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Exam 3 Ace Inhibitors, ARBS, Calcium Channel Blockers, Beta Blockers, Hydralazine, Nitroglycerin, Diuretics, Digoxin, Cholesterol Reducing drugs, Anticoagulants, Antiplatelets, Thrombolytic Drugs.
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Lasix is the most common Loop Diuretic, what are its pharmacokinetics?
- PO, IV, or IM.
- IV is for critical situations
- Hepatic Metabolism, and Renal excretion
What is the function of a Loop Diuretic?
- Lowers BP by reducing blood volume and promoting vasodilation.
- **this diuretic promotes the MOST volume because its action of blocking Na and Chloride reabsorption is in the loop of henle.
- AFFECTS THE PRELOAD
What are the 3 types of Diuretics?
Loops, Thiazides, and K Sparings
What special consideration does Nitro indictate?
Must be kept in the dark to prevent light exposure from desinigrating the medication and the med should be discontinued slowly.
What meds interact with Nitro?
- BP meds
- Beta Blockers (Verapamil, Diltiazem)
- Hypotensive Drugs
Adverse effects of Nitro include:
flusing, headache, reflex tachycardia, decreased BP, hypotension, dizziness
Nitro is used to treat:
CAD and Angina
What are the pharmacokinetics of Nitro?
- Not PO
- given transdermal (patch good for 12 hrs), sublingual, buccal, and spray (x3 max)
What is the mechanism of action of Nitroglycerin(Nitro)?
Dilation of the veins and vascular smooth muscle to decrease O2 demand, and pressure on veins (decreases chest pain)
What type of medication is Nitroglycerin?
What medications interact with Hydralazine?
- Beta Blokcers help protect against the reflex tachycardia
- Diuretics prevent Na and water retension and expansion of BV
- BP meds will intensify
- Antihypertensive meds need monitoring
What are some adverse effects of Hydralazine?
- Reflex Tachycardia
- Increase of Blood volume
- Lupus-like syndrome
What is Hydralazine use for:
- Hypertensive crisis *first drug of choice for emergency
Explain the pharmacokinetics of Hydralazine.
- Absorbed PO and parenteral which is faster.
- Inactivated by metabolic process: Acetylation. The pace is genetically determined; those that acetylate slow have higher blood levels of the drug which can result in undesirable effects.
Hydralazine works to decrease BP by:
Dilation of the arteries that results from direct action of the vascular smooth muscle
What type of medication is Hydralazine?
This is a vasodilator
Beta Blockers common end with:
Beta Blockers are contraindicated in pts with:
- Diabetes (caution- can mask the signs of hypoglycemia)
- Sick sinus syndrome
- or 2nd-3rd degree Heart Block
What are some adverse effects of Beta Blockers?
- Sometimes blockade of the B1 cells can cause: brady cardia, and decreased AV conduction
- Blockade of B2 cells promotes Vasoconstriction.
- Common side effects:
- bizarre dreams
- sexual disfunction
What is the therapeutic use of Beta Blockers?
- Anginal Pectoris (stable)
- NOT Vasopactic angina
Beta blockers work by:
- Blocking primarity B1 cardiac cells, and also some B2 pulmonary cells
- (Causing decreased contractility, and decreased respiratory rate)
What are some examples of Beta Blocker medications?
Can a pregnant woman take any ARB medications?
No, can cause fetal harm
Calcium Channel Blockers are contraindicated in pts wtih:
What are some things that should be monitored as a nurse with a pt taking a Calcium Channel Blocker medication?
- Monitor the BP
- and Administer this med on an empty stomach.
What are the therapeutic uses of Calcium Channel Blockers?
- Cardiac Dysrhthmias
- Angina Pectoris
- Essential Hypertension
- Sometimes Migranes
What are the adverse effects of Diltiazem?
- exacerbation of cardiac dysfunction
- sick sinus syndrome
- Less constipation than verapamil
What are the adverse effects of Verapamil?
- Facial Flushing
- Edema of the feet and ankles
What medications interact with Verapamil and Diltiazem?
Digoxin (risk of AV block is increased) and Beta Blockers (risk of excessive cardio suppression)
What are the two main Calcium Channle Blockers?
Verapamil, and Diltiazem
How do Calcium Channel Blockers work?
Block calcium channels in the heart and the blood vessels; reduces HR, increases coronary perfusion, dilation of arteries, decreased AV nodal conduction, decreases the force of contraction
What does a Calcium channel blocker typically end in?
Can you take antihypersensitive drugs with ARBs?
No, they interact
What are some adverse effects of ARBs?
- Fetal Harm
- Renal Failure
What are the therapeutic uses of ARBs?
- Stroke prevention
What are some examples of ARB medications?
What are the pharmacokinetics of ARBs?
PO with or without food; metabolized in the liver, excreted in the kidneys
What are the therapeutic uses of ACE Inhibitors?
- L Ventricular dysfunction
- Prevention of death in pts with high risk for cardiovascular evetns.
What is the Mechanism of action of an ARB?
Blocking the actions of Angiotensin II; causing a dilaton of the arterioles & veins (decreasing BP) which decrease the release of aldosterone.
What do ARBs commonly end in?
What do ACE Inhibitors commonly end in?
What are some things that you want to monitor as a nurse with a pt taking ACE Inhibitors?
- Monitor the WBC, K level, and BP
- *educate on eating low K foods and avoiding OTC drugs
Can Lotensin or Enalapril be given to a pregnant woman?
No, ACE Inhibitors pose fetal injury.
What are some adverse effects of ACE Inhibitors?
- Dry cough
- Renal Failure
- First dose Hypertension
Nearly all ACE Inhibitors are PO with food, but what are the two that need to be given 1hr before meals?
Meoxipril, and Captopril
What are some examples of ACE Inhibitor Drugs?
What is the Mechanism of Action of an ACE Inhibitor?
Blocking of Angiotensin I to Angiotensin II; this decreases aldosterone and kinase and increases bradykinin. Overall, vessels dilate (decreasing BP), and blood volume degreases.
Niacin is used for:
Hypercholesterolema, decreases LDL & Tryglycerides, increases HDL
SPecail considerations for pts taking streptokinase:
- NOT for pregnant women
- NOT for pts with ischemic stroke in last 3 months; or intracranial hemorrhage prior, or internal bleeding. Should be given within 3 hrs of onset.
Streptokinase adverse effects:
- Antibody production causing allergy or neutralization to med
- Acute MI
- Massive pulmonary embolism
How can streptokinase be given administered?
IV infusion, or infusion into the coronary artery
Streptokinase works by:
indirect mechanism: binds to plasminogen to form the active complex then converts to plasmin- plasmin digests clots and clotting factors
Streptokinase is what kind of drug?
A Thrombolytic drug "clott buster"
Pletal medications Interactions include:
Omeprazole, grapefruit, sertraline, erythromycin, ketocanazole, fluoxetine
Pletal adverse effects:
- preipheral edema
Platel (cilostazol) uses:
Intermittent claudication (arterial insuficiency)
Pletals mechanism of action is what?
- inhibits platelets and vasodilates. Suppresses by inhibiting PDE3
Ticlid (ticlopidine) , an antiplatelet drug, works similar to which other antiplatelet drug?
Plavix medication interactions and side effects:
- Side effects: GI, same as aspirin
- Interactions: Prilosec and drugs that promote bleeding
Prevention of stroke, stenosis of coronary stens and MI
Plavix can be taken with or without food?
Either way is fine
Plavix (clopidogrel), an antiplatelet drug, works by:
blocking ADP receptors on the platelets, preventing the formation of platelets
Aspirin adverse effects:
- GI bleeding
- Peptic ulcer disease
- Increased risk of hemmorrhagic stroke
- CAD- to keep injured vessel from clotting up
- Chronci stable angina
Aspirin inhibits platelet formation by:
causing irreversible inhibition of cyclooxygenase; and inhibiting synthesis of prostacyclin
The 4 Antiplatelet drugs that we are studying include:
Special implimentations when taking warfarin:
- monitor INR, PT< and CBC
- For Atrial fibrilation or stroke- pts INR should be 2-3
- For valve replacement INR shoud be 2.5-3.5
Interactions with Warfarin include:
- Sulfa drugs
- Vitamin K
Warfarin uses include:
- Long term prophylaxis of thrombosis
- ATRIAL FIBRILATION
- pulmonary embolism
- reduces risk of MI
Warfarin is excreted in the :
urine and feces
Warfarin, aka coumadin, works by:
- suppressing coagulation by producing clotting factors VII, IX, X, and prothrombin.
- It is a vitamin K agonist
Can enoxaparin be taken by a pregnant woman?
Yes; drug of choice of anti-coagulants
Enoxaprin antidote is same as regualr heparin which is:
Lovenox is used for:
- DVT prevention following surgery
- prevention of ischemic complication swith unstable angina
Enoxaprin (Lovenox) can only be given what way?
Enoxaparin (Lovenox) works by what mechanism:
Inactivates Xa factor, this is a low molecular heparin
Heparin is contraindicated in pts :
- Post of
- Low platelet count
- lumbar puncture
- bleeding disorders
Interactions with Heparin:
- Protamin Sulfate- antidote for overdose
- NSAIDs - promotion of bleeding
Adverse effects of Heparin:
- Haparin induced thrombocytopenia
- Hypersensitivity rxns
- Long term treatment can cause osteoporosis
- can be used during pregnancy- (preferred)
- Pulmonary edema
- renal dyalisis
- Acute MI
- Venous thrombosis (post-op)
- IV (fast) or SubQ- NO PO
- hepatic metabolism, excreted in the kidney
Heparin works by:
inactivating thrombin and factor Xa which causes suppression of fibrin (no clott without fibrin)
3 types of Anti-coagulants medications are:
- Enoxaparin (lovenox)
- Warfarin (Coumadin)
Ezetimibe is not recommended in pts with:
Liver impairment; or the elderly
Ezetimibe works better when combine with what meds?
Ezetimibe adverse effects:
- NOT for pregnanty women
Ezetimibe (Zetia) works as a what? How does it work?
- -Cholesterol reducer
- -works by: inhibiting absorption of cholesterol; works on the brush border of the small intestine
What drugs interact with Fibrates
- WARFARIN- risk of bleeding
- Statins- increase risk of myopathy
What can high tryglyceride levels cause damage to?
What are adverse effects of Fibrates?
- GI upstet
- Gall stones
- liver injury
What are the therapeutic uses of Fibrates?
- High trygliceride levles
- Needing to raise HDL
Fibrates work to:
- Lower tyrglyceride levels by breaddown of lipoproteins from tissues, removes them from the plasma.
- Interacts with PPAR alpha receptor in the liver and adipose tissue
What are some examples of Fibrate medications?
- Gemfibrozil (lopid)
- Fenofibrate (tricor)
What can you take with Niacin to releave the flushing and itching?
Interactions of Niacin with other drugs include:
- Slo-niacin is most likely to cause liver damage
- Consult Dr. before taking with STATINS
What are some adverse effects of Niacin?
- Bodily flushing
- GI upset
Nicotinic acid is also known as:
Niacin, or Vitamin B3
Bile Acid sequestrants are contraindicated in pts with:
Intestinal problems, crones, or colitis
What are drugs that interfere with Bile acid sequestrants?
- Thiazides diuretics
- Some antibiotics
- GRAPEFRUIT, and other gas producing foods
What are some adverse effects of Bile sequestrants?
- decrease in uptake of fat-soluble vitamins
Bile sequestrant uses:
Treats Hypercholesterolemia in conjuction with diet and exercise
Bile acid sequestrant pharmacokinetics:
- Works only in INTESTINE
- excreted through kidneys
- Can not be broken down in GI or by digestive enzymes
Bile sequestrants work by:
forming insoluble solids in the intestine preventing reabsorption of bile acids and accelerates their excretion- reducing LDL
What is an example of a Bile Sequestrant medication?
What would you want to measure as a nurse with a pt taking lipitor?
- Monitor ASD, ALT labs
- watch for signs of muscle pain
- watch LDL levels- normal <120, if chronically ill pt can be <100
- Teaching: omega 3, fish, exercise, diet
HMGCOA adverse effects:
- NOT for pregnanty women
- Muscle Myopathy/Rhabdomyolysis
- Kidney Failure
Uses of HMGCOA's include:
Pharmacokinetics of HMGCOAs?
- PO, take at night because liver produces cholesterol then
- Metabolized in liver- Hepatoxic
How do HMGCoA's work?
decreases LDL and Increases HDL by inhibiting the HMG-CoA enzyme which inhibits VLDL which causes LDL to lower
What do HMG-CoA's commonly end in?
What are some examples of HMG-CoA drugs?
What are the 5 types of cholesterol reducing drugs?
- HMG-CoA inhibitors
- Bile Acid Sequestrants
- Nicotinic Acid
What do you watch for as a nurse with a pt taking digoxin?
- Watch HR, and level of drug closely
- Labs- the OPTIMAL RANGE IS: 0.5-0.8
What meds interact with Digoxin?
- Thiazides, and loop diuretics
- ACE inhibitors
- Sympathomimetics- act on heart ot increase force of contraction
- Quinidine- this is an anti dysrhythmic that can cause increased digoxin levels
- VERAPAMIL- can significantly increase plasma levles- could also counter act the benefits
What are the adverse effects of Digoxin?
- Decreased sypathetic tone
- Increased urine production
- decreased renin release causing decreased blood volume
- ventricular fib
- visual disterbances
What are the pharmacokinetics of Digoxin?
- PO- meals high in bran can decrease absorption
- Distributed widely and across placenta
- Excretion in kidneys after liver metabolism which is minimal
Explain the mechanism of action of Digoxin.
- Inhibits sodium, potassium, and ATPase- promoting Ca accumulation within the myocytes and facilitates the interaction of myocardial contractile proteins: actin and myosin.
- They exert positive inotropic action on the heart ; increasing force of ventricular contraction- increasing cardiac output.
What type of medication is Digoxin?
Drugs that interact with Spironolactone:
- ACE Inhibitors
- Aldosterone antagonists- because of hyperkalemia promotion
- ***NOT to be taken with K supplement.
What is the mechanism of action of spironolactone?
- Blocks aldosterone action in the kidneys.
- *Small degree of diuresis so the hypotensive effects are modest.
What is the main K Sparing Diuretic?
Give some examples of K rich foods?
Bananas, citris fruits
Thiazides interact with what meds?
- NSAIDs, K sparing diuretics, Digoxin.
- Caution in pts with diabetes!
Adverse effects of thiazides include:
Uses of thiazides include:
HTN and Edema
What is the action of a thiazide diuretic?
Blocks tha Na reabsorption in the DCT in the kidney by two mechanisms: reducing blood volume and by reducing the arterial resistance
What is an example of a Thiazide diuretic?
What are special considerations of Loop diuretics?
- Best time to take this med is in the morning
- Usually takes a K supplement with this because of the loss of K with the Na.
Medications that interfere with loop diuretics include:
- Ototoxic drugs
- K sparing drugs
Loop diuretics must be cautioned in pts with:
The adverse effects of loop diuretics include:
- Hearing Loss
What are the therapeutic uses for all diuretics?
- - CHF (primarity spironolactone)
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