PHARMACOLOGY DRUGS for ATI test, ATI LPN
Pharmacology Proctored Exam Review
Receptors - ANS-Norepinephrine-Adrenergic (adrenergic comes from the word adrenalin)
Alpha 1-all sympathetic target organs except the heart-constrict the blood vessels and dilation of pupils
Alpha 2-Presynaptic adrenergic nerve terminal-inhibits the release of norepinephrine
Beta 1-Heart and Kidneys (BETA 1-ONE HEART)-increased heart rate and force of contraction, release of
renin
Beta 2-All sympathetic target organs-inhibits smooth muscle (BETA 2-TWO LUNGS)
Beta blockers/olol's - ANS-Beta-Adrenergic Blockers
Metoprolol/Lopressor ENDING OLOL
Beta Blockers are use with heart failure, hypertension, angina and with myocardial infarctions.
Action = Blocks Beta-Receptors in the heart causing...
Decreases = HR, force of contraction, Rate of atrioventricular (AV) conduction
SE = Bradycardia, lethargy, GI disturbance, congestive heart failure, decrease BP, depression
The beta blockers stop sympathetic nervous system stimulation of the heart. Does not allow the heart rate
and blood pressure to rise with stress thus lowering the oxygen demand of the heart. It is very heart
protective!
Will slow the heart rate and lower the blood pressure
Can have beta 2 blockage with larger doses-will constrict the bronchioles-watch for clients with known
COPD, Asthma
Nursing Interventions
Check pulse-needs to be 60 or above
Check blood pressure-if hypotensive do not give (Systolic below 100 is a good rule of thumb I go by)
Monitor for sexual dysfunction-impotence for men-a good reason for non-compliance
Drowsiness/Fatigue-operating heavy machinery, driving could put client at risk
Insomnia-
Contraindicated with Heart Blocks, Bradycardia, Worsening Heart Failure
Increases Hypoglycemic effect of Insulin-monitor blood sugars and for hypoglycemia, may need to lower
insulin dosage
Beta Blockers have to be weaned slowly to prevent rebound hypertension and tachycardia-if a client wants
to stop his beta-blocker they need to contract their physician
CCB,/calcium channel blockers - ANS-Nifedipine/Adalat/Procardia/Norvasc-controls blood vessels
Diltiazem/Cardizem
Verapamil/Calan/Isoptin/Verelan-controls heart rate and blood vessels
Angina/Raynaud's/Vasospastic Angina/Atrial Arrhythmia's
,Blocks calcium channels in the myocardial and vascular smooth muscles, decreases the contraction of
smooth muscle-relaxes the arteries-vasodilation. Blocking of calcium channels in the SA and AV node-
Slows conduction through the SA and AV node. Decreases the force of contraction slows heart rate
Grapefruit juice may increase absorption of nifedipine
Side Effects: Relaxes smooth muscle and cardiac muscle-
Headache
Dizziness-Take lying, sitting and standing B/P, educate client to sit and stand slowly
Peripheral edema-assess for edema, monitor for worsening (diuretic)
Flushing
Reflex tachycardia-monitor for elevated heart rate (may need a BB)
Constipation-increase fibers and fluids (if not restricted) stool softener
Fatigue-Due to low heart rate-monitor EKG, pulse rate and rhythm
Weakness-Monitor B/P and Heart Rate
Impotence and sexual dysfunction-Discuss possibility with client-have client to call and not just to stop
medications
Hepatotoxicity-ALT, AST, ALK PHOS, Bilirubin
MI-Monitor for chest pain, dyspnea, increases fatigue, weakness
CHF-Monitor for chest pain, dyspnea, edema, increasing weight, decreasing output, increasing HR and B/P
Angioedema-edema in face, throat, trouble swallowing, trouble breathing, thickened tongue
Grapefruit juice may increase absorption of nifedipine
Acute Toxicity
With an overdose or overmedicated
Gastric lavage
Monitor EKG-bradycardia-widening QRS, hypotension
Norepinephrine to treat hypotension and decreased cardiac contractility
Atropine or Isoproterenol-Bradycardia and Cardiac Blocks
Verapamil (Calan, Covera, Isoptin Verelan)
Class IV antidysrhythmic
Calcium channel blocker
Inhibits the flow of calcium ions both into the myocardia cells and the vascular smooth muscle, slow the
conductions velocity and stabilizes dysrhythmias. Lowers the blood pressure, reduces cardiac workload
and lowers the blood pressure. Dilates the coronary arteries-anti-anginal
Side Effects: Headache, constipation, hypotension, edema, bradycardia
Pril/ace inhibitors - ANS-Enalapril/Vasotec
PRIL-is the ending for ace's
Reduces Angiotensin 2 and aldosterone levels
Prevents Angiotensin 1 from converting to Angiotensin 2 in the lungs-leaves the Angiotensin 1 hanging in
the lungs-creates irritation-cough
Vasodilation-mostly arteriole (decreases afterload)
Excretion of sodium and water-retention of K (decreases preload)
Treats hypertension and heart failure
Do not take 2nd and 3rd Trimester of pregnancy
,SE = Angioedema-allergic reaction-swelling of tongue, throat-stop taking and notify md
Hyperkalemia-monitor for widening and slowing of pulse/qrs, weakness, fatigue, avoid high K foods, AVOID
SALT SUBSTITUTES-usually very high in K, avoid potassium sparing diuretics, sport drinks are high in K
also
Orthostatic Hypotension-teach client to sit and stand slowly, enact fall precautions
Neutropenia/Agranulocytosis-monitor CBC-WBC count, reoccurring infections
Renal Insufficiency-Monitor weight, edema, I/O, BUN, Cr, and GFR
Hepatic Insufficiency-Monitor AST, ALT, ALK PHOS, Bilirubin
Cough-Cough lozenges, hard candy, increase fluid intake, sleep with HOB elevated, antihistamines
ACE Inhibitors
Discussed these medications with hypertension
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent
Sartan's/angiotension blockers/arb's - ANS-...
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent
Nitrates - ANS-Nitroglycerin/Nitrostat, Nitro-Bid, Nitro-Dur
Nitrates form nitric acid which is a relaxes smooth muscle and dilates venous and arterial blood vessels
Open veins-blood pools in the legs-not as much blood returning to the heart-reduces preload
Open arteries-heart does not have to work as hard to pump blood out of the heart-reduces afterload
Opens the coronary arteries and helps supply blood to the heart tissue
Can be given sublingually, orally, topically, IV, buccal
Can be for acute or long term use
Nitroglycerin dilates any artery and vein-including yours if you touch it while administering it-WEAR
GLOVES
Nitroglycerin IV needs a glass bottle and covered from light-some hospitals still use special tubing (nitro is
absorbed in the tubing)
Short term-nitrostat-sublingually-1 tablet every 5 minutes x 3 for relief of chest pain-still having chest pain
call 911/physician
Long-term nitro-dur will last for up to 14 hours in the body
Side Effects:
Headache-dilates the cerebral arteries-do not give with head trauma or increased intracranial pressure
Hypotension and reflex tachycardia-do not give with hypotension, monitor blood pressure and HR when
administering
Hypotension-correct hypervolemia prior to giving nitroglycerin
DO NOT GIVE WITH VIAGRA, LEVITRA, OR CIALIS (nitroglycerin and Viagra increase nitric acid and
relaxation of the smooth muscles-can kill a client with hypotension with a combination of these drugs)
Digoxin - ANS-Cardiac Glycoside
,Digoxin/Digitek, Lanoxin, Lanoxicaps (Dig)
Increases the contractility of the heart muscle - Inotropic effect-
Increases cardiac output
Also Suppresses the SA node and slows conduction through the AV node
Half-life is 3-4 days
Great Drug-real side effects
Digoxin SE =
Dysrhythmias
Toxicity 0.5-1.8 normal level
Signs of toxicity-halos around objects, Nausea/Vomiting/Anorexia, blurred vision, fatigue
Bradycardia-must take an apical pulse for one full minute, must be 60 or above to give digoxin
Give with caution with pediatric and geriatric patients due to inadequate renal or hepatic metabolic
enzymes
Hyperkalemia can reduce effects of digoxin
Digoxin and Beta Blockers can really lower the pulse
Give with caution with renal failure-digoxin excreted via the kidneys
DIGIBIND IS THE ANTIDOTE FOR DIGOXIN TOXICITY
Digoxin
Decreases automaticity of the SA nose and slows conduction through the AV node
Atrial dysrhythmias
All the side effects and warnings are still important
Heparin - ANS-Naturally found in the liver and lining of blood vessels
Prolong coagulation time
IV immediate onset, Sub Q 1 hour
Destroyed by gastric enzymes
Weight based
aPTT (PTT also, but in the hospital we use the aPTT)
Sub Q
Thrombocytopenia occurs in 30% of client
Protamine Sulfate is the antidote, 1 mg for every100 units of heparin, works for Lovenox also
Coumadin - ANS-Warfarin/Coumadin
Warfarin inhibits the action of Vitamin K, and without adequate Vitamin K the synthesis of clotting factors 2,
7, 9, and 10 is diminished
INR/PT
Warfarin takes 2-3 days to achieve therapeutic effect-99% of warfarin is bound to plasma proteins and
unavailable to produce effects
Vitamin K is the antidote-green leafy veggies Aquamephyton-works within 6 hours
Normal INR therapeutic range is 2-3
Normal INR for everyone who is not taking an anticoagulant is around 1
Category X for pregnancy
Avoid alcohol, diuretics, SSRI's, Antidepressants, Steroids, Antibiotics, Vaccines, Some Vitamins,
Amiodarone-all can potentiate warfarin
Bleeding-
,Amiodarone - ANS-Amiodarone (Cordarone/Pacerone)
Class III antidysrhythmic
Potassium channel blocker
Ventricular and Atrial Arrhythmias-especially with heart failure
IV onset or PO onset looks to be 2-3 days to 1-3 weeks
Half life can be greater than 100 days
Check K and MG levels prior to starting therapy
Side Effects: Fibrosis of lungs, destruction of thyroid, Photosensitivity-Smurfs, Liver destruction, N/V,
Hypotension, Blindness, very hard on the stomach-GI Distress
Can increase serum digoxin levels by 70%, Increase warfarin levels, Increase phenytoion (Dilantin), Stop
BB and CCB?
Statins (Lipitor) - ANS-HMG-CoA reductace inhibitor-(liver is where the cholesterol is made, it is where the
HMG-CoA work)
LDL/Cholesterol is reduced
Give with food to reduce GI symptoms
Lipitor can be taken at anytime, most of the class of this medication needs to be taken at bedtime-
cholesterol is made by the liver at night
Up to 30 days to achieve full affect
Side Effects:
GI-constipation, bloating, gas, nausea
Liver-monitor enzymes-alt, ast, alk phas, bilirubin, jaundice, enlarged liver-ascites
Rhabdomyolysis-muscle destruction-CK elevation-muscle pain-MD has to be notified.
Renal failure is very common with Rhabdomyolysis-need to make sure urine output is 30 ml or greater an
hour
No grapefruit juice
The statins are hard on the liver-you need to make sure other drugs the client is on is not hard on the liver-
Amiodarone and Nizoral are two drugs that come immediately to my mind
furosemide/lasix - ANS-...Loop Diuretics-prevents Na/Cl reabsorption, thus Na leaves the body, water
follows Na and K follows the water
Furosemide/Lasix, Bumex/Bumetanide, Torsemide/Demadex
Work on the entire Loop of Henle-large volumes of water, Na, and K are removed
Works in renal failure
Hypovolemic and hypokalemia very common
Nursing interventions
Know your potassium level prior to administration
Assess Lung Sounds, Weight, I/O, Edema, SaO2, RR, Blood Pressure, K Level prior to administration,
assess all of these post administration, especially K Level and Lung Sounds, Sao2, I/O. If you urine bag is
not twice as full 30 minutes post IV Lasix administration, check your IV site. If your client without a Foley
has not called to urinate within an hour of giving po Lasix, check your client
Warn your client to get up slowly after taking Lasix, watch for orthostatic hypotension
Lasix does have sulfa as a base component
,May not be used with anuria, hepatic coma
Use with extreme caution with electrolyte depletion
Low K with Digoxin can equal lethal Dysrhythmias, know your potassium level-has a digoxin level been ran
plavix - ANS-Anti-platelet drugs
ASA
Persantine
ADP Receptor Blockers (Plavix, Ticlid, Effient)
Glycoprotein 2b./3a receptor antagonist (Repro, Integrillin, Aggrastat
ADP receptor blockers
Irreversibly alter the plasma membrane of platelets, alters the ability of platelets to aggregate
Ticlid and Plavix are given orally
Ticlid can cause Agranulocytosis-only used when someone is allergic to Plavix
Glycoprotein is an enzyme necessary for platelet aggregation, IV only, Very expensive used with MI's
Strokes, and PTCA's
Clopidogrel (Plavix) Antiplatelet drug
ADP receptor blocker
Inhibits ADP binding to its receptor's-irreversible and will be with the platelet for their lifespan (5-7 days)
Used for MI's, CVA's, PAD/PVD, Unstable Angina, PTCA's-first 6 months post ptca's
Bleeding is a problem
EXAM 2 DRUGS!!!!!!!!!!!! - ANS-..........
Vasopressin (pitressin) - ANS-The antidiuretic action of vasopressin is ascribed to increasing reabsorption
of water by the renal tubules
40u IV
Adverse = cardiac ischemia/angina
DDAVP (desmopressin) - ANS-Prevents or controls thirst and frequent urination caused by diabetes
insipidus and certain brain injuries.
Works on posterior pituitary....Treatment for: diabetes insipidus, bedwetting(nocturia), brain injuries,
hemophilia A w/ some factor VIII production
nasally, IV, oral/subling tab
up to 20 hours
Synthroid - ANS-Treats hypothyroidism. Also treats an enlarged thyroid gland (goiter) and thyroid cancer.
Cortef - ANS-Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-
retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic
analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems.
Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune
responses to diverse stimuli.
,Hydrocortisone - ANS-Hydrocortisone belongs to the family of medications known as corticosteroids. It is
used to treat many different conditions. It works by reducing swelling, inflammation, and irritation or as a
replacement when the body does not make enough cortisol. Hydrocortisone is more commonly used to
treat allergic reactions, some skin conditions, severe asthma, lupus, and arthritis.
It can also be used to treat steroid deficiency in the body, certain blood disorders, certain types of cancer,
multiple sclerosis, and ulcerative colitis.
Cortisol - ANS-When people are under stress, levels of cortisol hormone rise. Chronic stress can result in
chronically high levels of cortisol, which can lead to symptoms like weight gain, memory problems, high
blood pressure, and other health problems. The stress release of cortisol is designed to enable the flight or
fight response with a quick burst of energy, but when people are in a state of constant high stress, levels of
the hormone never have a chance to fall back down to normal levels. This is one reason why treatments for
chronic stress include exercises and activities that are designed to reduce stress levels, allowing production
of this hormone to slow down.
Tapazole - ANS-Treats hyperthyroidism (too much thyroid hormone produced by the thyroid gland).
PTU - ANS-Treats Graves' disease and hyperthyroidism (too much thyroid hormone from the thyroid gland)
in patients who have already been treated with other medicines (such as methimazole) that did not work
well.
H2 Blockers (-tidine) - ANS-Ranitidine
PPI's (-prazole) - ANS-Omeprazole
Antacids - ANS-...
Maalox - ANS-30mL QID
Mylanta - ANS-This medication is used to treat the symptoms of too much stomach acid such as stomach
upset, heartburn, and acid indigestion. Aluminum and magnesium antacids work quickly to lower the acid in
the stomach. Liquid antacids usually work faster/better than tablets or capsules.
Mylanta - ANS-This medication works only on existing acid in the stomach. It does not prevent acid
production. It may be used alone or with other medications that lower acid production (e.g., H2 blockers
such as cimetidine/ranitidine and proton pump inhibitors such as omeprazole).
This medication can cause nausea, constipation, diarrhea, or headache
by mouth, usually after meals and at bedtimehis product may react with other medications (e.g., digoxin,
iron, tetracycline antibiotics, quinolone antibiotics such as ciprofloxacin), preventing them from being fully
absorbed by your body.
Bulk-Producing Laxative - ANS-Metamucil
*decrease* the *absorption* and *effects* of *Warfarin*, *Digoxin* and *Aspirin*. *Do not give* to patients
with: *GI obstructions*, *fecal impaction* or *abdominal pain* and *N/V*
Monitor elevated serum glucose
Lomotil - ANS-Antidiarrheal, Anticholinergic
, Insulins - ANS-(dec blood sugar)
Insulin - ANS-Is a polypeptide hormone that controls the storage and metabolism of carbohydrates,
proteins, and fats. This activity occurs primarily in the liver, in muscle, ind in adipose tissues after binding of
the insulin molecules to receptor sites on cellular plasma membranes
Logs -->fast acting - ANS-is a man-made insulin used to control high blood sugar in adults/children with
DM.
Reg -->short acting - ANS-Humulin® R U-100 is a polypeptide hormone structurally identical to human
insulin synthesized through rDNA technology in a special non-disease-producing laboratory strain of
Escherichia coli bacteria
NPH -->intermediate-acting - ANS-Often used in combination with a shorter-acting insulin. NPH insulin is a
man-made insulin product is the same as human insulin. It replaces the insulin that your body would
normally make. It is an insulin (isophane). It starts to work more slowly but lasts longer than regular insulin.
Helps blood sugar (glucose) get into cells so your body can use it for energy.
Lantas -->long-acting insulin - ANS-Treats diabetes mellitus. Insulin is a hormone that helps get sugar from
the blood to the muscles, where it is used for energy. This type of insulin usually works longer than regular
insulin.
Glucophage (metformin) - ANS-Used with diet and exercise to control blood sugar in patients with type 2
diabetes. May be used alone or with other medicines.
starting dose of GLUCOPHAGE (metformin hydrochloride) Tablets is 500 mg twice a day or 850 mg once a
day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every
2 weeks, up to a total of 2000 mg per day.
The purpose of both insulin and metformin is to lower blood glucose levels. Insulin injections replace the
insulin your body can no longer make when the cells in the pancreas cease to function. Metformin is an oral
hypoglycemic, which lowers blood glucose levels by decreasing the liver's output of glucose. Metformin
also increases insulin sensitivity, and improves not only blood glucose levels but also lipid levels and often
results in weight loss.
Diabetics: - ANS-14% take insulin only
57% take oral medications only
14% take a combo of both.
Insulin VS Metformin Treatments? Mechanisms - ANS-Oral hypoglycemics are used only in Type 2
diabetes, because Type 1 diabetics make little or no insulin, so reducing the glucose levels produced by the
liver won't reduce blood glucose levels. Without insulin, glucose can't enter cells and remains in the
bloodstream. While all Type 1 diabetics take insulin, some Type 2 diabetics also need insulin in addition or
instead of oral hypoglycemics such as metformin. Insulin, which must be injected, comes in several forms
and doses, and can have rapid or slow onset.
Pharmacology Proctored Exam Review
Receptors - ANS-Norepinephrine-Adrenergic (adrenergic comes from the word adrenalin)
Alpha 1-all sympathetic target organs except the heart-constrict the blood vessels and dilation of pupils
Alpha 2-Presynaptic adrenergic nerve terminal-inhibits the release of norepinephrine
Beta 1-Heart and Kidneys (BETA 1-ONE HEART)-increased heart rate and force of contraction, release of
renin
Beta 2-All sympathetic target organs-inhibits smooth muscle (BETA 2-TWO LUNGS)
Beta blockers/olol's - ANS-Beta-Adrenergic Blockers
Metoprolol/Lopressor ENDING OLOL
Beta Blockers are use with heart failure, hypertension, angina and with myocardial infarctions.
Action = Blocks Beta-Receptors in the heart causing...
Decreases = HR, force of contraction, Rate of atrioventricular (AV) conduction
SE = Bradycardia, lethargy, GI disturbance, congestive heart failure, decrease BP, depression
The beta blockers stop sympathetic nervous system stimulation of the heart. Does not allow the heart rate
and blood pressure to rise with stress thus lowering the oxygen demand of the heart. It is very heart
protective!
Will slow the heart rate and lower the blood pressure
Can have beta 2 blockage with larger doses-will constrict the bronchioles-watch for clients with known
COPD, Asthma
Nursing Interventions
Check pulse-needs to be 60 or above
Check blood pressure-if hypotensive do not give (Systolic below 100 is a good rule of thumb I go by)
Monitor for sexual dysfunction-impotence for men-a good reason for non-compliance
Drowsiness/Fatigue-operating heavy machinery, driving could put client at risk
Insomnia-
Contraindicated with Heart Blocks, Bradycardia, Worsening Heart Failure
Increases Hypoglycemic effect of Insulin-monitor blood sugars and for hypoglycemia, may need to lower
insulin dosage
Beta Blockers have to be weaned slowly to prevent rebound hypertension and tachycardia-if a client wants
to stop his beta-blocker they need to contract their physician
CCB,/calcium channel blockers - ANS-Nifedipine/Adalat/Procardia/Norvasc-controls blood vessels
Diltiazem/Cardizem
Verapamil/Calan/Isoptin/Verelan-controls heart rate and blood vessels
Angina/Raynaud's/Vasospastic Angina/Atrial Arrhythmia's
,Blocks calcium channels in the myocardial and vascular smooth muscles, decreases the contraction of
smooth muscle-relaxes the arteries-vasodilation. Blocking of calcium channels in the SA and AV node-
Slows conduction through the SA and AV node. Decreases the force of contraction slows heart rate
Grapefruit juice may increase absorption of nifedipine
Side Effects: Relaxes smooth muscle and cardiac muscle-
Headache
Dizziness-Take lying, sitting and standing B/P, educate client to sit and stand slowly
Peripheral edema-assess for edema, monitor for worsening (diuretic)
Flushing
Reflex tachycardia-monitor for elevated heart rate (may need a BB)
Constipation-increase fibers and fluids (if not restricted) stool softener
Fatigue-Due to low heart rate-monitor EKG, pulse rate and rhythm
Weakness-Monitor B/P and Heart Rate
Impotence and sexual dysfunction-Discuss possibility with client-have client to call and not just to stop
medications
Hepatotoxicity-ALT, AST, ALK PHOS, Bilirubin
MI-Monitor for chest pain, dyspnea, increases fatigue, weakness
CHF-Monitor for chest pain, dyspnea, edema, increasing weight, decreasing output, increasing HR and B/P
Angioedema-edema in face, throat, trouble swallowing, trouble breathing, thickened tongue
Grapefruit juice may increase absorption of nifedipine
Acute Toxicity
With an overdose or overmedicated
Gastric lavage
Monitor EKG-bradycardia-widening QRS, hypotension
Norepinephrine to treat hypotension and decreased cardiac contractility
Atropine or Isoproterenol-Bradycardia and Cardiac Blocks
Verapamil (Calan, Covera, Isoptin Verelan)
Class IV antidysrhythmic
Calcium channel blocker
Inhibits the flow of calcium ions both into the myocardia cells and the vascular smooth muscle, slow the
conductions velocity and stabilizes dysrhythmias. Lowers the blood pressure, reduces cardiac workload
and lowers the blood pressure. Dilates the coronary arteries-anti-anginal
Side Effects: Headache, constipation, hypotension, edema, bradycardia
Pril/ace inhibitors - ANS-Enalapril/Vasotec
PRIL-is the ending for ace's
Reduces Angiotensin 2 and aldosterone levels
Prevents Angiotensin 1 from converting to Angiotensin 2 in the lungs-leaves the Angiotensin 1 hanging in
the lungs-creates irritation-cough
Vasodilation-mostly arteriole (decreases afterload)
Excretion of sodium and water-retention of K (decreases preload)
Treats hypertension and heart failure
Do not take 2nd and 3rd Trimester of pregnancy
,SE = Angioedema-allergic reaction-swelling of tongue, throat-stop taking and notify md
Hyperkalemia-monitor for widening and slowing of pulse/qrs, weakness, fatigue, avoid high K foods, AVOID
SALT SUBSTITUTES-usually very high in K, avoid potassium sparing diuretics, sport drinks are high in K
also
Orthostatic Hypotension-teach client to sit and stand slowly, enact fall precautions
Neutropenia/Agranulocytosis-monitor CBC-WBC count, reoccurring infections
Renal Insufficiency-Monitor weight, edema, I/O, BUN, Cr, and GFR
Hepatic Insufficiency-Monitor AST, ALT, ALK PHOS, Bilirubin
Cough-Cough lozenges, hard candy, increase fluid intake, sleep with HOB elevated, antihistamines
ACE Inhibitors
Discussed these medications with hypertension
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent
Sartan's/angiotension blockers/arb's - ANS-...
Arb's-Angiotensin receptor blockers, sartan's
No Cough, same effects and side effects as Ace's-just not as potent
Nitrates - ANS-Nitroglycerin/Nitrostat, Nitro-Bid, Nitro-Dur
Nitrates form nitric acid which is a relaxes smooth muscle and dilates venous and arterial blood vessels
Open veins-blood pools in the legs-not as much blood returning to the heart-reduces preload
Open arteries-heart does not have to work as hard to pump blood out of the heart-reduces afterload
Opens the coronary arteries and helps supply blood to the heart tissue
Can be given sublingually, orally, topically, IV, buccal
Can be for acute or long term use
Nitroglycerin dilates any artery and vein-including yours if you touch it while administering it-WEAR
GLOVES
Nitroglycerin IV needs a glass bottle and covered from light-some hospitals still use special tubing (nitro is
absorbed in the tubing)
Short term-nitrostat-sublingually-1 tablet every 5 minutes x 3 for relief of chest pain-still having chest pain
call 911/physician
Long-term nitro-dur will last for up to 14 hours in the body
Side Effects:
Headache-dilates the cerebral arteries-do not give with head trauma or increased intracranial pressure
Hypotension and reflex tachycardia-do not give with hypotension, monitor blood pressure and HR when
administering
Hypotension-correct hypervolemia prior to giving nitroglycerin
DO NOT GIVE WITH VIAGRA, LEVITRA, OR CIALIS (nitroglycerin and Viagra increase nitric acid and
relaxation of the smooth muscles-can kill a client with hypotension with a combination of these drugs)
Digoxin - ANS-Cardiac Glycoside
,Digoxin/Digitek, Lanoxin, Lanoxicaps (Dig)
Increases the contractility of the heart muscle - Inotropic effect-
Increases cardiac output
Also Suppresses the SA node and slows conduction through the AV node
Half-life is 3-4 days
Great Drug-real side effects
Digoxin SE =
Dysrhythmias
Toxicity 0.5-1.8 normal level
Signs of toxicity-halos around objects, Nausea/Vomiting/Anorexia, blurred vision, fatigue
Bradycardia-must take an apical pulse for one full minute, must be 60 or above to give digoxin
Give with caution with pediatric and geriatric patients due to inadequate renal or hepatic metabolic
enzymes
Hyperkalemia can reduce effects of digoxin
Digoxin and Beta Blockers can really lower the pulse
Give with caution with renal failure-digoxin excreted via the kidneys
DIGIBIND IS THE ANTIDOTE FOR DIGOXIN TOXICITY
Digoxin
Decreases automaticity of the SA nose and slows conduction through the AV node
Atrial dysrhythmias
All the side effects and warnings are still important
Heparin - ANS-Naturally found in the liver and lining of blood vessels
Prolong coagulation time
IV immediate onset, Sub Q 1 hour
Destroyed by gastric enzymes
Weight based
aPTT (PTT also, but in the hospital we use the aPTT)
Sub Q
Thrombocytopenia occurs in 30% of client
Protamine Sulfate is the antidote, 1 mg for every100 units of heparin, works for Lovenox also
Coumadin - ANS-Warfarin/Coumadin
Warfarin inhibits the action of Vitamin K, and without adequate Vitamin K the synthesis of clotting factors 2,
7, 9, and 10 is diminished
INR/PT
Warfarin takes 2-3 days to achieve therapeutic effect-99% of warfarin is bound to plasma proteins and
unavailable to produce effects
Vitamin K is the antidote-green leafy veggies Aquamephyton-works within 6 hours
Normal INR therapeutic range is 2-3
Normal INR for everyone who is not taking an anticoagulant is around 1
Category X for pregnancy
Avoid alcohol, diuretics, SSRI's, Antidepressants, Steroids, Antibiotics, Vaccines, Some Vitamins,
Amiodarone-all can potentiate warfarin
Bleeding-
,Amiodarone - ANS-Amiodarone (Cordarone/Pacerone)
Class III antidysrhythmic
Potassium channel blocker
Ventricular and Atrial Arrhythmias-especially with heart failure
IV onset or PO onset looks to be 2-3 days to 1-3 weeks
Half life can be greater than 100 days
Check K and MG levels prior to starting therapy
Side Effects: Fibrosis of lungs, destruction of thyroid, Photosensitivity-Smurfs, Liver destruction, N/V,
Hypotension, Blindness, very hard on the stomach-GI Distress
Can increase serum digoxin levels by 70%, Increase warfarin levels, Increase phenytoion (Dilantin), Stop
BB and CCB?
Statins (Lipitor) - ANS-HMG-CoA reductace inhibitor-(liver is where the cholesterol is made, it is where the
HMG-CoA work)
LDL/Cholesterol is reduced
Give with food to reduce GI symptoms
Lipitor can be taken at anytime, most of the class of this medication needs to be taken at bedtime-
cholesterol is made by the liver at night
Up to 30 days to achieve full affect
Side Effects:
GI-constipation, bloating, gas, nausea
Liver-monitor enzymes-alt, ast, alk phas, bilirubin, jaundice, enlarged liver-ascites
Rhabdomyolysis-muscle destruction-CK elevation-muscle pain-MD has to be notified.
Renal failure is very common with Rhabdomyolysis-need to make sure urine output is 30 ml or greater an
hour
No grapefruit juice
The statins are hard on the liver-you need to make sure other drugs the client is on is not hard on the liver-
Amiodarone and Nizoral are two drugs that come immediately to my mind
furosemide/lasix - ANS-...Loop Diuretics-prevents Na/Cl reabsorption, thus Na leaves the body, water
follows Na and K follows the water
Furosemide/Lasix, Bumex/Bumetanide, Torsemide/Demadex
Work on the entire Loop of Henle-large volumes of water, Na, and K are removed
Works in renal failure
Hypovolemic and hypokalemia very common
Nursing interventions
Know your potassium level prior to administration
Assess Lung Sounds, Weight, I/O, Edema, SaO2, RR, Blood Pressure, K Level prior to administration,
assess all of these post administration, especially K Level and Lung Sounds, Sao2, I/O. If you urine bag is
not twice as full 30 minutes post IV Lasix administration, check your IV site. If your client without a Foley
has not called to urinate within an hour of giving po Lasix, check your client
Warn your client to get up slowly after taking Lasix, watch for orthostatic hypotension
Lasix does have sulfa as a base component
,May not be used with anuria, hepatic coma
Use with extreme caution with electrolyte depletion
Low K with Digoxin can equal lethal Dysrhythmias, know your potassium level-has a digoxin level been ran
plavix - ANS-Anti-platelet drugs
ASA
Persantine
ADP Receptor Blockers (Plavix, Ticlid, Effient)
Glycoprotein 2b./3a receptor antagonist (Repro, Integrillin, Aggrastat
ADP receptor blockers
Irreversibly alter the plasma membrane of platelets, alters the ability of platelets to aggregate
Ticlid and Plavix are given orally
Ticlid can cause Agranulocytosis-only used when someone is allergic to Plavix
Glycoprotein is an enzyme necessary for platelet aggregation, IV only, Very expensive used with MI's
Strokes, and PTCA's
Clopidogrel (Plavix) Antiplatelet drug
ADP receptor blocker
Inhibits ADP binding to its receptor's-irreversible and will be with the platelet for their lifespan (5-7 days)
Used for MI's, CVA's, PAD/PVD, Unstable Angina, PTCA's-first 6 months post ptca's
Bleeding is a problem
EXAM 2 DRUGS!!!!!!!!!!!! - ANS-..........
Vasopressin (pitressin) - ANS-The antidiuretic action of vasopressin is ascribed to increasing reabsorption
of water by the renal tubules
40u IV
Adverse = cardiac ischemia/angina
DDAVP (desmopressin) - ANS-Prevents or controls thirst and frequent urination caused by diabetes
insipidus and certain brain injuries.
Works on posterior pituitary....Treatment for: diabetes insipidus, bedwetting(nocturia), brain injuries,
hemophilia A w/ some factor VIII production
nasally, IV, oral/subling tab
up to 20 hours
Synthroid - ANS-Treats hypothyroidism. Also treats an enlarged thyroid gland (goiter) and thyroid cancer.
Cortef - ANS-Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-
retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic
analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems.
Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune
responses to diverse stimuli.
,Hydrocortisone - ANS-Hydrocortisone belongs to the family of medications known as corticosteroids. It is
used to treat many different conditions. It works by reducing swelling, inflammation, and irritation or as a
replacement when the body does not make enough cortisol. Hydrocortisone is more commonly used to
treat allergic reactions, some skin conditions, severe asthma, lupus, and arthritis.
It can also be used to treat steroid deficiency in the body, certain blood disorders, certain types of cancer,
multiple sclerosis, and ulcerative colitis.
Cortisol - ANS-When people are under stress, levels of cortisol hormone rise. Chronic stress can result in
chronically high levels of cortisol, which can lead to symptoms like weight gain, memory problems, high
blood pressure, and other health problems. The stress release of cortisol is designed to enable the flight or
fight response with a quick burst of energy, but when people are in a state of constant high stress, levels of
the hormone never have a chance to fall back down to normal levels. This is one reason why treatments for
chronic stress include exercises and activities that are designed to reduce stress levels, allowing production
of this hormone to slow down.
Tapazole - ANS-Treats hyperthyroidism (too much thyroid hormone produced by the thyroid gland).
PTU - ANS-Treats Graves' disease and hyperthyroidism (too much thyroid hormone from the thyroid gland)
in patients who have already been treated with other medicines (such as methimazole) that did not work
well.
H2 Blockers (-tidine) - ANS-Ranitidine
PPI's (-prazole) - ANS-Omeprazole
Antacids - ANS-...
Maalox - ANS-30mL QID
Mylanta - ANS-This medication is used to treat the symptoms of too much stomach acid such as stomach
upset, heartburn, and acid indigestion. Aluminum and magnesium antacids work quickly to lower the acid in
the stomach. Liquid antacids usually work faster/better than tablets or capsules.
Mylanta - ANS-This medication works only on existing acid in the stomach. It does not prevent acid
production. It may be used alone or with other medications that lower acid production (e.g., H2 blockers
such as cimetidine/ranitidine and proton pump inhibitors such as omeprazole).
This medication can cause nausea, constipation, diarrhea, or headache
by mouth, usually after meals and at bedtimehis product may react with other medications (e.g., digoxin,
iron, tetracycline antibiotics, quinolone antibiotics such as ciprofloxacin), preventing them from being fully
absorbed by your body.
Bulk-Producing Laxative - ANS-Metamucil
*decrease* the *absorption* and *effects* of *Warfarin*, *Digoxin* and *Aspirin*. *Do not give* to patients
with: *GI obstructions*, *fecal impaction* or *abdominal pain* and *N/V*
Monitor elevated serum glucose
Lomotil - ANS-Antidiarrheal, Anticholinergic
, Insulins - ANS-(dec blood sugar)
Insulin - ANS-Is a polypeptide hormone that controls the storage and metabolism of carbohydrates,
proteins, and fats. This activity occurs primarily in the liver, in muscle, ind in adipose tissues after binding of
the insulin molecules to receptor sites on cellular plasma membranes
Logs -->fast acting - ANS-is a man-made insulin used to control high blood sugar in adults/children with
DM.
Reg -->short acting - ANS-Humulin® R U-100 is a polypeptide hormone structurally identical to human
insulin synthesized through rDNA technology in a special non-disease-producing laboratory strain of
Escherichia coli bacteria
NPH -->intermediate-acting - ANS-Often used in combination with a shorter-acting insulin. NPH insulin is a
man-made insulin product is the same as human insulin. It replaces the insulin that your body would
normally make. It is an insulin (isophane). It starts to work more slowly but lasts longer than regular insulin.
Helps blood sugar (glucose) get into cells so your body can use it for energy.
Lantas -->long-acting insulin - ANS-Treats diabetes mellitus. Insulin is a hormone that helps get sugar from
the blood to the muscles, where it is used for energy. This type of insulin usually works longer than regular
insulin.
Glucophage (metformin) - ANS-Used with diet and exercise to control blood sugar in patients with type 2
diabetes. May be used alone or with other medicines.
starting dose of GLUCOPHAGE (metformin hydrochloride) Tablets is 500 mg twice a day or 850 mg once a
day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every
2 weeks, up to a total of 2000 mg per day.
The purpose of both insulin and metformin is to lower blood glucose levels. Insulin injections replace the
insulin your body can no longer make when the cells in the pancreas cease to function. Metformin is an oral
hypoglycemic, which lowers blood glucose levels by decreasing the liver's output of glucose. Metformin
also increases insulin sensitivity, and improves not only blood glucose levels but also lipid levels and often
results in weight loss.
Diabetics: - ANS-14% take insulin only
57% take oral medications only
14% take a combo of both.
Insulin VS Metformin Treatments? Mechanisms - ANS-Oral hypoglycemics are used only in Type 2
diabetes, because Type 1 diabetics make little or no insulin, so reducing the glucose levels produced by the
liver won't reduce blood glucose levels. Without insulin, glucose can't enter cells and remains in the
bloodstream. While all Type 1 diabetics take insulin, some Type 2 diabetics also need insulin in addition or
instead of oral hypoglycemics such as metformin. Insulin, which must be injected, comes in several forms
and doses, and can have rapid or slow onset.
