Key Drug Exam - P2 Fall MOA, Counseling, Box Warnings

benazepril pharmacological category

ACE inhibitor

ACE inhibitor box warning

fetal toxicity

benazepril MOA

Prevents conversion of angiotensin I to angiotensin II, resulting in lower levels of angiotensin II, which causes and increase in plasma renin activity and a reduction in aldosterone secretion

ACE inhibitor key counseling

Cough, Hypotension, Dizziness, Headache, increases potassium (monitor)

benazepril primary therapeutic uses

hypertension

benazepril dose adjustments?

yes

enalapril maleate pharmacologic category

ACE inhibitor

enalapril maleate MOA

A pro-drug that is converted to its active metabolite. Prevents conversion of angiotensin I to angiotensin II, resulting in lower levels of angiotensin II, which causes and increase in plasma renin activity and a reduction in aldosterone secretion

enalapril maleate primary thereapeutic uses

HF, HTN, kidney disease(non- diabetes related), diabetic neuropathy, MI, proteinuric CKD

enalapril dose adjustments?

yes

lisinopril pharmacological category

ACE inhibitor

lisinopril MOA

Prevents conversion of angiotensin I to angiotensin II, resulting in lower levels of angiotensin II, which causes and increase in plasma renin activity and a reduction in aldosterone secretion

lisinopril primary therapeutic uses

HFrEF, Hypertension, ST-elevated MyoInf

lisinopril dose adjustments?

yes

lisinopril-HCTZ pharmacolgic category

ACE inhibitor and thiazide diuretic combo

lisinopril-HCTZ MOA

HCTZ:Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions Lisinopril: competitive inhibitor of ACE; prevents conversion of angiotensin I to angiotensin II, results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion

lisinopril-HCTZ key counseling

Cough, Hypotension, Dizziness, Headache, increases potassium (monitor);

HCTZ - reduces potassium (monitor); dizziness, take in morning to avoid frequent urination at night

lisinopril-HCTZ primary therapeutic uses

hypertension

lisinopril-HCTZ dose adjustments?

yes

norepinephrine bitartrate pharmacologic category

alpha-1 and 2 agonist, beta-1 catecholamine (inotrope)

norepinephrine bitartrate MOA

action on alpha receptors causes peripheral vasoconstriction of blood vessels to maintain blood pressure and heart function

norepinephrine bitartrate key counseling info

bradycardia, arrhythmia, anxiety, transient headache

norepinephrine bitartrate therapeutic uses

used primarily to increase or maintain blood pressure during acute medical situations

epinephrine pharmacologic category

alpha-1 and 2 agonist, beta-1 and 2 agonist (catecholamine)

epinephrine MOA

action on alpha receptors causes peripheral vasoconstriction of blood vessels to maintain blood pressure and heart function. action on beta receptors, it increases heart rate and contractivity & also relaxes smooth muscles in the lungs to relieve SOB and wheezing (during anaphylaxis)

epinephrine key counseling info

anxiety, disorientation, headache, restlessness

epinephrine primary therapeutic uses

acute treatment of allergic reactions, treats low BP during septic shock. Use in eye surgery to maintain pupil dilation

dopamine hydrochloride pharmacologic category

alpha-1 agonist, beta-1 agonist, dopamine agonist catecholamine (Inotrope)

dopamine HCl MOA

dose dependent pharmacology:

lower doses: used for renal perfusion in AKI and HF

intermediate doses: it activates beta-1 receptors enhancing HR and contractility. used in shock for inotropic effect

high doses: primarily impacts alpha-1 receptors causing vasoconstriction. used for hypotension in shock

dopamine HCl key counseling info

monitor for tachycardia, arrhythmias, and excessive vasoconstriction (can compromise organ function)

dopmaine HCl primary therapeutic uses

used primarily to increase or maintain BP during acute medical situations

doxazosin pharmacologic category

alpha 1 antagonist

doxazosin MOA

hypertension: competitively inhibits postsynaptic alpha-adrenergic receptors which results in vasodilation of veins and arterioles and a decrease in total peripheral resistance and blood pressure

BPH: antagonist of alpha(1A)-adrenoreceptors in the prostate, leads to relaxation of smooth muscle in the bladder neck and prostate causing an improvement of urine flow and decreased symptoms of BPH

doxazosin key counseling info

may cause low BP causing dizziness or fainting, tachycardia, sexual dysfunction, some weakness. Usually resolves within 2 weeks

doxazosin primary therapeutic uses

BPH, Hypertension

clonidine pharmacologic activity

alpha 2 agonist

clonidine box warnings

epidural use (500 mcg/mL should be diluted prior to use)

clonidine MOA

stimulates alpha-2 adrenoceptors in the brain stem, thus activating an inhibitory neuron, resulting in reduced sympathetic outflow from the CNS, producing a decrease in peripheral resistance, renal vascular resistance, heart rate, and blood pressure

clonidine key counseling info

drowsiness, headache, dizziness, rash, dry mouth

clonidine primary therapeutic uses

ADHD, hypertension

irbesartan pharmacologic category

ARB

irbesartan box warnings

fetal toxicity

irbesartan MOA

block binding of angiotensin II to AT1 receptor on blood vessel walls - promotes vasodilation indirectly

ARB key counseling info

dizziness, fatigue, hypotension, headache, can raise potassium

irbesartan primary therapeutic uses

diabetic neuropathy, hypertension

losartan pharmacologic category

ARB

losartan box warning

fetal toxicity

losartan MOA

block binding of angiotensin II to AT1 receptor on blood vessel walls - promotes vasodilation indirectly

losartan primary therapeutic uses

hypertension, diabetic neuropathy

olmesartan pharmacologic category

ARB

olmesartan box warning

fetal toxicity

olmesartan MOA

block binding of angiotensin II to AT1 receptor on blood vessel walls - promotes vasodilation indirectly

olmesartan primary therapeutic uses

hypertension

valsartan pharmacologic category

ARB

valsartan box warnings

fetal toxicity

valsartan MOA

block binding of angiotensin II to AT1 receptor on blood vessel walls - promotes vasodilation indirectly

valsartan primary therapeutic uses

HFrEF, hypertension, post-MI

adenosine pharmacologic category

antiarrhythmic agent

adenosine MOA

slows conduction time through AV node, vasodilation and increases blood flow in normal coronary arteries

adenosine key counseling info

immediately after administration may experience sudden but transient chest pressure or sense of impending doom

adenosine primary therapeutic uses

paroxysmal supraventricular tachycardia

amiodarone pharmacologic category

antiarrhythmic agent (Class III)

amiodarone box warnings

arrhythmias, pulmonary toxicity, hepatotoxicity

amiodarone MOA

inhibits adrenergic stimulation, affects sodium, potassium, and calcium channels, prolongs the AP and refractory period in myocardial tissue; decreases AV conduction and sinus node function

amiodarone key counseling info

epithelial keratopathy (Eyes), hypotension, nausea/vomiting

amiodarone primary therapeutic uses

ventricular arrhythmias

flecainide pharmacologic category

antiarrhythmic agent, class IC

flecainide box warnings

excess mortality in patients with recent MI; ventricular proarrhythmic events in patients with atrial fibrillation/flutter

flecainide MOA

class IC antiarrhythmic; slows conduction in cardiac tissue by altering transport of ions across cell membranes; causes slight prolongation of refractory periods; decreases the rate of rise of the action potential without affecting its duration; increases electrical stimulation threshold of ventricle, His-Purkinje system

flecainide key counseling info

dizziness, ventricular arrhythmia, visual disturbances

flecainide primary therapeutic uses

paroxysmal AFib/flutter and SVT prevention, ventricular arrhythmias prevention

flecainide dose adjustments?

yes

atropine pharmacologic category

anticholinergic/antimuscarinic M1, M2, M3, M4, and M5

atropine MOA

blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS; increases cardiac output, dries secretions

atropine key counseling info

drying effects, constipation, dizziness, drowsiness

atropine primary therapeutic uses

sinus bradycardia, AV nodal block, ventricular arrhythmias, antidote for cholinergic crisis, inhibit salivation/secretions during surgery

heparin sodium, unfractionated pharmacologic category

anticoagulant

heparin sodium, unfractionated MOA

potentiates the action of antithrombin III and thereby inactivates thrombin and prevents the conversion of fibrinogen to fibrin; also stimulates release of lipoprotein lipase

heparin sodium, unfractionated key counseling info

major bleed, osteoporosis, thrombocytopenia

heparin sodium, unfractionated primary therapeutic uses

anticoagulation

vasopressin pharmacologic category

anti-diuretic homone (ADH) analog

vasopressin MOA

stimulates the V1 receptors in blood vessels and increases systemic vascular resistance and mean arterial blood pressure to increase BP and improve fluid balance (Note, also increases water reabsorption in kidney via V2 receptors)

vasopressin key counseling info

recommended that patient drinks 1-2 glasses of water when given a dose to reduce nausea, cramps

vasopressin primary therapeutic uses

regulates water balance in the body, vasodilatory shock

clopidogrel pharmacologic category

antiplatelet agent

clopidogrel box warning

CYP2C19 poor metabolizers

clopidogrel MOA

requires in vitro biotransformation to active thiol metabolite, which then irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface, which prevents activation of GPIIb/IIIa receptor complex, thereby reducing platelet aggregation

clopidogrel key counseling info

hemorrhage, bruise, hematoma

clopidogrel primary therapeutic uses

ST-elevated MI, non-ST acute coronary syndrome, MI/ischemic stroke or peripheral ASD

atenolol pharmacologic category

beta-1 blocker (cardioselective)

atenolol box warnings

do not abruptly stop taking - may cause chest pain, irregular heartbeat, or even a heart attack

atenolol MOA

competitively blocks response to beta-adrenergic stimulation, selectively blocks beta1-receptors with little or no effect on beta2-receptors except at high doses

atenolol key counseling info

HF, hypotension, bradycardia, SVT, fatigue

atenolol primary therapeutic uses

acute MI, angina caused by coronary atherosclerosis

atenolol dose adjustments?

yes

metoprolol succinate pharmacologic category

beta-1 blocker (cardioselective)

metoprolol succinate box warnings

do not abruptly stop taking - may cause chest pain, irregular heartbeat, or even a heart attack

metoprolol succinate MOA

selective inhibitor of beta1-adrenergic receptors; competitively blocks beta1-receptors, with little or no effect on beta2-receptors at oral doses

metoprolol succinate key counseling info

bradyarrhythmias, hypotension, fatigue

metoprolol succinate primary therapeutic uses

angina, HFrEF, hypertension, myoinf