Pharmacology Module 2

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Pharmacology Module 2
2011-09-24 12:59:45

Antihypertensives, Antianginals, CHF Therapy, Thrombolytics, Antilipemics
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  1. simvastatin (Zocor)
    • Classification:
    • Cardiovascular: Antilipemics
    • HMG-CoA Reductase Inhibitors (statins)
    • Expected action:
    • -Increase HDL
    • -Decrease LDL
    • -Recommended to reduce mortality in pt’s with type 2 DM
    • -Decrease total cholesterol by inhibiting HMG-CoA reductase, an enzyme which synthesizes cholesterol in the liver
    • -Decrease triglycerides (VLDLs) by inhibiting
    • production of a lipoprotein (apolipoprotein C-III) responsible for stimulating
    • production of triglycerides by liver cells
    • Side and adverse effects (occur infrequently):
    • -Myopathy (pain in muscles and joints) can
    • progress to rhabdomyolysis (breakdown of muscle protein, causing kidney damage)
    • -Liver toxicity (more likely to occur in pt’s who
    • take a statin on a long term basis such as over 1 year)
    • Interventions:
    • -Monitor for muscle and joint pain and report
    • myopathy
    • -Measure creatine phosphokinase (CPK) levels if
    • muscle pain occurs
    • -Monitor liver function tests and report impaired
    • liver function
    • Patient education:
    • -Report unexplained muscle or joint pain
    • -Report abdominal pain, jaundice, or fatigue as
    • this could be an indication of liver dysfunction
    • -Comply with periodic liver function testing
    • (6-12 mo)
    • Contraindications:
    • -Pregnancy category X, lactation
    • -Current liver disease, jaundice, elevated
    • transaminase or greatly elevated AST or ALT
    • -Renal failure
    • -Rhabdomyolysis or myopathy
    • -Multiple sclerosis
    • -Children younger than 10 years of age
  2. gemfibrozil (Lopid)
    • Classification:
    • Cardiovascular: Antilipemics
    • Fibrate
    • Expected Pharmacologic Action:
    • -Activate a substance,
    • peroxisome proliferator activated receptor (PPAR alpha), found in the liver and
    • in certain adipose tissue in the body
    • -PPAR alpha increases production of an enzyme called LPL, which:
    • *Decreases production of
    • triglycerides (VLDLs
    • *Moderately reduces LDLs
    • -PPAR alpha also increases production of certain lipoproteins
    • (apolipoproteins A-I & A-II), which:
    • *Increase levels of HDL
    • Side and Adverse Effects:
    • -Gastrointestinal symptoms: nausea, vomiting, diarrhea
    • -Gallstones
    • -Myopathy (pain in muscles and joints)
    • -Liver toxicity
    • Interventions:
    • -Monitor for and report gastrointestinal symptoms
    • -Monitor for and report symptoms of gall bladder disease
    • -Monitor for and report myopathy
    • -Measure creatine kinase (CPK) if muscle pain occurs
    • -Monitor liver function tests and report impaired liver function
    • Patient education:
    • -Report GI symptoms to provider
    • -Report new inability to tolerate fried foods, upper abdominal
    • discomfort, and bloating (signs of gallbladder disease)
    • -Report muscle or joint pain
    • -Report abdominal pain, jaundice, and fatigue (signs of liver
    • disease)
    • -Comply with periodic liver function testing
    • Contraindications
    • -Gall bladder disease
    • -Liver dysfunction
    • -Severe renal impairmet
  3. Nitroglycerin