UVM pharmacology exam 2

Hypertension drugs & prototypes

Hypertension drugs & prototypes

Angiotensin-converting enzyme inhibitors (ACE): captopril (Capoten)
Angiotensin II receptor blockers (ARBs): losartan (Cozaar)
Aldosterone antagonists: eplerenone (Inspra)
Direct renin inhibitors: aliskiren (Tekturna)
Calcium channel blockers (CCB): nifedipine (Adalat, Procardia)
Alpha I blockers: doxazosin (Cardura)
Beta blockers: metoprolol (Lopressor)
Direct acting vasodilators: hydralazine

Angiotensin- converting enzyme inhibitors: prototype

captopril (Capoten)

ACE: EPA

blocks ACE (enzyme that converts ang I to II in RAAS) --> decreases vasoconstriction & aldosterone --> leads to vasodilation & K retention

ACE: admin

PO

ACE: therapeutic use

HTN
HF (decreases SVR)

ACE: ADRs

dry cough
OH
hyperkalemia, angioedema (allergy swelling), dysgeusia (taste distortion)
rash

ACE: cont/ints

teratogenic
liver disease w/ elevated liver enzymes (non controlled liver disease)
ints: avoid NSAIDS

ACE: RN intervention

avoid salt substitutes (contains high K)
monitor: BP, K value (should be 3.5-5)
educate on cough

Angiotensin II receptor blockers (ARBs): prototype

losartan (Cozaar)

ARBs: EPA

blocks ang II's aldosterone secretion & vasoconstriction --> inc renal blood flow --> vasodilation & K retention

ARBs: admin

PO

ARBs: therapeutic use

HTN, stroke prevention, diabetic nephropathy, HF

ARBs: ADRs

angioedema
dizziness, headache
hypotension
insomnia

ARBs: cont/ints

teratogenic
children < 6 y/o
Ints: lithium, NSAIDS

ARBs: RN intervention

monitor: BP, K value (lower risk of hyperkalemia than ACEs), angioedema (facial/ tongue swelling)

Aldosterone antagonists: prototype

eplerenone (Inspra)

Aldosterone antagonists: EPA

blocks aldosterone --> Na excretion, K & water retention

Aldosterone antagonists: admin

PO
takes multiple weeks to work

Aldosterone antagonists: therapeutic use

HTN, symptoms of HF after a MI

Aldosterone antagonists: ADRs

hyperkalemia (v common)

Aldosterone antagonists: cont/ints

breastfeeding
caution in children, hyperkalemia & meds that raise K serum
ints: lithium, NSAIDS

Aldosterone antagonists: RN intervention

avoid salt substitutes
Monitor: BP, K, BUN, creatinine
s/sx of hyperkalemia

hyperkalemia s/sx

palpitations. diarrhea, slow irregular HR

Direct renin inhibitors: prototype

aliskiren (Tekturna)

Direct renin inhibitors: EPA

binds with renin --> inhibits angi I --> vasodilation, Na & water excretion

Direct renin inhibitors: admin

PO
takes multiple weeks to work

Direct renin inhibitors: therapeutic use

HTN

Direct renin inhibitors: ADRs

GI: dyspepsia, diarrhea, abd pain
cough, angioedema, hyperkalemia (less common)

Direct renin inhibitors: cont/ints

teratogenic
caution in < 18 y/o, hyperkalemia and meds that raise K
Ints: lipitor

Direct renin inhibitors: RN intervention

avoid fatty foods and salt substitutes
monitor: BP, K, BUN, creatinine
hyperkalemia s/sx

Calcium channel blockers (CCBs): prototype

nifedipine (Adalat, Procardia)

CCBs: EPA

blocks Ca channels in vascular smooth muscles of peripheral arteries --> vasodilation & lower BP

CCBs: admin

PO (IR, ER)

CCBs: therapeutic use

HTN, stable angina

CCBs: ADRs

reflex tachycardia
angina
gingival hyperplasia
vasodilatory effects: headache, dizziness, flushing, peripheral edema, arrhythmias

vasodilatory effects

headache, dizziness, flushing, peripheral edema, arrhythmias

CCBs: cont/ints

avoid in children, 2-3rd degree heart blocks, a SBP < 90
ints: grapefruit juice, anti seizure meds

CCBs: RN intervention

monitor: fall risk, BP, HR, peripheral edema
dental check ups
no grapefruit and hold for SBP < 90!

Alpha I blockers: prototype

doxazosin (Cardura)

Alpha I blockers: EPA

blocks A1 receptors --> causes venous and arteriolar dilation --> lowers BP

Alpha I blockers: admin

PO
at bedtime

Alpha I blockers: therapeutic use

HTN
benign prostatic hypertrophy

Alpha I blockers: ADRs

orthostatic hypotension
reflex tachycardia
headache, dizziness

Alpha I blockers: cont/ints

avoid in children & liver disease
Ints: sildenafil (Viagra)

Alpha I blockers: RN intervention

Monitor: fall risk, BP
raise slowly from sitting to standing for OH

Beta blockers: prototype

atenolol (Tenormin)
metoprolol (Lopressor)

Beta blockers: EPA

blocks beta 1 receptors --> decrease HR and contractility, reflex tachycardia and CO blocks renin release by blocking b1 in kidneys

Beta blockers: admin

PO, IV

Beta blockers: therapeutic use

HTN
angina
dysrhythmias
MI
HF

Beta blockers: ADRs

bradycardia, HF
rebound excitation from withdrawal

Beta blockers: cont/ints

avoid in children < 6 y/o
1st degree heart blocks, HF, asthma/COPD
Int: oral hypoglycemics

Beta blockers: RN intervention

Monitor: BP, HR
s/sx of heart failure
hold for SBP < 90 and HR < 60
taper!

Direct acting vasodilators: prototype

hydralazine

Direct acting vasodilators: EPA

acts directly on arterioles to relax smooth muscle --> vasodilation

Direct acting vasodilators: admin

PO, IV

Direct acting vasodilators: therapeutic use

HTN and HTN crisis

Direct acting vasodilators: ADRs

reflex tachycardia
fluid retention
dizziness

Direct acting vasodilators: RN intervention

monitor BP
taper!

heart failure: drugs & prototypes

inotropic agents:
1. cardiac glycoside: digoxin (Lanoxin)
2. sympathomimetics: Dobutamine
3. phosphodiesterase Inhibitor: Milrinone
adjuvants:
1. loop diuretics: furosemide (Lasix)
2. thiazide diuretic: Hydrochlorothiazide (HCTZ)
3. aldosterone agonist: spironolactone

Inotropes

drugs that change the force of heart muscle contractions
inotropic effect: changes in cardiac contractility when inotropes are administered

positive inotropic effect (PIE)

increase the force of the heart's contractility: heart pumps more with fewer beats

inotropic agents: class and prototype

cardiac glycoside: digoxin (Lanoxin)
sympathomimetics: Dobutamine
phosphodiesterase inhibitor: Milrinone

cardiac glycoside: prototype

digoxin (Lanoxin)

digoxin: EPA

positive inotropic effects
inhibits Na, K, ATPase --> increases force of contractility

digoxin: admin

PO
IV slow

digoxin: therapeutic use

managing HF with reduced ejection fraction

digoxin: ADRs

digoxin toxicity!!!
narrow therapeutic window
antidote: antigen binding fragments- digibind (digoxin immune fab)

digoxin toxicity s/sx

n/v
dysrhythmias, AV block, PVCs
vision disturbances

digoxin antidote

digibind (digoxin immune fab) --> antigen binding fragments

digoxin: cont/ints

caution with infants, children, older adults
avoid pts with ventricular dysrhythmias and AV blocks
Ints: many meds and herbs

digoxin: RN intervention

admin 1 hr prior to antacid everyday at same time
monitor: HR (hold < 60), serum level, toxicity s/sx, IV site (vesicant!)

sympathomimetics: prototype

Dobutamine

dobutamine: EPA

beta I adrenergic agonist --> positive inotropic effects (increase contractility)

dobutamine: admin

IV

dobutamine: therapeutic use

severe HF
short term therapy

dobutamine: ADRs

tachycardia
dysrhythmias
possible angina

dobutamine: RN intervention

monitor: telemetry, ECG, urine output
titrate to therapeutic effect

phosphodiesterase inhibitor: prototype

Milrinone

Milrinone: EPA

Blocks PDE3 (enzyme that breaks down cAMP) --> positive inotropic effects

Milrinone: admin

PO

Milrinone: therapeutic use

severe HF
short term therapy for unresponsive pt

Milrinone: ADRs

ventricular dysrhythmias
hypotension, hypokalemia
angina

Milrinone: cont/ints

allergic rxn
clients who have aortic or pulmonary valve disorders

Milrinone: RN intervention

Monitor: electrolytes (K), cardiac rhythm, chest pain, BP, HR

adjuvants: class and prototypes

loop diuretics: furosemide (Lasix)
thiazide diuretics: Hydrochlorothiazide (HCTZ)
aldosterone agonist: spironolactone

loop diuretics: prototype

furosemide (Lasix)

thiazide diuretic: protoype

Hydrochlorothiazide (HCTZ)

aldosterone agonist: prototype

spironolactone

diuretics: EPA

increase water and electrolyte excretion --> increase urine output --> lowers BP and heart workload

diuretics: admin

PO
IV slow

diuretics: therapeutic use

management of fluid overload
1st line for HF symptoms

diuretics: ADRs

orthostatic hypotension, hypokalemia/ electrolyte deficiencies
Lasi: cause ototoxicity

diuretics: RN intervention

Monitor: BP, weight, intake and urine output, electrolytes (K)
IV: slow push, risk of tinnitus/ ototoxicity (Lasix)

CAD and dysrhythmias: drug class & prototypes

HMG-CoA reductase inhibitors (statins): atorvastatin (Lipitor)
Fibrates: gemfibrozil (Lopid)
Nitrates (antianginals): Nitroglycerin
Class IB sodium channel blockers: lidocaine
Class IC sodium channel blockers: flecainide (Tambocor)
Class III potassium channel blockers: amiodarone
Class IV calcium channel blocker: diltiazem (Cardizem and Verapamil)
Unclassified antidysrhythmic drugs: Adenosine and Magnesium

HMG-CoA reductase inhibitors (statins): prototype

atorvastatin (Lipitor)

statins: EPA

increase HDL, decrease LDL by inhibiting HMG-CoA reductase, an enzyme that synthesizes cholesterol in the liver

statins: admin

PO
evening

statins: therapeutic use

treat high cholesterol
prevent vascular disease

statins: ADRs

myopathy (untreated progress to rhabdomyolysis)
hepatotoxicity

statins: cont/ints

teratogenic
Liver and ETOH disease
int: grapefruit juice, statin + warfarin causes increase bleeding risk