cardiovascular

Vasodilation

decrease BP

Vasoconstriction

increase BP

Uncontrolled HTN

angina, heart failure, stroke, renal disease, blindness

Hydrochlorothiazide (Thiazide diuretics)

decrease blood volume, decrease BP, used with antihypertensives to prevent rebound fluid retention (edema and hypertension \= TI)

Hydrochlorothiazide (Thiazide diuretics) ADR

hypotension, hypothermia, hypokalemia, dehydration, hyperglycemia, hyperuricemia, hypercholesterolemia, GI

Hydrochlorothiazide (Thiazide diuretics) considerations

take in the morning

Captopril, enalapril (ACE inhibitors)

blocks RAAS, lower BP

Captopril, enalapril (ACE inhibitors) ADR

angioedema, persistent dry cough, hyperkalemia (avoid potassium), renal impairment, hypotension

Captopril, enalapril (ACE inhibitors) consideration

avoid potassium

Losaeran (ang II blocker)

newest, block ang II receptors (blocks vasoconstriction and aldosterone release) lowers BP

Losaeran (ang II blocker) ADR

hypotension

Aliskerin (direct renin)

block renin, decease BP, used only for HTN (not sure what else for currently)

Aliskerin (direct renin) ADR

hypotension, hyperkalemia (rare); PO (do NOT take with food)

propranolol, atenolol (beta blocker)

block NE \= decrease HR and contractility, decrease BP, also blocks renin

Propranolol, atenolol (beta blockers) ADR

sex dysfunction, bronchospasms, diabetes, allergy, ghypotension, bradycardia, NVD, fatigue, depression

B1

heart

B2

lungs (bronchospasms)

Propranolol

non selective (B1 and 2)

Atenolol

B1 blocker (avoid bronchospasms)

Doxazosin (alpha blocker)

blocks vasodilation \= decrease BP

Doxazosin (alpha blocker) ADR

hypotension, syncope, HA, dizziness, flushing, edema, reflex tachycardia (counteracted by beta blocker), NVD

Nifedipine, verapamil (Calcium channel blocker)

muscles relax, vasodilation, decrease HR and force of contraction

Nifedipine, verapamil (Calcium channel blocker) ADR

dizziness, flusining, edema, bradycardia, SOB, constipation, leg/muscle cramps, allergic reaction, hypotension, HA

Direct acting vasodilators

hydralazine, minoxidil, nitroprusside

hydralazine, minoxidil, nitroprusside (direct acting vasodilators)

act on arterioles/veins

hydralazine, minoxidil, nitroprusside (direct acting vasodilators) ADR

hypotension, dizziness, flusining, edema, reflex tachycardia

Minoxidil extra ADR

hypertrichosis (excessive hair growth)

Nitroprusside extra consideration

IV, hypertensive crisis (give in dark tubing)

clonidine, methyldopa (Centrally acting antihypertensives)

act in CNS, decrease activity of sym NS, resemble A and B blockers

clonidine, methyldopa (Centrally acting antihypertensives) ADR

all ADRs of alpha and beta blockers \= not widely used (edema, HA, flushing, bradycardia, bronchospasm, allergic reactions, diabetes, etc)

Clonidine use

HT crisis, PO

Methyldopa use

pregnancy

Angina treatments

wt reduction, stop nicotine and alcohol and stress, bypass, stenting, balloon

glycerol trinitrate (nitrate) use

not used for HTN only angina

glycerol trinitrate (nitrate)

decrease preload and afterload (higher dose needed for afterload), decrease O2 demand\= relieve ischemia , rapid act (before or during attack)

glycerol trinitrate (nitrate) ADR

hypotension, HA, dizziness, flushing, reflex tachycardia (same as vasodilators)

Glyceryl trinitrate

nitrate

Nitrate tolerance

keep high dose, start with lowest possible, have breaks (do not take at night)

Nitrate toxicity

hypotension, reflex tachycardia, exacerbated by alcohol and antihypertensives

Nitrate rapid

mouth cavity (sublingual/spray)

Nitrate long

buccal/patches, oral extended release, have repair on hand

Nitrate absorption

increase lipid soluble, readily cross membrane, rapid onset, many alt routes

Nitrate metabolism

rapidly degraded by liver, short acting, extensive first pass

Nitrate emergency

one tab every 5 mins, if not relieved ER (may be MI)

Metoprolol (beta blocker)

angina, decrease HR and force of contractions

Verapamil (calcium channel blocker)

angina, decrease cardiac work, vasodilator

Digoxin (cardiac glycoside)

heart failure, increase cardiac contractility, increase stroke volume, *positive inotropic action (increase contraction), improve blood flow, clears edema

Digoxin (cardiac glycoside) ADR

weakness, fainting, fatigue, double vision, flash lights, change in color vision, bradycardia, arrhythmias, hallucinations, abdominal pain

Digoxin (cardiac glycoside) considerations

long ½ life, increase dose then maintain, only for heart failure

Digoxin toxicity

narrow TI, measure concentration, low K \= more likely toxic (use potassium sparing over thiazide/loop diuretics)

Dioxin toxicity antidote

digiblind (digoxin immune fab)

Do not give digoxin if

apical pulse is below 60 or over 100

Diuretics

remove edema, decrease BP, decrease afterload, decrease work of heart (Thiazides, loop diuretic, potassium sparing)

Diuretics ADR

low BP

Thiazides (hydrochlorothiazide), loop diuretics (furosemide)

care for hypokalemia

Potassium sparing (spironolactone)

weak diuretic, conserves potassium

Atorvastatin (statins)

antilipemic, decrease LDL, inhibit enzyme for cholesterol synthesis

Atorvastatin (statins) ADR

myalgia, liver damage

Atorvastatin (statins) CI

liver disease, pregnant, monitor liver function, give drug at bedtime

Niacin

B complex vitamin

Niacin ADR

flushing, itching, hepatotoxicity, GI, orthostatic hypotension, (grad increase dose, slow release, aspirin)

Cholestyramine resin, colesevelam (bile acid resins)

bind with bile acids in GI tract, aid in fat absorption (BA eliminated cholesterol used to make more BA which lower cholesterol and LDL)

Cholestyramine resin, colesevelam (bile acid resins) ADR

few bc no systemic action, GI (steatorrhea)

Cholestyramine resin, colesevelam (bile acid resins) considerations

mix with water (suspension) decreased absorption of food so take on empty stomach

Colesevelam

less GI effects

Exetimibe (cholesterol absorption inhibitor)

blocks cholesterol, well tolerated

Gemfibrozil (fibric acid derivatives)

decrease TG levels

Gemfibrozil (fibric acid derivatives) ADR

GI, rash, myopathy, hepatotoxicity, ball stones

Heparin

enoxaparin, heparin sodium

Heparins use

anticoagulant, prevent formation of new clots, prevent extension of existing clots

Heparin considerations

*monitor blood work to ensure correct dose; parenteral (high charge), rapid acting, IV/SC (not oral), units

Heparin CI

surgery of eye, brain, spine

Heparin ADR

unwanted bleeding (monitor closely), [drop in BP, bruises, cloudy/discolored urine, red/black stools, pelvic pain, HA, faintness] allergic reaction, thrombocytopenia (decrease platelet count)

Too much heparin

bleeding

Too little heparin

clotting

aPTT (activated partial thromboplastin time)

time taken for blood to clot with heparin increase 1.5 to 2 times the baseline

aPTT too short

increase dose of heparin

aPPT too long

discontinue heparin, antidote \= protamine sulfate, transfusion

Heparin antidote

protamine sulfate

Warfarin

anticoagulant, coumarins (sweet clover and grass), vitamin K antagonist (absence of VK \= impair coagulation); oral anticoagulant (blood thinning), slow onset, indirect

Warfarin use

prophylaxis and treatment of thrombosis

Warfarin considerations

oral (long term therapy), highly protein bound (lots of drug interactions), takes 48 to 72 hours for effect, take with food

Warfarin ADR

bleeding (decrease BP), abd cramps, nausea, anorexia, alopecia (report), black stool

Warfarin monitoring

too little (clotting), too much (hemorrhage), prothrombin time PT (time taken for blood to clot after addition of tissue factor, labs

Between 2 and 3

INR (warfarin) ideal

INR to short (under .5)

increase warfarin

INR to long (over 5)

warfarin antidote (vitamin K)

Warfarin drug and food interactions

increase effect of warfarin (enhance bleeding, aspirin \= displacement from pp binding sites) decrease effect of warfarin (enhance clotting, anti epileptics (induction of liver enzymes) vitamin K rich foods (antagonistic effect))

Warfarin CI

aspirin, phenytoin (antiepileptics), vitamin K rich foods (greens), pregnancy

anticoagulant pregnancy

use LMW heparin

Heparin

IV/SC, potentiate antithrombin III, rapid onset, aPTT, protamine \= antidote

Warfarin

oral, VK antagonist, 3 day onset, INR, VK \= antidote

Dabigatran

Direct oral anticoagulant, alternative to warfarin (safer and easier)

Dabigatran ADR

NVD (take with food)

Aspirin

antiplatelet, COX inhibitor, inhibits clot formation (at low doses)

Abciximab

platelet receptor inhibitor, glycoprotein receptor antagonist, given IV, antiplatelet

Clopidogrel

platelet receptor inhibitor , ADP receptor needed for aggregation

Clopidogrel considerations

delayed onset of action, significant individual variability in platelet response

Antiplatelet drug ADR

bleeding (monitor, minimize, report)

Thrombolytics (alteplase) use

medical emergency to treat ADR thromboembolic events (MI, PE, arterial occlusion, DVT), restore patency to occluded central venous catheters