Download Week 8 Review Pharmacology

Week 8 Review Pharmacology
Ch. 41 & 42
Ch. 41 Antihypertensive Drugs
HTN = >______BP?
150/90
_________HTN is the most common type, 90% have this kind.
Essential HTN
Contributing factors to essential htn include (8)
1-family hx
2-hyperlipidemia
3-black
4-diabetes
5-obesity
6-aging
7-stress
8-smoking/alcohol
10% of htn is related to ______ & ________and is called ________HTN.
renal and endocrine disorders
called secondary htn
Blacks are less responsive to _____&_____ HTN meds? (need diuretic w/)
ACE inhibitors & beta blockers
Nonpharmacologic control of HTN includes (5):
1-stress reduction
2-exercise (increase HDL)
3-salt restriction
4-decrease alcohol
5-weight reduction
By _____years of age, 50% + have HTN.
60 years
The Sympatholytics comprise 5 groups of drugs (5):
1-beta-adrenergic blockers
2-centrally acting sympatholytics
(adrenergic blockers)
3-alpha-adrenergic blockers
4-adrenergic neuron blockers
(peripherally acting sypatholytics)
5-alpha1, and beta1 adrenergic
blockers
Beta blockers are used as step ______ antihypertensive drugs.
step 1
Some beta blockers can cause diabetics to become __________ (glucophage)
Beta blockers reduce ______ _______, diminishing sympathetic NS
Response and thereby diminishing vascular resistance.
__________ beta blockers such as propranolol (Inderal), inhibit beta1(heart)
and beta2(bronchial) receptors, heart & resp rates slow with secondary
blood pressure decrease and bronchoconstriction.
hyperglycemic
cardiac output.
Nonselective
___________ beta blockers are preferred because they act mainly on
the beta1 rather than the beta2 and ____________is less likely.
Cardioselective,
bronchoconstiction
__________is the most-used cardioselective beta blocker.
Metoprolol (Lopressor)
Interactions for metoprolol (Lopressor) =
Increase bradycardia w/ digitalis,
alcohol
Contraindications for metoprolol (Lopressor) =
Bradycardia, hepatic/renal
SE for metoprolol (Lopressor) =
Decreased BP, fatigue, dizziness,
mental changes (slow),
impotence, decreased libido,
depression, insomnia, nightmares
Don’t ________ ________ Lopressor b/c of ________ HTN
Abruptly stop rebound htn
Methyldopa (Aldomet) may be used in combo with a _____________.
Diuretic
This herb decrease or counteract antihypertensives:
Ephedra (ma huang),
These 2 herbs decrease effect of beta blockers &/or lower BP:
Black cohosh (antihypertensives),
Hawthorn(> effect betas and ACE’s)
________ ________ __________don’t have an effect on the kidneys, etc.
Centrally acting sympatholytics
Don’t use them with _____________b/c of bradycardia and rebound effect
With discontinuation.
Beta blockers
Main drug in this group is __________.
Methyldopa (Aldomet)
Methyldopa (Aldomet) is usually given with ________b/c of edema.
Diuretic
SE of methyldopa (Aldomet) = (2)
Peripheral edema, dry mouth
_______ ________ blockers are not as popular. Ex. = Prazosin (Minipress)
Alpha adrenergic blockers
Orthostatic hypotension is a common SE of ____________
Adrenergic neuron blockers
Adrenergic neuron blockers are part of step ________
IV (last resort)
Reserpine, guanethidine (Ismelin) may cause SE of ___________ (ck)
Nightmares, hallucinations
Alpha1 and beta1 adrenergic blockers include ____________
Labetalol (Trandate, normodyne)
Labetalol (Trandate, Normodyne) are taken how often?
Bid, q12 hrs.
These are for stage ____htn. May be used alone or w/ _____.
1-2, diuretic
The alpha1 and beta1 adrenergic blockers Labetalol (Trandate, Normodyne)
May not be combined with _______ _______, but this is popular drug.
There are SE’s but most tolerate well.
They are not for ___________, (not cardioselective.)
_______is highly protein bound and can displace other P-B drugs.
Alpha adrenergic blockers general SE:
Beta blockers
Asthmatics
Prazosin (Minipress)
Rebound htn
Orthostatic hypotension
Dizziness, drowsiness
Impotence
Edema
Don’t mix cold/cough/allergy meds
Direct-acting arterioloar vasodilators:
Step III
What step are these?
______ _________is for hypertensive crisis, may cause major hypotension
Sodium nitroprusside (Nipride,
Nitropress)
Other SE’s of direct acting arteriolar vasodilators: (3)
Edema, Tachycardia, confusion
ACE inhibitors:
These are used for htn and ________ pts.
Heart failure
These are usually used with __________, and don’t need to add _______.
Diuretics, vitamin K
These drugs are not intended for _____________________________.
General SE’s: (5)
Monitor ______.
Examples of ACE inhibitors mentioned:
1st line antihtn therapy
dry cough,
diarrhea,
dizziness,
fatigue,
hyperkalemia
creatinine
captopril(Capoten);
benazepril (Lotensin)with
amlodipine (Lotrel) (combo w/
Ca+ blocker)
Angiotensis II Receptor Anagonists (A-II blockers) include ________.
Caution with diabetes, heart failure, renal dysfx
Losartan (Cozaar)
Calcium channel blockers
They decrease Ca+ levels and promote ________. They affect the _____
Arteries first then the ___________.
Vasodilation, coronary,
Peripheral arteries
Most frequently used Ca+ channel blocker =_____________
Verapamil (Calan) SR
It is also used for ________ _________ & _____________
Stable angina,
Rt. side CHF/dysrhythmias
Diltiazem (Cardizem) is used PO for ______and IV for _______.
PO Htn,
IVheart (atrial fib)
Nefedipine (Procardia) used to inject oil portion under tongue but too many SE’s
SE’s of Calcium channel blockers: (6)
1-flush
2-headache
3-dizziness
4-ankle edema
5-bradycardia,
6-AV block
Major SE of sympatholytic (betas) and direct-acting vasodilators is _________.sodium/water retention
[metoprolol (Lopressor), methyldopa(Aldomet), nitroprusside (Nipride)]
Pt should wear medicAlert bracelet with _______because they block the
compensatory effects of the body to the shock state. Glucagon may be
needed to reverse the effects so the pt can be resuscitated.
Beta blockers
____________is the most commonly prescribed diuretic for htn. Diuretics
are as effective as 1st line drugs for mild htn.
Hydrochlorothiazide
(HydroDiuril) [a thiazide]
In the step approach, stage 1 htn is paired with step 1 protocol, and so on,
To avoid ___________. But many Dr’s individualize treatment.
Side/adverse effects, which are
more likely with each step.
Stepped Care Approach
Step 1
Diuretic
Beta Blocker
Calcium Blocker
ACE inhibitor
Modified Pharmacologic Approach
Lifestyle changes
Decrease wt., sodium intake, alcohol, smoking
Increase exercise
BP remains high
Step 2
Diuretic with Beta Blocker
Sympatholytics
Step 3
Direct-acting vasodilator
Sympatholytic with Diuretic
Diuretic or Beta Blocker
BP remains high
Increase drug dose or substitute:
Calcium blocker, OR
ACE inhibitor, OR
A-II blocker, OR
Combination drug
BP remains high
Step 4
Adrenergic Neuron Blocker
Combos from Steps 1-3
Diuretic w/ Beta Blocker or add a 2nd drug:
Calcium blocker, OR
ACE inhibitor, OR
Alpha Blocker, OR
Centrally acting sympatholytic
BP remains high
Add 2 or 3 drugs:
Alpha Blocker, OR
Direct-acting vasodilator, OR
Adrenergic Neuron Blocker
Ch. 42 Drugs for Circulatory Disorders
5 major groups:
1-anticoagulants
2-antiplatelets
3-thrombolytics
4-antilipemics
5-peripheral vasodilators
Anticoagulants are used in clients with venough and arterial vessel
disorders that put them at high risk for ________ ________.
The venous disorders include (2):
The arterieal disorders include (3):
clot formation
DVT, pulmonary embolism
MI, artificial heart valves, CVA
Anticoagulants
______________is the most frequently used anticoagulant.
Heparin
______and _______ are monitored during heparin therapy.
PTT (Partial Thromboplastin
time)
APTT(activated partial
thromboplastin time)
_____is monitored during use of Warfarin(Coumadin):
PT & INR (Internat’l normalized
ratio)
Pts are warfarin are maintained at an INR of __________.
2.0-3.0 (3.5 on overhead)
Heparin is given where? ___________
Heparin is usually given as ________then ______based on wt & PTT:
Warfarin (Coumadin) is given where?
how often?
Joint Contraindications:
Hemophilia, ulcer, liver/kidney
Heparin: stage 3-4 htn,
dissecting aneurysm
Warfarin: blood
discrasias, acute MI, alcoholism
When should pt take warfain to avoid SE’s?
SE heparin:
SE warfain(Coumadin)
PO
Protamine sulfate
What is the antidote for warfarin (Coumadin)?
Interactions warfarin(Coumadin):
Bolus, SC q1hr (book q8hr)
q/day
What is the antidote for heparin?
Interactions heparin:
Abdomen (don’t rubbruise)
Aquamifitin (vit. K)
Quinidine, digoxin,
Increase effect w/
aspirin/NSAIDS, decrease effect
w/ nitro, protamine, CVA
Increase effect w/ amiodarone,
Aspirin/NSAIDS, CVA
Hs
Itching, burning
Anorexia, nausea
adverse reactions heparin/warfarin:
adverse reaction for warfarin:
Bleeding (gums, hematuria,
epistaxis), ecchymoses
Stomatitis
Oral anticoagulants inhibit hepatic syntheses of ______thus affecting clotting
factors II, Vii, IX, and X. Used to prevent thromboembolic conditions such
Vitamin K
as thromobphlebitis, pulmonary embolis, and embolism from atrial fib (which
can lead to CVA)
_____________________comes prepackaged in syringe with an
air bubble, you keep it in to avoid bruising, lasts longer than heparin.
____, ______&_______ may increase bleeding w/ warfarin (anticoagulants)
_____, _________& ___________may decrese the effects of warfarin
client teaching for anticoagulants (3)
Antiplatelets (=>prophylactics)
Antiplatelets are used to prevent thrombosis in the arteries by suppressing
_________ __________.
Used mainly prophylactically for (3)
Enoxaparin sodium (Lovenox)
Garlic, anise & ginger
Ginsing, alfalfa & valerian
Soft toothbrush, electric shaver,
MedicAlert bracelet
Platelet aggregation.
1- MI or stroke b/c family hx
2- repeat MI
3-stroke for those w/ TIA’s
aspirin, clopidogrel (Plavix)
Common antiplatelet drugs are (2):
clopidogrel (Plavix)
____________, usually taken q24hrs is more effective than aspirin.
Two other antiplatelet drugs:
Dipyridamole (Persantine),
ticlopidine (Ticlid)
Thrombolytics:
Used in ER for ________ or ________.
CVA or aneurysm
Most used thrombolytic is________.
Streptokinase (streptase,
Kabikinase)
SE’s of streptokinase are (4):
1-headache 2-flush
3-rash
4- fever
Start streptokinase as a _____determined by weight in ________ _______.
Need to start within _______ _______, doesn’t work well on old clots.
Antilipemics
Cholesterol should be <_______mg/dl
Dietary modification will typically lower cholesterol by ____-____%
bolus, femoral artery,
2-3 hours of MI, etc.
200
10-30%
The antilipemics _______ are used prophylacticly w/ risk of CAD
Statins
Examples include:
atorvastatin calcium (Lipitor),
lovastatin (Mevaclor),
Simvastatin (Zocor)
Contraindication for locastatin(Mevaclor) is _____________, also liver disease Acute clotting situation
SE’s of lovastatin(Mevaclor) are: (3)
1-abdominal pain at first
2-nausea
3-pruritus
Adverse reaction to lovastatin(Mevaclor): (statins)
rhabdomyolosis- fever
A patient with hx of gallbladder disease but no surgery candidate may get
__________ __________(_________), comes in a powder- mix well in fluid
cholestyramine resin
(Questran)
_____ _______(_______)is not tolerated well by many, used sporadically
nicotinic acid(Niacin)
atorvastatin calcium (Lipitor) is taken ________/day
1x/day
With statins, we monitor __________________&_____________.
liver & blood lipid levels q6-8wks
Watch for _______-associated with rhabdomyolosis
muscular tenderness/weakness
Pt should not _______when taking statins?
stop abruptly (rebound effect)
____________is common SE of statins
GI
Peripheral vasodilators
Used for ____________ __________, they increase blood flow to extremities
Vascular insufficiency
More effective for disorders resulting from ___________ _________ than
vessel occlusion or arteriosclerosis.
Vasospasm (Raynaud’s)
Sx-cool, intermittent leg pain
Most used is ___________(___________)
Isoxsuprine(Vasodilan,
Vasoprine)
SE’s are (3)
Dizziness, tremors,
Chest pain(discontinue)
The only actual blood thinner is _________(_________). (Thins viscosity)
Pentoxifylline(Trental)
It is taken how often? For those with ___________________.
~~~~Tx may take 1 ½ to3 month~~~~(vasodilators)
t.i.d. with meals
(ck compliance)
tortuous, wind-y leg veins
For those with peripheral vascular disorders, alleviates _________ ________
intermittent claudication
SE’s include (2)
tremors, dizziness, orthostatic
htn,