IMPORTANT DRUGS

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ACE inhibitors (-pril)

treats HTN, heart failure, diabetic neuropathy, and left ventricular dysfunction. works by blocking angiotensin 2 production, allowing for vasodilation, excretion of Na and water, and retention of potassium by blocking release of ADH. an oral medication. ADRs include severe hypotension in clients with preexisting HTN, on diuretics, or on low sodium diets; rash, metallic taste, hyperkalemia (causing dysrhythmias), neutropenia, and a dry, non productive cough. angioedema may also occur in allergic reactions. start client’s on a low dose and increase gradually. monitor BP, K⁺ levels, CBC, and WBC. client should report any ADRs, not use salt subs, and report signs of infection. teratogenic.

angiotensin 2 receptor blockers (-sartan)

treats HTN and prevents stroke, along with treating diabetic neuropathy. blocks angiotensin 2 receptors, resulting in vasodilation, urinary excretion of Na and water, and retention of K⁺. an oral medication. ADRs include angioedema, headache, hypotension, insomnia, and dizziness. should monitor BP and treat angioedema if necessary with diphenhydramine or epinephrine. client should report any signs of allergic reaction. teratogenic. not recommended for those with hyperkalemia or liver/renal disorders.

beta blockers (-olol)

blocks beta 1 receptors in heart and kidney to reduce contractility, heart rate, renin release, vasoconstriction, fluid retention, and blood pressure. ADRs include bradycardia, low CO, rebound tachycardia and angina, and possibly heart failure. monitor HR and report if too low, also monitor for s/s of HF (SOB, edema, cough). discontinuing requires tapering. patient should check pulse daily, not stop abruptly, report new onset chest pain, and s/s of HF. not recommended for those with bradycardia, HF, PVD or Raynaud’s. use caution with asthma, COPD, and diabetes.

calcium channel blockers (nifedipine)

treats HTN, angina, and dysrhythmias. significantly blocks Ca⁺ channels in smooth muscle cells of peripheral arterioles and minimally blocks channels in cardiac arteries, resulting in vasodilation and lowered blood pressure. ADRs include reflex tachycardia, vasodilation that can cause headaches and dizziness, edema, arrhythmias, and gingival hyperplasia. monitor HR and BP (hold if too low), for vasodilatory effects, and for peripheral edema. client should report any ADRs, practice good dental hygiene, and avoid grapefruits. not recommended for patients with low BP or other heart complications.

thiazide diuretics (hydrochlorothiazide)

blocks reabsorption of Na⁺ and Cl^-, promoting excretion of both along with water. increases urine output and potassium excretion. adequate kidney perfusion and GFR are needed for this medication to work. acts on DCT. ADRs include hypokalemia, dehydration, hypochloremia, hyponatremia, hyperglycemia, and hyperuricemia. monitor patients electrolytes and s/s of imbalances, dysrhythmias, and glucose in diabetics. client should increase potassium intake, take last dose well before bedtime, and report s/s of electrolyte imbalance. not recommended for those with anuria, preexisting electrolyte imbalances, and those with renal or hepatic impairment. teratogenic.

loop diuretics (furosemide)

blocks Na⁺ and Cl^- reabsorption, increases excretion of both with water, and increases urine output with potassium excretion. very potent; acts on ascending limb of loop of henle. ADRs include hypokalemia, dehydration, hypocholremia, hyponatremia, hypotension, ototoxicity, and hyperglycemia. monitor patient for electrolyte imbalances and s/s, blood pressure, dysrhythmias, and report tinnitus or vertigo. client should eat foods rich in potassium, take well before bedtime, and report any ADRs. not recommended for those with anuria, preexisting electrolyte imbalances, and those with renal or hepatic impairment. teratogenic.

K sparing diuretics (spironolactone)

blocks aldosterone, increasing Na and water excretion and K⁺ retention. urine output is small. acts on DCT and collecting duct. ADRs include hyperkalemia, menstrual irregularities, abnormalities in hair growth for women, gynecomastia (increase in breast gland tissue) in men, and impotence (ED) in men as well. monitor K levels and report if high. monitor blood pressure, dysrhythmias, and endocrine effects as well. client should report any ADRs and avoid K⁺ supplements and foods, as well as salt subs. not recommended for renal insufficiency, preexisting hyperkalemia, hepatic dysfunction, or diabetes. teratogenic.

digoxin (cardiac glycoside)

inhibits Na⁺/K⁺ pump to allow calcium to collect in heart cells, increasing contractility and decreasing vasoconstriction. also stimulates the vagus nerve which lowers HR. ADRs include cardiac dysrhythmias (bradycardia and AV blocks) and possible toxicity (s/s include nausea & vomiting, anorexia, fatigue, and vision changes/halos). take apical pulse for a full minute before admin, hold if <60. monitor and report GI and CNS symptoms (vision changes); monitor med and potassium levels along with EKG. antidote is immune fab. client should report any ADRs and hypokalemia; they should take the med at the same time everyday and know how to take their own pulse. not recommended for preexisting cardiac dysrhythmias, toxicity, or hypokalemia, hypercalcemia, or diuretics.

nitroglycerin (nitrates)

causes vasodilation to decrease preload (EDV), oxygen demand, and increase oxygen supply while relaxing coronary artery spasms. ADRs include headache, hypotension, tachycardia, and tolerance. do NOT touch ointment form of medication, always wear gloves. check baseline BP and HR and monitor frequently. give 3 doses q5 min for chest pain. if chest pain persists after first dose, call 911 then finish last 2 doses. remove topical patch for part of the day and place it low to reduce risk of headache (can be helped with Tylenol). not recommended for those on ED drugs as it can lead to hypotension, liver dysfunction, or severe renal impairment.

aspirin

an antiplatelet that inhibits platelet aggregation, reducing risk of MI, stroke, and angina along with the reocclusion of stents. irreversibly binds to COX-1 enzyme, inhibiting its action of enhancing platelet aggregation. is permanent until death of platelet. 81 mg is sufficient for therapeutic effect. ADRs include bleeding tendency due to blood thinning, GI ulceration, renal dysfunction, reye’s syndrome for children under 18, and salicysm (toxicity). monitor patients for ADRs and educate them to stop 1 week before surgery. teratogenic.

clopidogrel (Plavix)

inhibits platelet aggregation by blocking ADP receptor on platelets, blocking the signal for aggregation. irreversible and lasts for the life of the platelet. ADRs include GI dysfunction, thrombotic thrombocytopenia purpura (plts clump together and impair blood flow to organs. sheer number of clots manifests as low plts, leading to bleeding). patients should stop taking at least 1 week before surgery and avoid anticoagulants, NSAIDs, glucocorticoids, and herbs. monitor patients platelets and PT.