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pharm test 3

Terms in this set (54)

enalapril (Vasotec)
ACE inhibitor
blocks effects of angiotensin II; dilates vessels
decreases blood volume by working on kidneys, also relaxes vessels
*persistent cough
from venom of pit vipers
enhances thiazide diuretics, monitor K levels
angioedema AIRWAY
may bottom out on first dose
D for pregnancy
give saline for OD
work in lungs
hydralazine (Apresoline)
direct acting vasodilator
used in crisis or when other meds don't work
reflex tachy. may give beta blocker
Na/fluid retention possible and then- may give Lasix
youve accomplished nothing
side effects bad
only given when diastolic pressure greater than 120 AND in organ failure
contra in MI, tachy, lupus
diltiazem (Cardizem)
Calcium channel blocker
blocks muscular contraction that dilates muscle
can treat angina, dysrhythmias, htn
can cause sexual dysfx, myalgia/arthralgia
edema to lower extremities
st johns wart and ginseng decrease, garlic increases
metoprolol (Lopressor)
Beta blockers
slow heart rate
negative inotropic effect- decrease contractility, decrease HR
works on preload
fluid retention, fatigue, bradycardia, heart block risk
can shrink heart to normal size
contraindicated with asthma, brady
digoxin (Lanoxin, Digitek)
Cardiac glycosides
increases force, slows heart rate
(increased contractility)
HIGH RISK HIGH ALERT
watch for dysrhythmias, renal, drug interactions, restriction w/ antidiarrheal/antacids
0.5-0.8 ng/mL
neutropenia, dysrhythmias, Dig toxicity risk
frequent lab work
give electrolytes
toxicity signs: dizzy, blurred vision, V/D, difficulty breathing, loss of apetite, yellow green eye halo
ginseng can cause toxicity
nitroglycerin (Nitro-stat)
Organic Nitrates
relax smooth muscle, dilate coronary arteries, reduce output, decrease O2 demand
major headache-educate
short acting: tablets in brown jar
0.4 mg, up to 3 q5min
long acting: transdermal patch, remove 6-12 hours for tolerance
Viagra interaction- hypotension
not for those with IICP/head trauma
atenolol (Tenormin)
beta blocker
prophylaxis of stable angina
fatigue, angina, impotence, drowsy
not used if having vasospasm, hold if low pulse
Pregnancy D
atorvastatin (Lipitor)
HMG-CoA Reductase Inhibitor
reduce bad and raise HDLs
can cause muscle pain --> rhabdomyolysis; heartburn, headache, fatigue
no grapefruit juice- inhibits metabolism
pregnancy X
monitor liver fx
take with food
can be taken any time of day, while most statins/tors need to be taken before bed
cholestyramine (Questran)
bile acid-binding resin/sequestrant
GI adverse effects (not in bloodstream)
interact with digoxin and warfarin
contra-total biliary obstruction
powder mixed with water
give 2-4 hours after or before other drugs
30 days before effect (as opposed to 2 weeks)
Nicotinic acid (Niacin)
B-complex vitamin
decreases VLDL
niacin flush-take aspirin, hot flashes, nausea, gas, diarrhea; possibly liver toxicity and gout
often used with statins
can increase fasting blood glucose
watch out for rabdomyolysis, GI pain
Hydrochlorothiazide (Microzide)
thiazide diuretic
for mild to moderate HTN
remember it works on the early distal tube to block Na+
Also to reduce edema with heart, hepatic, and renal failure
monitor for cardiac dysrhythmias
electrolyte imbalances
decreased effectiveness of Lithium- pushed out of body like salt
Digoxin needs normal K level, otherwise is toxic
Furosemide (Lasix)
Loop diuretics most effective class
work by blocking the reabsorption of sodium and chloride in loop of Henle
give over about 2 min
Nurse must monitor lab values
watch for heart, hearing (ototoxicity), renal problems
monitor electrolytes (esp hypokalemia) and CBC
observe for rash or pruritis
take in the morning
orthostatic hypotension
Spironolactone (Aldactone)
K-sparing diuretics
weaker diuresis- used in heart failure, edema
hyperkalemia possible
Sodium Chloride (NaCL)
.9 is normal
first line in loss of blood
must monitor for fluid vol overload or deficit
Potassium Chloride (KCL)
HIGH RISK DRUG
dilute, b/c very acidic
NEVER given IV push
Sodium bicarbonate
used in metabolic acidosis
starvation, alc use
monitor pH in ABG's
K should start to decrease
chronic use of milk/Ca supplement- milk syndrome
total cholesterol <200
desirable
total cholesterol 200-240
moderate risk
total cholesterol >240
high risk
LDL cholesterol <100
optimal
LDL cholesterol 130-159
moderate risk LDL
LDL cholesterol >190
high risk LDL
HDL cholesterol <35
high risk HDL
HDL cholesterol >60
desirable HDL
HDL cholesterol 35-45
moderate risk HDL
HDL cholesterol 46-59
low risk HDL
triglycerides <149
desirable Tri
triglycerides 150-199
borderline high risk Tri
Triglycerides 200-499
high risk Tri
rhabdomyolysis
acute renal failure
dark, tea-colored urine
ask about muscle pain
avoid antifungals, HIV protease inhibitors, and telaprevir when taking statins
Normal serum albumin (Plasbumin)
to maintain plasma oncotic pressure and transport substances through blood
monitor fluid volume status for overload
allergies and protein overload risk
don't have to treat as blood product- no type and crossing and double verification, but you do have to use blood tubing & needle
norepinephrine (Levophed)
Non-selective adrenergic agonist: Vasopressor vasoconstrictor/sympathomimetics
work on alpha-adrenergic to raise blood pressure (for shock)
increases myocardial contractility-> increase cardiac output
drug of choice for septic shock
adverse effects: greatly decreases blood flow to extremities, very little urine
Black box warning: Phentolamine given to decrease tissue necrosis in Extravasation
dopamine (Intropin)
also for shock and hypotension, increases contractility and therefore output
(will cause problems if infiltrates like other catecholemines. can cause gangrene)
positive inotropic agent- increases contractility
epinephrine (Adrenalin)
Nonselective adrenergic agonist; vasopressor
often given in cardiac arrest. given for the Fatal Five and anaphylactic shock (different concentrations)
sodium channel blocker prototype: Lidocaine (from previous chapter)
ventricular
propranolol (Inderal)
Beta-adrenergic antagonist (non-selective so affects B-1 as well as B-2)
Blocks beta receptors, which reduces automaticity and slows conduction velocity across myocardium
Atrial dysrhythmias
sometimes used for anxiety attacks, PTSD
Bradycardia, bronchospasms, hypoglycemia (sympathetic signs and symptoms are blocked, need to check even if don't feel), diminished libido - compliance
contraindicated in asthmatics, those with COPD (b/c blocking beta-2 receptors, resulting in bronchospasm
Black box warning- must take 1-2 weeks to taper off drug (to avoid MI/HTN)
Vasopressors for OD (like dopamine)
amiodarone (Cordarone, Pacerone)
Potassium channel blocker
for atrial and ventricular (esp Vtach)
blocks K+ channels, prolonging time for the heart to fill
pneumonia-like syndrome is unique: related to pulmonary toxicity
half-life: up to 150 days, potential for drug-drug interaction and pregnancy risk D
Interacts with Digoxin: can increase serum Digoxin by 70%*
with Warfarin: enhances anticoagulant action
black box warning: pulmonary toxicity can be fatal. Nurse must assess lung fx, O2 sat, abg's
Cardizem (From previous chapter)
Calcium channel blocker
atrial dysrhythmias (atrial fib, so this is a common drug)
blocking calcium channels _________________
Heparin (Heplock)
Indirect thrombin inhibitor
works on intrinsic factor
we naturally have it in the liver and lining of vessels
works in veins
does not break down existing clots
venous thrombus
never PO, not absorbed
works immediately IV
don't aspirate or massage to avoid local tissue damage/bleed
recall ginger, ginkgo cause increase bleeding risk
monitor aPTT, activated clotting time, and thrombin time
also monitor hct, RBC, platelet levels
HIT symptoms appear in 5-10 with decreased platelet count
can be given to pregnant women
Warfarin (Coumadin)
Vitamin K agonist
prevention of CVA, MI, DVT
inhibits Vitamin K-dependent clotting factors in liver (can give Vitamin K to reverse)
works on extrinsic pathway
for venous thrombus (not artery)
may take several days
Pregnancy category X
monitor PT and INR
garlic, ginger, ginseng, and ginkgo increase risk of bleeding
teach to be aware of high vitamin K foods
Clopidogrel (Plavix)
ADP receptor blocker
Anti-platelet drug
used to prevent clot formation in arteries
for those with unstable angina, coronary artery stents, postop DVT prevention; unable to tolerate aspirin (are cousins)
duration: 5 days, the lifetime of a platelet and is irreversible in that platelet's life, d/c prior to sx
PO- advantage
monitor coagulation studies: WBC (can cause neutropenia), bleeding times
cerebral hemorrhage risk
can transfuse platelets
teaching: soft bristle toothbrush, electric razor
Alteplase (Activase)
Thrombolytic; drug for dissolving blood clots
converts plasminogen to plasmin to dissolve clot
monitor PT, aPTT, hgb and hct (for risk of bleeding)
MUST get good pt hx because certain window of time for it to work is 3 hours
for stroke related to blood clot
epoetin alfa (Epogen, Procrit)
Hematopoietic growth factor; for anemia
given to patients in chronic renal failure, also chemo patients in secondary anemia
can be given to bloodless medicine & HIV pt's
just know that it has a lot of black box warnings
SubQ>IV
HTN in 30% of pts
phlebotomy in OD (too many RBC)
Filgrastim (Neupogen)
Colony-stimulating factor, for increasing neutrophil production
to boost white blood cells instead of RBC's
good in immunocompromised cancer patients, AIDS
adverse effect: bone pain
Cyanocobalamin (Calomist)
Vitamin supplement, drug for pernicious anemia
basically purified form of Vitamin B12, have to continue for life
PO or IV or IM (more rapid correction; give it Ztrack to decrease staining)
can also be given IV for cyanide poisoning
Ferrous sulfate (Feosol)
Iron supplement; anti-anemic
for iron deficiency anemia
give Ztrack/be careful with IV be careful because irritating
can cause N/V, constipation (teach to increase fiber & fluid)
take 1 hr before or 2 hrs after food to maximize absorption
can cause dark tarry stool (pt is not bleeding into stool)
do not take with antacids because they will reduce absorption of Fe
Desferal for OD
3 factors that make up bp
cardiac output, blood volume, peripheral vascular resistance
losartan (Cozar)
angiotensin-receptor blockers
like ACE inhibitors
block angiotensin receptors in smooth muscle and adrenal glands
dilate vessels, excrete NA
hypotension, no cough
work in kidneys
rare angioedema
Nitropress
like hydralazine, emergency vasopressor
more for HTN emergency
when diastolic pressure greater than 120 AND in organ failure
body forms cyanide
Thrombolytics
dissolve clots blocking coronary arteries
20 min -12 hrs
no help >75 years old or >24 hours
narrow margin of safety
Lidocaine
Calcium channel blocker
for ventricular dysrhythmias (vtach, vfib)
adverse: CNS toxicity
Albumin (Plasbumin)
18-20 g needle
to maintain osmotic pressure
allergic possibilities
what is still important?
to look at slides!!
monitor for internal bleeding
monitor cbc for RBC/platelet, lumbar pain, abdominal bulging, guaiac test for fecal occult, petechiae (esp in eyes), gum bleed, nosebleed
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