Pharm Drugs - Lecture 3

Drugs to manage Type 2 Diabetes

metformin

sulfonylureas

DPP-4 inhibitors

GLP-1 Receptor Agonists

metformin

1st-line treatment to improve insulin sensitivity

sulfonylureas

stimulate insulin secretion from pancreas

DPP-4 inhibitors

increase insulin release and decrease glucagon levels

GLP-1 Receptor Agonists

enhance insulin secretion & suppress appetite (ex. Ozempic)

Lipid Disorder Drug Management

statins

fibrates

niacin

bile acid resins

omega-3 fatty acids

Statins - mechanism of action

lower LDL cholesterol by inhibiting HGM-CoA reductase enzyme

modest raise of HDL

HGM-CoA is an enzyme involved in the synthesis of cholesterol in the liver

fibrates

lower triglycerides

increase HDL cholesterol

niacin

lowers LDL

lowers triglycerides

raises HDL

Hypertension drugs

ACE inhibitors

ARBs

Calcium channel blockers

diuretics

beta blockers

ACE inhibitors - mech of action

relax blood vessels by inhibiting angiotensin-converting enzyme, which prevents the formation of angiotensin II

• angiotensin II increases blood pressure by vasoconstriction

  • SE = dry cough (patients don’t like this, affects adherence)

effective at lowering blood pressure, protecting kidney function in pts with diabetes (since the kidneys activate angiotensin II)

ARBs - mech of action

Angiotensin II Receptor Blockers

block action of angiotensin II, relax blood vessels

newer drug, used instead of ACE inhibitors (more manageable side effects)

Calcium channel blockers - mech of action

prevent calcium from entering heart cells and blood vessel walls

relaxes blood vessels

decrease blood pressure

without calcium, muscle can’t contract as strongly

ex. nifedipine (also used for vasospasm because it stabilizes the vessel wall)

diuretics - mech of action

make you pee

help eliminate excess sodium and water from body

lower blood pressure by reducing preload

1st line of treatment for htn

chylomicrons

lipoprotein that transports dietary lipids from the intestines to other parts of the body

VLDL

very low density lipoprotein

transports triglycerides from the liver to tissues

IDL

intermediate density lipoprotein

formed from degraded VLDL

LDL

low density lipoprotein

‘bad’ cholesterol

high levels lead to plaque buildup in arteriesHD

HDL

high density lipoprotein

‘good’ cholesterol

help removes other forms of cholesterol from the bloodstream

bile acid resins - mech of action

bind bile acids in the intestine, preventing reabsorption

forces liver to use cholesterol to make more bile acids which lowers cholesterol blood levels

lower LDL

omega-3 fatty acids

lower triglycerides

Antilipemic meds for cholesterol control

statins (most effective at lowering LDL)

bile acid resins (lower LDL)

ezetimibe (inhibit absorption of cholesterol from SI)

Antilipemic for triglyceride control

fibrates (most effective at lowering triglycerides)

niacin (lowers triglycerides, raises HDL)

Omega-3 fatty acids (lowers triglycerides)

Statins - nursing assessment

baseline liver function test: assess enzymes (ALT, AST) prior to therapy

lipid profile: monitor HDL, LDL, triglyceride levels

muscle pain assessment: check for signs of myopathy (muscle diseases) or rhabdomyolysis (the drug could breakdown muscle —> harm the kidneys)

patient education: side effects and adherence

• muscle pain and weakness must be checked out if patient notices it!

• digestive problems

• headache

• sleep disturbances

Bile acid resins - nursing assessment

GI: monitor constipation, bloating, abdominal (make sure not developed from the med)

Lipid profile: monitor LDL levels

Vitamin levels: assess for deficiencies in fat-soluble vitamins (A, D, E, K)

• vitamin K is needed for clotting

• absorbed in intestines, so if bile acid is blocked, absorption may be affected

patient ed: take other meds 1 hr before or 4 hours after bile acid resins so the meds can still be absorbed properly

Fibrates - nursing assessment

baseline liver function tests: assess liver enzymes (ALT, AST) prior to starting therapy

lipid profile: monitor triglyceride and HDL cholesterol levels

• fibrates work in the liver (so need a liver that works)

muscle pain assessment: fibrates can cause muscle breakdown (so check for signs of myopathy or rhabdo which could lead to kidney failure)

renal function tests: monitor serum creatinine and BUN levels (will see a rise if in rhabdo)

myopathy

muscle pain/weaknessn

niacin - nursing assessment

can buy niacin OTC (in some pre-workout)

liver function tests: monitor liver enzymes (ALT, AST)

blood glucose levels: check for hyperglycemia in a diabetic pt (can cause hyperglycemia)

flushing assessment: monitor for flushing & advise how to minimize

flushing

massive vasodilation

get sweaty, super red, itchy, feels like needles all over body

omega-3 fatty acids - nursing assessment

can buy OTC
lipid profile: monitor triglyceride levels

GI assessment: check for GI discomfort or fishy aftertaste (side effects)

can interfere in clotting pathway (a patient with platelet problems should probably not take O3)

Should a patient with platelet problems take omega-3 fatty acid supplements?

No, could cause even more bleeding as O3 can interfere in the clotting pathway

monotherapy

using one medication if lifestyle modifications are insufficient

combination therapy

using 2+ meds if monotherapy is not effective

resistant hypertension

consider additional meds or refer to specialist if blood pressure is still uncontrolled with combination therapy

diuretics - nursing considerations

monitor electrolyte levels (excreting sodium)

assess for signs of dehydration

educate patients about the importance of maintaining adequate fluid intake

ACE inhibitors - nursing considerations

monitor bp

assess for signs of hyperkalemia (potassium excreted in the kidneys)

educate patient about SEs (dry cough and dizziness, especially after standing up)

when are ARBs used?

when the patient can’t tolerate ACE inhibitors

ARBs - nursing considerations

monitor blood pressure

assess for hyperkalemia

educate patient about side effects (dizzy and headache)

newer, less side effects than ACEs

orthostatic htn - stand up and get dizzy

Calcium channel blockers - uses

lower bp

treat certain heart conditions (like coronary vasospasm)cal

calcium channel blockers - nursing considerations

monitor bp and hr

assess for peripheral edema and educate patients about potential side effects (dizzy and constipation)

Beta blockers - mech of action

block effects of adrenaline on the heart and blood vessels, reducing HR and bp

beta blockers - uses

manage htn, angina, and certain arrhythmias

beta blockers - nursing considerations

monitor bp!

monitor HR

assess for bradycardia

educate pts about potential SEs (fatigue and cold extremities)

• fatigue because adrenaline makes us awake and alert

VERY effective at dropping bp and HR

• be aware of BOTH bp and HR before administering