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PHARMACOTHERAPEUTICS > PHARM 1 FINAL (COMPREHENSIVE + WKS 9 & 10) > Flashcards

PHARM 1 FINAL (COMPREHENSIVE + WKS 9 & 10) Flashcards

1
Q

Differentiate the actions of cardiac glycosides, antianginal drugs, and antidysrhythmic drugs

A
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2
Q

CARDIAC GLYCOSIDES

A

dealing with heart failure (HF)
+ Inotrope
Digoxin

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3
Q

Describe the signs and symptoms of digitalis toxicity

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4
Q

Compare the side effects and adverse reactions of nitrates, beta blockers, calcium channel blockers, quinidine, and procainamide

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5
Q

Apply the nursing process, including patient teaching, related to cardiac glycosides, antianginal drugs, and antidysrhythmic drugs

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6
Q

Drugs used to maintain or restore circulation

A

Anticoagulants: Prevent the formation of clots that inhibit circulation
— Anticoagulant = NO CLOTS

Antiplatelets (antithrombotics): Prevent platelet aggregation
— Antiplatelets = NO congregation

Thrombolytics: Attack and dissolve blood clots that have already formed
— Thrombolytics = CUT IT…DISSOLVE IT…the blood clots already formed

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7
Q

Thrombus formation

A

Pathophysiology
— Formation of clot in artery or vein
— Caused by decreased circulation, platelet aggregation on vessel wall, blood coagulation

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8
Q

Arterial vs. Venous clot formation

A

Arterial clot formation
— Platelets initiate process.
— Fibrin formation occurs.
— RBCs are trapped in fibrin mesh.

Venous clot formation
— Platelet aggregation with fibrin that attaches to RBCs

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9
Q

Action of the parenteral anticoagulant Heparin

A

Heparin
Step I: (binds with) Antithrombin III
Step II: (inactivates) Thrombin
Step III (inhibits conversion of) Fibrinogen ==> Decr. Fibrin
Step IV: Clot prevented

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10
Q

HEPARIN

A

Medications: low-molecular-weight heparin (LMWH): enoxaparin sodium (Lovenox), dalteparin sodium (Fragmin), and tinzaparin sodium (Innohep)

Contraindications:
— Stroke, peptic ulcer, blood anomalies
— Patients having eye, brain, or spinal surgery

Administration of heparins
— Heparin = usually given subq for prophylaxis and IV for therapeutic anticoagulation

— Lovenox = subQ only
_________________________________
NOTE: As with unfractionated heparin, severe neurologic injury can occur if Lovenox is used in patients undergoing spinal puncture or spinal/epidural anesthesia.

Thrombin = creating a clot b/c last clotting factor needed to convert fibrinogen ==> fibrin ==> foundation for clotting

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11
Q

WARFARIN

A
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12
Q

Compare the action for anticoagulants, antiplatelets, and thrombolytics

A

Anticoagulants: prevent the formation of clots that inhibit circulation

Antiplatelets (antithrombotics): prevent platelet aggregation

Thrombolytics: attack and dissolve blood clots that have already formed

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13
Q

Differentiate the side effects and adverse reactions of anticoagulants, antiplatelets, and thrombolytic

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14
Q

Apply the nursing processes, including patient teaching, for anticoagulants and thrombolytics

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15
Q

Describe the action of the two main drug groups: antihyperlipidemics and peripheral vasodilators

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16
Q

Compare the side effects and adverse reactions of antihyperlipidemics

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17
Q

Differentiate the side effects and adverse reactions of peripheral vasodilators

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18
Q

Differentiate the side effects and adverse reactions of peripheral vasodilators

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19
Q

Apply the nursing process, including patient teaching, for antihyperlipidemics and peripheral vasodilators

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20
Q

Cholinergic drugs

A

Peripheral Nervous System
– Muscarnic agonists

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21
Q

Bethanechol (Urecholine)

A

PNS: Cholinergic drug

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22
Q

Muscarinic antagonists (anticholinergics)

A

– Atropine
–Scopolamine

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23
Q

Cholinesterase inhibitors

A

–Neostigmine (Prostigmine) AND Edrophonium (Tensiolon) = MG when peripherally acting
– Rivastigmine (Exelon) = for AD when centrally acting

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24
Q

Neuromuscular blockers

A

Succinycholine
Dantrolene = acts in CNS as muscle relaxant, but also used to tx malignant hyperthermia + neuroleptic malignant syndrome

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25
Q

ADRENERGIC DRUGS

A

Agonists
–Endogenous catecholamines: epinephrine (Adrenalin), Norepinephrine, Dopamine
–Synthetic catecholamine – Dobutamine
Beta 2 agonists = Albuterol
Alpha2 agonists = methyldopa (Aldomet), clonidine

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26
Q

ADRENERGIC ANTAGONISTS

A

Alpha 1 blockers = prazosin (Minipress), Tamsulosin (Flomax)
Beta 1 blockers = metoprolol (Lopressor) and atenolol (Tenormin) [cardioselective], propanolol (Inderal) [non-selective]

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27
Q

STATIN Side Effects

A

— Liver impairment
— Rhabdomyolysis (skeletal muscle disorder) = rare
— Cataracts

NOTE: Statins can injure muscle tissue. Mild injury occurs in 5-10% of patients, can progress to myositis ==> rhabdomyolysis ==> renal impairment.
— The risk for this sequela is increased when statins are combined with other lipid-lowering drugs (fibrates, niacin, and to a lesser degree bile acid sequestrants).

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28
Q

Antihyperlipidemics: Different Types

A

antilipidemics:

— Bile-acid sequestrants
— Fibrates (fibric acid)
— Nicotinic acid
— Cholesterol absorption inhibitor
— Hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)

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29
Q

Bile-acid Sequestrants

A

gassy poo

Drugs: Cholestyramine (Questran), colestipol (Colestid), colesevelam HCl
— Reduce LDL cholesterol (LDL-C) levels by binding with bile acids in the intestine

Side effects
— Constipation
— Flatulence
— Cramping
__________________
NOTE:
— Bile acid sequestrants are not absorbed thus devoid of systemic effects and safer than all other lipid lowering agents. Side effects are all GI
— Most bile secreted into the intestine is reabsorbed by the body. The sequestrants promote the excretion of bile in the stool, thereby increasing the cholesterol need for the liver to synthesize more bile which reduces the circulating LDL.

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30
Q

Fibrates

A

Drugs: Gemfibrozil (Lopid)
— Gemfibrozil (Lopid) is highly protein-bound and should not be taken with anticoagulants, because they compete for protein sites. Anticoagulant dose should be reduced during antihyperlipidemic therapy, and the international normalized ratio (INR) should be closely monitored.

Uses:
— fibrates are the most effective drugs for lowering triglyceride level
— Have little to no effect on LDL cholesterol
— Increase the biliary cholesterol saturation thereby increasing the risk of gallstones.

Manifestations of gallbladder disease to watch for: upper abdominal discomfort (especially after eating), intolerance of fried foods, bloating

RN Intervention:
— Do not take with anticoagulants
—

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31
Q

4 Classes of Antihyperlipidemics/Antilipemics

A
  1. Statins
  2. Bile-acid sequestrants
  3. Niacin
  4. Fibrin-acid derivatives
32
Q

Antihyperlipidemics: NIACIN

A

DRUGS — Nicotinic acid (Niacin, vitamin B2)

— Flushing can be intense
— Large doses are required to be effective
— As few as 20% of patients can initially tolerate niacin
— With proper counseling, careful drug titration, and concomitant use of aspirin, this number can be increased to as high as 60% to 70%.

RN Interventions:
— Warn of warm feeling and flushing within 2 hours PO and immediately parenterally
— Pellegra = dietary deficiency disease caused by Niacin (Vitamin B3); marked by: dermatitis, diarrhea, & d/o of CNS; RARE in developed countries d/t balanced diet and fortified foods

33
Q

NONpharmacologic Methods for cholesterol reduction

A

— Reduce saturated fats in diet.
— Reduce total fat intake to 30% or less of caloric intake.
— Reduce cholesterol intake to 300 mg/day or less.
— Exercise as much as possible.
— Stop smoking.

34
Q

STATINS RN Interventions

A

NOTE: Higher risk if you’re using Statins with other hyperlipidemics

RN Interventions:
— Monitor liver enzymes.
— Report unexplained muscle tenderness or weakness, fever, and malaise.
— Teach patient importance of compliance with health care regimen. Do not stop abruptly, which could precipitate plaque instability, leading to a thromboemboli (cardiovascular event).
— Monitor the patient’s blood lipid levels.
— Observe for signs and symptoms of GI upset.
— Inform patient that it may take several weeks before blood lipid levels decline.
— Instruct patient to have annual eye examinations and report changes in visual acuity.

35
Q

Peripheral Vasodilators

A

Peripheral arterial (vascular) disease (PAD, PVD)
— arteriosclerosis
— hyperlipidemia

Symptoms: PAD = cool, pale; dry, shiny ulcers | PVD = swollen legs, blood can’t get back to heart; beefy ulcers

Both PAD, and PVD can develop ulcers

Treatment: peripheral vasodilators to improve blood flow

36
Q

What is intermittent claudication?

A

— Pain in calf upon walking (short vs. long-distances; around the kitchen or around the park)
— It comes and goes
— Will tell me how bad/aggressive it is depending on the distance it begins to hurt

NOTE:
Ginkgo biloba + an antiplatelet drug = has been used to treat intermittent claudication, because of its vasodilating and antioxidant effects
— Gingko biloba = NOT been approved by the FDA.

37
Q

Peripheral Vasodilators Drugs

A

Classifications:
— Alpha-adrenergic antagonists
— Direct-acting peripheral vasodilators
— Hemorrheologic : agent that lowers the affect of blood viscosity (blood is not that thick)

Others Include:
— Antiplatelets
— Selected antihypertensives

38
Q

Peripheral Vasodilators that promote vasodilation

A

DRUGS
papaverine (Para-Time): Direct-acting peripheral vasodilator (Promote vasodilation = work right on the BVs to help dilate them)

prazosin (Minipress): Alpha blocker to cause vasodilation will be ALPHA-1 BLOCKER

nifedipine (Procardia): Calcium channel blocker — significant vasodilation

Side effects:
— Lightheadedness
— Dizziness
— Orthostatic hypotension
— Tachycardia
— Palpitation
— Flush
— GI distress
— vasodilation can cause dangerous hypotension and reflex tachycardia (b/c heart will try to compensate)

39
Q

ANTIINFLAMMATORY DRUGS

A

Understand inflammation pathophysiology
1st generation NSAIDS – aspirin, ibuprofen (Motrin), ketorolac (Toradol), indomethacin (Indocin)
2nd generation NSAIDS – celecoxib (Celebrex)

40
Q

Dopaminergic/dopamine agonist agents

A

levodopa/cabidopa
VS amantadine (Symmetrel)

41
Q

NMDA receptor antagonist

A

Memantine (Namenda) – for AD

42
Q

AED’s

A

Traditional: phenytoin, valproic acid, Phenobarbital
Newer: gabapentin (Neurontin), pregabalin (Lyrica) – has uses other than AED

43
Q

ANALGESICS

A

Opioids: morphine, hydromorphone (Dilaudid), meperidine (Demerol)
competitive antagonist: naloxone (Narcan)
selective mu receptor blocker: alvimopan (Entereg)
how to use PCA
Nonopioid: acetaminophen (Tylenol, Ofirmev)

44
Q

ANTIPSYCHOTICS

A

FGA/conventional: haloperidol (Haldol)
SGA/atypical: clozapine (Clozaril), risperidone (Risperdal), ziprasidone (Geodon), aripiprazole (Abilify)

45
Q

ANTIDEPRESSANTS

A

TCAs: amitriptyline (Elavil)
SSRIs: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)
SNRI: venlafaxine (Effexor)
Atypical: trazodone (Desyrel)
MAOIs: phenelzine (Nardil)

46
Q

MOOD STABILIZERS

A

Lithium VS. valproic acid – for BPD

47
Q

SEDATIVES/HYPNOTICS

A

zolpidem (Ambien)
ramelteon (Rozerem)
benzodiazepines: alprazolam (Xanax), lorazepam (Ativan)
flumazenil (Romazicon) – reversal agent

48
Q

ANXIOLYTICS

A

benzodiazepines: alprazolam (Xanax), lorazepam (Ativan)
flumazenil (Romazicon) – reversal agent
buspirone hydrochloride (Buspar)

49
Q

Drugs that affect BP + Heart

A

– Diuretics
– RAAS
– CCBs
– Direct-Acting Arterial Vasodilators
– Central-Acting Alpha 2 Agonists
– Alpha 1/Beta 1 Blockers
–Antidysrhythmic
– Cardiac Glycosides
– Antianginals
– Antihyperlipidemics
– Anticoagulants, Antithrombics, Thrombolytics

50
Q

Loop diuretics

A

Furosemide (Lasix)

51
Q

Thiazide diuretics

A

HCTZ (Hydrodiuril)

52
Q

Potassium-sparing diuretics

A

Spironolactone (Aldactone)

53
Q

ACE-Inhibitors

A

Lisinopril (Prinivil)

54
Q

ARBs

A

Valsartan (Diovan)

55
Q

Calcium-channel blockers

A

Nifedipine (Procardia)
___________________
Diltiazem (Cardizem)

56
Q

Direct-Acting arterial vasodilators

A

Hydralazine (Apresoline)
__________
Minoxidil (Loniten; Rogaine when used topically for hair growth)
_________
Nitroprusside (Nitropress)

57
Q

Central Acting Alpha2 Agonists

A

Clonidine
___________
Methyldopa (Aldomet)

58
Q

Alpha 1 + Beta 2 Blockers

A

Same as adrenergic antagonists

59
Q

Antidysrhythmic

A

procainamide (Procan) – Class IA
lidocaine – Class IB
acebutolol (Sectral) – Class II
amiodarone (Cordarone) – Class III
diltiazem (Cardizem) – Class IV

60
Q

Cardiac Glycoside

A

Digoxin

61
Q

Antianginals

A

– KNOW types of chest pain
– Nitrates = Nitroglycerin + Isosorbide dinitrate (Isordil)

62
Q

Antihyperlipidemics

A

Understand metabolic syndrome and associated lipid, waist, blood pressure, and blood sugar levels
_______________
– cholestyramine (Questran) – bile acid sequesterant
_____________
– genfibrozil (Lopid) – fibrate
– nicotinic acid (Niacin) – own class
– ezetimibe (Zetia) – cholesterol absorption inhibitor
– rosuastatin (Crestor) – statin

63
Q

Anticoagulants, Antithrombics, and Thrombolytics

A

Heparin

64
Q

Anticoagulants, Antithrombics, and Thrombolytics

A

antagonist: protamine
enoxaparin sodium (Lovenox)
warfarin (Coumadin)
antagonist: Vitamin K
cilostazol (Pletal)
clopidogrel bisulfate (Plavix)
alteplase tPA (Activase)

65
Q

CILOSTAZON (PLETAL)

A

Type: Direct-acting vasodilator and antiplatelet drug

MOA
— Causes peripheral vasodilation
— Inhibits platelet aggregation

USES — Tx intermittent claudication | help prevent aggregation of platelets that can cause an occlusion

SIDE EFFECTS — N/V, dizziness, syncope, blood in eye, headache, abdominal pain, abnormal stools, peripheral edema

RN INTERVENTIONS — Inform patient that a desired therapeutic response may take 1.5 to 3 months.

66
Q

HEMORRHEOLOGIC AGENT

A

DRUG: Pentoxifylline (Trental)

USES
— Good for someone who does not have good circulation of their blood
— Improves microcirculation and tissue perfusion
— Decreases blood viscosity
— Improves flexibility of erythrocytes
— Inhibits aggregation of platelets and red blood cells | makes your blood slicker…SLICK [PENTO]XIF[YLLINE]!
— Poor perfusion/occlusions are decreased

67
Q

XA INHIBITOR: ORAL ANTICOAGULANTS

A

Rivaroxaban (Xarelto)
Apixaban (Eliquis)

— Administered: QD or BID; either 5mg (normal dose) or 2.5mg (for renal disease)

RN Interventions:
— Do not require routine coagulation monitoring
— Report bleeding, bloody nose, gums, in urine, stool, let dentist know because you’re at risk for bleeding, soft toothbrush, electric razor to prevent nicks, do not greatly change your intake of Vitamin K,

ANTIDOTE = FFP and not a quick antidote; must be in hospital

68
Q

ANTIPLATELETS USES

A

— Prevents thrombosis in the arteries by suppressing platelet aggregation (inhibiting), which occurs after platelets are activated
— The most effective preventing arterial thrombosis (often prescribed with PAD d/t atherosclerotic plaques
— Heparin (Lovenox) and warfarin (Coumadin) prevent thrombosis

Prophylactic uses
— Prevent thrombosis in the arteries
— Prevention of myocardial infarction or stroke for patients with familial history
— Prevention of a repeat myocardial infarction or stroke
— Prevention of a stroke for patients having transient ischemic attacks

69
Q

Antiplatelets: ASPIRIN

A

— Effective and inexpensive treatment for suppressing platelet aggregation
— Long-term, low-dose therapy
— Inhibits cyclooxygenase, an enzyme needed by platelets to synthesize thromboxane A2 (TxA2)

70
Q

Other Antiplatelet Drugs

A

Dipyridamole (Persantine)
Ticlopidine (Ticlid)
Clopidogrel (Plavix)
Anagrelide HCl (Agrylin)
Abciximab (ReoPro)*
Eptifibatide (Integrilin)*
Tirofiban (Aggrastat)*
Ticagrelor (Brilinta)

  • = parenteral meds used in hospital settings
    — “super aspirins” = most effective antiplatelet drugs on the market
    — short term in acute coronary syndromes; e.g. unstable angina, non-Q wave MI and after PCI to prevent reocclusion
71
Q

Clopidogrel (Plavix)

A

MOA — inhibits platelet aggregation + prevents ADP from binding w/ the ADP platelet receptor

USE: Thromboembolism prophylaxis in AMI

S/EFF: abdominal pain, dizziness, confusion, epistaxis, H/A

Adverse: HoTN, HTN, bronchospasm, bleeding, peptic ulcer, agranulocytosis, aplastic anemia, thrombocytopenia, pancytopenia
Contraindications — intracranial hemorrhage, GI bleeding, hepatic/renal disease, surgery

RN INTERVENTIONS:
— Drug may increase bleeding when taken with NSAIDs, anticoagulant, SSRIs, barbiturates
— Interferes w/ metabolism of phenytoin, warfarin, fluvastatin, tamoxifen, CCBs, morphine and amiodarone
— Do not take w/ grapefruit juice; decreases effects of drug
— Herbs NOT to take w/ b/c will increase bleeding: ginger, garlic, ginkgo, feverfew, green tea
— d/c for 7 days PRIOR to surgery

72
Q

Which antiplatelet drugs are used for acute coronary syndromes in the hospital?

A

Abciximab (ReoPro) |Eptifibatide (Integrilin) | Tirofiban (Aggrastat)
— Known as “super aspirins” and most effective anti platelet drugs on the market
— Used short-term for ACS (unstable angina, non-Q wave MI), after PCI to prevent occlusion
— Reocclusion is common because PCI damages the arterial wall, and thereby encourages platelet aggregation.
— All are parenteral medications used in hospital settings.

73
Q

THROMBOLYTICS

A

Purpose: dissolve clot

Function: promotes conversion of plasminogen to plasmin

_Examples_
Streptokinase (Streptase)
Urokinase (Abbokinase)
Alteplase tPA (Activase) — very expensive
Reteplase rPA (Retavase) — very expensive
Tenecteplase TNK-tPA (TNKase)

74
Q

Thrombolytics Uses

A

— Myocardial infarction: thrombus, or blood clot, disintegrates when a thrombolytic drug is administered within 4 hours.
— Thrombolic stroke: drugs should be administered within 3 hours.
— Pulmonary embolism
— DVT
— Noncoronary arterial occlusion from an acute thromboembolism

75
Q

Thrombolytics RN INTERVENTIONS

A

— Monitor vital signs.
— Observe for signs and symptoms of active bleeding.
— Observe for signs of allergic reaction to thrombolytics.
— Avoid administering aspirin or NSAIDs for pain or discomfort when receiving a thrombolytic.
— Avoid venipuncture/arterial sticks.

** Amicar (aminocaproic acid) is used to stop bleeding that results from antithrombolytics**

76
Q

Anticoagulant Antagonists/ANTIDOTE

A

ANTIDOTE/ANTAGONIST FOR WARFARIN (COUMADIN) = VITAMIN K (PHYTONADIONE)

— Bleeding occurs in about 10% of patients taking oral anticoagulants
— Used for warfarin overdose or uncontrollable bleeding
— 24 to 48 hours to be effective
— Usually 1 to 10 mg of vitamin K1 is given at once
— Failure to control bleeding: Fresh whole blood, fresh-frozen plasma or platelets

77
Q

ANTIDOTES

A

PHARMACOTHERAPEUTICS (11 decks)

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