BMS exam 2 meds

antihypertensives

diuretics, ACE/ARB, beta blockers, calcium channel blockers, vasodilators, alpha 2 adrenergic agonist

check BP, BP trends, parameters, hold if BP low, hold if HR too low

statins

used for high total cholesterol, high LDL, high triglycerides, low HDL, high cardiovascular disease risk

monitor liver function9 every 3-6 months, give in evening, avoid grapefruit.

AE: myopathy, hepatotoxicity

coronary artery disease (CAD) meds

prevent MI and death. statins and antiplatelets.

prevent myocardial ischemia and anginal pain via beta blockers, calcium channel blockers, nitrates

anticoagulants

used for venous thrombus, large veins, areas with slower bloodflow.

used short term for DVT/PE prevention and treatment

used long term for prosthetic heart valve and afib

REVERSIBLE

antiplatelets

prevent arterial thrombus (MI, ischemic stroke), peripheral artery disease (PAD). in smaller arteries to prevent acute processes

IRREVERSIBLE

aspirin

antiplatelet

check vital signs and antagonists

AE: bleeding, GI upset, nephrotoxicity

clopidogrel

antiplatelet

for CAD, PAD, and ischemic stroke (CVA). used for dual antiplatelet therapy (2 at once)

check vital signs and antagonists

AE: bleeding

heparin

anticoagulant

IV: prevents and treats DVT/PE.

SQ: treats VTE prophylaxis, no aPTT monitoring

AE: bleeding, heparin-induced thrombocytopenia (HIT)

labs: PLT, aPTT

antagonist (reversal agent): protamine sulfate

enoxaparin

aka Lovenox. a low molecular weight heparin (LMWH)

same as normal heparin but no aPTT monitoring

has a little air bubble that goes INSIDE patient

home use: stable DVT/PE, reliable,

low bleeding risk, adequate renal function, normal VS, monitorable

never give concurrently with heparin

warfarin

AKA Coumadin

long-term for anticoagulation. treats and prevents DVT/PE

PO. get PT/INR labs (normal INR 0.8-1.1, therapeutic 2-3). 48-72 hr onset. ensure stable vitamin K diet consumption. avoid NSAIDS, salicylates, and OTC drugs.

antagonist: vitamin K

AE: bleeding

factor Xa inhibitor

fondaparinux (Arixtra) SQ. rivaroxaban (Xarelto) and apixaban (Eliquis) both PO

treat and prevent DVT/PE. long-term for anticoagulation.

no reversal agent.

AE: bleeding

direct thrombin inhibitors

dabigatran (Pradaxa)

treat and prevent DVT/PE. long-term anticoagulation. PO.

no reversal agent

AE: bleeding

skeletal muscle relaxant

dantrolene

for malignant hyperthermia. assess liver function.

AE: hepatotoxicity

antiemetics

promethazine, metoclopramide, prochlorperazine, ondansetron

for N/V

monitor I/Os, emesis quantity. working if decrease in what and increase in activity and intake

AE: excessive sedation, respiratory depression

surfactant laxative

docusate sodium

allows water and oil into stool to make it slipperier

stimulant laxative

bisacodyl

activate colon nerves to move it along

osmotic laxative

polyethylene glycol

brings water into colon to soften stool

laxatives

for surgery + procedure prep and constipation

assess for abd pain, bowel sounds, allergies. encourage fluid intake. do not give if bowel obstruction or fecal impaction. med is working if bowels are prepped for procedure and there is no constipation.

AE: electrolyte imbalance, dehydration, diarrhea

pain meds

assess pain and med effectiveness. working if increased activity, decreased pain indicators

strong opioid agonists

morphine, hydromorphone

for severe pain

monitor VS, sedation level, I/Os, bowels, LOC, swallowing pills

AE: resp depress, change in sedation/LOC, constipation, urinary retention

moderate to strong opioid agonists

oxycodone/acetaminophen, hydrocodone.acetaminophen

for moderate pain

assess pain 60 min after PO, VS, what, bowels, GI upset, sedation, LOC, education, give with food

AE: resp depress, constipation, urinary retention, cough suppression, change in LOC/sedation

opioid antagonist

naloxone

reverses opioid agonists (+ resp depress)

given IV, IM, or SQ. immediate effects, 30-90 duration, given several times due to short half-life. working if patient is less sedated and their pain status improves. monitor VS and LOC

AE: withdrawal symptoms in dependent patients

analgesic/antipyretic

acetaminophen

for mild pain

no more than 4g/day, give with food.

AE: hepatotoxicity (high liver function tests, jaundice)

mild pain NSAID

ibuprofen

GI upset, give with food, bleeding

AE: gastric ulcer, bleeding, renal impairment

moderate to severe NSAID

ketorolac

monitor for bleeding

AE: gastric ulcer, bleeding, renal impairment

NSAIDs

monitor VS and hemoglobin + hematocrit

AE: gastric ulcer, bleeding, renal impairment (elevated what)

glucocorticoids

prednisone, methylprednisolone

used for rheumatoid arthritis, autoimmune disorders, IBS, lupus, COPD, resp distress syndrome, transplant recipients, cancer, dermatologic disorders

AE: thromboembolism, hyperglycemia, decreased wound healing, infection, fluid electrolyte imbalance, osteoporosis

diuretics

for hypertension and edema

monitor fluid volume, VS, I/Os, weight, labs, nutrition

AE: dehydration, electrolyte imbalance

loop diuretics

-ide. furosemide, bumetanide

for hypertension, edema, and heart failure. tells loop of henle to not reabsorb water and Na into blood

AE: dehydration, electrolyte imbalance, hypokalemia

potassium sparing diuretics

AKA aldosterone receptor blockers

spironolactone

counters K loss, as opposed to other diuretics. do not give K supplements since med is already making K reabsorb

AE: electrolyte imbalance, dehydration, hyperkalemia

ACE inhibitors and ARBs

angiotensin converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs)

used for hypertension, heart failure, diabetic nephropathy, myocardial infarction

monitor BP, labs, K, BUN/Cr

AE: angioedema, hypotension

ACE inhibitors

-pril. captopril, enalapril, lisinopril

used for hypertension, heart failure, diabetic nephropathy, myocardial infarction

monitor BP, labs, K, BUN/Cr. decreased mortality for cardiovascular disease patients

SE: cough

AE: angioedema, hypotension, first dose effect (allergy)

ARBs

angiotensin 2 receptor blockers

-sartan. losartan, candesartan, valsartan

used for hypertension, heart failure, diabetic nephropathy, myocardial infarction

monitor BP, labs, K, BUN/Cr. decreased mortality for cardiovascular disease patients

SE: cough, hyperkalemia

AE: angioedema

beta blockers

adrenaline/epinephrine binds to beta receptors, causing fight or flight (high HR, high BP). blocks this to reduce stress on heart

-lol

cardioselective: atenolol, metoprolol (less chance to cause bronchoconstriction)

noncardioselective: carvedilol, labetolol, propanolol (hurts ppl with asthma or COPD)

used for angina, hypertension, heart failure, MI/CAD

monitor BP, HR, lung sounds

SE: fatigue, erectile dysfunction (ED)

AE: hypotension, bradycardia, bronchoconstriction (non-cardio)

topical beta blockers

betaxolol (Betoptic S) and timolol (Timoptic). for glaucomas

SE: blurred vision, photophobia (light sensitivity), dry eyes

AE: hypotension, bradycardia, bronchoconstriction (non-cardio)

use punctal occlusion (block puncta so drops in eye do not drain into nasal cavity for 30-60 seconds)

smooth muscle calcium channel blockers

-dipine.

amlodipine, nifedipine, nicardipine.

monitor BP, HR, bowels

AE: hypotension

smooth and heart muscle calcium channel blockers

verapamil, diltiazem

monitor BP, HR, bowels

AE: hypotension, bradycardia

vasodilators

isosorbide, hydralazine, nitroglycerin

for hypertension, angina, heart failure

monitor BP, use of ED drugs (sildenafil/Viagra). can be sublingual, IV drip, IV push, paste, and PO

AE: hypotension

alpha 2 adrenergic agonist

methyldopa, clonidine

for hypertension. can be transdermal or PO

monitor BP, sedation

SE: drowsiness (give at night).

AE: hypotension, rebound hypertension if not tapered off