medications unit 4

Short acting Nitrates

• Hold if systolic <90

• Erectile dysfunction meds contradicted within 24 (short)

• Antihypertensives may cause additive hypotension

• Pain within 5 min

• Max 3 doses in 15 min, if not resolved 911

• Should feel tingling/burning (sublingual)

• Headache common

• Rise slowly

• Carry at all times

• Replace 6 months after opening

• Keep away from light, heat

• Sit down prior to admin

Long acting nitrates

• erectile dysfunction meds contradicted, 48 hr

• Don’t crush, chew

• Paste/patch: wipe off/remove at night, reduce dependence

• Antihypertensives may cause additive hypotension

• Headache

• Adverse: profound hypertension, reflex tachycardia

ASA, Plavix

• prevent platelet activation, prevent platelets clumping

• ASA: GI bleeding, BP, HTN increases bleeding risk

• Plavix: platelets, active bleeding

• Can cause GI upset use Pepcid or protoxin

• Plavix should be help 7 days b4 most invasive procedures

• Omeprazole can reduce Plavix effectiveness, protoxin preferred

Anticoagulants unfractionated IV SQ heparin, Lovenox

• assess active bleeding, recent trauma/surgery

• aPTT (heparin)

• PT/IWR (warfarin)

Statins

• lower cholesterol & triglycerides

• Pregnancy contradicted

• Warfarin increased risk bleeding/myopathy

• Side effects: fatigue, headache, GI upset

• Adverse: hepatotoxicity, myopathy, kidney damage

• Take on empty stomach (atrovastatin, rosuvastatin)

• Take in evening same time of day

• Avoid grapefruit juice

• Report muscle pain, tea color urine (rhabdo)

• Simvastatin interacts w warfarin

Fibrates: fenofibrate, gemfibrozil

• lower triglycerides, lower HDL

• Anti hypoglycemics monitor for hypoglycemia

• Bleeding, bruising, nose bleeds, blood in stool

• Gallbladder disease, RUQ pain - gallstones

• Liver, renal function tests

• Fibrates increased bleeding risk when taken with warfarin

• take 30 min before breaky/dinner if ordered bid

• Don’t abruptly stop

• INR if on warfarin

Bile acid sequestrants - resins: cholestyramine, colestipol, colesevelam

• lower LDL

• Fat soluble vitamins ADEK if long term use expected

• Increase hydration, fiber

• Report black tarry stools

• Drug interactions

• Lipid panel, AST, ALT

Cholesterol absorption inhibitors ezetimibe, zetia

• Don’t interfere with vitamin ADEK

• Pt on statins rhabdo risk

• Taking bile acid sequestrants ezetimibe given > 2 hr before or > 4 hr after

• Side effects: headache, mild G.I. distress, fatigue, joint pain, cold, like symptoms, respiratory infection

• Rhabdo chances (w statins)

• Take same time of day

• Do not take w bile acid sequestrants

• Avoid pregnancy/breast feeding

• Monitor lipid panel, liver function