KCC Pharm 1 Exam 2

HMG-CoA Reductase Inhibitors

Atorvastatin (Lipitor), pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor)

ACTION of Statins

Statins reduce the amount of cholesterol that enters the blood from the liver by blocking its production.

CONTRAINDICATIONS for Statins

Impaired hepatic function, pregnancy.

ADVERSE EFFECTS of Statins

Myopathies, rhabdomyolysis, elevated CK levels, dark reddish brown urine, can lead to acute tubular necrosis or acute renal failure.

CONSIDERATIONS for Statins

Give at bedtime, may take 4.6 weeks to take full effect, do not take with grapefruit juice, teach symptoms of rhabdomyolysis, monitor for liver impairment, fast for 12 hours before blood draws.

Bile Acid Sequestrants

Cholestyramine (Questran), colesevelam (Welchol).

ACTION of Bile Acid Sequestrants

Binds to bile acids in the intestinal lumen, causing more cholesterol to move into the liver and out of the bloodstream.

CONTRAINDICATIONS for Bile Acid Sequestrants

Complete biliary obstruction, use caution with patients on anticoagulants.

ADVERSE EFFECTS of Bile Acid Sequestrants

Bloating, flatulence, diarrhea, nausea, constipation, increased blood glucose.

CONSIDERATIONS for Bile Acid Sequestrants

Not absorbed systemically (metabolized in liver), mix powder with 60-180mL of fluid, give other drugs 1 hour before or 4 hours after cholestyramine, educate patient on good dental hygiene and bowel regimen.

Fibrates

Fenofibrate (Tricor), gemfibrozil (Lopid).

ACTION of Fibrates

Increases oxidation of fatty acids in the liver and muscle tissues, which decreases the liver's production of triglycerides and raises HDL.

CONTRAINDICATIONS for Fibrates

Severe hepatic or renal impairment, preexisting gallbladder disease, primary biliary cirrhosis.

ADVERSE EFFECTS of Fibrates

GI discomfort, diarrhea, gallstones.

CONSIDERATIONS for Fibrates

Fenofibrate should be taken with food, gemfibrozil should be taken without food and 30 minutes before meals, monitor for liver impairment: jaundice, dark-colored urine, bleeding, notify HCP of abdominal pain.

Cholesterol Absorption Inhibitors

Ezetimibe (Zetia).

ACTION of Cholesterol Absorption Inhibitors

Blocks biliary and dietary cholesterol absorption in the small intestine.

CONTRAINDICATIONS for Cholesterol Absorption Inhibitors

Pregnancy, lactation.

ADVERSE EFFECTS of Cholesterol Absorption Inhibitors

Headache, rash, diarrhea, nausea.

CONSIDERATIONS for Cholesterol Absorption Inhibitors

Give with or without food, take at the same time each day, take 2 hours before or 4 hours after taking a bile acid sequestrant if in combination with a statin.

PCSK9 Inhibitors

Alirocumab (Praluent), evolocumab (Repatha).

ACTION of PCSK9 Inhibitors

Allow liver to remove more LDL cholesterol from the blood.

ADVERSE EFFECTS of PCSK9 Inhibitors

Injection site reaction, nasopharyngitis, itching, influenza, muscle pain, diarrhea.

CONSIDERATIONS for PCSK9 Inhibitors

Sub-q injection every 2 weeks, rotate injection sites, warm to room temperature before administration, injection can take up to 20 seconds, proper needle disposal.

Nasal decongestants

Pseudoepinephrine (Sudafed), oxymetazoline (Afrin).

ACTION of Nasal decongestants

Works indirectly to release norepinephrine which provides vasoconstriction, decreasing congestion.

CONTRAINDICATIONS for Nasal decongestants

Severe hypertension, coronary artery disease.

ADVERSE EFFECTS of Nasal decongestants

Hypertension, dysrhythmia, dizziness/lightheadedness, insomnia/restlessness, dry mucous membranes, urinary retention, difficulty voiding.

CONSIDERATIONS for Nasal decongestants

Only recommended for short-term use, blow nose prior to administration and occlude 1 nostril, can lead to rebound nasal congestion.

Antitussives

Dextromethorphan (Delstm), benzonatate (Tessalon Pearls).

ACTION of Antitussives

Suppresses cough reflex.

CONTRAINDICATIONS for Antitussives

Concurrent with use of MAOIs or herbal supplements.

ADVERSE EFFECTS of Antitussives

Drowsiness, rash, difficulty breathing.

CONSIDERATIONS for Antitussives

Safety (e.g., do not drive), respiratory assessment, avoid eating or drinking for 30 minutes after taking, only for patients with a non-productive cough.

Expectorants

Guaifenesin (Mucinex).

ACTION of Expectorants

Reduces viscosity of secretions.

ADVERSE EFFECTS of Expectorants

Skin rash, headache, nausea/vomiting.

CONSIDERATIONS for Expectorants

Assess for productive cough, monitor for rash, take with food if nausea/vomiting occurs, increase fluid intake.

Mucolytics

Acetylcysteine (Acedadote).

ACTION of Mucolytics

Liquifies mucus.

ADVERSE EFFECTS of Mucolytics

Difficulty breathing, inability to expel secretions, bronchospasms, chest tightness.

CONSIDERATIONS for Mucolytics

Administer via nebulizer, antidote for acetaminophen overdose, respiratory assessment.

Nebulizer

A device used to administer medication in the form of a mist inhaled into the lungs.

Acetaminophen overdose

A condition resulting from the ingestion of excessive amounts of acetaminophen, requiring respiratory assessment and monitoring.

1st Generation H1 Receptor Antagonists

Medications such as diphenhydramine (Benadryl) and hydroxizine pamoate (Vistaril) that bind to histamine receptors, preventing histamine from attaching.

Contraindications for 1st Generation H1 Receptor Antagonists

Pregnancy, narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease, and bladder neck obstruction.

Adverse effects of 1st Generation H1 Receptor Antagonists

CNS depression, anticholinergic effects, CNS stimulation.

CNS stimulation

Increased activity in the central nervous system, which can lead to restlessness or agitation.

2nd Generation H1 Receptor Antagonists

Medications such as cetirizine (Zyrtec) and loratadine (Claritin) that block histamine from binding to H1 receptors.

Adverse effects of 2nd Generation H1 Receptor Antagonists

Headache, dizziness, nausea/vomiting, fatigue, drowsiness.

3rd Generation H1 Receptor Antagonists

Medications such as fexofenadine (Allegra) and levocetirizine (Xyzal) that provide highly selective blocking of H1 receptors.

Adverse effects of 3rd Generation H1 Receptor Antagonists

Headache, nausea/vomiting, dysmenorrhea, fatigue.

Bronchodilators

Medications that promote smooth muscle relaxation, leading to bronchodilation.

Beta Adrenergic agonists

A class of bronchodilators including albuterol (Proventil, Ventolin, Proair) and epinephrine (Adrenaline, Racemic Epi).

Adverse effects of Beta Adrenergic agonists

Angina, tachycardia, palpitations, agitation, anxiety, insomnia, seizures, tremors.

Anticholinergics

Bronchodilators like ipratropium (Atrovent) and tiotropium (Spiriva) that block muscarinic receptors in the airways.

Adverse effects of Anticholinergics

Cough, nervousness, GI upset, headache, dizziness.

Xanthines

Bronchodilators such as theophylline (Theochron) that relax smooth muscle of the bronchial airways and reduce inflammation.

Therapeutic range for theophylline

5-15 mcg/mL.

Corticosteroids

Medications like beclomethasone (Quar Redihaler) and budesonide (Pulmicort) that suppress airway inflammation and decrease mucus secretion.

Adverse effects of Corticosteroids

Headache, hoarseness, cough, dry mouth, oral candidiasis.

Leukotriene Modifiers

Medications such as Montelukast (Singulair) that block the production or effects of leukotrienes.

Adverse effects of Leukotriene Modifiers

Headache, nausea/vomiting, hyperkinesia, psychomotor hyperactivity, infection.