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MIDTERM PHARM

Terms in this set (63)

ACE
angiotensin converting enzyme inhibitor
ALT
for the liver
between 7 to 60 units per liter
amiodarone Cordarone
prototype - potassium channel blocker
ANTIARRHYTHMIC
vasodilator
no grapefruit
ONLY for life threatening V-tach, V-fib
side effects: hypotension, brady, nausea
highly protein bound to albumin
PROLONGS REFRACTORY PERIOD
angina
chest pain
caused by: atherosclerotic plaque
which progresses from angina to MI
DIABETICS HAVE DIFFERENT SYMPTOMS
anticoagulants
used in thrombotic disorders
thins blood
given to prevent new clot formation
antiplatelets
plavix, aspirin
used to prevent arterial thrombosis
aPTT
activated partial thromboplastin time
heparin level 45 - 70 seconds
ARB
angiotensin II reception blocker
LOWERS BLOOD PRESSURE
by blocking vasoconstrictive effects of angiotensin II
AST
for the liver
between 10 to 40 units per liter
artherosclerosis
plaque in coronary arteries that causes angina
artery only
can affect any organ or tissue
heart (thrombus may precipitate MI)
brain (thrombus may precipitate stroke)
legs (thrombus may precipitate DVT)
atorvastin Lipitor
ANTIDYSLIPIDEMIC
prototype HMG-CoA reductase inhibitor
take at bedtime
absorption: rapid PO undergoes extensive first pass effect by liver
inhibits an enzyme required for hepatic synthesis of cholesterol
80-85% excreted in feces
adverse:
N/V, diarrhea, constipation, hepatic dysfunction, myopathy (muscle pain)
NO ANTACIDS WITHIN 2 HRS
monitor liver function AST and ALT b4 and 12 wks after starting med then periodically
atropine
used for severe bradycardia
antiarrythmic
this is the antidote for Aricept and Urecholine
anticholinergic
can be given pre-operatively for prevention of bradycardia, excessive resp. secretions
NO BLACK LICORICE
blood pressure
normal 120 and 80-89
prehypertension 120-139 or 80-89
stage 1 hyper 140-159 or 90-99
stage 2 hyper >160 or >100
blood pressure regulation
tissues regulate own blood flow by o2 and metabolism by-products.

important factors:
histamine, bradykinin
serotinin, prostaglandins
response to hypertension
increased renal secretion
fluid loss decreases circulating volume, which
decreases cardiac output, which
lowers arterial blood pressure, which
lowers blood pressure
response to hypotension
sns stimulated
adrenal medulla secrete epinepherine and norepinephrine
angiotensin II and aldosterone are formed
kidneys retain fluid
blood pressure is increased
BUN
should be 6-20 (kidneys)
CAD
development, progression of atherosclerotic plaque
progresses from angina to MI
overlapping factors:
coronary atherosclerosis
myocardial ischemia
acute coronary syndrome
resultant cardiovascular impairments
captopril Capoten
ACE inhibitor
FOR HBP, RENAL IMPAIRMENT
blocks production of angiotensin II
lowers BP relaxes blood vessels
good for diabetics
absorbed in GI tract
side effects: angioedema, increased serum potassium, dry cough, fatigue, rash, dizzi, headache
NO SALT SUBSTITUTES
check BP, HR and potassium
causes of CAD
obesity
smoking
elevated cholesterol
high BP, HTN
causes of HF
HTN
CAD
hyperthyroidism
endothelial dysfunction allows narrowing of vessels
excessive IV fluids or blood transfusions
antidysrhythmic meds
corticosteroids
estrogens
NSAIDS
clonidine Catapres
prototype
ANTIHYPERTENSIVE - ITS A PATCH
calcium channel blocker
central agonist - works in the brain
relieves angina, lowers BP
inhibits release of norepinephrine
blocks SNS
TAKE APICAL PULSE RATE
side effects: weakness, dizzi, dry mouth, constipation, fever, anemia, ED
GOOD FOR 7 DAYS
NOT EFFECTIVE IMMEDIATELY
must be taken with another drug
clopidogrel Plavix
antiplatelet
given with new MI
absorbed after PO and undergoes extensive first pass metabolism in the liver
platelet inhibition by occur 2 h after 1 dose
half life 8 h
platelets live 3-5 days
for use in:
reduction of MI and CVA, post cardiac stent placement, A-fib
adverse:
pruritus, rash, diarrhea, hemorrhage, thrombotic thrombocytopenia, severe neutropenia
take with or without food, do not double if missed
corticosteriods
decreases inflammation
increases risk of infection
raises blood glucose levels
decreases immune system
taper off these drugs
creatinine
0.6 - 1.3 (kidneys)
digoxin Lanoxin
cardiac glycoside
given PO or IV
FOR HEART FAILURE - added with diuretics
A-FIB, FLUTTER----not v-fib or v-tach
slows and strengthens heart rate
APICAL PULSE RATE ABOVE 60
antidote is digibind
metabolized partially in the stomach
excreted in the kidneys - reduce dose with renal failure
side effects: brady, V-brady, V-tachy, PVCs, N/V, blurred vision,
SERUM POTASSIUM, BUN, CREATININE, GFR
1 week to work/eliminate
digoxin toxicity
contributing factors:
hypothyroidism
impaired renal function
electrolyte imbalance (potassium levels)
age extremes
concurrent cardiac meds
signs/symptoms:
weak, brady, N/V, life threatening heart rhythm
ADMINISTER DIGIBIND
no antacids within 1 hr
diltiazem Cardizem
ANTIDYSRYTHMIC
calcium channel blocker for heart
give for: A-fib, flutter, HTN
monitor heart rate, BP and potassium
s/s lower BP, brady, orthostatic hypotension,
lowers your vasoconstriction
DVT
50% will break down and become PE's
less cohesive than arterial thrombus
associated with venous stasis
embolus likely to detach and travel
dyslipidemia
elevated blood lipid levels
blood lipids: cholestrol, phospholipids, triglycerides
associated with atherosclerosis
primary: genetic, familial
secondary: diet, alcoholism, hypothyroidism, obesity, obstructive liver disease, DM
embolus
section of a thrombosis that breaks off and travels
enoxparin Lovenox
SubQ
antidote - protomine
for blood clots
ANTICOAGULANT
watch for: black stools, bruising, excessive bleed
epinephrine Adrenalin
vasopressor anaphylactic shock
asthma bronchodilator
Subq for allergic response
inhaled
IVP for code blue-
can cause rebound bronchospasm
furosemide Lasix
For: HTN, HF, Edema, Ototoxicity
Loop diuretic - drug of choice
metabolized in the KIDNEYS
excreted in the KIDNEYS
safe for all ages
PO 30 - 60 mins, peaks in 1-2 h lasts 6-8h
IV give over 1-2 mins, 5mins, peaks in 30m lasts 2h
TAKE IN THE MORNING
side effects: orthostatic hypotension
weigh every day-same scale, clothing time
monitor electrolytes
HGBA1C
for diabetes it means check the glucose that is attached to your hemoglobin, taken over a 3 month period, want it under 7, non diabetics under 6.5
heartbeat
stimulation from electrical impulse
transmission to adjacent tissue
contraction of atria, then ventricles
relaxation of atria, then ventricles
heart failure s/s
dyspnea (shortness of breath)
fatigue
exercise intolerance
edema
pulomary congestion
left sided will affect lungs
right sided will affect rest of body
HTN
persistent high BP
this increases the risk of MI, HF
cerebral infarction and hemorrhage
renal disease

symptoms:
N/V, decreased LOC, disorientation, visual and neurological disturbances severe HA
heparin
prototype - anticoagulant
IV or SubQ monitor: aPTT
IV - immediate draw lab 1h b4 dose
SubQ - 20 - 30 mins
inhibits the conversion of prothrombin to thrombin and prevents new thrombus formation

inhibits additional coagulation by inactivating thrombin and preventing the conversion of fibrinogen to fibrin and inhibiting factor XIII

antidote - protamine

watch for black stools, bruising, excessive bleed
hemostasis
prevention or stoppage of blood loss from injured vessel
mechanisms involved:
vasoconstriction
formation of platelet plug
sequential activation of clotting factors
repare of the opening in damaged vessel
hypochloremia
low chloride
hypokalemia
low potassium
hyponatremia
low sodium
INR
international normalized ratio
to see how fast the blood clots
2 - 2.5 range
the higher the number, the thinner the blood
kidneys
receive 25% of cardiac output!
nephron is functional unit
daily minimum output - 720 mL/day
lidocaine
prototype
drug of choice for PVCs - stops excitability
absorbed throughout body and brain
reduces automaticity
side effects: confusion, tremor, restless, hypotension, seizure, cardiac arrest, tinnitus anaphylaxsis
monitor: BUN, creatinine, electrolyte
loop diuretics
ex: furosemide (Lasix)
act on kidneys to decrease reabsorption
PREFERRED WHEN RENAL IMPAIRMENT IS PRESENT

works in the ascending loop of henley
methylprednisone
steriod
Solumedrol
will give 125mg IVP in ER
nitroglycerin
RELIEVES ANGINA
potent vasodilator
venous dilation- decreases preload
arteriole dilation-decreases afterload
sublingual for chest pain, headache, HTN
also by patch for angina
side effects: orthostatic hypotension, bradycardia, headache, dizzi
contraindications: hypersensitivity, severe anemia, hypotension, hypovolemia
HR AND BP BEFORE ADMINISTERING AND 1-3 MINS AFTER, REPEAT EVERY 3MIN
3:15
osmotic diuretics
works in the descending loop of henley
prevents renal failure and cerebral edema
decreases intracranial pressure
helps in excretion of toxic substances
phase I clinical drug trial
for healthy adult men (usually)
phase II clinical drug trial
trials with human subjects who have the disease
phase III clinical drug trial
large numbers of patients receive drug for infrequent or rare side effect study
phase IV clinical drug trial
voluntary postmarket evaluation of drugs therapeutic effects
potassium sparing diuretics
AKA THIAZIDE DIURETICS
works in distal tubules
used concurrently with other diuretics
by PO
prototype - spironolactone (Aldactone)
onset 24-48 h
TREATS - HF, ASCITES, HYPOKALEMIA
side effects:
deepening of voice, gynecomastia, menstrual irreg., testicular atrophy
DO NOT TAKE WITH DIGOXIN
PT
pro time
to see how fast the blood clots
18 seconds for therapeutic level
regular insulin
only one by IV push
also given SubQ
if sick or surgery, you will need increased dose
SA node
pacemaker of the heart
has the fastest rate of automaticity
IMPLUSE DEPENDANT ON SODIUM AND POTASSIUM
scopolamine
called the transdermal scope
anticholinergic
for motion sickness, antinausea drug
patch form
put on 4h before activity-can leave on 3 days
s/s: urinary retention, dry mouth, constipation
serum potassium level
high potassium will stop heart - give calcium to reverse
should be 3.5 - 5
magic number 4
thrombolytics
clot busters
dissolve thrombi and limit tissue damage in thromboembolic disorders
ONLY IN LIFE THREATENING EVENT
administer IV
prototype - alteplase (Activase)
adverse: sever bleeding
symptomatic brain hemmorhage
only by experience personnel in ICU
INR, aPTT, platelet count, fibrinogen preadministeratin
treatment of CAD
beta blockers
calcium channel blockers
81mg aspirin daily
organic nitrates - nitroglycerin (nitro-bid)
warfarin Coumadin
ANTICOAGULANT
know labs, INR PT
absorbed orally - food will delay absorption
highly protein bound
VITAMIN K ANTAGONIST
acts in liver to prevent synthesis of vitamin K dependent clotting factors

monitor PT and INR daily until therapeutic, then every 2 - 7 weeks

therapeutic value is 1.5 times baseline or 18 seconds
CHANGES URINE/SWEAT TO ORANGE
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