Pharm Exam 2

Cardiovascular Medications

-Categories

• antihypertensives

  • adrenergic

  • ACE inhibitors

  • ARB’s- angiotensin II receptor blockers

  • Ca Channel blockers

  • vasodilators

  • direct renin inhibitors

  • diuretics

• antianginals

• heart failure

• anti-dysrhythmics

• coagulation modifiers

• antilipemic

• diuretics

Adrenergic medications

-affect autnomic nervous system

• parasympathetic- rest and relax

• sympathetic- fight or flight

-affect sympathetic

• stimulation (agnost)

  • increases HR (increased CO) at AV node

  • increased force of contraction (increases CO)

  • drives vasocontriction (increase SVR)

• suppression (blockers/antagonist)

  • decreased HR at AV node (decreases CO)

  • decreased force of contraction (decreased CO)

  • drives vasodilation (decreased SVR)

RAAS System

-kidneys responsible for changes in BP

• circulating blood volume associated with amounts of water and Na

-with drop in fluid/Na concentration: renin and angiotensinofen released into blood → angiotensin 1 → angiotensin 2 via ACE enzyme → stimulates vasocontraiction and increases aldosterone release → stimualtes ADH and Na+ reuptake

-ARB’s and ACE inhibitors affect this system

Antianginals

-potent- do not need a lot

• SM relaxation in cell

• reduce HR to reduce demand on heart

-Categories

• nitrates and nitrites

• beta blockers

• Ca Channel blockers

• ranolzaine

Heart Failure Categories

-Angiotensin-Convertin Enzyme (ACE) Inhibitors

-Angiotensin II receptor blockers (ARBs)

-Angeiotensin-receptor neprilysin Inhibitor (ARN’s)

-Aldosterone Antagonists

-Phosphodierterase Inhibitors

-Cardiac Glycosides

Antidysrhythmics

-correct abnormal electrophysiollogic function- correcting rate and rythmn

-effectiveness increases as number goes higher for class

Coagulation Pathophysiology

-can modify pathways to inhibit or enhance clotting pathways

-hemostasis- any process that rsults in the stopping of a bleed

-coagulation- when bleeding is stopped by a clot formation

-thrombus- clot

-embolus- clot on the move

-firbin- major component of thombi (made by fibrinogen)

-fibrinolysis- breakdown of fibrin/trhombi

-plasmi- breaks down firbin/thrombi

-Coagulation Derangement- excessive clotting, lack of fibrinloysis, inability to clot

• CVA

• DVT

• MI

• Exsanguination

Coagulation Modifiers

-anticoagulants- no blood congealing; prevent clot formation

• ALWAYS QUESTION 2 ANTICOAGULANT ORDERS

-antiplatelets- stop platelet plug formation; prevent adherence of platelets to site to cuase the clot

-thrombolytics- help breakdown clots

-antifibrinolytics- stop clot breakdown so its stays where it needs to be

Anticoagullants transition

-for short transition from one medicaiton to another can be on two anticoagulants

• -taper one and slowly raise the other to keep blood levels stable wihtout window of anticoagulation

• 4-5 day transition

• prioritize therapeutic levels

Heparin Complications

-Heparin-unfractionated- large molecule that can have unpredicatble affect os need labs q6hr for clotting check

-Enoxaparin-fractionated- small molecule so more available in body and more stable throughout, longer half-life (stays in body longer)

HIT (Heparin Induced Therombocytopenia

-ie drug allergy to heparin medications

-signifcant drop in platelets that is either gradual or acute

-body form numerous clots and uses up platelets in that process

-worried about: strokes, PE, DVT

-check patients labs!

Types:

• type 1- can keep doing therapy; gradual drop in platelets

-type 2- much worse, acute and fast drop in platelets (>50%); stop use of medication therapy

Nursing Considerations for Coagulation Modifiers

-assessment

• bleeding risk

• clotting risk

• labs- PTT, INR, platelets

-administration

• contraindications

• dose

• monitoring

-monitoring for

• bleeding signs

• signs of thrombus

• labs- PTT, INR, PLT, CBC

-have caution when combining multiple coagulation modifiers (RED FLAG)

Antilipemic Drugs

-Cholesterol- fat soluble steroid in animal fats and throughout body

• steroid hormones

• cell memebrane

• bile acids

-triglycerides

• fatty acids and glycerl

• storage of unused calories- released for energy

-Liver can make varying amounts of cholesterol and usually all that we need- builds up in system as we eat it

-risk of coronary heart disease in patients with cholesterol levels of 300 mg/dL is three to four times greater than that in patients with levels less than 200 mg/dL

• want to reduce build up in blood vessels

-Primary- prevention of the first cardaic event

-Secondary- prevention of subsequent cardiac events

-Treatment

• first options start with diet and exercise

• increase herbal options- flax/seed, soy, green tea

Rhabdomylosis

-risk from antilpemic statin drugs

• Muscle Breakdown → Myoglobinuria →Kidney damage → Kidney Failure

  • muscle break down and leaves via urine and hurts kidneys which can put them into failure

• more common when combined with other meds that increase the risk

• need to educate patients on this as it is deadly and can have mild s/s

-Increase Risk:

• Specific drug combinations

• Grapefruit juice

• >65 Years of age

• Hypothyroidism

• Renal Insufficiency

-Signs/Symptoms:

• Muscle Soreness

• Changes in Color of Urine

Antilipemic Drugs- Bile Acid Sequestrants

-administration timing must be either 1 hour before or 4-6 hours after any other medications

• allows correct absorption into GI tract

Diuretic Medications

-classes- based on site of action in nephron structure

• carbonic anhydrase inhibitors

• loop diuretics

• osmotic diuretics

• postassium-sparing diuretics

• thiazide

• thiazide-like diuretics

Diuretics- Nursing Assessment

-must include:

• Auscultation of breath sounds and heart sounds

  • need to know baseline VS

• thorough medical hx

• Determining neurologic status (need to know baseline)

• Moisture levels

• capillary refill

• Vital signs- want to be stable before giving

  • Postural blood pressures can drop 20mmHg when given

  • Weight- monitor for loss of fluid

• Intake/output measurements

  • want patient in a deficit so that output > input

-Lab Values Associated- many medications do not work if kidneys are impaired and can cause further kidney damage

• renal failure

  • BUN, Creatinine

• hepatic function

  • ALP, ASP, LDH

• serum electrolytes

Nursing Evaluation for Diuretics

-resolution or reduction in

• edema

• fluid volume overlod

• heart failyre

• HTN

• intraocular pressures

-monitor patient for the occurence of adverse reactions

Diuretics Lifespan Considerations- Age Extremes

-Increased risk for adverse effects

• for both young and old

-Taken in the morning to help prevent nocturia

• as young and old have increased sensitivity to adverse effects, important

-Assess living arrangements

• can do home health visits for monitoring and living arangements

• to assess SE (dizzy, confusion, headaches)

-Thiazide diuretics

• cross the placenta

• avoid in pregnancy

-Half-life of furosemide is increased in neonates

• stays in their body longer

Autonomic Nervous System

-sympathetic (SNS) → stress

• adrenergic (PNS) → accelerate

• catecholamines → neurotransmitters (epinephrine, norepinephrine, dopamine)

-parasympathetic (PNS) → peace

• cholinergic → calm

Adrenergic Drugs: Vasoactive Adrenergics

-affect this equation

• CO x SVR → BP

• BP: increase HR and contractility → increase CO so the heart can push out more

• SVR: (after load) increases BP (vasoconstriction)

-Vasoactive Adrenergics

• Assess the IV site

• vesicant- a medication that can cause severe damage to vessels and surrounding tissue (burns tissue when in contact with non-intravascular tissue)

• concern for dopamine and midrodrine

-Adrenergic Blocking Drugs- block the SNS (stress)

• classified based on adrenergic receptor they block

• Alpha 1 and 2 and Beta 1 and 2 receptors

• 
  

Adrenergic Drugs: Miscellaneous Medications

-respiratory meds

-nasal decongestants

-opthalmic medications

-overactive bladder

• Mirabegron (Myrbetriq) (sustained release)

  • relaxes detrusor muscle (in pelvic floor to increase capacity to hold on to urine)

  • increases bladder storage capacity

• no contraindications

• SE: HTN, UTI, headache, n, dizziness

Cholinergic Drugs

-Toxicity- cholinergic collapse

• circulatory collapse

• hypotension

• blood diarrhea

• shock

• cardiac arrest

-treatment- support and anticholinergic

-SLUDGE

• sweating and salivation

• lacrimation

• urination

• diarrhea

• GI cramps and pain

• emesis