Pharmacology test #1 Drugs

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Aspirin Trade Names
-ASA (acetylsalicylic acid)
-Bayer,
-Cosprin
-Aspergum
Aspirin Half Life Time
15-20 minutes
Aspirin Classes
-Analgesic (pain reliever)
-Salicylate
-Antiplatelet
-Anti-Inflammatory
-Antipyretic (fever reducer)
Aspirin Mechanism
-Inhibits Cyclooxygenase (COX-1, COX-2)
which causes Suppression of Platelet Aggregation (Clotting--> is an anticoagulant)

- synthesis of TXA2 promotes aggregation (COX-1 produces TXA2)

-The effects of ASA last 7-10 days
Routes of Aspirin
PO
Suppository
Adverse Drug Reactions of Aspirin
-Gastric ulceration/ perforation/ bleeding

-renal impairment

-coughing up blood

-Salicylism Syndrome: Tinnitus (ringing of ears), sweating, headache, dizziness

-Reye's Syndrome: In children/ teens with chickenpox or flu
Interactions of Aspirin
-Anticoagulants: Warfarin and Heparin (aspirin will intensify the anticoagulants)

-Alcohol: increases risk of gastric bleeding

-ACE Inhibitors and ARBS: Enalapril (increases risk of impairing renal function)
Reasoning for Taking Aspirin
-Helps prevent: MI, Stroke, angina (chest pain), Inflammation, pain, fever, dysmenorrhea (period pain)
Information RN needs prior to administration of Aspirin
-Contraindications: vitamin K disorders, hemophilia, CHF (Congestive Heart Failure), pregnancy, children <2, children/ teens with the chicken pox/ flu

-Always take with food, report black/ bloody stools
Atorvastatin Trade Name
Lipitor
Atorvastatin half life time
14 hours
Atorvastatin Mechanism
-Used for cholesterol

-grapefruit juice may increase risk of myopathy and rhabdomyolysis (muscle disease and muscle breakdown)

-decreases myocardial infraction/ stroke (MI= heart attack)
Atorvastatin classes
-Antilipemic agent (prevents accumulation of fatty acids in the blood)

-HMG-COA Reductase Inhibitor (Statin--> cholesterol lowering drugs)
Atorvastatin Route
PO
Atorvastatin Adverse Drug Reactions
-Back pain
-myalgia (muscle pain)
-rhabdomyolysis (break down of muscle fibers- releases myoglobin)
-dyspepsia (painful digestion)
-flatulence
-myopathy
-decreased LDL and increased HDL
Atorvastatin Interactions
Do not take with Digoxin or oral contraceptives, Erythromycin can increase Lipitor level
Reasons for taking Atorvastatin
-Hypercholesterolemia
-prevention of CVD
- MI
-stroke
-Hyperlipidemia
-Hyperglyceridemia
-to lower cholesterol
Information nurse needs prior to administration of Atorvastatin
-Contraindications: renal failure/ impairment, hepatic problems

-Monitor lipid levels (2-4 weeks after)

-assess for: myalgia, CPK level, LFT Test (12 weeks, every 6 months)

-Monitor LDL
Dabigatran Trade Name
Pradaxa
Dabigatran half life time period
12-17 hours
Dabigatran classes
Thrombin inhibitor--->anticoagulant
Dabigatran action
A direct thrombin inhibitor. It works by preventing the formation of a blood clot (anticoagulant)
Dabigatran Route
PO
Dabigatran Adverse Drug Reactions
-Black, tarry or bloody stools
-coughing up blood
-pink, brown or dark urine
-unusual bruising or bleeding
-vomit that looks like blood or coffee grounds
Dabigatran Interactions
-Anticoagulants (Warfarin)
-Antiplatelet agents (aspirin)
-St. John's wort (natures SSRI- anti depressant)
Reason for taking Dabigatran
-Reducing the risk of stroke and serous blood clots in certain patients with atrial fibrillation.
-Helps with DVT (deep vein thrombosis)
-prevent MI
Information RN needs before administering Dabigatran
-RN can give as outpatient med
-ADR risk low
-same dosing can be used
Digoxin trade name
lanoxin
Digoxin half life time
1.5 days
Digoxin classes
Cardiac Glycoside, Antiarrhythmic, Inotropic drug
Route for digoxin
PO, IV
Digoxin adverse reactions
-Cardiac dysrhythmias (due to hypokalemia)
-Side Affects: anorexia, dysrhythmia, or fatigue
Digoxin Interactions
-Don't give with Diuretics (Lasix) because it promotes loss of K = Inc risk of dysrhythmias

-Epinephrine will give off opposite effect
ACE Inhibitors and ARBs (Enalapril) (inc K levels = decrease therapeutic effects)

-Ginseng (can inc Dig levels)

-St. John's wort (decrease plasma concentration)

-Atorvastatin (inc Dig levels)

-Sympathomimetics (Epi/NE), Verapamil, Quinidine Cause visual disturbances- yellow/ green tint (halo)- toxicity
reasoning for taking digoxin
-for Heart failure patients for control of dysrhythmias

-Fast heart beats; heart double beats

-Heart contractions will be slower/ stronger
information RN needs about Digoxin before administering
-Take apical pulse for 1 full minute before giving the drug- note rate, rhythm, quality before giving drug (without med if pulse falls below parameters)
-Test Dig levels- report to doc if pulse falls <60 or >110 or if dysrhythmia is detected
-Maintain K intake, don't give with unusual K
-Should be 60+, if below the age of 60, do not give
-Narrow therapeutic range (0.5-0.8) (toxic > 1)
-Inhibit sodium and potassium (ATPase pump)
Enalapril Trade Name
Vasotec
Enalapril Half life time
2 hours
Enalapril classes
Antihypertensive; Angiotensin converting enzyme inhibitors (ACE)
Enalapril Mechanism
-Used to lower BP, given for high BP

-ACE inhibitor that catalyzes that conversion of Angiotensin I to Angiotensin II (a vasoconstrictor substance)

-Suppression of RAAS (hormone system that regulates blood pressure and water balance) causes vasodilation = lower BP
Enalapril adverse drug reactions
-First does hypertension,
-Acute kidney failure,
-hyperkalemia (high K in blood)
-cough due to Bradykinin,
- renal failure,
-orthostatic hypotension,
- angioedema (swelling of face and tongue)
Enalapril Route
PO, IV
Enalapril Interactions
Do not take with Diuretics or Digoxin
Reasoning for taking Enalapril
- Mild to severe hypertension
- congestive heart failure
Information RN needs before administering Enalapril
-Contraindications: Kidney disease

-Monitor BP for first 3 hours after administration, be alert to hyperkalemia (K>5.7 mEq/L)

-Dc diuretics 2-3 days before giving med
Fluoxetine trade name
-Prozac
-Sarafem
-Rapiflux
-Selfemra
Fluoxetine half life
2-3 days
fluoxetine classes
Antidepressant, Selective Serotonin Reuptake Inhibitor (SSRI)
Action of fluoxetine
-Blocks the neuronal reuptake of serotonin and thus causes the transmitter to accumulate in the synaptic space and intensifying transmission and Produces CNS excitation
fluoxetine route
PO
fluoxetine adverse drug reactions
-Sexual dysfunction
-weight gain
-Serotonin Syndrome
-withdrawal syndrome
Fluoxetine Interactions
-Warfarin (flux can displace it)
-St. John's wort (may cause Serotonin Syndrome) burn up and can overdose
-hyperthermic
-Helps with depression
-Dabigatran
-Increases Serotonin levels
-Dry Mouth
reasoning for taking fluoxetine
Used for:
-major depression
-OCD, panic disorder
-bulimia
-depressive side of Bipolar disease
-PTSD
Information RN needs before administering Fluoxetine
-Precautions: Ulcers, GI bleeding (watch out for children and adolescents)
-Monitor children/ teens for suicide risks, -weigh weekly
-Do not break pill
-Regular visits for 12 weeks
-Avoid abrupt withdrawal
Levothyroxine Trade names
Levoxyl
Levolet
Novothyrox
Synthroid, Unithroid
Levothyroid
Thyroid
Levothyroxine half life time
7 days
levothyroxine route
PO, IV
Levothyroxine Mechanism
Synthetic prep of thyroxine (t4) - Replaces decreased or absent thyroid hormone = restores metabolic rate of pt
levothyroxine classes
Hormone, Thyroid Hormone Replacement
levothyroxine adverse drug reactions
-Acute overdose (thyrotoxicosis)
- tachycardia
-tremor
-hyperthermia
-arrhythmias
levothyroxine drug interactions
Warfarin (accelerates the degradation of Vitamin K- dep clotting factors = Warfarin's anticoagulant effects enhanced)

Weight Loss
Levothyroxine info the nurse must know before administering
-Contraindications: do not use for obesity treatment
-Monitor pulse before and during administration. If >100 cont. doc
-Monitor PT/INR for evidence of bleeding if taking Warfarin
-Monitor t4 serum levels and TSH levels
Nitroglycerine Trade Names
Nitrogard
Nirtocap
Nirtodisc
Nitrostat
Nitropatch
Nitroglycerine half life time
5-7 mins
nitroglycerine mechanism
-Decreases pain of angina by decreasing Cardiac oxygen demand (Nitro dilates veins and so venous return dec = dec ventricular filling = dec oxygen demand)

-Also relaxes/ prevents spasm in coronary arteries = inc oxygen supply

-Vasodilator
nitroglycerine route
Sublingual
PO
IV
Transdermal Unit
Topical
nitroglycerine adverse drug reactions
ADRs: tachycardia (prevent with B blocker)

Circulatory collapse,

Orthostatic hypotension
nitroglycerine drug interactions
Don't give with Viagra- both vasodilating
Headache because of vasodilation from the medication
Dry Mouth
Orthostatic hypotension
Postural hypertension (can faint)
*No alcohol because it slows down heart rate
Watch carefully if liver problems (it metabolizes in the liver)
Fast heart rate
Can cause hypotension
nitroglycerine info the nurse must know before administering the medications
- Monitor for dysrhythmias
- take baseline BP/P with patient sitting
-assess for headaches
-check BP/P after 1 hour
Nitroglycerine classes
-Nitrate Vasodilator
-Anti-ischemic
-Anti-hypertensive effects
-Anti-anginal (prevents chest pain)
Reasoning for taking nitroglycerine
-Angina pectoris
-acute anginal attack
warfarin trade name
Coumadin
warfarin half life time
1.5-2 days
warfarin classes
anticoagulant
warfarin route
PO (only oral anticoagulant), IV
warfarin mechanism
-Suppresses coagulation by decreasing production of clotting factors VII, IX, X and Prothrombin (Vitamin K dependent clotting factors).

-Warfarin inhibits Vitamin K- epoxide reductase complex 1
warfarin adverse drug reactions
-Hemorrhage
-fetal hemorrhage and teratogenesis from use during pregnancy
warfarin interaction
-Drugs that increase the effects of Warfarin (aspirin)
- avocado
-Fluoxetine
-Levothyroxine
-Dabigatran
-Vitamin K (green vegetables) competitive antagonist
-Bleeding gums/ rectum
reasoning for taking warfarin
DVT, TIAs, Thromboembolism
info the RN must know about warfarin before administration
-Monitor Prothrombin Time (PT) - coagulation test or an INR test

-Norm PT: 12s, INR: 2-3 (time it takes for blood to clot)
Cranberry Juice may incorporate INR

-Anecdote: Vitamin K (leafy vegetables)
Don't use 3-5 days before surgery
Digoxin mechanism
Exerts positive intropic action = Inc force of ventricular contraction- it inhibits Na+, K+ -ATpase (competes with K+) Decreases conduction velocity through the AV node = Antiarrhythmic props
Increases contractibility of heart muscle, makes it pump stronger (more blood)
Norm K levels: 3.5-5 mEq/L
Dig Level: 0.5-0.8
(>.1 = toxic)
*When K Levels are low, binding of Dig INC = excessive inhibition of Na, K, -ATpase = toxicity