NR 565 Advanced Pharmacology Fundamentals Week 1-4 &
Midterm Exam Study Guide: Chamberlain.
optimal digoxin plasma drug level range
0.5 to 0.8 ng/mL
adverse effects of digoxin
GI- anorexia, nausea, vomiting
CNS- fatigue
Visual disturbances **(appearance of halos around dark objects)
dysrhythmias
Black box warning for quinidine
increase mortality in patients with a-flutter and a-fib
black box warning for mexiletine
increased risk for mortality when used to treat non-life threatening arrhythmias
black box warning for amiodarone
lung damage - resemble HF and pneumonia
Amiodarone should NOT be taken with what?
CYP3A4 inhibitors and grapefruit juice (levels can be increased)
Are statins safe in pregnancy?
No
What can be used in pregnancy if needed? (related to statins and pregnancy)
ezetimibe and fibrates
At what time of day should statins be given and why?
evening- cholesterol synthesis increases at night
adverse effects of statins
rhabdomyolysis, hepatoxicity, new-onset diabetes
What medications should be used cautiously with statins bc they can raise plasma levels?
inhibitors of CYP3A4 (ex/ erythromycin, amiodarone, grapefruit)
What are bile salts such as colesevlam used for?
decrease LDL
, What is gemfibrozil used to treat
decreases total glyiceride and raises HDL
What is a major drug interaction with gemfibrozil (fibrate)
warfarin (increases anti-coagulant effects)
fibrates are contraindicated in what patients
liver and gallbladder disease
adverse effects of nitro
headache, hypotension, and tachycardia (secondary to vasodilation)
what medication is contraindicated when a patient is prescribed nitro?
inhibitors of PDE-5
How can we prevent nitro tolerance?
use lowest effective dosage and long term acting formulations (patches, sustained release) used on
intermittent schedule allowing at least 8 drug free hours every day (usually at night)
Warfarin MOA
suppresses coagulation by decreasing production of four clotting factors, inhibits enzyme vit K from
converting to active form
INR target range for warfarin
2.5 to 3.5
patient education on warfarin
bleeding - soft toothbrush, electric razor, avoid green leafy vegetables
Beta-blockers use with nitroglycerin
Beta Blockers suppress nitroglycerin induced tachycardia. They do so by preventing sympathetic
activation of beta 1 adrenergic receptors on the heart.
Nitroglycerin lowers BP by reducing venous return and dilating arterioles. the lowered BP activates the
baroreceptor reflex causing reflex tachycardia. Which will increase cardiac demand and negate the
therapeutic effects of nitroglycerin. Txt with beta blocker can suppress the heart and slow the rate.
no digoxin - increase contractility of heart
examples of beta blockers
end in -lol/-olol
Atenolol, bisoprolol, metoprolol, metoprolol succinate,
Carvedilol, labetalol, nadolol, propranolol, and Sotalol (Betapace®)
Risk of stopping beta blockers abruptly
Midterm Exam Study Guide: Chamberlain.
optimal digoxin plasma drug level range
0.5 to 0.8 ng/mL
adverse effects of digoxin
GI- anorexia, nausea, vomiting
CNS- fatigue
Visual disturbances **(appearance of halos around dark objects)
dysrhythmias
Black box warning for quinidine
increase mortality in patients with a-flutter and a-fib
black box warning for mexiletine
increased risk for mortality when used to treat non-life threatening arrhythmias
black box warning for amiodarone
lung damage - resemble HF and pneumonia
Amiodarone should NOT be taken with what?
CYP3A4 inhibitors and grapefruit juice (levels can be increased)
Are statins safe in pregnancy?
No
What can be used in pregnancy if needed? (related to statins and pregnancy)
ezetimibe and fibrates
At what time of day should statins be given and why?
evening- cholesterol synthesis increases at night
adverse effects of statins
rhabdomyolysis, hepatoxicity, new-onset diabetes
What medications should be used cautiously with statins bc they can raise plasma levels?
inhibitors of CYP3A4 (ex/ erythromycin, amiodarone, grapefruit)
What are bile salts such as colesevlam used for?
decrease LDL
, What is gemfibrozil used to treat
decreases total glyiceride and raises HDL
What is a major drug interaction with gemfibrozil (fibrate)
warfarin (increases anti-coagulant effects)
fibrates are contraindicated in what patients
liver and gallbladder disease
adverse effects of nitro
headache, hypotension, and tachycardia (secondary to vasodilation)
what medication is contraindicated when a patient is prescribed nitro?
inhibitors of PDE-5
How can we prevent nitro tolerance?
use lowest effective dosage and long term acting formulations (patches, sustained release) used on
intermittent schedule allowing at least 8 drug free hours every day (usually at night)
Warfarin MOA
suppresses coagulation by decreasing production of four clotting factors, inhibits enzyme vit K from
converting to active form
INR target range for warfarin
2.5 to 3.5
patient education on warfarin
bleeding - soft toothbrush, electric razor, avoid green leafy vegetables
Beta-blockers use with nitroglycerin
Beta Blockers suppress nitroglycerin induced tachycardia. They do so by preventing sympathetic
activation of beta 1 adrenergic receptors on the heart.
Nitroglycerin lowers BP by reducing venous return and dilating arterioles. the lowered BP activates the
baroreceptor reflex causing reflex tachycardia. Which will increase cardiac demand and negate the
therapeutic effects of nitroglycerin. Txt with beta blocker can suppress the heart and slow the rate.
no digoxin - increase contractility of heart
examples of beta blockers
end in -lol/-olol
Atenolol, bisoprolol, metoprolol, metoprolol succinate,
Carvedilol, labetalol, nadolol, propranolol, and Sotalol (Betapace®)
Risk of stopping beta blockers abruptly
