Chronic EXAM 2 MEDS

Streptokinase

Thrombolytic; dissolves existing clots; major risk = serious bleeding.

t-PA (Alteplase)

Thrombolytic; converts plasminogen to plasmin to dissolve existing clots; monitor closely for bleeding, especially intracranial hemorrhage.

Heparin

Anticoagulant; prevents clot extension and new clot formation; monitor aPTT or anti-Xa as ordered, platelets and bleeding; antidote = protamine sulfate.

Enoxaparin (Lovenox)

Low-molecular-weight heparin anticoagulant; prevents clots; administer SQ, commonly in abdomen; no routine aPTT; do not rub injection site; monitor bleeding and platelets.

Warfarin (Coumadin)

Oral vitamin K antagonist anticoagulant; prevents clot formation; monitor PT/INR; maintain consistent dietary vitamin K; reversal = vitamin K, with additional reversal agents for major bleeding.

Apixaban (Eliquis)

Direct factor Xa inhibitor anticoagulant; prevents clots; no routine INR; monitor bleeding; take consistently and do not discontinue without provider direction.

Rivaroxaban (Xarelto)

Direct factor Xa inhibitor anticoagulant; prevents clots; no routine INR; monitor bleeding; follow food instructions for prescribed dose and do not stop abruptly.

Abciximab

IV glycoprotein IIb/IIIa inhibitor; prevents platelet aggregation; used during selected acute coronary interventions; monitor bleeding and platelet count.

Aspirin

Antiplatelet; irreversibly inhibits platelet aggregation; reduces thrombotic cardiovascular events; monitor for bleeding and GI irritation.

Clopidogrel (Plavix)

Antiplatelet; inhibits platelet P2Y12 receptors to reduce aggregation; used to prevent MI and ischemic stroke; major risk = bleeding.

Cilostazol (Pletal)

PDE-3 inhibitor; improves intermittent claudication in PAD; contraindicated in heart failure.

Pentoxifylline (Trental)

Hemorheologic agent used for intermittent claudication; improves red blood cell flexibility and blood flow; may cause GI upset or dizziness.

Ramipril (Altace)

ACE inhibitor; decreases angiotensin II and aldosterone; monitor BP, renal function, potassium, cough and angioedema.

Nifedipine (Procardia)

Calcium channel blocker; vasodilates and can treat Raynaud's; monitor hypotension, dizziness, headache and peripheral edema.

Amlodipine (Norvasc)

Calcium channel blocker; vasodilates; used for hypertension, angina and sometimes Raynaud's; monitor BP, edema and dizziness.

Procainamide (Pronestyl/Procan SR)

Class IA sodium-channel blocker antiarrhythmic; slows depolarization and prolongs repolarization; monitor ECG and hypotension.

Quinidine (Quinidex)

Class IA sodium-channel blocker antiarrhythmic; slows conduction and prolongs repolarization; monitor QT interval and dysrhythmias.

Disopyramide (Norpace)

Class IA sodium-channel blocker antiarrhythmic; slows conduction; may cause anticholinergic effects and worsen heart failure.

Lidocaine

Class IB sodium-channel blocker antiarrhythmic; IV for selected ventricular dysrhythmias; monitor CNS toxicity, confusion, tremors and seizures.

Mexiletine (Mexitil)

Oral Class IB sodium-channel blocker antiarrhythmic; used for ventricular dysrhythmias; monitor GI and neurologic adverse effects.

Phenytoin (Dilantin)

Anticonvulsant with Class IB antiarrhythmic properties; historically used for selected ventricular dysrhythmias, including digoxin-associated dysrhythmias.

Flecainide (Tambocor)

Class IC sodium-channel blocker antiarrhythmic; slows cardiac conduction; monitor ECG for proarrhythmia.

Propranolol (Inderal)

Class II nonselective beta blocker; decreases heart rate and conduction; monitor HR/BP; caution with asthma and bradycardia.

Atenolol (Tenormin)

Class II beta-1 blocker; decreases heart rate and cardiac workload; monitor HR and BP.

Metoprolol (Lopressor)

Class II beta-1 blocker; decreases heart rate, conduction and contractility; monitor HR/BP.

Nadolol (Corgard)

Class II nonselective beta blocker; decreases cardiac sympathetic stimulation; monitor HR/BP.

Amiodarone (Cordarone/Pacerone)

Class III antiarrhythmic; prolongs repolarization and refractory period; monitor ECG, thyroid, liver and pulmonary toxicity.

Sotalol (Betapace)

Class III antiarrhythmic with beta-blocking effects; prolongs repolarization; monitor QT interval, HR, renal function and electrolytes.

Verapamil (Calan)

Class IV calcium channel blocker; slows AV-node conduction; monitor HR/BP, bradycardia and constipation.

Diltiazem (Cardizem)

Class IV calcium channel blocker; slows AV-node conduction; monitor HR/BP and bradycardia.

Adenosine (Adenocard)

Antiarrhythmic for selected supraventricular tachycardias; administer rapid IV push followed by flush; extremely short half-life; monitor ECG.

Ibutilide (Corvert)

IV Class III antiarrhythmic used to convert atrial flutter/fibrillation; administer over 10 minutes; monitor QT and torsades de pointes.

Digoxin (Lanoxin)

Cardiac glycoside; increases contractility and slows AV conduction; used for selected HF and atrial dysrhythmias; monitor pulse, renal function, potassium and toxicity.

Digoxin immune Fab (Digibind/DigiFab)

Antidote for severe or life-threatening digoxin toxicity.

Nitroglycerin (Nitrostat/Nitro-Bid)

Nitrate for angina; vasodilates and decreases preload/myocardial oxygen demand; causes headache and hypotension; avoid PDE-5 inhibitors such as sildenafil.

Sublingual nitroglycerin

Rapid treatment for acute angina; stop activity and sit down; take one dose under tongue; call 911 if pain persists after 5 minutes; may repeat every 5 minutes up to 3 total doses while awaiting help, per instructions.

Isosorbide dinitrate (Isordil)

Nitrate used for angina prevention and selected HF regimens; relaxes vascular smooth muscle; monitor headache and hypotension.

Isosorbide mononitrate (Monoket)

Long-acting nitrate for angina prevention, not immediate relief of an acute attack; monitor headache and hypotension.

Colesevelam (WelChol)

Bile-acid sequestrant; decreases LDL; may cause constipation; take with food and liquid; separate interacting medications as directed, often at least 4 hours before.

Atorvastatin (Lipitor)

Statin; decreases cholesterol synthesis and LDL; monitor muscle pain/rhabdomyolysis and liver symptoms; avoid excessive grapefruit; may be taken any time of day.

Rosuvastatin (Crestor)

Statin; decreases hepatic cholesterol synthesis and LDL; monitor muscle toxicity and liver symptoms.

Simvastatin (Zocor)

Statin; decreases cholesterol synthesis and LDL; monitor muscle/liver toxicity; avoid grapefruit; commonly taken in evening.

Pravastatin (Pravachol)

Statin; decreases cholesterol synthesis and LDL; monitor muscle and liver toxicity.

Lovastatin

Statin; decreases cholesterol synthesis and LDL; generally take with evening meal; monitor muscle and liver toxicity.

Fluvastatin (Lescol)

Statin; decreases cholesterol synthesis and LDL; monitor muscle and liver toxicity.

Pitavastatin (Livalo)

Statin; decreases cholesterol synthesis and LDL; monitor muscle and liver toxicity.

Ezetimibe (Zetia)

Cholesterol absorption inhibitor; blocks cholesterol absorption in the small intestine; used alone or with a statin.

PCSK9 inhibitors (Alirocumab/Evolocumab)

Lipid-lowering monoclonal antibodies; increase LDL receptor recycling and decrease LDL; monitor injection-site and allergic reactions.

Niacin (Vitamin B3)

Lipid-lowering agent; reduces triglyceride production; adverse effects include flushing, hyperglycemia and hepatotoxicity.

Fenofibrate (Tricor)

Fibrate; primarily lowers triglycerides; monitor liver function, gallstones and muscle toxicity, especially with statins.

Omega-3 fatty acids (Lovaza)

Prescription omega-3 product used to reduce severe triglyceride elevations; may cause GI upset and increase bleeding tendency.

Fondaparinux (Arixtra)

Indirect factor Xa inhibitor anticoagulant; prevents clot formation; administer SQ; monitor bleeding and renal function.

Dabigatran (Pradaxa)

Direct thrombin inhibitor anticoagulant; prevents clots; no routine INR; monitor bleeding; specific reversal agent = idarucizumab.

Famotidine (Pepcid)

H2 receptor antagonist; decreases gastric acid secretion; monitor renal function because dose adjustment may be necessary.

Omeprazole (Prilosec)

Proton pump inhibitor; suppresses gastric acid production; give before meals; follow delayed-release formulation instructions.

Pantoprazole (Protonix)

Proton pump inhibitor; suppresses gastric acid production; generally give before meals; monitor for adverse effects with prolonged use.

Esomeprazole (Nexium)

Proton pump inhibitor; blocks final step of gastric acid production; generally give before meals.

Lansoprazole (Prevacid)

Proton pump inhibitor; reduces gastric acid secretion; generally give before meals.

Calcium carbonate (Tums)

Antacid; neutralizes existing stomach acid; can cause constipation and hypercalcemia with excessive use.

Magnesium hydroxide (Milk of Magnesia)

Antacid; neutralizes stomach acid; can cause diarrhea; avoid in significant renal impairment.

Aluminum hydroxide

Antacid; neutralizes stomach acid; can cause constipation and hypophosphatemia.

Sodium bicarbonate

Antacid; neutralizes stomach acid; sodium load can worsen fluid retention in heart failure.

Sucralfate (Carafate)

GI protectant; forms a barrier over ulcers; give on empty stomach and separate from interacting medications; can cause constipation.

Misoprostol (Cytotec)

Prostaglandin E1 analogue; protects gastric mucosa and prevents NSAID-induced ulcers; can cause diarrhea and cramping; contraindicated in pregnancy when used for ulcer prevention.

Promethazine (Phenergan)

Phenothiazine antiemetic; suppresses CTZ stimulation; causes sedation, hypotension, dry mouth, urinary retention and photosensitivity; monitor CNS depression and administration-related tissue injury.

Metoclopramide (Reglan)

Dopamine antagonist and prokinetic antiemetic; increases gastric motility; give approximately 30 minutes before meals and at bedtime as prescribed; contraindicated in mechanical GI obstruction; monitor EPS and tardive dyskinesia.

Ondansetron (Zofran)

5-HT3 receptor antagonist antiemetic; blocks serotonin-mediated nausea; monitor QT prolongation, hypersensitivity and possible serotonin syndrome with serotonergic drugs.

Granisetron (Kytril)

5-HT3 receptor antagonist antiemetic; prevents chemotherapy-related and postoperative nausea/vomiting; monitor headache, constipation and QT concerns.

Dronabinol (Marinol)

Cannabinoid antiemetic; used for selected chemotherapy-induced nausea/vomiting; monitor dizziness, sedation and altered mood or perception.

Scopolamine (Transderm Scop)

Anticholinergic antiemetic for motion sickness and prevention of postoperative nausea/vomiting; commonly transdermal; causes dry mouth, blurred vision and urinary retention; avoid in angle-closure glaucoma.

Meclizine (Antivert/Bonine)

Antihistamine used for motion sickness and vertigo-related nausea; can cause drowsiness, dizziness and dry mouth.

Aprepitant (Emend)

NK1 receptor antagonist; blocks substance P to prevent chemotherapy-induced nausea/vomiting; often used with other antiemetics; check medication interactions.