Pharm Drug Cards

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Pharm Drug Cards
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2010-04-06 15:11:09
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  1. –Neutral fats
    –90% of all lipids in the body
    Triglycerides
  2. –Helps with plasma membrane building
    Phosopholipids
  3. –Most commonly called cholesterol
    –Widely known to cause atherosclerosis
    Steroids
  4. –Transports cholesterol out of tissues
    –AKA good cholesterol
    High Density Lipoprotein HDL
  5. –Transport cholesterol into the tissues–AKA bad cholesterol
    Low Density Lipoproteins (LDL)
  6. –Precursor of LDL
    –Primary carrier of triglycerides in the blood
    • Very low density lipoprotein
    • VLDL
  7. •Pr: atorvastatin (Lipitor)
    •Action: interferes with the synthesis of cholesterol in the liver
    •Use: ↓LDL, VLDL, triglyceride levels; ↑HDL
    •Adverse effects: HA, fatigue, muscle or joint pain, and heartburn
    Statins for reducing blood lipids
  8. •Pr: cholestyramine (Questran)
    •Action: binds with bile acids in the GI tractto increase excretion of cholesterol in the stool
    •Use: ↓LDL levels
    •Adverse effects: more SE than statins; GI c/o’s; bloating, constipation, steatorrhea
    Bile Acid Resins; Sequesterants for Reducing Blood Lipids
  9. •Pr: niacin (B complex vitamin)
    •Action: ↓ VLDL level, ∴↓ LDL level
    •Use: ↓ VLDL, triglyceride levels; ↑ HDL
    •Adverse effects: more SE than statins; flushing (take ASA), hot flashes, N/D, excess gas, hepatotoxicity. Can raise blood glucose in diabetics.
    Nicotinic Acid for Reducing Blood Lipids
  10. •Pr: gemfibrozil (Lopid)
    •Action: unknown, but it ↓ VLDL and ∴ triglycerides, and ↑ HDL
    •Use: severe hypertryglyceridemia
    •Adverse effects: GI distress, watch for bleeding with clients on anticoagulants
    Fibric Acid for Reducing Blood Lipids
  11. •Pr: ezetimibe (Zetia)
    •Action: inhibits the absorption of cholesterol
    •Use: modest reduction of LDL
    •Adverse effects: none
    Cholesterol Absorption Inhibitors for Reducing Blood Lipids
  12. •Assessment
    •Nursing Diagnosis–Knowledge deficit regarding condition–Ineffective regimen management–Risk for bleeding
    •Planning: the client will:
    •Implementation
    Nursing Process for Lipid Disorders
  13. Cardiovascular Disease (CVD)
    • •Includes conditions of heart and blood vessels
    • •Hypertension is most common form of CVD
    • •Most frequent causes of death in U.S
    • •Target organs
    • •Disease progression
  14. Hypertension: Classified into Three Categories
    • •Pre-hypertension
    • •Stage 1
    • •Stage 2
    • •“Normal” B/P at one age; abnormal as we age
  15. Goals and Drug Selection of Antihypertensives
    •Goal of antihypertensive therapy
    •A single drug begins anti-HTN therapy
    •Stepped care
    •Hypotension (orthostatic) can be caused by ANY drug that alters the BP
  16. •Pr: hydrochlorothiazide (Hydrodiuril)
    •Action: increase urine output to reduce blood volume to reduce resistance
    •Use: mild to moderate HTN
    •Adverse effects: electrolyte imbalances, especially potassium
    Diuretics for Hypertension
  17. •Pr; nifedipine (Procardia)
    •Action: prevents Ca from entering muscle, relaxing arterioles (vasodilates)
    •Use: hypertension and angina
    •Adverse effects: dizziness, HA, flushing, reflex tachycardia. Can become toxic with grapefruit juice (causes greater absorption, causing a greater response.)
    Ca Channel Blockers for HTN
  18. •Pr; enalapril (Vasotec)
    •Action: ACE inhibitors block angiotensin I→II (powerful vasoconstrictor). Also, it decreases reabsorption of Na causing increased urine excretion
    •Use: HTN, HF, and MI
    •Adverse effects: persistent cough, orthostatic hypotension, angioedema
    Angiotensin Converting Enzyme (ACE) Inhibitors for HTN
  19. •Pr: losartan potassium (Cozaar)
    •Action: blocks angiotensin receptors in arterial smooth muscle (after II is formed)
    •Use: HTN
    •Adverse effects: hypotension
    Angiotensin-Receptor Blockers (ARBs) for HTN
  20. •Pr: doxazosin (Cardura)
    •Action: blocks affects of sympathetic nervous system leading to vasodilation
    •Use: HTN
    •Adverse effects: orthostatic hypotension, nausea, bradycardia, dry mouth
    •SE are predictable fight or flight
    Adrenergic Blockers for HTN
  21. •Pr: hydralazine (Apresoline)
    •Action: cause vasodilation by direct relaxation of arterial smooth muscle
    •Use: severe hypertension and hypertension crisis (2 minute half life)
    •Adverse effects: reflex tachycardia, sodium and fluid retention
    Direct Vasodilators for HTN
  22. •Diuretics–Electrolyte labs, daily weight
    •Ca Channel Blockers
    •ACE Inhibitors
    •Adrenergic Blockers
    •Direct Vasodilators
    Nursing Considerations for Antihypertensives
  23. •Prototype; lisinopril (Prinivil, Zestril)
    •Action; enhances excretion of Na & water
    •Use; lowers BP and peripheral resistance
    •Adverse effects; first-dose hypotension, cough, hyperkalemia, RF6djm6Diuretics
    ACE Inhibitors: HF Drug of Choice
  24. •Prototype; furosemide (Lasix)
    •Action; to increase urine excretion, reducing blood volume (peripheral resistance) and cardiac workload
    •Use; reduce edema and pulmonary congestion
    •Adverse effects; dehydration, electrolyte imbalance, hypotension, ototoxicity
    Diuretics for HF
  25. •Prototype; metoprolol (Lopressor, Toprol XL)
    •Action; slows the heart rate and ↓ BP resulting in ↓ cardiac workload
    •Use; to reduce symptoms of HF and slow progression of disease
    •Adverse effects; fluid retention, worsening of HF, fatigue hypotension, bradycardia, heart block
    Beta Adrenergic Blockers for HF
  26. •Prototype; isosorbide dinitrate (Isordil)
    •Action; Directly relax blood vessels and ↓BP resulting in ↓preload, and ↓workload
    •Use; to lower BP, especially for those who cannot take ACE Inhibitors
    •Adverse effects; reflex tachycardia, orthostatic hypotension
    Vasodilators for HF
  27. •Prototype; digoxin (Lanoxin)
    •Actions; a more forceful, slow heart beat
    •Use; increase the contractility or strength of myocardial contraction
    •Adverse effects; Narrow margin of safety, dysrhythmias, digitalis toxicity, visual #s
    Cardiac Glycosides for HF
  28. •Prototype; milrinone (Primacor)
    •Action; positive inotrope, blocks enzyme phosphodiesterase in cardiac and smooth muscle, and ↑ contractility
    •Use; a short-term therapy for HF
    •Adverse effects; Very toxic, hypokalemia, hypotension, supra and ventricular dysrhythmias11djm11Nursing
    Phosphodiesterase Inhibitors for HF
  29. •Prototype drug:nitroglycerin (Nitrostat)
    •Action:potent coronary artery vasodilator
    •Use:for lowering myocardial oxygen demand
    •Adverse effects:hypotension, dizziness, blurred vision, dry mouth, headache17djm17Beta
    Nitrates for Angina
  30. •Prototype drug:atenolol (Tenormin)
    •Action:slows rate and reduces contractility to reduce cardiac workload
    •Use:for prophylaxis of chronic angina
    •Adverse effects:hypotension, dizziness, fatigue during exercise18djm18Calcium
    Beta Adrenergic Blockers for Angina
  31. •Prototype drug:diltiazem (Cardizem)
    •Action:relax coronary arteries (dilate) to reduce cardiac workload
    •Use:for lowering blood pressure
    •Adverse effects:hypotension, bradycardia, heart failure, constipation
    Calcium Channel Blockers for Angina
  32. •Prototype drug:reteplase (Retavase)
    •Action:to dissolve clots obstructing coronary arteries
    •Use:for restoring circulation to myocardium
    •Adverse effects:excessive bleeding21djm21Other
    Thrombolytics for MI
  33. •Prototype drug:procainamide (Pronestyl)
    •Action:Blocks Na channels, therefore slowing conduction of stimulus
    •Use:to correct atrial and ventricular dysrhythmias
    •Adverse effects:can create new dysrhythmias or worsen existing ones–Lupus effect, NV, abdominal pain, headache–High doses can produce CNS effects29djm29Beta
    Sodium Channel Blockers(Class I)
  34. •Prototype drug:propranolol (Inderal)
    •Action:to block beta receptors, which ↓HR, conduction velocity& automaticity
    •Use:atrial dysrhythmias associated with HF
    •Adverse effects:bradycardia, hypotension with dizziness and fainting–Bronchospasms, hypoglycemia, diminished libido
    Beta-adrenergic Blockers (Class II)
  35. •Prototype drug:amiodarone (Cordarone)
    •Action:blocks potassium channels in myocardial cells, which prolongs duration (refractory period) of action potential (slows)
    •Use:to treat resistant ventricular tachycardia, atrial dysrhythmias with HF
    •Adverse effects:blurred vision, pneumonia-like syndrome, bradycardia, hypotension–Can create new dysrhythmias or worsen existing ones–Restricted use because of serious SE
    Potassium Channel Blockers (Class III)
  36. •Prototype drug:verapamil (Calan)
    •Action:to block calcium-ion channels, which reduces automaticity of the SA node and slows impulse through AV node
    •Use:to treat supraventricular tachycardia
    •Adverse effects:bradycardia, hypotension, headache
    Calcium Channel Blockers (Class IV)
  37. •Prototype drugs:heparin (parenteral) and warfarin (Coumadin) (po) (LMWH: low molecular weight heparins)
    •Action:to inhibit platelet aggregation (“clumping”) to ↓formation or enlargement of clots (do not “thin” blood)
    •Use:to prevent thrombi from forming or enlarging, prevent formation of clots in veins, treat thromboembolic disorders
    •Adverse effects:abnormal bleeding
    Parenteral and Oral Anticoagulants
  38. •Prototype drug:(ADP receptor blocker) clopidogrel (Plavix)
    •Action:platelets do not aggregate (clot)
    •Use:to prevent thrombi formation after a stroke (CVA) or myocardial infarction (MI)
    •Adverse effects:abnormal bleeding
    Antiplatelet Aggregate Drug for Anticoagulants
  39. •Prototype drug:aminocaproic acid (Amicar)
    •Action:to prevent fibrin from dissolving clots
    •Use:To promote formation of clots by preventing and treating excessive bleeding from surgical sites, therefore shortens bleeding time
    •Adverse effects:May cause hyper-coagulation (clots) with concurrent use of estrogens and oral contraceptives45Nursing
    Hemostatics (Antifibrinolytics) Drugs that Promote the Formation of Clots
  40. •Prototype drug: erythropoietin, epoetin alpha (Epogen, Procrit)
    •Action: hormone secreted by kidneys, sends message to bone marrow to increase erythrocyte production
    •Use: treatment of anemia
    •Adverse effects: hypertension, seizures
    •Nursing cons: HTN, thromboembolism, H/H
    Hematopoetic growth factor
  41. •Prototype drug: filgrastim (Neupogen)
    •Action: to increase neutrophil production
    •Use: chemo, organ transplant, AIDS complications, severe bacterial infections
    •Adverse effects: bone pain, allergies, thrombocytopenia
    •Nursing cons: WBC levels, not given within 24 hours of chemo. Report dyspnea, tachycardia, and low BP
    Colony stimulating factors
  42. •Pr: oprelvekin (Neumega): only drug in this class
    •Action: Stimulates thrombopoeitin to increase production of platelets
    •Use: chemo pts with thrombocytopenia
    •Adverse effects: fluid retention
    •Nursing cons: do not give within 24 hours of chemo
    Platelet enhancers
  43. •Prototype drug: cyanocobalamin (Crystamine, vitamin B12, others)
    •Action: to replace vitamin B12
    •Use: treatment of vitamin B12 deficiency
    •Adverse effects: diarrhea, hypokalemia, rash, anaphylaxis
    •Nursing cons: stools may be dark green or black
    Pernicious Anemia
  44. •Prototype drug:ferrous sulfate (Feosol)
    •Action:to supplement iron needed by body
    •Use:to treat iron deficiency
    •Adverse effects:–Nausea, heartburn, constipation, dark stools
    •Nursing cons: give 1 hour before or 2 hours after a meal, take as directed since excessive doses can be toxic
    Iron deficiency anemia
  45. •Prototype drug: normal serum albumin (Albuminar, Albutein)
    •Action: to maintain plasma osmotic pressure and transport substances through blood
    •Use: restoration of plasma volume and blood proteins
    •Adverse effects: allergies and protein overload
    Colloid
  46. •Pr: norepinephrine (Levaterenol, Levophed)
    •Action: to act directly on alpha-adrenergic receptors to raise blood pressure; also has positive inotropic effects
    •Use: treat acute shock and cardiac arrest
    •Adverse effects: tachycardia, bradycardia, and hypertension
    Sympathomimetics
  47. •Prototype drug: dopamine (Dopastat, Inotropin)
    •Action: is dose dependent; low doses = dopaminergic effect, high doses = beta-adrenergic effect
    •Use: to treat septic and cardiogenic shock
    •Adverse effects: dysrhythmias, hypertension, gangrene
    Inotropics (Cardiotonic Agents)
  48. •Prototype drug: epinephrine (Adrenalin)
    •Action: for use as nonselective adrenergic agonist
    •Use: to treat anaphylaxis, shock, cardiac arrest
    •Adverse effects: hypertension and dysrhythmias
    Sympathomimetic/ Anaphylaxis
  49. •Prototype; furosemide (Lasix)
    •Action: Block reabsorption of Na in loop
    •Uses: treat HTN, Moderate to severe fluid retention from HF, hepatic cirrhosis, RF
    •Adverse effects: rapid, large excretion of urine, dehydration and electrolyte imbalances, ototoxicity
    pharmacotherapy with loop diuretics
  50. •Prototype; chlorothiazide (Diuril)
    •Action: Block reabsorption of sodium, in distal tubule, increasing urine excretion
    •Uses: Mild to moderate hypertension
    •Adverse effects: Dehydration, orthostatic hypotension, hypokalemia
    pharmacotherapy with thiazide diuretics
  51. •Prototype: spironolactone (Aldactone)
    •Action: blocks aldosterone by not reabsorbing Na (and water) and not excreting K
    •Use: mild diuresis in HF
    •Adverse effects: hyperkalemia
    pharmacotherapy with potassium sparring diuretics
  52. •Prototype; dextran 40
    •Action: raise oncotic pressure of blood, therefore pulling water and expanding plasma volume within minutes
    •Use: fluid replacement for hypovolemia D/T hemorrhage, surgery, severe burns
    •Adverse effects: hypersensitivity reactions fluid overload, HTN
    IV fluid therapy with Colloids
  53. •Prototype; Sodium chloride (NaCl)
    •Major electrolyte in ECF
    •Connected to water balance: water travels toward or with Na
    •Regulation of Na output is important function of kidneys
    •Hypernatremia: Na level > 145 mEq/L
    •Hyponatremia: Na level < 135 mEq/L
    pharmacotherapy of sodium imbalances
  54. •Prototype; potassium chloride
    •Most abundant electrolyte in ICF
    •Renal excretion closely linked with that of sodium
    •Hyperkalemia: K level > 5 mEq/L
    •Hypokalemia: K level < 3.5 mEq/L
    pharmacotherapy of potassium imbalances
  55. •Prototype; potassium chloride
    •Most abundant electrolyte in ICF
    •Renal excretion closely linked with that of sodium
    •Hyperkalemia: K level > 5 mEq/L
    •Hypokalemia: K level < 3.5 mEq/L
    pharmacotherapy of acidosis
  56. •Prototype; ammonium chloride•Alkalosis develops at pH values > 7.45•Symptoms; nervousness, hyper reflexes, convulsions: slow, shallow respirations to retain CO2•Causes;–Respiratory: hyperventilation (asthma, anxiety)–Metabolic: prolonged constipation, excess sodium bicarbonate, potassium depleting diuretics, severe vomiting
    Pharmacotherpay of alkalosis

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