Pharm Exam 3

What are the therapeutic uses for captopril

Treatment of Hypertension, Heart Failure, diabetic nephropathy, Left ventricular dysfunction

What are adverse drug reactions associated with captopril

Severe Hypotension

What interventions should be planned for client taking captopril

Start ACE inhibitors (Low dose)

Monitor BP

Monitor for and report Dry cough

Monitor for potassium levels

Monitor WBC with differential

What administrations considerations apply to Captopril

Oral Use only

Must be taken 2-3 times daily for Hypertension

Give 1 hour before meals for absorption

What education should be provided for captopril

Lie supine if lightheaded

Report dry cough

Report Rash

Report Muscle twitching (HyperKalemia)

What contraindications are there for Captopril

Angioedema

Liver Disease

Hypotension

Allergy to ACE inhibitors

What precautions are there for Captopril

Decreased renal function

Bone marrow depression

Cardiovascular disease

Cerebral vascular disease

Rheumatoid Arthritis

Hyperkalemia

Hyponatremia

Less effective in African American pts.

Older adults

What are the potential interactions for captopril

salt substitutes increase risk for Hyperkalemia

Antihypertensive drugs = increase risk for hypotension

NSAIDs may decrease effectiveness

What are the therapeutic uses for losartan

Treats hypertensions

Prevents stroke

Manages diabetic nephropathy

What are the adverse drug reactions with losartan

Angioedema

Headache

Dizziness

hypotension

insomnia

what interventions should be planned for losartan

discontinue if ARB angioedema occurs

Monitor for CNS effects

Monitor BP before giving losartan

what administrations considerations apply to losartan

ARBs are only available in Oral form

May be taken with or without food

what education should be given about Losartan

report swelling of the mouth and throat to provider

report headache or insomnia

Pregnancy category X

What contraindication are there for the use of losartan

Allergy

Pregnancy Category X

Children under the age of 6

Children over the age of 6 who have low creatinine

What precautions are there for the use of losartan

HyperKalemia

Liver or renal disorders

Concurrent diuretic use

Pregnancy

What are potential interactions for losartan

NSAIDs decrease the effectiveness of ARBs

Increased risk of renal complications

Antihypertensive drugs increase risk for hypotension

What are the therapeutic uses for spironolactone

Treats hypertension

Treats symptoms of heart failure following a MI

What are the adverse effects of spironolactone

HyperKalemia

What interventions should be taken for spironolactone

Monitor for signs of Hyperkalemia

Monitor potassium levels, BUN, & creatinine

what administration considerations apply to spironolactone

Oral use ONLY

Give alone

Maximum effect takes up to 4 weeks

What education should be provided for spironolactone

DO NOT take potassium supplements

DO NOT use potassium containing salt substitutes

Report palpitations, muscle twitching, weakness

What contraindications are there for spironolactone

Increased serum creatinine

Lactation

What precautions are there for spironolactone

Children

Liver failure or disease

What are the therapeutic uses for atenolol and metoprolol

Treat Hypertension

Treat angina pectoris

Treatment to decrease mortality following MI

Treat cardiac dysrhythmias

Treat Heart Failure

What are the adverse effects of atenolol and metoprolol

Bradycardia

Heart failure (shortness of breath, edema, coughing)

What interventions should be planned for atenolol and metoprolol

Monitor heart rate and report slower than 60 beats

Monitor for signs of heart failure

DO NOT STOP BLOCKER SUDDENLY

tapper dose slowly over 1-2 weeks for discontinuation

What administration consideration apply to atenolol and metoprolol

atenolol and metoprolol are available for ORAL OR IV use

give orally for hypertension

Give IV initially and then orally for acute MI

atenolol = available in tablets that can becrushedd

what education should be provided for atenolol and metoprolol

check pulse rate daily

shortness of breath and cough

do not stop taking abruptly

report new onset of chest pain to provider

what contraindications are there for atenolol and metoprolol

sinus bradycardia

moderate to severe heart failure

atenolol: peripheral vascular disease

metoprolol: children under the age of 6

what precautions are there for atenolol and metoprolol

Asthma

COPD

renal or liver disorders

myasthenia gravis

what are the adverse effects of digoxin

Cardiac dysrhythmias

digoxin toxicity

GI symptoms= nausea, vomiting, anorexia

CNS symptoms

Increased mortality in women

what are potential interactions for digoxin

Diuretics increase risk for digoxin toxicity by decreasing potassium levels

what interventions should be planned for carvedilol

monitor BP and report hypotension

monitor Heart rate and report slower 60

what education should be given carvedilol

report dizziness, syncope

move slowly from lying to standing position

what administration should be give about carvedilol

Oral use only

Give with food

What education should be provided for a client taking hydrochlorothiazide

eat foods rich in potassium (citrus fruits, potatoes, Bananas)

report signs of electrolyte imbalance

What administration considerations apply to atorvastatin

Oral Only

Most effectiveness take in the evening without food

what are the potential interactions for hydrochlorothiazide

increased risk of digoxin toxicity with potassium or magnesium

NSAIDs can reduce effectivness

What are the precautions of digoxin

Hypokalemia

Hypercalcemia

impaired kidney function

concurrent use of diuretics

What are the contraindications are there for the use of hydrohlorothiazide

Decreased urine output (anuria)

electrolyte imbalance

what are the adverse drug reactions associated with carvedilol

dizziness

hypotension

bradycardia

exacerbation of asthma

postural hypotension

what education should be given for furosemide

Eat foods rich in potassium (citrus fruits. potatoes, bananas)

report electrolyte imbalance

report dizziness & syncope

avoid hazardous activities

report hearing loss, ringing in ears, or vertigo

What administration consideration apply to hydrochlorothiazide

Available orally alone and fixed-dose combos

give with food

give last dose by 3pm

what are the therapeutic uses for carvedilol

treats hypertension

treats heart failure

prolongs chance of survival following MI

what contraindications are there for use of carvedilol

Unstable heart failure

asthma

severe bradycardia

Lactation/Pregnancy

cardiogenic shock

what contraindications are there for furosemide

hepatic coma

allergy

electrolyte imbalance

dehydration

anuria

what education should be provided for atorvastatin

report muscle pain

report abdominal pain, jaundice, fatigue

what administration considerations apply to furosemide

Available Oral, IM or IV

give oral form food

give IV form undiluted slowly

what education should be planned for digoxin

Vomiting = Hypokalemia

Monitor and report CNS effects

take the apical pulse for 1 full min

Monitor GI symptoms

Monitor cardiac rhythm

Antidote = DIGOXIN IMMUNE FAB (DIGIBIND)

what contraindications are there for atorvastatin

Not safe for pregnancy or lactation

current liver disease or elevated AST/ ALT

children younger 8 years old

what are the adverse drug reactions with furosemide

electrolyte imbalance

ototoxicity

hyperglycemia

hypotension

dehydration

hyponatremia

what administration considerations apply to digoxin

Available as oral tablets, capsules, elixir and IV

give oral with/without food

tablets may be crushed if needed

IV form give over at least 5 mins

what contraindications are there for digoxin

Ventricular dysthymias

Heart disease

digoxin toxicity

what precautions are there for carvedilol

children younger than 18

diabetes mellitus

renal or hepatic disorders

peripheral vascular disease

what are the therapeutic uses for digoxin

Second-line drug for HEART FAILURE

treats some cardiac dysrhythmias (atrial fibrillation& flutter)

what are the potential interactions for carvedilol

Alters effectiveness of insulin

may increase risk of digoxin toxicity and bradycardia

what are the adverse drug reactions with hydrochlorothiazide

electrolyte imbalance

hyponatremia

dehydration

hypokalemia (most common)

hyperglycemia

increased uric acid levels

what precautions are there for furosemide

renal or hepatic disorders

older adults

diabetes mellitus

pregnancy/ lactation

what are the therapeutic uses for hydrochlorothiazide

treats heart failure

treats cirrhosis of liver and renal failure

treats hypertension

what education should be planned for client taking atorvastatin

monitor for myopathy

measure muscle pain

monitor liver function tests

what potential interactions for furosemide

digoxin toxicity = Hypokalemia

NSAIDs can decrease the diuretic effect

neuromuscular blocking agents

ototoxicity

what are the therapeutic uses for atorvastatin

Reduces LDL and triglycerides

Increases HDL cholesterol

reduces risk and can prevent cardiovascular disease (heart attacks)

what are the therapeutic uses for furosemide

treats Pulmonary edema

treats edema

treats hypertension

what education should be planned for hydrochlorothiazide

monitor serum electrolytes

monitor electrolytes imbalance

monitor for dysrhythmias

monitor hypokalemia

monitor blood glucose

monitor uric acid levels

what are the adverse drug reactions for atorvastatin

myopathy (muscle pain)

hepatoxicity

what precautions are there for hydrochlorothiazide

renal or hepatic disorders

older adults

pregnancy/lactation

what are the precautions for atorvastatin

history of liver disorders

alcohol use disorders

renal disorders

what are the potential interactions for atorvastatin

liver toxicity

myopathy

NO GRAPEFRUIT JUICE

what are the therapeutic uses for nitroglycerin

Treatment and prophylaxis of angina pectoris

Rapid-acting (transmucosal tablets, translingual sprat, and sublingual tablets treat angina attack)

Longer-acting (regular tablets, sustained release prevent attacks from occurring)

IV nitroglycerin is used for unstable angina attacks & controls BP

what are the adverse effects of nitroglycerin

Headaches

Orthostatic hypotension,

Tachycardia

Tolerance develops (decreased effectiveness)

what interventions should be planned for nitroglycerin

Providers should avoid touching ointment when applying

Monitor length and severity of headache

Monitor baseline BP and pulse

Monitor Heart rate

Monitor drug tolerance

give nitroglycerin form in smallest needed amount

what administration considerations apply to nitroglycerin

Available in sublingual tablets, sustained release, translingual spray, transmucosal tablets, transdermal ointment patch, or IV

sublingual = if pain not relieved after 5 mins call 911, take 2nd tablet, take a third 5 mins later if no relief

Store tablets in a dark tightly closed container

transdermal = apply to hairless area and rotate site remove patch 10-12 hrs daily

what education should be provided for nitroglycerin

take over the counter analgesic for unrelieved headaches

report dizziness

move slowly from lying to standing

Do Not drive

Take pulse and report tachycardia

what contraindications are there for nitroglycerin

Allergy

Tolerance

Pregnancy/Lactation

increased intracranial pressure

severe anemia

pericardial tamponade

What precautions are there for nitroglycerin

head trauma

glaucoma

cardiomyopathy

severe liver disease

what are potential interactions for nitroglycerin

increased hypotension when mixed with alcohol

PDE5 inhibitors = severe hypotension

what are the adverse drug reactions with propranolol

bradycardia

heart failure

rebound excitation causing angina pain or MI

Peripheral arterial insufficiency

fatigue

drowsiness

confusion

what interventions should be planned for propranolol

Monitor heart rate (report lower than 60)

Monitor for signs of heart failure

Never stop med suddenly

Monitor color (temp, and pulses)

Taper over 1-2 weeks

Monitor for CNS effects

what administration considerations are for propranolol

Available for oral or IV use

IV = to life-threatening dysrhythmias

Take with or without food

Take BP and pulse before giving medication (lower 90/60)

IV= bolus over 1 minute

what education should be given for propranolol

check PR daily (report less than 60)

report shortness of breath

report peripheral edema

night cough

do not stop abruptly

report increased or new onset of chest pain

report cold or numbness in hands or feet

protect extremities from severe cold

NO DRIVING

what contraindications for propranolol

sinus bradycardia

pulmonary edema

Mitral or aortic valve disease

Cardiogenic shock

Peripheral vascular disease

Asthma

Severe COPD

what precautions are there for propranolol

hyperthyroidism

renal or liver disorders

myasthenia gravis

stroke

hypoglycemia

surgery

allergy (stinging insects)

older adults

what are potential interactions for propranolol

antacids may decrease absorption

digoxin has an additive effect= bradycardia

beta-blockers = neuromuscular blockers

hypoglycemia

what are the therapeutic uses for amiodarone

life-threatening ventricular tachycardia or fibrillation

atrial dysrhythmias

what are the adverse drug reactions for amiodarone

GI symptoms = nausea, vomiting, constipation, anorexia

Pulmonary toxicity

dizziness

fatigue

malaise

bradycardia/hypotension

blue-grey discoloration of skin

heart failure

what interventions should be planned for amiodarone

monitor GI symptoms

Test pulmonary function before treatment for baseline

auscultate breath sounds

Monitor for vision changes

Monitor pulse and BP

Monitor for bradycardia and hypotension

Monitor weight changes and edema

what administration considerations apply to amiodarone

Available for oral and IV use

Oral with/without food at consistent times

IV dose through central line catheter (prevent thrombophlebitis)

correct low potassium or magnesium levels before treatment

what education should be provided for amiodarone

take with food or milk

take at consistent times

report fever, dry cough, shortness of breath

report sensitivity to light and vision changes

avoid sun exposure

report dizziness or syncope (fainting)

report weight loss or edema

monitor pulse under 60

long half life

no pregnancies or breastfeeding

what are the contraindications of amiodarone

allergy

shock

bradycardia

pregnancy x

severe hepatic disease

what precautions should be used for amiodarone

hepatic disease

thyroid dysfunction

heart failure

electrolyte imbalance

pulmonary disease

what are potential interactions for amiodarone

GRAPEFRUIT JUICE

erythromycin

antifungal drugs

diuretics increase QT intervals

Beta-blockers & Calcium channel blockers = increased risk of bradycardia

what are the therapeutic use for verapamil

convert supraventricular tachycardia to sinus rhythm

slow rate of atrial fibrillation

Calcium channel blockers = treats angina and hypertension

what are the adverse drug reactions with verapamil

Hypotension (IV dose)

bradycardia (IV dose and oral)

heart failure

peripheral edema of feet and legs

lightheadedness (vasodilation)

what interventions should be planned for verapamil

IV form = monitor cardiac rhythm & lying supine for 1 hour

Oral = monitor blood pressure (report if lower than 90/60)

Monitor heart rate of less than 60

Monitor for edema

Monitor I&O’s and report low output

Monitor for crackles in lungs

what administration considerations apply to verapamil

Available in Oral and IV

Oral = with food

IV = dilution over 2-3 minutes

Monitor cardiac rhythm and vital signs

what education should be provided for verapamil

take medication as prescribed,

report dizziness and syncope

check pulse rate daily before taking medication

report swelling of feet

report shortness of breath

what are the contraindications for verapamil

known sensitivity to drug

Systolic BP less than 90mmHg

cardiogenic shock

sinus syndrome

2nd or 3rd degree AV block

what are the precautions for verapamil

severe hepatic dysfunction

history of heart failure

serious ventricular arrhythmias

Older adults = IV infusion at a slower rate and reduced dose

what are the potential interactions for verapamil

Digoxin levels increased = AV blocks

Beta Blockers increased = risk of bradycardia and heart failure

Hypotension

IV calcium decreases effects

large amounts of grapefruit juice = increased blood levels

Medications affecting Coagulation

Aspirin

Clopidogrel

Warfarin

Heparin

Enoxaparin

Alteplase

Antidotes for Anticoagulants