Test 2 Drugs Flashcards
Atorvastatin, Rosuvastatin, Simvastatin
- Statins/HMB-CoA Reductase Inhibitors
- MOA: 1) Inhibition of HMG-CoA results in decreased LDL production 2) Decreased LDL production results in an increase in LDL receptor production, resulting in more LDL being pulled from the blood
- Pharmacokinetics: Taken orally at bed time and hepatically metabolized
- Uses: Hyperlipidemia. Lower LDL, promote plaque stability, reduced inflammation at site of plaque, enhance blood vessel dilation, reduce coagulation and platelet aggregation
- Side effects: Few side effects. Hepatotoxicity and rhabdomyolysis (muscle breakdown)
- Adverse effects (rare): Hepatotoxicity and myopathy
- Nursing considerations: Monitor hepatic function
- Who gets statins: 20-75y/o with LDL >190, 40-75 y/o w T2DM (regardless of LDL levels), >75 y/o, 40-75 with LDL 70-190
Niacin
-Nicotinic Acid
-Uses: Hyperlipidemia. Reduce LDL and TG levels. Also increases HDL
Side effects: Intense flushing, GI upset, liver injury
Cholestyramine/Colesevelam
- Bile-Acid Sequestrant
- MOA: Binds to bile acids (derivatives of cholesterol) and prevents their reabsorption in the small intestine
- Uses: Hyperlipidemia
- Used alongside with statins
- Dosing: Oral. Due to interactions with diuretics, antibiotics, and blood thinners, bile-acid sequestrants should be give an hour after or 4 hours before
- Side effects: GI issues, such as bloating
Gemfibrozil (Lopid) /Fenofibrate (Tricor)
-Fibrates
-MOA: Interact with receptors on the liver to accelerate clearance of TG
-Uses: Hyperlipidemia. Lowers TG but no effect on LDL
Side effects: Increased risk of bleeding for those taking Coumadin. Well tolerated. Some GI issues (bloating), rash, increased risk of gallstones, myopathy
-Dosing: Oral. Hepatically metabolized
-Nursing considerations: Monitor patients taking fibrates and Coumadin due to risk of increased bleeding
Nitroglycerine, Imdur, and Isordil
- Nitrate
- Antianginal drugs
- Vasodilator
- MOA: Converted into active nitric oxide, which is a vasodilator, thereby decreasing oxygen demand of the heart (works less hard). Decreases preload
- Uses: Angina
- Dosing: PO, SL, IV, transdermal. Begins working very quickly
- Side effects: Headache, orthostatic hypotension, tachycardia
- Nursing considerations: Do not abruptly stop due to risk of vasospasm. Can increase effects of other hypotensive drugs
Metoprolol and Propranolol
- Beta Blockers
- Antianginal
- MOA: Block beta receptors, thereby decreasing cardiac oxygen demand. Additionally, B1 block decreases renin release which decrease afterload
- Dosing: PO and IV, hepatically metabolized
- Uses: MI, HF, hypertension
- Side effects: Bradycardia, decreased AV conduction (dromotropic) , reduction of contractility, bronchoconstriction (B2), masking hypoglycemia
- Nursing considerations: Do not stop abruptly (can cause vasospasm) and monitor for signs of hypoglycemia
Verapamil, Diltiazem, and Nifedipine
- Calcium Channel Blockers
- Antianginal
- MOA: Slow movement of calcium into cells of heart and blood vessels resulting in decreased afterload, HR, and contractility
- Dosing: PO and IV. Hepatically metabolized (effected by first pass effect)
- Uses: MI, HF, hypertension
- Side effects: Constipation due to reduced flow of calcium into intestinal smooth muscle, and bradycardia
- Interacts with grapefruit (grapefruit inhibits drug metabolism) and digoxin (increased risk of heart block)
Morphine
- Opioid
- Treatment of choice for STEMI-associated pain
- MOA: CNS depressant that decreases anxiety, thereby lowering SNS response, thereby decreasing CO
- Also decrease preload and afterload
Warfarin (Coumadin)
-Vitamin K Antagonist
-Anticoagulant
-MOA: Decreases production of vitamin K dependent clotting factors (VII, IX, X, prothrombin). Additionally, inhibits the vitamin K epoxide reductase complex 1 (VKORC1) which prevents vitamin K from being converted into its active from
-Dosing: Oral, 99% binds to albumin. Amount is variable based on genetics
-Uses: Prevention of DVT and PE
-Interactions: Many fucking drugs, some increase and some decrease the effects. Important ones
-ASA (aspirin): Increased
risk of bleeding and
gastric ulcers
-Other NSAIDS:
Increased risk of ulcers
-Acetaminophen:
Inhibition of warfarin
(coumadin) degradation
-Antidote: Vitamin K (foods or supplements)
-Nursing considerations: Must monitor pt’s prothrombin time (PT) and International Normalized Ration (INR). INR is super important to monitor
-Contraindicated for people who are pregnant or lactating
Dabigatran (Pradaxa)
- Direct Thrombin Inhibitor
- Anticoagulant
- MOA: Binds to the activation site of thrombin, inhibiting its activation thereby preventing clotting
- Uses: Prevention of DVT and PE
- Advantages over warfarin: Rapid onset, few drug interaction, same dose for all patients, lower risk for bleeding
- Disadvantages over warfarin: Short duration of action (must be taken at the prescribed time), limited clinical experience
Rivaroxaban (xarelto)/ Abixiban
- Direct Factor Xa inhibitor
- Anticoagulant
- MOA: Binds directly to the active center of factor Xa, which inhibits activation of thrombin
- Uses: Prevent blood clots
- Dosing: Oral
- Advantages over warfarin: Rapid onset, few drug interactions, same dose for all patients, lower risk of bleeding
- Disadvantages over warfarin: short duration of action meaning it must be taken at the prescribed time, and limited clinical experience
Aspirin
- NSAID/COX inhibitor
- MOA: Inhibition of cyclooxygenase results in decrease TXA2 availability, which results in decreased activation of GP IIb/IIIa receptor, which leads to decreased platelet aggregation. Lasts for the life of the platelet
- Dosing: Oral 81 mg/day
- Uses: Prevent of stroke and MI
- Not to be given to anyone under 18 (Reye’s syndrome)
Clopidogrel
- P2Y12 ADP Receptor Antagonist
- Antiplatelet aggregation
- MOA: Irreversible blockage of P2Y12 ADP receptors on platelets results in less activation of GP IIb/IIIa, which results in decreased platelet aggregation. Lasts for the life of the platelet
- Dosing: Oral
- Uses: Prevention of atherosclerotic events in patients with unstable angina and MI
- Side effects: Similar to aspirin (bleeding). Small risk of TTP (thrombotic thrombocytopenic purpura)
Abciximab
- Glycoprotein IIb/IIIa Receptor Antagonist
- Antiplatelet
- Super Aspirin
- MOA: Blocks GP IIb/IIIa receptor, which inhibits receptor binding to fibrinogen
- Dosing: IV (short term use)
- Uses: Short term for patient undergoing cardiac angiography or stentings, or in acute coronary syndrome
- Nursing consideration: Bleeding
Alteplase (tPA)
- Thrombolytic
- MOA: Catalyzes conversion of plasminogen to plasmin, an enzyme that digests fibrin meshwork of clots
- Uses: Acute MI, acute ischemic stroke, acute pulmonary embolus
- Side effects: Greatly increases risk of bleeding
Unfractionated Heparin
-Anticoagulant
-MOA: Inactivated factor Xa and thrombin
Molecular weight range: 3000-30,000
-Molecular weight mean: 12,000-15,000
-Dosing: SubQ and IV. Adjusted based on aPTT (partial thromboplastin clotting time)
-Cheaper than LMW Heparin but must be taken in the hospital, meaning costs for treatment are higher
-Uses: DVT/PE prevention
-Preferred during pregnancy
-Side effects: Heparin Induced Thrombocytopenia
-Antidote: Protamine
Low molecular weight Heparin
- Anticoagulant
- MOA: Inactivation of factor Xa, some inactivation of thrombin
- Molecular weight range:1000-9000
- Molecular weight mean: 4000-5000
- Dosing: Only subQ. Amount often based on body weight
- Uses: Prevention of DVT/PE
- More expensive than unfractionated heparin, but can be taken at home meaning no costs from the hospital
- Side effects: Heparin Induced Thrombocytopenia
- Antidote: Protamine
Fondaparinux
- Anticoagulant
- MOA: Selective inactivation of Xa
- Molecular wieght: 1728
- Dosing: Sub Q only (like LMW heparin)
- Dosage: Fixed (not based on pt’s weight or PTT levels)
- Uses: DVT/PE prevention
- More expensive than u.f heparin and LMW heparin, but not lab or hospital costs
Furosemide (Lasix) and Bumetanide (Bumex)
- Loop diuretics
- Antihypertensive
- MOA: Blocks reabsorption of sodium and chloride in the thick segment of the ascending loop of Henle
- Dosing: PO, IV
- Uses: Lower BP/hypertension
- Side effects: Hypokalemia, hyponatremia, hypochloremia, dehydration, hypotension, ototoxicity (hearing loss related to medication)
- Drug interactions: Digoxin (becomes more toxic if patient is hyponatremic), oxotoxic drugs, potassium sparing drugs (given with loop diuretics to counteract potassium wasting)
- Metabolized via renal
Hydrochlorothiazide and Metolazone
- Thiazide diuretics
- Antihypertensive
- MOA: Blocks reabsorption of sodium and chloride in the early segment of the distal convoluted tubule. Since only 10% of sodium and chloride is reabsorbed at the distant convoluted tubule, the maximum diuresis of thiazide loop diuretics is less than that of loop diuretics
- Dosing: PO
- Side effects: Same as loop diuretics but less sever and no ototoxicity
- Nursing considerations: Monitor electrolytes
Spironolactone (aldactone)
- Potassium-sparing diuretics
- Antihypertensive
- MOA: Blocks actions of aldosterone in the distal nephron, resulting in retention of potassium and increased excretion of sodium. Minimal diuresis (diuresis = kidney’s filtering too much bodily fluid)
- Uses: Hypertension and edema (used alongside a loop or thiazide), heart failure (reduces mortality and hospital admission via protective effects of blockade at heart and vessels), and HRT
- Side effects: Hyperkalemia and endocrine effects owing to its similarity in structure to other hormones
- Drug interactions: Frequently combined with thiazide and loop diuretics, interacts with other drugs that increase potassium levels (i.e renin inhibitors)
Mannitol
- Osmotic diuretic
- Antihypertensive
- Dosing: Must be IV
- Has 4 ideal properties (freely filtered at the glomerulus, undergoes minimal tubular reabsorption, undergoes minimal metabolism, is pharmacologically inert
Doxazosin and Terazosin
- Sympatholytic Alpha 1 blockers
- Antihypertensive
- MOA: Prevents stimulation of alpha 1 receptors on arterioles and veins which prevents vasoconstriction
- SE: Orthostatic hypotension
Propranolol, metoprolol, atenolol, carvedilol
-Sympatholytic beta blockers
