Pharm test 1

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erg333
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201193
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Pharm test 1
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2013-02-18 17:09:42
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pharm test nursing NYU
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pharm
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  1. Nitrates
    -pharmodynamics- causes generalized vascular    + coronary vasodilatation

    • ⋀ blood flow via coronary arteries to myocardial cells
    • ⋁myocardial ischemia but ⋁ BP
    • Variant ( vasospastic) Angina= 
    • - Relaxes coronary arteries=> ⋁ vasospasm +⋀ O2 supply
    • Classic ( Stable ) angina
    • - dilates veins => ⋁preload and ⋁ O2 demand
  2. Nitroglycerin
    • PO/ SL: comes in many doses
    • most common SL=> readily absorbed vs. swallowed=> bypass 1st pass effect
    • -SL onset 1-3 mins, duration 10 mins
    • - tabs decompose when exposed to sunlight = keep in specialized case.( 0.4 mg)
  3. nitro other routes
    • -IV dose
    • dilute with D5w or 0.9% NaCl

    • use glass infusion bottle and non polvinyl tubing cuz NTG absorbed via plastic
    • -Topical= apply transdermal path to chest or thigh. remove after 8-12 hours and wipe site. 
    • PO-extended release capsule.
  4. NTG: Pharmacodynamics
    • -reduces 02 demand
    • -acts on smooth muscle of blood vessels
    •      relax and dialation
    • ∨preload = amount of blood in RV at end of diastole.
    • ∨ afterload= peripheral vascular resistance
    • -enhanced if given + β blockers, Ca ++ channel blockers, antiHTN, ETOH
    • - IV NTG will decrease Heparin effects. 
    • - Don't give with Antihypertensives like viagra, cialis, levitra.
  5. NTG: Side Effects
    • H/A ( Most Common). May decrease with contd usage
    • - ∨ BP, dizziness, weakness, faintness.
    • - rebound myocardial ischemia if NTG is not tapered. 
    • - reflex tachycardia if NTG pushed too quickly
    • - watch for circulatory collapse.
  6. Beta Blockers
    • block βand β2 receptor sites
    • - ∨ effects of sympathetic NS via blocking ax of catecholamines
    • ( Epinephrine and Norep)
    • - ∨ HR and BP
    • Uses
    • - antianginal, antidysrhythmic, antihypertensive
  7. Beta Blocker Contraindications + interactions
    • contra- 
    • ∨ HR & BP
    • 2nd or 3rd degree AV block( conduction disturbances and possible death)
  8. Nonselective β- blockers
    • Propanolol ( Inderal)
    • - ∨ HR & BP
    • - Adverse reaction
    • bronchoconstricion
    • behavioral or psychotic rx 
    • impotence

    • - look closely at V/S
    • - Assess lungs before dose
  9. Selective β blockers ( mostly β1)
    • Metoprolol ( Lopressor)
    • - ∨ HR & BP
    • - monitor VS closely in early Tx
  10. Ca++ channel blockers
    • -neg inotropic effect: relaxation of smooth muscle.( Contractility)
    •      ∨ workload and O2 demand.
    • - ∨ afterload ∨ peripheral resistance
    •      ∨workload & O2 demand
    • Effective for 
    •      Classic ( stable): Odemand by relaxing peripheral arterioles.
    •      Variant ( vacospastic): Relaxes coronary arteries.
    • Other uses:
    • -dysrthmias
    • -HTN
  11. Ca++ blocker side effects
    • -H/A
    • - hypotension
    • - dizziness
    • -flushing
    • -reflex tachycardia r/t ∨ BP
    • - changes in liver & kidney f(x): √ labs
    • -don't push Nifedipine unless in SCD ( severe BP crisis)
  12. Nifedipine ( Procardia)
    • - Ca ++ channel blocker
    • -most potent 
    • -HYPERTENSION CAN OCCUR ( don't push)
    • - Highly protein bound
  13. Amlodipine ( Norvasc)
    • - Ca++ blocker
    • -Most recently invented
    • - highly protein bound
  14. Ca++ channel blocker Assessment
    • - Monitor BP & pulse
    • - Monitor EKG periodically => can prolong PR interval
    • -monitor I & O / daily wt
    • - assess for signs of CHF
    •    peripheral edema, crackles, dyspnea, wt gain, JVD
    • - IF on digoxin, monitor for serum digoxin level for toxicity.
  15. Anti-Anginals planning and ct teachings
    • - increase activity level in proportion to PT tolerance.
    • CT teaching
    • Instruct re: proper administration & possible drug interactions
    • - Notify HCP if angina unrelieved
    • - do not D/C without HCP
    • -Edu for S/E
    • - β blockers and Ca++ 
    •   teach to take own pulse
    •   => W/D sx severe

  16. Physiologic Risk Factors HTN
    • Diet:
    • Excess fat + carbs
    • Carbs can affect sympathetic NS
    • ETOH
    • Renin secretion=> ∧ angiotension II
    • Obesity:
    • ∧ CO, SV & Left Ventricular filling
    • - 2/3 of HTN's obese
    • Normal wt loss & mild to mod Na+ restriction => ∨ HTN
  17. HTN Guidelines
    • Normal <120/ <80
    • Pre-   120-139/80-89
    • 1 -   140-139/ 90-99
    • 2-    >160 />100
  18. AntiHTN cultural
    • -African-Americans get HTN at earlier age + have higher Mortality than whites
    • < effective β blockers + ACE inhibitors 
    • > effective α1 blockers+ Ca++  channel blockers
    • diuretics as 1° monotherapy
    • - Asians 2 x's as sensitive as whites to β blockers and other anti-HTN's. 
    • usually need ∨ dose
    • - Whites respond well to all Anti-HTN's.
  19. Anti-HTN drugs
    • -Diuretics
    • -Beta- Blockers
    • - Alpha2 agonists
    • - Alpha adrenergic blockers
    • - ACE inhibitors
    • - Angiotensin II receptor antagonists ( blockers)
    • - direct renin inhibitors
    • - Ca++ channel blockers
  20. Diuretics
    • - promote Na+ depletion => water depletion
    • ( ∨ extracellular fluid volume)
    • - 1° tx for mild HTN
    • Loop Diuretics- Furosemide ( Lasix)
    • - most powerful
    • inhibit the exchange of Cl, Na, K in thick segment of the ascending loop of Henle.
    • - Nausea, diarrhea, electrolyte imbalance (hypokalemia)
    • K-sparing diuretics
    • Inhibit reabsorption of Na in distal convoluted + collecting tubule.( no risk of hypokalemia)
    • Thiazides ( hydochlorthizide)
    • - Inhibit active exchange of Cl-Na in the cortical dilluting segment of the ascending loop of Henle.

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