NR 565 Cardiac drugs – Download To Score An A+

NR 565 Cardiac drugs – Download To Score An A+ 1. Hydrochlorothiazide Hydrochlorothiazide (Microzide) is the most widely used thiazide diuretic and will serve as the prototype for this group. Because of its use in hypertension, hydrochlorothiazide is one of the most commonly used drugs. Mechanism of action Hydrochlorothiazide promotes urine production by blocking the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule. Retention of sodium and chloride in the nephron causes water to be retained as well, thereby producing an increased flow of urine. Because only 10% of filtered sodium and chloride is normally reabsorbed at the site where thiazides act, the maximal urine flow these drugs can produce is lower than that produced by the loop diuretics. • The ability of thiazides to promote diuresis is dependent on adequate kidney function. These drugs are ineffective when GFR is low (less than 15 to 20 mL/min). Hence, in contrast to loop diuretics, thiazides cannot be used to promote fluid loss in patients with severe renal impairment. Pharmacokinetics and pharmacodynamics Diuresis begins about 2 hours after oral administration. Effects peak within 4 to 6 hours and may persist up to 12 hours. Most of the drug is excreted unchanged in the urine. Common or severe side effects Hyponatremia, hypochloremia, and dehydration Hypotension Hypokalemia Hyperglycemia Hyperuricemia Reduction of HDL cholesterol Increase in LDL cholesterol and triglycerides Monitoring needs Monitor blood pressure and pulse rate; also, patients should weigh themselves daily and evaluate decreased edema. Have patients monitor for signs or symptoms of hypokalemia. 2. Nitroglycerin • Therapeutic Goal: Reduction of the frequency and intensity of anginal attacks. • Baseline Data: Frequency and intensity of anginal attacks and the factors that precipitate anginal attacks. Blood pressure and heart rate should be noted. • Monitoring: No routine blood monitoring necessary. • Identifying High-Risk Patients: Use with caution in hypotensive patients and patients taking drugs that can lower blood pressure. • Evaluating Therapeutic Effects: Instruct patients to keep a record of the frequency and intensity of anginal attacks and the factors that precipitate these attacks. • Minimizing Adverse Effects: Use with phosphodiesterase type 5 inhibitors (sildenafil) is contraindicated. 3. Anticoagulant and Antiplatelet Drugs Anticoagulants Drugs That Activate Antithrombin • Heparin (unfractionated) • Enoxaparin (low-molecular-weight heparin) Vitamin K Antagonist • Warfarin Direct Thrombin Inhibitor • Dabigatran Direct Factor Xa Inhibitors • Rivaroxaban Antiplatelet Drugs • Aspirin (cyclooxygenase [COX] inhibitor) • Clopidogrel (P2Y12 adenosine triphosphate receptor antagonist) • Vorapaxar (protease-activated receptor-1 [PAR-1] antagonist)