Pharm Drugs Exam 1

Epinephrine (Adrenalin) - Drug Classification / Mechanism of Action

Nonselective Adrenergic Agonist

stimulates alpha & beta adrenergic receptors

Epinephrine (Adrenalin) - Therapeutic Uses

• CPR

• Anaphylaxis

• Local vasoconstriction

• Mydriasis

Epinephrine (Adrenalin) - Adverse effects

• nervousness

• tremors

• HTN

• tachycardia

• dysrhythmias

• pulmonary edema

• CNS stimulation

• local —> necrosis

Epinephrine (Adrenalin) - contraindications

• hypersensitivity

• closed angle glaucoma

• CAD

Epinephrine (Adrenalin) - Routes / Pharmicokinetics

• IV

• IM

• Subcut

• Topical

• Sublingual

• Ophthalmic

Onset =

• IV = immediate

• IM = 5-10 min

Epinephrine (Adrenalin) - Nursing Considerations / Client Education

• Assess BP

• Assess HR

Dobutamine (Dubutrex) - Drug Classification / Mechanism of Action

Selective Beta 1 Agonist

Stimulates beta-1 adrenergic receptors

Dobutamine (Dubutrex) - Therapeutic Uses

• Acute Decompensated HF

• Cardiogenic Shock

Dobutamine (Dubutrex) - Adverse Effects

• HTN

• Palpitations

• Dysrhythmias

• Chest pain

• Headache

• N/V

Dobutamine (Dubutrex) - Contraindications

• HTN

• CAD

• Dysrhythmias

Dobutamine (Dubutrex) - Routes / Pharmicokinetics

• IV (only) - central line

• Onset = immediate

Dobutamine (Dubutrex) - Nursing Considerations / Patient Education

• monitor HR (advanced monitoring)

• monitor BP

• administer via central line

Albuterol (proventil,ventolin) - Drug Classification / Mechanism of Action

Selective Beta 2 Agonist

• adrenergic beta 2 agonist

  • binds with beta 2 adrenergic receptors in bronchial smooth muscle

Albuterol (proventil,ventolin) - Therapeutic Uses

• Relieve/prevent bronchospasms

Albuterol (proventil,ventolin) - Adverse Effects

• Palpitations

• nervousness

• Headache

• tremors

• tachycardia

• insomnia with PO & Neb

• transient hypokalemia

Albuterol (proventil,ventolin) - Contraindications

• hypersensivity

• careful with cardiac hx

Albuterol (proventil,ventolin) - Nursing Considerations / Patient Education

• Assess HR, BP

• monitor Potassium - transcient decrease

• Educate on inhaler use

Albuterol (proventil,ventolin) - Routes / Pharmicokinetics

• PO

• Sublingual

• Onset =

  • sublingual = 5-15 min

  • PO = 30 min

Prazosin (Minipress) - Drug Classification / Mechanism of Action

• selective alpha 1 antagonist

Competes with NE at alpha receptors on vascular smooth muscle

Prazosin (Minipress) - Therapeutic Uses

• HTN

• BPH (benign prostatic hyperplasia)

Prazosin (Minipress) - Adverse Effects

• orthostatic hypotension

• dizziness

• drowsiness

• fatigue

• FIRST DOSE PHENOMENON

Prazosin (Minipress) - Contraindications

• Hypersensitivity

• CAD

• Old → renal impairment

Prazosin (Minipress) - Routes / Pharmicokinetics

• PO

Onset = 2 hours (varies)

Prazosin (Minipress) - Nursing Considerations / Patient Education

• Assess BP

• Fall Precaution Education

Prapanalol (Inderall) - Drug Classification / Mechanism of Action

Nonselective Beta Antagonists

• blocks beta 1 receptors in heart

• blocks beta 2 receptors in lungs

Prapanalol (Inderall) - Therapeutic Uses

• HTN

• Angina

• Dysrhythmias

• Anxiety

• Migraine prophylaxis

Prapanalol (Inderall) - Adverse Effects

• bronchospasms

• fatigue

• SJS

• bradycardia

• edema

With abrupt withdrawal → REBOUND HTN, tachycardia, dysrhythmias, myocardial ischemia

Prapanalol (Inderall) - Contraindications

• severe HF

• bradycardia

• COPD/asthma

• Diabetes → mask signs of hypoglycemia

Prapanalol (Inderall) - Consideration

• Assess HR —> don’t give if 50 or under

• monitor fluid overload

• monitor glucose

Prapanalol (Inderall) - routes / pharmicokinetics

• PO

• IV

• Onset =

  • IV → immediate

  • PO → 1-2 hours

Metoprolol (lopressor/torpol XL) - Drug Classification / Mechanism of Action

• Selective Beta 1 antagonist

Selective beta 1 antagonists in heart

Metoprolol (lopressor/torpol XL) - Therapeutic Uses

• HTN

• Chronic Stable Angine

• Stable HF

• Acute MI

Metoprolol (lopressor/torpol XL) - adverse effects

• dizziness

• fatigue

• edema

• edema

• bradycardia

• rebound cardiac excitation with abrupt withdrawal

Metoprolol (lopressor/torpol XL) - contraindications

• cardiogenic shock

• severe bradycardia

• heart block

• severe HF

Metoprolol (lopressor/torpol XL) - Routes / pharmicokinetics

• PO

• IV

• Onset =

  • IV = immediate

  • PO = 15 min

Metoprolol (lopressor/torpol XL) - Nursing Consideration / Patient Education

• Assess HR → 50 or less, dont give

• Assess BP

Bethanechol (Urecholine) - Drug Classification / Mechanism of Action

• Muscarinic Cholinergic Agonist

stimulate muscuranic receptors in bladder (PNS)

Bethanechol (Urecholine) - Therapeutic Uses

• nonobstructive uriniary retention

• neurogenic bladder

Bethanechol (Urecholine) - Adverse effects

• N/V/D

• abdominal pain

• orthostatic hypotension

• sweating

• bradycardia

• bronchospasms

Bethanechol (Urecholine) - Contraindications

• hypersensitivity

• GU/GI obstruction

• caution with CVD, PUD, asthma

Bethanechol (Urecholine) - Nursing Considerations / Patient Education

• Assess VS

• Monitor I&Os

• Palpate bladder for distension

Bethanechol (Urecholine) - Routes

• PO

• Subcut

• Onset =

  • SQ → 5-15 min

  • PO → 30 min

Atropine (AtroPen, Isopto) - Drug Classification / Mechanism of Action

Muscarinic Cholinergic Antagonist

blocks Ach at postganglionic receptors in PNS

Atropine (AtroPen, Isopto) - Therapeutic Uses

• Sx bradycardia

• Preop to reduce secretions/respiratory secretions

• cholinergic agonist poisoning

Atropine (AtroPen, Isopto) - Adverse Effects

• tachycardia

• drowsiness

• palpitations

  • urinary retention constipation

Atropine (AtroPen, Isopto) - contraindications

• galucoma

• GI obstruction

• caution in OA’s, BPH

Atropine (AtroPen, Isopto) - Nursing Considerations / Patient Education

• Assess VS

• Monitor EKG

• Monitor I&Os , BMs

Atropine (AtroPen, Isopto) - Routes / Pharmicokinetics

• PO

• IV

• IM

• SL

• Ophthalmic

• transdermal

• onset

  • IV - immediate

  • IM = 15 min

lisinopril (prinivil,zestril) - Drug Classification / Mechanism of Action

ACE inhibitor

binds to and inhibits ACE

lisinopril (prinivil,zestril) - therapeutic uses

• HF

• HTN

• Acute MI

*FIRST LINE FOR HF

*FIRST LINE FOR HTN

lisinopril (prinivil,zestril) - adverse effects

• cough

• rash

• angioedema

• dizziness

• hyperkalemia

• hypotension

• blood dyscrasias

• hepatoxicity

• nephrotoxicity

lisinopril (prinivil,zestril) - contraindications

• hyperkalemia

• angioedema

• caution w/ renal & hepatic dysfunction

• Category D - 2nd & 3rd trimesters pregnancy

lisinopril (prinivil,zestril) - Routes / pharmicokinetics

• PO

• Onset

  • 1 hour

• peak

  • 6-8 hour

lisinopril (prinivil,zestril) - Nursing Considerations / Patient Education

• monitor BP

• monitor daily weight

• renal & hepatic function

• CBC

• Avoid salt substitutes with potassium

Losartan (Cozaar) - Drug Classification / Mechanism of Action

ARB blockers - angiotensin II receptor blocker

blocks angiotensin 2 receptors

Losartan (Cozaar) - therapeutic uses

• HTN

• stroke prophylaxis

• off label HF

• Kidney Protection with diabetes II

*FIRST LINE FOR HTN

Losartan (Cozaar) - adverse effects

• headache

• dizziness

• fatigue

• hypotension

• hyperkalemia

• angioedema (low risk)

• acute renal failure

Losartan (Cozaar) - contraindications

• hypersensitvity

• liver & kidney disease

• pregnancy/lactation - D for 2nd and 3rd trimester

• hypovolemia

Losartan (Cozaar) - Nursing Considerations / Patient Education

• monitor BP

• monitor electrolytes

Losartan (Cozaar) - Routes / pharmicokinetics

• PO

• onset = 1 hour

• peak = 6 hours

Furosimide (lasix) - Drug classification / Mechanism of Action

loop diuretics

prevents reabsorption of Na+ & Cl- in loop of henle

Furosimide (lasix) - therapeutic uses

• ACUTE edema

• pulmonary edema in HF

• HTN

Furosimide (lasix) - adverse effects

• hypotension

• syncope

• Headache

• electrolyte disturbances (k+)

  • hypokalemia

• ototoxicity

• gout

• hyperglycemia

Furosimide (lasix) - contraindications

• hypersensitivity

• anuria

  • careful with electrolyte imbalances

Furosimide (lasix) - routes / pharmicokinetics

• PO

• IV

• IM

• onset

  • Po = 30-60 min

  • IV = 5 min

  • IM = 10-30 min

Furosimide (lasix) - Nursing Considerations / Patient Education

• assess BP

• I&Os

• daily weight

• assess K+

• hearing changes

• glucose

hydrochlorothiazide (Microzide) - Drug Classification / Mechanism of Action

Thiazide Diuretic

Acts on distal tube to decrease reabsorption of Na+

hydrochlorothiazide (Microzide) - therapeutic uses

• HTN

• HF

• Edema

*FIRST LINE FOR HTN

hydrochlorothiazide (Microzide) - Adverse Effects

• hypotension

• electrolyte imbalances

  • hypokalemia

• gout

• photosensitivity

• hyperglycemia

hydrochlorothiazide (Microzide) - Contraindications

• hypersensitivity (sulfa)

• anuria

• jaundiced neonates

hydrochlorothiazide (Microzide) - Nursing Considerations / Patient Education

• Assess BP

• edema level

• daily weight

• electrolytes

• glucose

hydrochlorothiazide (Microzide) - routes / pharmicokinetics

• PO

onset = 2 hours

peak = 4 hours

Spironolactone (Aldactone) - Drug Classification / Mechanisms of action

potassium sparing diuretic

inhibits action of aldosterone in distal tubule & collecting duct

Spironolactone (Aldactone) - Therapeutic Uses

• HTN

• nephrotic syndrome

• edema in HF

• cirrhosis

• hypokalemia

Spironolactone (Aldactone) - Adverse Effects

• hyperkalemia

• dizziness

• gynecomastia

• impotence in males

• irregular periods in females

Spironolactone (Aldactone) - contraindications

• anuria

• hyperkalemia

• kidney disease

Spironolactone (Aldactone) - nursing considerations / patient education

• monitor K+

Spironolactone (Aldactone) - route / pharmicokinetics

• PO

onset = 2-3 days

peak = up to 2 weeks

Amlodipine (Norvasc) - Drug Classification / Mechanisms of Action

• Calcium Channel Blocker (Dihydropyridine)

• block calcium channels in vascular smooth muscle → coronary arteries

  • (more affect on vasodilation)

Amlodipine (Norvasc) - Therapeutic Uses

• HTN

• Chronic Stable Angina

• Vasopastic Angina

• CAD

*FIRST LINE FOR HTN

Amlodipine (Norvasc) - Adverse Effects

• Hypotension

• HA

• dizziness

• flushing

• peripheral edema

• HF

Amlodipine (Norvasc) - Contraindications

• hypersensitivity

• caution with HF

Amlodipine (Norvasc) - Nursing Considerations / Patient Education

• Assess BP

• Assess HR

• Monitor for Edema

Amlodipine (Norvasc) - Routes / Pharmicokinetics

• PO

Onset =

• 30-60 min

• XL = 6 hours

Diltiazem (Cardizem, Dilacor, Tiazac) - Drug Classification / Mechanisms of Action

• Calcium channel blockers (nondihydripyridine)

• inhibits flow of calcium into cardiac & vascular smooth muscle cells

Diltiazem (Cardizem, Dilacor, Tiazac) - Therapeutic Uses

• HTN

• Angina

• tachydysrhythmias

Diltiazem (Cardizem, Dilacor, Tiazac) - Adverse Effects

• constipation

• worsening HF

• peripheral edema

• flushing

• dizziness

• urinary frequency

• bradycardia

• hypotension

• headache

Diltiazem (Cardizem, Dilacor, Tiazac) - Contraindications

• AV block

• SSS → bad SA node function

• severe hypotension

• recent MI

Diltiazem (Cardizem, Dilacor, Tiazac) - Nursing Considerations / Patient Education

• Assess BP, HR

• Monitor continuous ECG for IV tx

Diltiazem (Cardizem, Dilacor, Tiazac) - Routes / Pharmicokinetics

• PO

• IV

Onset =

• IV → immediate

• PO → 1-2 hours

Nitroglycerin (Nitrostat, nitro-dur) - Drug Classification / Mechanisms of Action

• Organic nitrates

• relaxes arterial & venous smooth muscle

Nitroglycerin (Nitrostat, nitro-dur) - Therapeutic Uses

• ACUTE ANGINA

• controlled HTN

• HF

• Acute MI

• Acute pulmonary edema

• HTN crisis

Nitroglycerin (Nitrostat, nitro-dur) - Adverse Effects

• facial flushing

• HA

• orthostatic hypotension

• rash → transdermal (patches, ointment)

Nitroglycerin (Nitrostat, nitro-dur) - Nursing Considerations / Patient Education

• monitor BP, HR, RR, SPo2

• continuous cardiac monitoring for IV

Nitroglycerin (Nitrostat, nitro-dur) - Routes / Pharmicokinetics

• PO

• IV

• Topical

• Buccal

• SUBLINGUAL

onset = varies, 1-60 min

Nitroglycerin (Nitrostat, nitro-dur) - Contraindications

• hypotension

• shock

• head injury

• pericardial tamponade

• PDE-5 inhibitor

Ranolazine (Ranexa) - Drug Classification / Mechanisms of Action

• Antianginal/Misc. Cardiovascular agent

• inhibits Na+ current, blocking Ca2+ from flooding cell → improved blood flow to coronary arteries

Ranolazine (Ranexa) - therapeutic uses

CHRONIC angina

Ranolazine (Ranexa) - Adverse Effects

• HA

• dizziness

• constipation

• tinnitus

• blurred vision

• dysrythmias

• orthostatic hypotension

• renal failure

Ranolazine (Ranexa) - Contraindications

• liver disease

• kidney disease

• prolonged QT interval

• grapefruit juice is inhibitor