Pharmacology Flashcards
Cardiovascular Medications (all act to lower BP- cover slide)
- Angiotensin Converting Enzymes (ACE) Inhibitors
- pril (lisinopril) - Angiotensin II Receptor Blockers (ARBs)
- sartan (losartan) - Beta-adrenergic blockers
- lol (carvedilol) - Alpha-1 adrenergic blockers
- osin (doxazosin) - Centrally-acting alpha adrenergics
- clonidine or methyldopa - Calcium channel blockers
- pine (amlodipine) - Direct-acting vasodilators
- hydralazine or minoxidil
Angiotensin Converting Enzyme (ACE) Inhibitors
Mechanism of action:
- Blocks the conversion of angiotensin I to angiotensin II (prevents vasoconstriction)
- Blocks release of aldosterone (prevents reabsorption of Na and H2O)
- Increases diuresis
- Decreases systemic vascular resistance (decreases after load)
- Decreases venous pressure
Assessment:
- hyperkalemia
- dry cough (stop the med and switch to an ARB)
- angioedema
Angiotensin II Receptor Blockers (ARBs)
Mechanism of action:
-Blocks angiotensin II from binding to angiotensin II receptors
-Blocks release of aldosterone (preventing reabsorption of Na and H20)
-Increase diuresis
-Decreasing systemic vascular resistance (decreasing after load)
Decreasing venous pressure
Assessment:
- Hyperkalemia
- Angioedema
Beta Blockers
Mechanism of action:
- Blocks the beta-adrenergic receptors of the sympathetic nervous system (beta 1, minimal effect of beta 2)
- Decrease HR
- Beta selective=only beta 1, Beta-nonselective= beta 1 & beta 2, Alpha blocking
Assessment:
- BP (drop in HR-drop in CO-drop in BP)
- Bradycardia
- Lung sounds (bronchoconstriction)
- Blood sugar (hyperglycemia masking)
Calcium Channel Blockers
Mechanism of action:
- Blocks calcium from getting into the cells-vasodilation of arteries and peripheral arterioles, but not veins
- Decrease heart contractility (negative inotropic effect)
- Decrease HR (negative chronotropic effect)
- Decreases conduction velocity within the heart
Assessment:
- BP (hypotension more common with nifedipine, less common with diltiazem)
- Bradycardia (especially with use of verapamil)
- Peripheral edema (with nicardipine, nifedipine, verapamil)
- Periodic liver and kidney function tests
Most common adverse effect of all cardiovascular medications
Orthostatic hypotension.
Can ACE Inhibitors and ARBs be given together?
NO!
They act via the same route.
Herbal Interactions with Antihypertensives
- Ma Huang (Ephedra)
- Goldenseal
- Black Cohosh
*both decrease effectiveness
Nursing Considerations with Cardiovascular Meds
- Check BP before and after administering
- Teach clients to sit on the edge of the bed before getting up in the morning and to change positions slowly
- Reinforce a low-sodium diet and regular exercise
- Assess for herbal supplement use and teach clients which supplements to avoid
Thiazide Diuretics
Examples:
- Hydrochlorothiazide
- Chlorothiazide
Action:
Inhibits reabsorption of sodium and chloride in the distal convoluted tubules.
Adverse effects:
-Hypokalemia, hyperglycemia, blurred vision, dry mouth, hypotension
Nursing Considerations:
- Avoid giving at bedtime
- Monitor I/O, electrolytes, weight, BUN, creatinine & glucose
Potassium Sparing Diuretics
Example: Spironolactone
Action:
Inhibits action of aldosterone in distal tubule, which interferes with the sodium reabsorption.
Adverse Effects:
-Hyperkalemia, hyponatremia, hepatic damage, tinnitus
Nursing Considerations:
- give with meals
- use with other diuretics
- monitor I/O
Loop Diuretics
Examples:
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic acid
Action:
Inhibits sodium, potassium, chloride, magnesium, and calcium reabsorption in the loop of Henle
Adverse effects:
Hypokalemia, hyperglycemia, hypotension, GI upset, weakness
Nursing Considerations:
- Avoid giving at bedtime
- Monitor I/O, BP, pulse, electrolytes, weight, glucose
- IV: give slow over 2 minutes, diuresis occurs within 10 minutes
- PO: diuresis occurs within 30 minutes
Osmotic Diuretics
Example: Mannitol
Action:
Increases osmotic pressure of the glomerular filtrate, thereby inhibiting tubular reabsorption of water
Adverse effects:
Circulatory overload, tachycardia, pulmonary congestion, dyspnea, headache, seizures
Nursing Considerations:
Monitor I/O, VS, electrolytes, neurological status
Chlorthalidone
Action: unclear diuretic
Adverse effects: aplastic anemia, hypokalemia, hyperglycemia, dizziness, orthostatic hypotension
Nursing Considerations: avoid taking at bedtime, take with food, long-lasting (2-3 days), monitor I/O, BP, electrolytes, weight, glucose
Antibiotic: Cephalosporins
Examples: cefazolin, cephalexin, ceftriaxone, cefaclor, cefepime, cefdinir, ceftaroline
Adverse Reactions: CNS toxicity (seizures, headache), C. diff, n/v, pancytopenia, nephrotoxicity, rash, urticaria, anaphylaxis (rare)
Drug Interactions: may increase Metformin level (monitor bg frequently), may cause nephrotoxicity if concurrently taking an aminoglycoside
Contraindications: hypersensitivity to any cephalosporin or penicillin
Precautions: pregnancy, lactation, renal/hepatic impairment
Antibiotic: Penicillins
Examples: Penicillin G, Penicillin V Potassium, Amoxicillin, Amoxicillin-clavulanate
Adverse Reactions:
Rash, anaphylaxis, CNS toxicity (come, seizures…), nephrotoxicity, C. diff, bone marrow depression
Drug Interactions: Aspirin increases penicillin concentrations, penicillins decrease effect of oral contraceptives
Contraindications: hypersensitivity to penicillins
Precautions: hypersensitivity to cephalosporins, lactation, severe renal disease
Antibiotic: Fluoroquinolones
Examples: ciprofloxacin, levofloxacin, moxifloxacin
Adverse Reactions: CNS effects (dizziness, headache, hallucinations, seizures), bone marrow depression, ventricular arrhythmias, sudden cardiac death, strongly associated with C. diff
Black Box Warnings:
- rupture of the Achilles tendon
- may exacerbate weakness in clients with Myasthenia gravis
Drug Interactions:
Medications that cause QT prolongation or bradycardia. Ciprofloxacin interacts with metformin (causing hyper- or hypoglycemia). Levofloxacin potentiates effects of warfarin
Contraindications:
hypersensitivity to fluoroquinolones, previous arrhythmias, uncorrected hypokalemia or hypomagnesemia
Antibiotic: Macrolides
Examples: azithromycin, clarithromycin, erythromycin
Adverse Reactions: GI disturbances (abdominal pain, nausea, colitis), QT-interval prolongation, arrhythmias, tinnitus, hearing loss, cholestatic jaundice, hepatotoxicity, angioedema
Drug Interactions:
- Erythromycin and clarithromycin: Warfarin (elevation of PT/INR)
- Lovastatin and simvastatin: rhabdomyolysis
- tacrolimus, cyclosporine, ergot alkaloids: elevated serum levels of these meds
Contraindications: hypersensitivity to macrolides
Precautions: fatal colitis can occur during treatment
Antibiotic: Tetracyclines
Examples: doxycycline, minocycline, tetracycline
Adverse Reactions: GI disturbances (colitis, n/v), C. diff, candidiasis, photosensitivity, bone and dental effects in children, hepatotoxicity
Drug Interactions: decrease effect of oral contraceptives and potentiate effect of oral anticoagulants
Precautions: renal or hepatic impairment
Antibiotic: Sulfonamides
Examples: sulfamethoxazole/trimethoprim, sulfadiazine, sulfadiazine
Adverse Reactions: hypersensitivity reactions (rash, Steven-Johnson syndrome, angioedema), crystalluria, oliguria, anuria, hematologic reactions (agranulocytosis, thrombocytopenia, hemolytic anemia), kernicterus in neonates, photosensitivity, neurological effects (headaches, hallucinations, insomnia, seizures)
Drug Interactions: Potentiates sulfonylureas (causing hypoglycemia), phenytoin (increases adverse effects), and anticoagulants
Contraindications:
do not use sulfamethoxazole/trimethoprim when near due date or breastfeeding, clients < 2 months
Precautions: renal or hepatic impairment, bronchial asthma
Antibiotic: Aminoglycosides
Examples: amikacin, gentamicin, streptomycin, neomycin, tobramycin
**REQUIRE PEAK & TROUGH LEVELS DUE TO HIGH RISK OF TOXICITY
Adverse Reactions: frequent or high does or prolonged duration, especially in the elderly or those with renal impairment
- signs of vestibular damage (vertigo, ataxia)
- paresthesias, peripheral neuropathy
Black Box Warnings:
- nephrotoxicity (often reversible)
- vestibular and auditory toxicity (often irreversible)
Drug Interactions: vancomycin, cycosporine, amphotericin B, contrast agents (renal toxicity), loop diuretics (ototoxicity), worsening weakness in disorders affecting neuromuscular transmission
Contraindications: pregnancy, avoid use of other ototoxic, neurotoxic, or nephrotoxic drugs
Precautions: toxicity may develop even with conventional doses
GI: Proton Pump Inhibitors
Examples: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole
Action: bind to enzyme in presence of gastric pH to prevent transport of hydrogen ion into stomach
Adverse Effects: headache, abdominal pain, constipation, d/n
Client Education: take medication at least 1 hour before meals
GI: H2 Blockers
Examples: Cimetidine, Famotidine
Action: inhibit gastric secretion and decrease total pepsin output
Adverse Effects: dysrhythmias, diarrhea, confusion, dizziness, headache
Client Education: avoid antacids within 1 hour of medication
Anticoagulants (examples)
- Vitamin K Antagonists
- Warfarin - Heparin
- Standard Unfractionated Heparin - Low-Molecular-Weight Heparins (LMWH)
- Enoxaparin - Direct Thrombin Inhibitors (DTI)
- Bivalirudin & Dabigatran - Direct Factor Xa Inhibitors
- Apixaban, Edoxaban & Rivaroxaban - Thrombolytics
- Alteplase (tPA “clot buster”)
