions for particular drug class
  2. Physical
    - baseline: skin, mucus membranes, heart and lung sounds
    - I/O; voiding patients
    - vitals, weight
  3. Labs
    - renal and hepatic function tests
    - electrolytes
    - Glucose
111
Q

What is included in the nursing conclusions of diuretic agents?

A
  1. Risk for alterations in fluid volume
  2. Risk for electrolyte disturbances
  3. Hypotension risk
  4. Knowledge deficit
112
Q

What is included in the implementation of diuretic agents?

A
  1. Can be given with food or milk
  2. Administer early in the day
  3. Administer IV diuretics slowly and switch to oral form ASAP
  4. Assess weight daily
  5. Assess for dehydration and electrolyte imbalance
  6. Appropriate amount of potassium
  7. Appropriate amount of fluid to prevent fluid rebound
  8. Safety precautions
  9. Patient teaching
113
Q

What is included in the evaluation of diuretic agents?

A
  1. Response to drug
  2. Effectiveness of teaching plan
  3. Effectiveness of comfort and safety measures
  4. Compliance with the regimen
114
Q

What are the 6 L’s of hypokalemia

A
  1. Lethargy
  2. Leg cramps
  3. Limp muscles
  4. Low, shallow respirations
  5. Lethal cardiac dysrhythmias
  6. Lots of urine (polyuria)
115
Q

What are the indications of ophthalmic agents?

A
  1. Miotics
    - constrict pupils
    - decrease resistance to aqueous flow
    -Used for glaucoma
  2. Mydriatics
    - dilate the pupils
    - allow for examination of retina
  3. Cycloplegics
    - paralyze muscle that controls the lens to aid refraction
  4. Ophthalmic infections and inflammation
  5. Treat allergy symptoms
116
Q

What are the contraindications of ophthalmic agents?

A
  1. Absolute
    - allergy
117
Q

What are the cautions of ophthalmic agents?

A
  1. Systemic effects (potential but unlikely)
  2. Pregnancy: animal studies have shown adverse effects on fetus
118
Q

What are the drug-drug interactions of ophthalmic agents?

A

Space drugs apart

119
Q

What are the adverse effects of ophthalmic agents?

A
  1. Irritation
    -Burning/stinging
  2. Blurring of vision
  3. Tearing
  4. Headache
120
Q

What is included in the assessment of the ophthalmic agents?

A
  1. History:
    -Drug allergy
    - current medication and conditions
  2. Physical:
    - eye assessment
    - possible vision exam
121
Q

What is included in the nursing conclusions/diagnosis of the ophthalmic agents?

A
  1. Acute pain - impaired comfort
  2. Risk for injury - injury risk
  3. Deficient knowledge - knowledge deficit
122
Q

What is included in the implementation of the ophthalmic agents?

A
  1. Administration
  2. Comfort and safety measures
  3. Patient teaching
123
Q

What is included in the evaluation of the ophthalmic agents?

A
  1. Response to the drug
  2. Effectiveness of comfort and safety measures
  3. Effectiveness of teaching plan
124
Q

What are the steps of eye drop administration?

A
  1. Grasp lower eyelid near the margin with thumb and index finger and pull outward to create pouch in the lower culdasac
    2.

Pharmacology (4 decks)

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