pharm final

Diuretic examples

thiazide, loop, potassium-sparing

Diuretics

medications that increase urine output by removing sodium and water from the body

Adverse effects of diuretics

dehydration, electrolyte imbalance (especially potassium), hypotension

When to take diuretics

take in the morning (and early afternoon if twice daily) to prevent nocturia and sleep disruption

spironolactone (Spira)

potassium-sparing diuretic that blocks aldosterone causing sodium and water excretion while retaining potassium

labs for diuretics

monitor electrolytes (especially potassium, sodium), kidney function (BUN, creatinine) to prevent imbalance and toxicity

cardiac glycoside (digoxin)

medication with narrow therapeutic index that increases cardiac contractility and slows heart rate

digoxin toxicity signs

nausea, vomiting, visual changes (yellow/green halos), bradycardia

angina

chest pain caused by reduced blood flow to the heart

stable angina

predictable chest pain with exertion relieved by rest or nitroglycerin

unstable angina

unpredictable chest pain at rest, medical emergency

nitrates (sublingual nitroglycerin)

taken at onset of chest pain and before activities that may cause angina

beta blocker prototype (metoprolol)

decreases heart rate, blood pressure, and myocardial oxygen demand

beta blocker adverse effects

bradycardia, hypotension, fatigue, bronchoconstriction

beta blocker nursing considerations

check heart rate and blood pressure before administration, hold if HR <60 or low BP

lipid-lowering drugs (statins)

reduce cholesterol by inhibiting cholesterol synthesis in the liver

cholesterol absorption inhibitors

block absorption of cholesterol in the intestines

statins side effects

muscle pain (myopathy), liver toxicity, GI upset

cholesterol inhibitors side effects

GI discomfort, diarrhea

hypertension first-line treatment

lifestyle modifications (diet, exercise, weight loss)

hypertension second-line drugs

ACE inhibitors, beta blockers, calcium channel blockers, diuretics

ACE inhibitor prototype

lisinopril

ACE inhibitor adverse effects

hypotension, dry cough, hyperkalemia

medications that raise blood pressure

vasopressors (e.g., norepinephrine) and inotropes (e.g., dopamine)

action of vasopressors/inotropes

increase blood pressure by vasoconstriction and increasing cardiac output

metformin

antidiabetic drug that lowers blood glucose and promotes weight loss, low risk of hypoglycemia

sulfonylureas (glyburide)

increase insulin secretion, side effects include weight gain and risk of hypoglycemia, avoid with sulfa allergy

diabetic ketoacidosis (DKA)

severe hyperglycemia (>500) with symptoms of polyuria, polydipsia, polyphagia

DKA treatment

IV regular insulin drip

NPH insulin

intermediate-acting insulin with peak at 4–8 hours, patient should eat during peak to prevent hypoglycemia

H2 blockers

reduce gastric acid to treat ulcers, GERD, and heartburn

H2 blocker adverse effects

confusion, dizziness, headache

5-HT3 antagonists (ondansetron)

prevent nausea and vomiting, especially post-op

5-HT3 adverse effects

headache, dizziness

antacids (magnesium)

cause diarrhea

antacids (aluminum)

cause constipation

stool softener (docusate/Colace)

softens stool, requires adequate water intake

sucralfate

GI protectant that coats ulcers and protects from acid, take before meals and at bedtime

metoclopramide

GI stimulant that increases gastric motility and prevents nausea, GERD, and vomiting

proton pump inhibitors (PPIs)

block acid secretion for GERD and ulcers, take before meals on empty stomach

osmotic laxatives (PEG)

draw water into intestines to relieve constipation