PHARM: DRUGS and LECTURE Chapter 22 and 23
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Therapeutic Class: Antihyperlipidemic
Pharmacologic Class: HMG-CoA Reductase inhibitor
Mechanism of Action: Acts by inhibiting HMG-CoA reductase. Liver makes less cholesterol and creates more LDL receptors, decreases the amount of LDL in the blood
- Administration Alerts: Administer with food to reduce GI upset, may be taken anytime of day, OTC niacin can cause an increased risk for rhabdomyolysis
Adverse effects: Headache, GI upset(cramping, diarrhea, constipation), liver damage, rhabdomyolysis
- Contraindications: patients with liver disease, prior hyersensitivity, unexplained persistent elevation of transamines
- Therapeutic Class: Antihyperlipdiemic
- Pharmacologic Class: Bile Acid Resin
- Mechanism of Action: binds with bile acids (containing cholesterol) in an insoluble complex that is excreted in the feces
- Administration Alerts: mix thoroughly with liquid; drink immediately to avoid GI obstruction/irritation, give other drugs 2 hours before, or 4 hours after chlestyramine
- Adverse effects: constipation, bloating, gas, nausea
- Contraindications: patients with total biliary obstruction, prior hypersensitivity
- Therapeutic Class: Antihyperlipidemic
- Pharmacologic Class: Fibric Acid agent
- Mechanism of Action: UNKNOWN :up to 50% reduction in VLDL
- Administration Alerts: administer with meals to reduce GI distress
- Adverse effects: may increase likelihood of gallstones, may affect liver function, dyspepsia, diarrhea, nausea, cramping,
- Contraindications: hepatic impairment, severe renal dysfunction, pre-exisitng gall baldder disease, prior sensitivity
- Therapeutic Class: Drug for hypertension and edema
- Pharmacologic Class: Thiazide Diuretic
- Mechanism of Action: acts on the kidney tubule to decrease the reabsorption of Sodium(sent to the urine). Water flows with the sodium. Blood volume decreases and blood pressure falls
- Administration Alerts: administer early in the day to prevent nocturia
- Adverse effects: electrolyte imbalances due to loss of K+ and Na+, increase K+ intake as precaution, may precipitate gout attacks
- Contraindications: anuria
Nifedipine (Adalat, Procardia)
- Therapeutic Class: Drug for hypertension and angina
- Pharmacologic Class: Calcium Channel Blocker
- Mechanism of Action:Selectively blocks calcium channels in myocardial and vascular smooth muscle. Results in less oxygen utilization by the heart, increases Cardiac Output, decreases blood pressure
- Administration Alerts: DO NOT administer immediate-release formulation if MI is suspected or within 2 weeks after a confirmed MI
- Adverse effects: related to vasodilation: headache, dizziness, peripheral edema, flushing, reflex tachycardia
- Contraindications: prior hypersensitivity
Therapeutic Class: Drug for hypertension and heart failure
Pharmacologic Class: ACE (angiotensin-converting enzyme) inhibitor
Mechanism of Action: reduces angiotensis II and aldosterone levels to produce significant reduction in blood pressure
- Administration Alerts: may produce first-dose phenomenon (profound hypotension which may result in syncope)
- Adverse Effects: may cause hyperkalemia, orthostatic hypertension, headache, dizziness, angioedeme, neutropenia, aranulocytosis
Contraindications: prior hypersensitivity, pregnancy, lactation
- Therapeutic Class: Drug for hypertension and BPH
- Pharmacologic Class: Alpha-1-adrenergic blocker
- Mechanism of Action: dilates arteries and veins by blocking alpha-1 receptors in vascular smooth muscle
- Administration Alerts: monitor for profounf hypotension and possible syncope (first-dose phenomenon)
- Adverse Effects: orthostatic hypotension, dizziness, headache
- Contraindications: prior hypersensitivity to alpha blockers
- Therapeutic Class: Drug for hypertension and heart failure
- Pharmacologic Class: Direct-acting vasodilator
- Mechanism of Action: direct vaso-dilation of arterial smooth muscle (no affect on veins)
Administration Alerts: abrupt withdrawal may cause rebound hypertension and anxiety
Adverse Effects: headache, reflex tachycardia, palpitations, flushing, nausea, diarrhea. Rarely: a lupus-like syndrome that could persist for 6 months or longer, sodium and fluid retention
Contraindications: patients with angina, rheumatic heart disease, MI, tachycardia, lupus
A fat-like substance that is found in certain foods and is also produced in the body by the liver
What are the different types of cholesterol?
HDL-high density lipoprotein
LDL- low density lipoprotein
VLDL-Very low density lipoprotein
What are triglycerides and what purpose do they serve in the body?
main consituent of animal fat, serve as energy source and transporter of dietary fat
What is hyperlipidemia?
An increae in the amount of lipids in body that can start to cause problems
What is the purpose of lipoproteins?
transfer cholesterol from liver to tissues and organs
What are some problems that occur when there is excess LDL?
extra is placed in storage on lining of blood vessels and can cause plaques to build up, which can lead to coronary artery disease
What is atherosclerosis?
hardening of the arteries
What are some causes of atherosclerosis?
lipids get into vascular endothelium white blood cells try to clear them. WBC release growth factors that promote plaque formation, plaques block the artery which becomes rigid and can't constrict and dilate normally
What are some drug interactions for atorvastatin (lipitor)?
Interacts with macrolide anitbiotics, azole antifungals, and immunosupressant agents. These should be avoided because they interfere with statin metabolism. Increase risk of rhabdomyolysis
What are some risk factors that a patient would be put on atorvastatin (lipitor)?
risk factors for atherosclerosis: High BP, overweight, smoking, family history, high LDLs, diabetes
Why are patients with diabetes at higher risk for atherosclerosis?
they have smaller LDL paticles that can be more penetrating and damaging to arteries.
What are some areas to monitor/consider when a Nurse has a patient on atorvastatin (lipitor)?
assess liver function (liver function test): more liver enzymes means the liver is being damaged.
perform tests before treatment begins, and after 6-12 weeks
perform tests when there is a dose increase
lipitor is an adjunct to a low cholesterol diet not a replacement
Why is it better to give statin drugs at night?
cholesterol biosynthesis is higher at night
What are some drugs that interact with bile acid binding agents?
tetracyclines, digitalis, penicillins, thyroid hormone, thiazide diuretics: bile acid binding agents bind with these and decrease their absorption
Bile acid binding agents can interfere with the absorption of ?
fats and fat soluble vitamins A,D,E,K--important to monitor for deficiency of vitamins A and D
What are some nursing considerations for administering Bile acid binding agent?
tell patient to take drugs before meals, bile sequestrant powders must be mixed with water or fruit juice, bile acid sequestrants decrease the ability of the body to absorb numerous drugs, long term use may increase bleeding tendency from hyperprothrombinemia(caused by Vitamin K deficiency)
take before meals, drink plenty of fluids and increase bull in diet to reduce constipation, serum cholesterol levels should be checked, other drugs should be taken 1 hour before or 4-6 hours after
What is the mechanism of action for gemfibrozil (Lopid)?
It decreases the hepatic triglyceride production by reducing VLDL synthesis, inhibiting peripheral lipolysis(breakdown of fat). It interferes with the synthesis of LDL and VLDL.
inflammation of blood vessels
What are some key adverse effects of gemfibrozil (Lopid)?
CNS--chills/fatigue, vasculitis, blurred vision, cataracts, abdominal pain, epigastric pain anemia, leukopenia
What are important nursing considerations for someone taking gemfibrozil (lopid)?
monitor serum triglycerides and cholesterol levels as appropriate, reveiw CBC and liver function test periodically, caution to avoid hazardous activities until CNS effects are known
What is the mechanism of action for nicotinic acid when treating hyperlipidemia?
it reduces teh production of triglycerides therefore interfereing with changing from VLDL to the LDL. It also causes a rise ih HDL.
What are some side effects of nicotinic acid?
FLUSHING and HOT FLASHES in almost EVERY CLIENT, variety of intestinal effects (nausea, excess gas, diarrhea), not prescribed for patients with diabetes because it can raise fasting glucose levels, can get OTC, but should not be used to decrease lipids with consulting a doctor
What is hypertension?
consistent elevation of systemic arterial blood pressure normal =120/80
What organs are affected by hypertension?
TIA-transient ischemic attack, heart failure, renal failure, visula impairments/blindness, CVA(cerebral vascular accident)
What factors are responsible for blood pressure?
cardiac output (volume pump per minute), blood volume (fluid loss, fluid retention), peripheral resistance (sympathetic nervous system, renin/angiotensin, increase in blood viscosity)
What are some effects of chronic hypertension?
heart must work harder to pump blood to organs and tissues (fluid can back up into the lungs), adversely affect the vascular system (decrease blood flow to brain and vital organs
What are some drugs used for hypertension?
diuretics, calcium channel blockers, drugs affecting the renin/angiotensin system, adrenergic antagonist, centrally acting agents, direct vaso-dilators, beta-adrenergic blockers
When would diuretics be used?
indicated in the presence of fluid retention, treatment of heart failure/CHF, hypertension. They enhance renal excretion of NA+ and water
What is the mechanism of action for diuretics?
reduce blood volume, reduce peripheral edema, and reduce pulmonary or systemic congestion
How do loop diuretics work?
work to move large volumes of fluid and work quickly especially if given by IV. (lasix) They are K+ losing drugs--need to monitor potassium levels
Why are hydrochlorothiazide and spironalactone sometimes prescribed together?
thiazide diuretics are K+ losing and spironalactones are K+sparing. It is less effective diuretic but helps to spare K+
What are possible adverse effects of diuretics?
K+ loss (hypokalemia) when using lasix and thiazide diuretics, hyperkalemia. Both hyper and hypokalemia can cause dysrhythmias, dehydration, and electorlyte imbalance
What are some important administration and nursing considerations for giving diuretics?
monitor labs, strict intake and output, weigh patient daily, monitor for dysrythmias and hypokalemia
What are the actions of calcium channel blockers?
used for patients where heart needs rest, reduces the amount of calcium that enters the muscle cells in the coronary walls, muscle spasms can be prevented. some decrease the workload in the heart by decreasing vascular resistance and increasing coronary blood flow, some lower the heart rate, reduce myocardial oxygen demand
What are some uses for calcium channel blockers?
treat and prevent unstable angina, hypertension, prevent and control tachycardia, treat post MI complications
What are some important nursing considerations when using calcium channel blockers?
When starting and stopping theray should be tapered over 7-14 days, urge patient to take exactly what is prescribed even if feeling well, should measure pulse rate and BP regularly/call provider if it falls below accepted level
What are some administration and nursing considerations for giving agiotensin-converting enzyme(ACE) inhibitors?
begin with lowest dose and gradually increase, always take BP prior to administration, ACE inhibitors are often taken with diuretics to reduce BP, all can be taken with meals except: captopril and moexipril, monitor for first dose phenomenon--give normal saline(NS) to increase volume
What are some adverse effects of ACE inhibitors?
hypotension, hyperkalemia( when taking with K+sparing diuretics), angioedema (swelling of tissue below surface of skin), cough, dizziness, headache.
- AVOID: K+sparing diuretics
- DO NOT give to patients in renal failure
- MONITOR: ECG, intake/output
What is the mechanism of action for direct renin inhibitor?
Aliskirin (Tekturnal)--acts on renin to inhibit conversion of angiotensin into angiotensin I, take PO, side effects same as ACE inhibitors but to lesser extent, approved only for the treatment of hypertension
What is the mechanism of action for Alpha-1 (cardura)--adrenergic antagonist
completely inhibits alpha-1 adrenergic receptors in sympathetic nervous system causing peripheral dilation and reduced peripheral vascular resistance. It is given for benign prostatic hyperplasia(enlarged prostate) and hypertension. Decreases BP especially when patient stands.
What are common side effects for beta adrenergic antagonists?
bronchoconstriction and bradycardia--use caustiously with asthmatics, rebound HTN, angina, MI--if stopped abruptly
What are some common side effects for alpha-1 adrenergic antagonists?
orthostatic hypotension, dizziness, nausea, drymouth, impotence
What are some important nursing considerations for administering adrenergic antagonists?
teach client to take own pulse and blood pressure, monitor cardiac response, compliance is a major problem, encourage discussion of sexuality as related to drugs, warn not to stop taking abruptly, grapefruit and antacids may impair affects of some hypertensive drugs
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