Patho/Pharm Exam III Drugs

Antitubercular medications

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

6 month regimen

Drug compliance is imperative, many times directly observed therapy

Avoid alcohol, keep lab draw appointments, notify about visual changes

Rifampin may turn urine, sweat, and tears orange/red (alarming for the patient but an expected side effect)

Report signs of liver impairment (jaundice)

Statins

Atorvastatin

Fluvastatin

Pravastatin

Rosuvastatin

Simvastatin

Atorvastatin

Drug Class: Statin

Mechanism of Action: Inhibits HMG-CoA reductase, an enzyme involved in cholesterol synthesis

Indications: To reduce the risk of cardiovascular events in specific populations, primary hyperlipidemia, heterozygous and homozygous familial hypercholesterolemia, primary dysbetalipoproteinemia, hypertriglyceridemia

Therapeutic Effects: Decrease LDL-cholesterol and triglyceride levels

Drug Interactions: YES

Food Interactions: YES; grapefruit juice

Side Effects: Myopathy, arthralgia/myalgia (muscle and joint pain), pain in extremities

Adverse Effects: Rhabdomyolysis (skeletal muscle break down and releases contents into bloodstream)

Contraindications: Acute liver failure or decompensated cirrhosis, hypersensitivity or other excipients. Caution: myopathy, rhabdomyolysis, immune-mediated necrotizing myopathy, hepatic dysfunction

Nursing Implications: Assess food and drug interactions (many), monitor for MSK symptoms, monitor LDL (should decrease if effective), monitor urine output

Patient Education: Report changes in MSK status, report very dark urine

ACE Inhibitors

Lisinopril

Benazepril

Captopril

Enalapril

Lisinopril

Drug Class: ACE Inhibitor

Mechanism of Action: Inhibits the enzyme that converts angiotensin I to angiotensin II and thereby suppresses the RAAS (blocked vasoconstriction)

Indications: Hypertension, heart failure, reduction of mortality in acute MI

Therapeutic Effects: Lower BP, increase blood supply and O2 to the heart

Drug Interactions: YES; NSAIDs

Food Interactions: YES; Alcohol, tobacco

Side Effects: Dizziness, vertigo, dry cough

Adverse Effects: Angioedema, hyperkalemia, orthostatic hypotension

Contraindications: Hypersensitivity, history of angioedema, pregnancy (*fetal toxicity), Caution: Aortic stenosis, diabetes, syncope, orthostatic hypotension, impaired renal function, breastfeeding

Nursing implications: Check BP 30-60 min. before and after, implement fall precautions, monitor K+, monitor for angioedema, hold and notify provider SBP <100

Patient Education: Avoid high K+ foods, persistent cough may occur, notify provider if lip or face swelling occur, teach how to check BP, do not stop abruptly, notify provider if you become pregnant

Angiotensin II receptor blockers (ARBs)

Losartan

Valsartan

Losartan

Drug Class: Angiotensin II Receptor Blocker (ARBs)

Mechanism of Action: Blocks the binding of angiotensin II to the angiotensin I receptor, thereby decreasing vasoconstriction and lower BP

Indications: Hypertension, heart failure, nephropathy in clients with Type 2 diabetes

Therapeutic Effects: Lowers BP, increases blood supply and O2 to the heart

Drug Interactions: YES; NSAIDs

Food Interactions: YES; Alcohol, tobacco

Side Effects: Angioedema (lower risk than with -prils), headache

Adverse Effects: Hyperkalemia, hypotension

Contraindications: Hypersensitivity, pregnancy (*fetal toxicity), Caution: Hepatic and renal impairment, hypotension, hypovolemia, hyperkalemia

Nursing Implications: Check BP 30-60 min. before and after, implement fall precautions, monitor K+, monitor for angioedema, hold and notify provider SBP <100

Patient Education: Avoid high K+ foods, persistent cough may occur, notify provider if lip or face swelling occur, teach how to check BP, do not stop abruptly, notify provider if you become pregnant

Calcium channel blockers (vascular-selective)

Amlodipine

Nifedipine

Nicardipine

Amlodipine

Drug Class: Ca+ Channel blocker

Mechanism of Action: Inhibits the influx of Ca+ ions into vascular smooth muscle and cardiac muscle, thereby decreasing peripheral vascular resistance and reducing BP

Indications: To control hypertension, treatment of angina

Therapeutic Effects: Lowers BP, increases blood supply and O2 to the heart

Drug Interactions: YES

Food Interactions: NO

Side Effects: Peripheral edema, headache, dizziness

Adverse Effects: Hypotension

Contraindications: Hypersensitivity, Caution: Aortic stenosis, symptomatic hypotension, angina, MI, hepatic impairment, pregnancy, breastfeeding

Nursing Implications: Monitor BP 30-60 min. before and after, implement fall precautions, hold for SBP <100

Patient Education: Do not stop abruptly, teach how to check BP

Beta Blockers

Metoprolol

Atenolol

Carvedilol

Propranolol

Labetalol

Metoprolol

Drug Class: Beta-adrenergic blocker

Mechanism of Action: Blocks beta 1 receptors, thereby lowering cardiac workload by slowing the heart and lowering the systolic BP

Indications: To control hypertension, treatment of angina, acute MI, and heart failure

Therapeutic Effects: Lowers BP and cardiac workload

Drug Interactions: YES; a lot

Food Interactions: YES; caffeine, alcohol, tobacco, licorice

Side Effects: Fatigue/weakness, dizziness, N/V/diarrhea

Adverse Effects: Hypotension, bradycardia

Contraindications: Hypersensitivity, AV block, cardiogenic shock, hypotension, acute heart failure, bradycardia, sick sinus syndrome, severe peripheral arterial circulatory disorders, Caution: Thyroid and hepatic impairment, asthma, PVD, diabetes, *COPD, cerebrovascular disease

Nursing Implications: Monitor 30-60 min. before and after, 60 sec. apical HR before, fall precautions, hold for SBP <100, hold for HR <60

Patient Education: Do not stop abruptly, teach how to check BP, pulse, HR

Nitrates

Nitroglycerin

Isosorbide dinitrate

Isosorbide mononitrate

Nitroglycerin

Drug Class: Nitrate

Mechanism of Action: Relaxes the smooth muscles and blood vessels, causing vasodilation, and thereby lowering BP, HR,cardiac workload, and preload

Indications: To control angina, treatment of hypertensive emergency, pulmonary edema, and heart failure

Therapeutic Effects: Lowers BP and cardiac workload

Drug Interactions: YES

Food Interactions: YES; Alcohol, tobacco

Side Effects: Tachycardia, flushing, headache

Adverse Effects: Orthostatic hypotension, syncope

Contraindications: Hypersensitivity, increased intracranial pressure, cardiomyopathy, shock, Caution: hepatic and renal impairment, MI, hypotension, hypovolemia, head trauma, pregnancy, breastfeeding

Nursing Implications: Hold and notify if SBP <90 or HR >100, assess for PDE5 use within 24hrs.

Patient Education: Take acetaminophen if headache occurs, SL tabs - every 5 min. up to 3 times if chest pain persists, then call 911, keep in amber bottle away from light, do not take with PDE5 inhibitors

Angiotensin receptor–neprilysin inhibitors (ARNIs)

Sacubitril/valsartan

Sacubitril/valsartan

Drug Class: Angiotensin receptor/neprilysin inhibitor

Mechanism of Action: Inhibition of the enzyme that breaks down DNP/causes angiotensin receptor blockade

Indications: Heart failure

Therapeutic Effects: Vasodilation, lowers preload and afterload

Drug Interactions: YES; NSAIDS

Food Interactions: NO

Side Effects: Cough

Adverse Effects: Angioedema, hypotension, hyperkalemia

Contraindications: *Pregnancy (fetal toxicity), history of angioedema with ACE inhibitor or ARB therapy

Nursing Implications: Monitor BP and hold if SBP <100, monitor K+, monitor for s/s of angioedema (face, lips, tongue, eyes)

Patient Education: Avoid foods high in K+, notify if pregnant or breastfeeding

SGLT2 inhibitors

Dapagliflozin

Empagliflozin

Canagliflozin

Seen in treatment of heart failure and diabetes

Diabetes: Pee out glucose

Dapagliflozin

Drug Class: Sodium-glucose cotransporter 2 inhibitor

Mechanism of Action: Blocks reabsorption of sodium and glucose in the proximal tubule by inhibiting the sodium-glucose cotransporter resulting in diuresis

Indications: Heart failure, Type 2 diabetes

Therapeutic Effects: Diuresis, lowers blood glucose and preload

Drug Interactions: YES; insulin can cause hypoglycemia

Food Interactions: NO

Side Effects: UTI, genital infection, polyuria

Adverse Effects: Hypotension, hypoglycemia

Contraindications: History of serious hypersensitivity reaction to dapagliflozin, severe renal impairment, end-stage liver disease, dialysis, pregnancy (fetal risk in 3rd trimester)

Nursing Implications: Monitor for interactions, monitor BP, monitor blood sugar

Patient Education: Notify if they become pregnant, notify if they have diabetes or take insulin

Cardiac glycosides

Digoxin

Digoxin

Drug Class: Cardiac glycoside

Mechanism of Action: Blocks the sodium-potassium ATPase pump, which ultimately causes K+ to remain in the cardiac myocyte longer, leading to a stronger force of contraction. Increases parasympathetic stimulation of the heart which lowers HR

Indications: Continues heart failure symptoms even though 1st-line medications for heart failure have been optimized

Therapeutic Effects: Increased force of contraction, lowers HR, increases contractility

Drug Interactions: YES

Food Interactions: YES; those high in K+

Side Effects: Fatigue

Adverse Effects: Sinus bradycardia, visual disturbances (yellow or green halo around lights) = toxicity

Contraindications: Acute myocardial infarction, wolff-parkinson-white syndrome, ventricular fibrillation, hypokalemia, hypomagnesemia

Nursing Implications: Narrow therapeutic index (monitor serum trough), apical HR for 60 sec. hold and notify if HR <60

Patient Education: Home pulse monitoring, keep lab appointments, notify if N/V or visual changes occur

Rapid-Acting Insulins

Lispro, Aspart

Give with meals, comes on quick

Onset ~ 15min

Peak ~ 1hr

Duration ~2-4hr

Short-Acting Insulins

Regular Insulin

Onset ~ 30-60min

Peak ~ 2-4hr

Duration ~ 5-8hr

Regular Insulin

Drug Class: Insulin

Mechanism of Action: Lowers the level of glucose in the blood and provides cells with glucose for energy by helping cells to absorb glucose

Indications: Hyperglycemia, glucose homeostasis

Therapeutic Effects: Lowers blood glucose levels, promotes use of glucose by cells

Drug Interactions: YES; Alcohol

Food Interactions: NO

Side Effects: Weight gain, injection site reaction and irritation, lipodystrophy

Adverse Effects: Hypoglycemia

Contraindications: Hypoglycemia, Caution: monitor closely for signs of hypoglycemic reaction during insulin peak

Nursing Implications: Check blood glucose before admin, monitor for hypoglycemia (BG <70), know insulin onset, peak, and duration, assess meal availability and coordinate insulin admin with meals

Patient Education: Recognize hypoglycemia (sweating, shaking, confusion, hunger), treat BG <70 using 15-15 rule when awake and able to swallow, rotate injection sites to prevent lipodystrophy, monitor BG regularly and avoid skipping meals after mealtime insulin

Intermediate-Acting Insulins

NPH Insulin

Slower onset, has a peak, hangs around longer

Onset ~ 1-2hr

Peak ~ 4-12hr

Duration ~12-18hr

Long-Acting Insulins

Glargine, Detemir, Degludec

Slow, steady basal coverage, no pronounced peak

Onset ~ 1-2hr

Peak - none

Duration ~ 24hr or longer

GLP-1 receptor agonists

Dulaglutide

Semaglutide

Liraglutide

Exenatide

Increases insulin, decreases glucagon, slower stomach

Dulaglutide

Drug Class: Glucagon-like peptide (GLP-1) receptor agonist

Mechanism of Action: Increases insulin secretion when glucose levels are elevated, lowers glucagon secretion, and delays gastric emptying in an effort to lower postprandial glucose levels

Indications: As an adjunct to diet and exercise to improve glycemic control in individuals older than 10, lowers the risk of major cardiovascular events in adults with Type 2 diabetes who have establish CV disease or multiple CV disease risk factors

Therapeutic Effects: Lowers postprandial glucose levels

Drug Interactions: YES; due to delayed gastric emptying, oral drugs can have decreased rate of absorption

Food Interactions: NO

Side Effects: N/V, diarrhea

Adverse Effects: NO

Contraindications: Medullary thyroid carcinoma, multiple endocrine neoplasia, hypersensitivity, Caution: Thyroid C cell tumors, pancreatitis, hypoglycemia, AKI, severe GI disease, diabetic retinopathy, acute gallbladder disease

Nursing implications: Monitor blood glucose and A1C to evaluate effectiveness, assess for N/V, diarrhea, and dehydration,, monitor for pancreatitis (severe, persistent abdominal pain), screen for personal/family history of medullary thyroid carcinoma or MEN2

Patient Education: Inject subcutaneously once weekly on the same day, eat smaller meals and avoid high-fat foods to lower nausea, report severe abdominal pain or persistent vomiting, inform providers before surgery/procedure

Biguanides

Metformin

Metformin

Drug Class: Non-sulfonylurea biguanide

Indications: To control hyperglycemia in those with Type 2 diabetes

Therapeutic Effects: Lowers glucose production in the liver by decreasing gluconeogenesis, lowers glucose absorption from the intestines

Drug Interactions: YES; contrast dye

Food Interactions: Fiber-rich foods, grapefruit juice, guar gum

Side Effects: N/V/diarrhea/flatulence

Adverse Effects: Hypoglycemia (low risk)

Contraindications: *Renal and hepatic impairment, metabolic acidosis, megaloblastic anemia, history of MI, Caution: monitor closely for signs of hypoglycemic reaction, use cautiously in older clients with renal and hepatic impairment

Nursing Implications: Assess renal function before and during therapy, monitor BG and A1C for effectiveness, monitor for lactic acidosis (weakness, muscle pain, rapid breathing), assess vitamin B12 levels periodically especially with long-term use

Patient Education: Take with meals to lower Gi symptoms, avoid excess alcohol, report unusual weakness, difficulty breathing, or severe fatigue, notify team before procedures involving iodinated contrast dye

Sulfonylureas

Glipizide

Glimepiride

Glyburide

Pancreas releases insulin

DPP-4 inhibitors

Sitagliptin

Linagliptin

Saxagliptin

Preserves incretins (gut peptides like GLP-1)

Thiazolidinediones (TZDs)

Pioglitazone

Rosiglitazone

Makes tissues more sensitive to insulin

Severe hypoglycemia treatment

IV dextrose

Glucagon