Download Drug Class - Mrs.LeeRN

Jeanelle F. Jimenez RN, BSN, CCRN
 Bile acid resins
 Niacin
 HMG-CoA reductase inhibitors
 Omega-3 fatty acids
 Antilipemic agents used only if diet and
exercise are unsuccessful
 Combining bile acid resin with niacin or statin
can lower LDL by 40% to 50%
Slide 2
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 Drugs: cholestyramine, colestipol,
colesevelam
 Actions
 Bind to bile acids, promote increased
metabolism of cholesterol
 Uses
 In conjunction with dietary therapy to decrease
elevated cholesterol
 Common adverse effects
 Constipation, bloating, fullness, nausea,
flatulence
 Serious adverse effects
 Vitamin K deficiency (rare)
Slide 3
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 Actions
 Inhibit VLDL synthesis by liver cells
 Uses
 Treatment of dyslipidemias in conjunction with
bile acid-binding resins; reduces risk of CAD
 Common adverse effects
 Flushing, itching, rash, tingling, headache;
nausea, gas, abdominal discomfort, pain;
dizziness, faintness, hypotension
 Serious adverse effects
 Hepatotoxicity, myopathy
Slide 4
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 Actions
 Inhibit enzyme responsible for converting HMGCoA to mevalonate, ultimately reduce liver
cholesterol
 Uses
 In conjunction with dietary therapy to reduce
LDL and total cholesterol levels
 Common adverse effects
 Headaches; nausea, abdominal bloating, gas
 Serious adverse effects
Slide 5
 Liver dysfunction; myopathy, rhabdomyolysis;
myoglobinuria
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 Drug: omega-3 fatty acids (Lovaza)
 Actions
 Reduce synthesis of triglycerides in the liver;
mechanism of action unknown
 Uses
 In conjunction with dietary therapy to decrease
elevated triglyceride levels
 Common adverse effects
 Nausea, back and abdominal pain, bloating,
bad taste in mouth, weakness, diarrhea
Slide 6
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Slide 7
Lifestyle modifications are initial therapy
If no significant effect, drug therapy is
introduced
Start with diuretics for stage 1 hypertension
Add beta blockers, ACE inhibitors, calcium
channel blockers, and angiotensin receptor
blockers as tolerated
Start with two-drug combination for stage 2
hypertension
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Slide 8
Diuretics; beta-adrenergic blocking agents
ACE inhibitors; angiotensin II receptor
blockers (ARBs)
Calcium channel blockers; alpha-1
adrenergic blocking agents
Central-acting alpha-2 agonists;
peripheral-acting adrenergic antagonists;
direct vasodilators
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 Actions
 Cause volume depletion, sodium excretion,
vasodilation of peripheral arterioles
 Uses
 Most commonly prescribed antihypertensives
 In combination with other antihypertensive
agents
 Discussed further in Chapter 29
Slide 9
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 Actions
 Inhibit cardiac response to sympathetic nerve
stimulation
 Inhibit renin release from kidneys
 Uses
 Initial therapy for stage 1 and 2 hypertension
 Common adverse effects
 Bradycardia, peripheral vasoconstriction
(purple mottled skin); heart failure;
bronchospasm, wheezing; masks
hypoglycemia in diabetic patients
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Slide 10
 Actions
 Inhibit angiotensin I converting enzyme (ACE),
disrupting the conversion of angiotensin I to
angiotensin II
 Uses
 Single therapy for stage 1 or 2 hypertension
 Common adverse effects
 Nausea, fatigue, headache, diarrhea; orthostatic
hypotension
 Serious adverse effects
 Angioedema; neutropenia; hyperkalemia; chronic
cough; birth defects
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Slide 11
 Actions
 Bind to angiotensin II receptor sites and block the
vasoconstrictor from binding to receptor sites in
target organs
 Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
 Common adverse effects
 Dyspepsia, cramps, diarrhea; headache;
orthostatic hypotension
 Serious adverse effects
 Birth defects; hyperkalemia
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Slide 12
 Actions
 Inhibit movement of calcium ions across cell
membranes
 Uses
 Ideal for first- or second-line drug therapy for
hypertension
 Serious adverse effects
 Hypotension and syncope
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Slide 13
 Actions
 Block postsynaptic alpha-1 adrenergic
receptors to produce vasodilation, decrease
peripheral vascular resistance
 Uses
 Alone or in combination with other
antihypertensives to reduce blood pressure
 Reduce mild to moderate urinary obstruction
 Common adverse effects
 Drowsiness, headache, weakness, lethargy;
dizziness, tachycardia, fainting
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Slide 14
 Actions
 Stimulate alpha-adrenergic receptors in the
brainstem, reducing sympathetic outflow from
CNS
 Uses
 Considered adjunctive therapy; used only in
combination with other antihypertensives
 Common adverse effects
 Drowsiness, dry mouth, dizziness, altered urine
color, altered rest results
 Serious adverse effects
 Depression; rash
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Slide 15
 Actions
 Relax arterial smooth muscle, reducing peripheral
vascular resistance
 Uses
 Treatment of stage 2 hypertension, renal disease
hypertension, toxemia of pregnancy
 Common adverse effects
 Dizziness, numbness, tingling in legs; orthostatic
hypotension, palpitations, tachycardia; nasal
congestion; hair growth
 Serious adverse effects
 Fever, chills, joint and muscle pain, skin eruptions;
gynecomastia
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Slide 16
 Class I: myocardial depressant inhibits
sodium ion movement
 Class Ia agents – prolong duration of electrical
stimulation
 Class Ib agents – shorten duration of electrical
stimulation
 Class Ic agents – potent myocardial depressants,
slow conduction rate
 Class II: beta-adrenergic blocking agents
 Class III: slow rate of electrical conduction
 Class IV: block calcium ion flow
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Slide 17
 Actions
 Prolong the duration of electrical stimulation
 Uses
 Treat atrial fibrillation, Wolff-Parkinson-White
syndrome, paroxysmal supraventricular
tachycardia, premature ventricular tachycardia,
ventricular tachycardia
 Common adverse effects
 Dry mouth, nose, throat
 Serious adverse effects
 Myocardial toxicity, urinary hesitancy,
constipation with distension and flatus
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Slide 18
 Drug: IV lidocaine (Xylocaine)
 Actions: shorten the duration of electrical
stimulation
 Uses: treat premature ventricular contractions,
venticular tachycardia, ventricular fibrillation
 Common adverse effects
 Lightheadedness, muscle twitching, hallucinations,
agitation, euphoria; respiratory depression
 Serious adverse effects
 Dysrhythmias, neurotoxicity, seizures, confusion
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Slide 19
 Actions: potent myocardial depressants, slow
conduction rate
 Uses: treat ventricular tachycardias,
supraventricular tachyarrhythmia, frequent
premature ventricular contractions
 Common adverse effects
 Dizziness, lightheadedness, faintness,
unsteadiness, blurred vision, headaches,
constipation, nausea
 Serious adverse effects
 Visual disturbances, increasing dyspnea, exercise
intolerance edema, dysrhythmias
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Slide 20
 Drugs: amiodarone hydrochloride (Cordarone,
Pacerone)
 Actions
 Prolong the action potential of atrial and ventricular
tissue by increasing the refractory period
 Uses
 Treat life-threatening supraventricular tachycardia,
atrial fibrillation, atrial flutter
 Serious adverse effects
 Fatigue, tremors, involuntary movements, sleep
disturbances, numbness and tingling, dizziness,
ataxia, and confusion, thyroid disorders,
hepatotoxicity, dysrhythmias
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Slide 21
 Drugs
 Verapamil (Calan, Isoptin), diltiazem (Cardizem)
 Actions
 Slow AV conduction, prolong refractoriness,
decrease automaticity
 Uses
 Treat automatic and re-entrant tachycardias
 See Chapter 23 for further discussion
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Slide 22
 Drug: adenosine (Adenocard)
 Actions
 Naturally occurring chemical in the body; strong
depressant effects on the SA and AV nodes
 Uses
 Convert supraventricular tachycardia to normal
sinus rhythm
 Common adverse effects
 Flushing of the face, shortness of breath, chest
pressure, nausea, headache
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Slide 23
 Drug: digoxin (Lanoxin)
 Actions
 Slow conduction through the AV node,
reducing conduction velocity and automaticity;
increase cardiac output
 Uses
 Treat atrial fibrillation, atrial flutter,
paroxysmal tachycardia
 See Chapter 28 for further information
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Slide 24
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Nitrates
Beta-adrenergic blocking agents
ACE inhibitors
Calcium channel blockers
Statins
Platelet-active agents
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Slide 25
 Nitroglycerin – most common drug
 Actions
 Decreases oxygen demand on heart; dilates
arteries and veins; reduces blood volume;
decreases preload on heart
 Uses
 Drug of choice to treat angina pectoris
 Common adverse effects
 Excessive hypotension, prolonged headache,
tolerance
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Slide 26
 Administration forms
 Sublingual tablets – dissolve rapidly, primarily
for acute attacks
 Sustained-release capsules, tablets, ointment,
transmucosal tablets, and transdermal patches
– used prophylactically to prevent anginal
attacks
 Translingual spray – for acute and prophylaxis
of attacks
 Amyl nitrite for inhalation (glass vials)
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Slide 27
 Actions
 Block beta adrenergic receptors in heart
 Reduce myocardial oxygen demand
 Reduce blood pressure
 Uses
 Reduce the number of anginal attacks
 Reduce nitroglycerin use
 See Chapter 23 for further discussion
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Slide 28
 Actions
 Inhibit flow of calcium ions across cell
membrane
 Reduce peripheral vascular resistance
 Improve coronary blood flow
 Uses
 Reduce incidence of MI, secondary prevention
for patients with known coronary artery
disease
 See Chapter 23 for further discussion
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Slide 29
 Actions
 Promote vasodilation, minimize cellular
aggregation, prevent thrombus formation
 Uses
 Reduce incidence of MI; secondary prevention
for patients with known coronary artery
disease (CAD)
 See Chapter 23 for further discussion
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Slide 30
 Approved by the FDA to treat intermittent
claudication due to chronic occlusive
arterial disease of the limbs
 Pentoxifylline (Trental) – hemorheologic agent;
enhances RBC flexibility
 Cilostazol (Pletal) – platelet aggregation
inhibitor
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Slide 31
 Calcium ion agonists
 Diltiazem (Cardizem)
 Nifedipine (Procardia)
 Verapamil (Calan, Isoptin)
 Adrenergic antagonists
 Prazosin (Minipress), reserpine
 Guanethidine (Ismelin), methyldopa
 ACE inhibitor
 Captopril (Capoten)
 Direct vasodilator
 Nitroglycerin (Nitrostat, Nitro-Bid, Nitro-Dur)
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Slide 32
 Primary purpose is to prevent platelet
aggregation or inhibit steps in the clotting
cascade
 Four types of agents
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Platelet inhibitors
Anticoagulants
Glycoprotein IIb/IIIa inhibitors
Thrombolytics
 Anticoagulation therapy prevents new clot
formation or extension of existing clots
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Slide 33
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Key in the treatment of conditions used to
control clots
Use medication administration record for
scheduling
Mark one-time dosages clearly
Never administer anticoagulants before
first checking the chart for most recent
laboratory results
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Slide 34
 Actions
 Inhibit platelet aggregation
 Uses
 Primary prevention of MIs and stroke; prevent
blood clots from forming
 Common adverse effects
 Abdominal distress, hypotension
 Serious adverse effects
 Neutropenia, agranulocytosis, bleeding
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Slide 35
 Actions
 Low molecular weight heparin (LMWH)
 Uses
 Prevent deep vein thrombosis after hip
replacements or abdominal surgery; prevent
MIs, combined with aspirin
 Common adverse effects
 Hematoma formation, bleeding at injection
site
 Serious adverse effects
 Bleeding, thrombocytopenia
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Slide 36
 Drug: heparin
 Actions
 In the presence of heparin, antithrombin III
neutralizes thrombin, factors IXa, Xa, XI, and XII,
as well as plasmin
 Uses
 Treat deep vein thrombosis, pulmonary
embolism, cerebral embolism
 Can be given subcutaneously, IV push, IV
infusion
 Dosages vary depending on route
 Monitor aPPT, platelets, hematocrit
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Slide 37
 Drugs: abciximab (ReoPro), eptifibatide
(Integrilin), tirofiban (Aggrastat)
 Actions
 Block receptors on platelets, preventing
aggregation and clot formation
 Uses
 Prevent clots forming from the debris often
released during percutaneous coronary
intervention (PCI) procedures
 Serious adverse effects
 Bleeding, thrombocytopenia
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Slide 38
 Drugs: streptokinase, alteplase (Activase),
reteplase (Retavase), tenecteplase
(TNKase)
 Actions
 Stimulate the bodies own clot-dissolving
mechanism, converting plasminogen to
plasmin, which digests fibrin
 Uses
 Dissolve fibrin clots secondary to coronary
artery occlusion (MI), pulmonary emboli,
cerebral emboli, deep venous thrombosis
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Slide 39
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Vasodilators – reduce strain on left
ventricle by reducing systemic vascular
resistance (afterload)
Inotropic agents – boost cardiac output by
stimulating the heart to increase force of
contractions
Diuretics – enhance sodium and water
excretion, reducing preload
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Slide 40
 Drug: digoxin (Lanoxin)
 Actions
 Positive inotropy
 Negative chronotropy
 Uses
 Treat moderate to severe systolic failure not
responding to diuretics and ACE inhibitors
 Serious adverse effects
 Digoxin toxicity
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Slide 41
 Drugs: inamrinone, milrinone (Primacor)
 Actions
 Increase the force and velocity of myocardial
contractions
 Uses
 Short-term management of systolic
dysfunction heart failure in patients not
responding adequately to digoxin, diuretics, or
vasodilator therapy
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Slide 42
 Actions
 Reduce afterload by blocking angiotensin IImediated peripheral vasoconstriction; reduce
preload
 Uses
 Treat mild to moderate systolic dysfunction
heart failure
 See Chapter 23 for further discussion
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Slide 43
 Actions
 Inhibit cardiac response to sympathetic nerve
stimulation; inhibit renin release
 Uses
 In combination with ACE inhibitors to treat
heart failure
 See Chapter 23 for further discussion
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Slide 44
 Drug: nesiritide (Natrecor)
 Actions
 Reduce preload and afterload pressures,
increasing diuresis and sodium excretion
 Suppress RAAS
 Reduce secretion of norepinephrine
 Uses
 Treat severe heart failure
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Slide 45
 Drug: acetazolamide (Diamox)
 Actions
 Weak diuretic; inhibits the enzyme carbonic
anhydrase in kidney, brain, eye
 Uses
 Reduces intraocular pressure with glaucoma;
reduce seizure activity with certain types of
epilepsy
 See Chapters 19 and 43 for further
discussion
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Slide 46
 Actions
 Inhibit sodium and chloride reabsorption in
ascending limb of the loop of Henle
 Uses
 Treat conditions such as edema resulting from heart
failure, cirrhosis of the liver, renal disease
 Common adverse effects
 Oral irritation, dry mouth; orthostatic hypotension
 Serious adverse effects
 Gastric irritation, abdominal pain; electrolyte
imbalance, dehydration; hyperuricemia;
hyperglycemia; hives, pruritus, rash
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Slide 47
 Actions
 Block reabsorption of sodium and chloride ions
from the tubule
 Uses
 Treat edema associated with heart failure, renal
disease, hepatic disease, pregnancy, obesity,
premenstrual syndrome
 Common adverse effects
 Orthostatic hypotension
 Serious adverse effects
 Gastric irritation, electrolyte imbalance,
hyperuricemia, hyperglycemia
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Slide 48
 Drugs: amiloride (Midamor), spironolactone
(Aldactone), triamterene (Dyrenium)
 Actions
 Induce retention of potassium; excrete sodium at
the distal renal tubules
 Uses
 In combination with other diuretics to treat
hypertension or heart failure, prevent
hypokalemia
 Common and serious adverse effects
 Nausea, vomiting, anorexia, flatulence, headache,
electrolyte imbalance, dehydration
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Slide 49
 Drugs
 Spironolactone/hydrochlorothiazide (Aldactazide)
 Triamterene/hydrochlorothiazide (Dyazide, Maxzide)
 Amiloride/hydrochlorothiazide (Moduretic)
 Actions
 Potassium-sparing diuretics / thiazide diuretics
 Uses
 Promote diuresis while maintaining normal potassium
levels
 Common adverse effects
 Hyperkalemia, hyponatremia
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Slide 50