Overview Flashcards
Thiazide and Thiazide-Like Diuretics
- MOA?
- Prescribed for? (2)
- Side effects? (2)
- Nursing considerations? (4)
- Teaching points? (2)
Work in the distal convoluted tubule to:
- Inhibit reabsorption of Na, K, Cl, and water –> more excreted in the urine
- Helps dilate small blood vessels & decrease peripheral vascular resistance –> additional mechanism to decrease BP
Prescribed for:
- HTN
- Edema
Side effects:
- Hypokalemia (low K)
- Hyponatremia (low Na)
Nursing considerations:
- Check BP
- Check electrolytes labs (Na has neuro implications; K has cardiac implications)
- Decreased libido (effects pt compliance)
- Dizziness (esp. in beginning)
Teaching points:
- Instruct pt to change positions slowly (dizziness)
- Encourage to take medication in morning or afternoon (increased urination + fall risk)
Loop Diuretics
- MOA?
- Prescribed for? (4)
- Side effects? (4)
- Nursing considerations? (4)
- Drug interactions? (1)
- Teaching points? (2)
Given when diuresis needs to occur quickly.
Work in the loop of Henle to:
- Inhibit reabsorption Na, K, Cl, and water –> more excreted in urine
- Helps dilate small blood vessels & lower peripheral vascular resistance –> additional mechanism to lower BP
Prescribed for:
- HTN
- Edema
- Heart failure
- Kidney failure (depending on level)
Side effects:
- Hypokalemia (K wasting)
- Hypovolemia (diuresis quickly)
- Dizziness
- Tinnitus (ear ringing)
Nursing considerations:
- Check BP
- Check electrolytes labs
- CBC (complete blood count) for Torsemide* (thrombocytopenia)
- Good respiratory assessment (is fluid being drawn off?)
Drug interactions:
- Sulfonamides d/t possibility of cross-reactions
Teaching points:
- Instruct pt to change positions slowly (dizziness)
- Encourage to take in morning or afternoon (increased urination + fall risk)
Potassium-sparing diuretics
- MOA?
- Prescribed for? (1)
- Side effects? (3)
- Nursing considerations? (3)
- Medication interactions? (3)
Work in the collecting ducts and distal convoluted tubule to:
- Reabsorb (spare) K instead of excreting
- Exchange with Na, so more Na and water are excreted
- Competitive aldosterone receptor –> prevents Na and water reabsorption
Prescribed for:
- Protective purposes of the heart (K has cardiac implications)
Side effects:
- Hyperkalemia (potassium sparing)
- Gynecomastia (enlarged breast tissue) r/t male sex patients –> med effects testosterone hormone
- Amenorrhea (irregular/stopped menses) r/t female sex patients –> med effects testosterone hormone –> also post-menopausal bleeding
Nursing considerations:
- Check BP
- Check electrolytes labs
- Pregnancy category C –> can reduce levels of testosterone in male sex fetuses/could alter sex development
Medication interactions:
- Lithium –> can cause lithium toxicity
- Potassium supplements –> can cause potassium levels to be too high
- ACE inhibitor –> can increase chance of hyperkalemia
Osmotic diuretics
- MOA?
- Prescribed for? (2)
- Side effects? (3)
- Nursing considerations? (5)
Works in proximal convoluted tubule to:
- Remove water very quickly
- Dilate blood small blood vessels to reduce BP/decrease peripheral vascular resistance
Prescribed for: *Critical care situations
- Swelling in the brain/inter-cranial pressure
- Getting rid of toxic substances faster
Side effects:
- Convulsions
- Thrombophlebitis (blood clot blockage formation)
- Pulmonary congestion
Nursing considerations:
- Check BP
- Good cardiac assessment r/t electrical activity (K)
- Draw + monitor frequent electrolytes labs; renal labs
- Frequent neuro checks d/t swelling in the brain
- Will be given IV through a filter d/t crystallization
Isotonic Crystalloids (fluids)
- MOA?
- Nursing considerations?
Keeps everything steady and equal:
- fluid balance remains the same inside and outside the cell
- RBC looks “normal”
Most commonly used “maintenance fluid”
Nursing considerations:
- Know kidney function
- Know heart function
- Monitor electrolytes labs and renal labs
- Ensure ordered rate is correct (indications for heart and kidneys)
- Monitor site for infiltration (fluid leaking into tissues where IV has been place )
Hypotonic Crystalloids (fluids)
- MOA?
Lower concentration of solutes used to:
- pull water and sodium into cells
- cells swell
Hypertonic Crystalloids (fluids)
- MOA?
- Nursing considerations?
High concentration of solutes used to:
- draw water and sodium out of cells
- cells shrink
Nursing considerations:
- double check rate (high alert medication!)
- administer slowly –> r/t risk of osmotic demyelination syndrome (problems in the brain stem)
What is a “normal” sodium level range (labs)?
136-145
Alpha 2 Receptor Agonists
- i.e., Alpha 2 Adrenergic Receptor Stimulators
- MOA?
- Side effects?
- Nursing considerations?
MOA:
Work centrally in the brain to:
- Stimulate alpha 2 adrenergic receptors in the brain (and kidneys!)
- Decreases norepinephrine production –> reduces BP (brain)
- Decrease renin activity –> promotes vasodilation (kidney)
Side effects: Pretty significant
- Orthostatic hypotension
- Fatigue
- Dizziness
Nursing considerations:
- Check BP
- Pt can NOT stop taking suddenly (rebound hypertension)
Teaching points:
- Instruct to change positions slowly
- Instruct to not stop taking suddenly
Alpha 1 Receptor Blockers
- MOA?
- Side effects?
- Nursing considerations?
- Teaching points?
“azosin” - word root
MOA:
Work peripherally in the blood vessels to block alpha 1 adrenergic receptors from the effects of norepinephrine
- dilates arteries and veins
- reduces peripheral vascular resistance –> lowering BP
Side effects:
- Dizziness
- Orthostatic hypotension
- Bradycardia (slow HR)
Nursing considerations:
- Check BP
Teaching points:
- Change positions slowly (dizziness)
- Can’t stop taking suddenly (rebound hypertension)
Beta receptor blockers
- i.e., Beta Blockers
- MOA?
- Side effects?
- Nursing considerations?
- Teaching points?
- Medication interactions?
“Olols” = word root
MOA:
Work peripherally by blocking ALL Beta 2 receptors (including heart, lungs, GI, Kidneys)
- Reduces HR
- Also reduce renin activity in the kidneys –> causing vasodilation
Side effects:
- Bradycardia (slow HR)
- Dizziness
Nursing considerations:
- Check BP
- Check PULSE
- Can’t stop suddenly d/t rebound hypertension
Teaching points:
- Change positions slowly
- Don’t stop suddenly
Medication interactions:
- Albuterol –> can decrease effectiveness i.e., narrowing airways and worsening breathing (d/t being non-selective)
Dual-Action Alpha1 and Beta Receptor Blockers
- MOA?
- Side effects?
- Nursing considerations?
- Teaching points?
Works in the periphery to:
- Target alpha-1 receptors –> dilate heart and blood vessels
- Block beta receptors –> lower HR
Side effects:
- Dizziness
- Bradycardia (slow HR)
- Orthostatic hypotension
Nursing considerations:
- Check BP
- Check HR
- Can’t stop taking medication suddenly
Teaching points:
- Change positions slowly (dizziness; orthostatic hypo)
- Instruct to not stop taking medication suddenly (rebound hypertension)
Angiotensin-Converting Enzyme (ACE) Inhibitors
- MOA?
- Side effects?
- Nursing considerations?
- Teaching points?
- Medication interactions?
- Contraindications
“prils” = word root
MOA:
Inhibits ACE (enzyme):
- Inhibits angiotensin I conversion, promoting vasodilation (heart doesn’t have pump against resistance)
- Inhibits aldosterone secretions –> inhibits reabsorption sodium and water, promoting diuresis and lowering BP (decreases work-load for heart)
Side effects:
- Dry cough
- Hyperkalemia (cardiac implications)
- Fatigue
- Dizziness
Nursing considerations:
- Monitor BP
- Monitor potassium levels
- Talk to pt about cough and possibly trying another medication
Teaching points:
- Change positions slowly
- Pay attention to cough
Medication interactions:
-Potassium supplement
- Spironolactone (potassium sparing diuretic)
- Lithium –> toxicity
*NOT to be used for pregnant people –> can be toxic to fetus
Angiotensin II Receptor Blockers (ARBs)
- MOA?
- Side effects?
- Nursing considerations?
- Teaching points?
- Contraindications?
“sartans” - word root
MOA:
Blocks angiotensin 2 receptors (vasodilation blood vessels) and aldosterone secretion (prevents reabsorption sodium and water)
- more selective for smooth muscle (no cough)
- don’t have issues with hyperkalemia
Side effects:
- Chest pain
- Fatigue
- Weakness
- Diarrhea
Nursing considerations:
- Check BP
Teaching points:
- Change positions slowly
- Don’t stop taking suddenly
*Should NOT be given to pregnant people –> can be toxic to fetus
Calcium Channel Blockers
- MOA?
- Side effects?
- Nursing considerations?
- Teaching points?
“dipines” = word root
MOA:
Blocks the binding of calcium to receptors in the heart and blood vessels
- Prevents muscle contraction, promotes vasodilation
Results in:
- Decreased peripheral vascular resistance
- Decreased BP
- Decreased peripheral smooth muscle tone
Prescribed for:
- HTN
- Angina
Side effects:
- Hypotension (BP)
- Peripheral edema
Nursing considerations:
- Check BP
- Monitor for edema
Medication interactions:
- Grapefruit juice –> can cause higher drug levels in the blood
Vasodilators
- MOA?
- Nursing considerations?
MOA:
Works directly to relax smooth muscle in the blood vessels
Results in:
- Decreased peripheral vascular resistance (after-load)
Side effects: (Depending on medication example)
- Tachycardia/Bradycardia
- Headache
- Edema
- Decrease platelet aggregation
- hypotension
- Hair growth
Nursing considerations:
- Monitor BP –> through arterial line for Nitroprusside
Loop diuretics for Heart Failure
- MOA?
- Preload, After-load, Contractility?
- Side effects?
- Nursing considerations?
- Medication interactions?
Decrease BP and decrease blood volume through diuresis
- After-load
- Preload
Side effects:
- Ototoxicity
- Dehydration
Nursing considerations:
- Monitor BP
- Monitor K, Na, Cl labs
- Good respiratory assessment (is fluid being drawn off?)
- CBC (complete blood count)
Medication interactions:
- Sulfonamides
Thiazide diuretics for Heart failure
- MOA?
- Preload, After-load, Contractility?
- Side effects?
- Nursing considerations?
Decrease BP and decrease blood volume through diuresis
- After-load
- Pre-load
Side effects:
- Dehydration
- Hypokalemia
Nursing considerations:
- Monitor K, Na, and Cl labs
- Monitor BP
- Monitor dizziness
ACEs, ARBs, and Beta-blockers for heart failure
- Preload, after-load, contractility?
ACEs & ARBs = after-load d/t decreasing BP
Beta-blockers = after-load and contractility d/t decreasing BP and heart rate
*Decreases HR to increase contractility
Phosphodiesterase Inhibitors (PDIS)
- MOA?
- Preload, after-load, contractility?
- Side effects?
- Nursing considerations?
Inhibits phosphodiesterase:
- Increases contractility
- Decreases peripheral vascular resistance (after-load)
Side effects:
- Hypotension
- Cardiac side effects (ventricular tachycardia)
Nursing considerations:
- Monitor BP
- Monitor for cardiac side effects
- Use only short-term (can see rebound effects after certain amount of time)
Cardiac Glycosides
- MOA?
- Pre-load, after-load, contractility?
- Side effects?
- Nursing considerations?
- Teaching points
MOA:
- Inhibits Na from being pumped out of cell membranes; allows for calcium buildup and stronger contractions
- Increase heart contractility (HR)
Side effects:
- Increased risk for arrhythmias (cardiac implications)
- Bradycardia
- Dizziness
- Abnormal vision
- Headaches
Nursing considerations:
- Monitor EKG
- Monitor HR –> do not give below 60 bpm
- Narrow therapeutic range –> need to draw blood frequently
Teaching points:
- Change positions slowly
- Be aware of vision changes
Therapeutic range = 0.5-2.0 ng/mL
Digoxin antidote for toxicity = DIgoxin immune fab (Digibind)
Direct Vasodilators
- MOA?
- Pre-load, after-load, contractility?
- Side effects?
- Nursing considerations?
MOA:
Dilate blood vessels (arteries and veins)
- decrease BP (after-load)
Side effects:
- Dizziness
- Headache
- Hypotension
- Reflex tachycardia (heart trying to maintain CO esp. when standing)
Nursing considerations:
- Monitor BP
- Check for orthostatic hypotension
Drug interactions:
- Viagra (erectile dysfunction drug)
- Cialis (erectile dysfunction drug)
Nitrates and Nitrites
- Treats?
- Rapid-acting forms?
- Long-acting forms?
Dilates blood vessels to treat stable (chronic), unstable (acute onset), and vasospastic angina
Rapid-acting forms:
- Acute anginal attack
Long-acting forms:
- Prevent anginal episodes
Contraindications:
- Known drug allergy
- Severe anemia
- Hypotension (BP) (medication dilating blood vessels)
- Use of erectile dysfunction drugs –> Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil)
Nursing considerations:
- Tolerance for patients taking around-the-clock or long-acting forms –> ensure. a nitrate-free period
- Ensure patient’s take off their previous patch before placing another one on
- Potency lost 3 months after bottle is opened (PO)
HMG-CoA Reductase Inhibitors
- MOA?
- Side effects?
- Nursing considerations?
- Medication interactions?
- Teaching points?
“statins” = word root
Inhibits HMG-CoA Reductase enzyme to:
- Inhibit cholesterol synthesis in the liver
- Reduces LDL levels (very effective), can increase HDL levels, and can reduce triglyceride levels (not main effect)
Side effects:
- GI –> take with food if possible
- Elevated liver enzymes d/t medication working in the liver
- Rhabdomyolysis (dark urine) –> sign of muscle breakdown which can lead to kidney failure
Medication interactions:
- Warfarin –> toxic levels; pt at risk for bleeding
- Azoles (anti-fungals) –> myopathy; increased risk for rhabdomyolysis –> myopathy (muscle weakness or pain); increased risk for rhabdomyolysis
- Erythromycin
- Grapefruit juice
Teaching points:
- Should be taken in the evening when most cholesterol is synthesized
Bile Acid Sequestrates
- MOA?
- Side effects?
- Nursing considerations?
MOA:
Work in the small intestine and bind to bile acids to inhibit cholesterol reabsorption
Side effects:
- GI: constipation, heart burn, bloating, gas, belching (can increase fluid and fiber intake)
- Binds to other medications!
Nursing considerations:
- Must be taken 1-2 hours after or 4-6 hours before other medications
Niacin (Vitamin B3)
- MOA?
- Side effects?
- Nursing considerations?
Works on all elements of cholesterol:
- Decreases LDLs
- Increases HDLs
- Decreases Triglycerides
- Increases lipase (enzyme that breaks down lipids)
Side effects:
- Flushing
- Pruritus (itching)
- Hepatotoxicity
Nursing considerations:
- Needs to be given in high doses alone (not with other lipid lowering medications)
- Monitor liver functioning d/t hepatotoxicity
Fibric Acid Derivatives
- MOA?
- Side effects?
- Nursing considerations?
- Medication interactions?
Work to (primarily) lower triglycerides
- do NOT work on LDLs
- also work on Lipase
- Also can block synthesis of cholesterol; increase cholesterol secretion
Side effects:
- GI; Diarrhea and nausea
- Increased risk for gall stones
- Increased liver enzymes
- Pulmonary embolism (Rare)
Nursing considerations:
- Good respiratory assessment for rare side effect
Medication interactions:
- Anticoagulants –> can enhance
Cholesterol Absorption Inhibitors
- MOA?
- Side effects?
- Nursing considerations?
Inhibit cholesterol from being absorbed in the small intestine
- lowers LDLs and triglycerides
- increases HDLs
Side effects:
- Hepatotoxicity
- Pancreatitis
- Rhabdomyolysis (if combo med with statin)
Nursing considerations:
- Monitor liver functioning
- Monitor for dark urine
- Good extremity assessment (damaged or wasting muscles)
- Monitor amylase and lipase levels (pancreatitis side effect)
Potassium Channel Blocker
- MOA?
- Side effects?
Blocks potassium channels - prolonging re-polarization - to return heart to normal rhythm
Side effects:
- Ocular (eye) issues
- Bradycardia
- Hypotension
- Photosensitivity
- Hypo/hyper thyroidism
- Respiratory issues (Blue man syndrome)
- Pulmonary fibrosis
- Pulmonary toxicity
