Exam 3 Prototypes

atorvastatin: therapeutic class

antihyperlipidemic

atorvastatin: pharmacologic class

HMG-CoA reductase inhibitor, statin

atorvastatin: action

• inhibits HMG-CoA reductase which is needed for biosynthesis of cholesterol in the liver

• Decreases LDL cholesterol (less cholesterol production means liver produces more LDL receptors = more removal of LDL)

atorvastatin: use

decreases LDL, total cholesterol and triglycerides, and increases HDL

atorvastatin: adverse effects

rhabdomyolysis (increases risk when taken w/ macrolide antibiotics, cyclosporine, and niacin)

atorvastatin: side effects

• fatigue

• muscle and joint pain

• headache

• heartburn (GI upset)

• liver damage in small number of patients

atorvastatin: nursing considerations

• may take 2 weeks to reach full effect

• action only occurs while taking meds so must stay on statins for life for cholesterol reduction

• PO; give w/ food to reduce GI disturbance

• taken any time of day

• monitor LFTs and CK in the first few months of therapy

atorvastatin: contraindications

do not take while pregnant (teratogenic)

atorvastatin: interactions

• azole antifungals

• digoxin (can incr. levels of digoxin)

• oral contraceptives

• grapefruit juice effects the metabolism of atorvastatin (use w/ CoQ10 supplements)

cholestyramine: therapeutic class

antihyperlipidemic

cholestyramine: pharmacologic class

bile acid sequestrant (collector)

cholestyramine: action

• binds with bile acids in insoluble complex that is excreted in feces

• the bound bile acids and cholesterol are eliminated in feces (liver responds by increasing uptake of LDLs)

cholestyramine: use

decrease LDLs (produces a 20% drop in LDL cholesterol)

cholestyramine: side effects

• MORE THAN STATINS

• bloating

• constipation

• nausea

• abdominal pain

cholestyramine: nursing considerations

• comes in a powder (take w/ at least 100 to 800 mLs of water and drink immediately)

• give other drugs 2 hrs before of 4 hrs after taking

cholestyramine: contraindications

patients with biliary obstruction (gall baldder issues)

cholestyramine: interactions

decreases effect of digoxin, warfarin, and oral contraceptives

gemfibrozil: therapeutic class

antihyperlipidemic

gemfibrozil: pharmacologic class

fibric acid drug (fibrate)

gemfibrozil: action

activates a receptor in the liver which increases triglyceride breakdown and elimination of triglyceride rich particles from plasma

gemfibrozil: use

• reduces VLDL by 50%

• increases HDL

• first line for severe hypertriglyceridemia

gemfibrozil: adverse effects

• may cause the likelihood of gallstones

• may affect liver function

• increase risk of myopathy (muscle pain/fatigue) and rhabdomyolysis with statins

gemfibrozil: side effects

• All GI

  • nausea

  • diarrhea

  • abdominal pain

  • dyspepsia

gemfibrozil: nursing considerations

take 30 mins prior to am and pm meals

gemfibrozil: contraindications

people w/ hepatic impairment

gemfibrozil: interactions

• may increase the effect of anticoagulant meds

• increase risk of rhabdomyolysis with statins

hydrochlorothiazide: therapeutic class

drug for hypertension and edema

hydrochlorothiazide: pharmacologic class

thiazide diuretic (potassium wasting)

hydrochlorothiazide: action

acts on kidney tubule to decrease reabsorption of Na+ (water) therefore incr. excretion

hydrochlorothiazide: use

increases water excretion to lower blood pressure

hydrochlorothiazide: adverse effects

hypokalemia, hyponatremia, hypotension

hydrochlorothiazide: side effects

fatigue, dizziness, dehydration

hydrochlorothiazide: nursing considerations

• observe for hypokalemia

• increasing potassium-containing foods

• give early in day to prevent nocturia

• used along with other hypertention meds

hydrochlorothiazide: contraindications

patients who don’t make urine (anuresis)

hydrochlorothiazide: interactions

• hypokalemia increases risk of digoxin toxicity

• reduce effectiveness of insulin

• cholestryramine decreases the effectiveness of HCTZ

furosemide: therapeutic class

drug for hypertension and heart failure

furosemide: pharmacologic class

loop diuretic (potent potassium wasting diuretic)

furosemide: action

• works in nephron loop by preventing the reabsorption of sodium and chloride

• produces rapid diuresis when given through IV

furosemide: adverse effects

ototoxicity (can be permanent) and nephrotoxicity

furosemide: side effecs

• electrolyte imbalances (can cause dysrhythmias)

• dehydration

• hypovolemia

  • orthostatic hypotension

  • dizziness

  • fainting

furosemide: nursing considerations

• strict monitoring of I&Os, K+ levels, and blood glucose

• complaints of hearing changes or loss

• check serum potassium before given

furosemide: contraindications

patients with low potassium levels

furosemide: interactions

use cautiously with other drugs that deplete K+

spironolactone: therapeutic class

drug for hypertension and edema

spironolactone: pharmacologic class

potassium sparing diuretic and aldosterone antagonist

spironolactone: action

inhibits aldosterone (secreted by adrenal cortex) which increases water and sodium excretion and retention of K+

spironolactone: adverse effects

hyperkalemia (especially with ACE or ARBs)

spironolactone: side effects

• women

  • menstrual irregularities

  • hirsutism

  • breast tenderness

• men

  • gynecomastia

  • impotence

spironolactone: nursing considerations

• give with food to increase absorption

• do not give K+ supplements or use salt substitutes

• used along with other hypertension meds

spironolactone: contraindications

• patients with anuria

• CKD

• hyperkalemia

• pregnancy

lisinopril: therapeutic class

drug for hypertension and heart failure

lisinopril: pharamacologic class

ACE inhibitor

lisinopril: action

inhibits ACE which is responsible for converting angiotensin l to angiotensin ll which ultimately blocks effects of aldosterone

lisinopril: use

• improves survival if given within 24 hours of an acute MI

• decreases blood pressure

• decreases afterload and increases cardiac output

lisinopril: adverse effects

• angioedema

  • swelling

  • tongue fullness

  • difficulty breathing or talking

lisinopril: side effects

• usually tolerated but be alert for dry cough

• postural hypotension

• dizziness

• headache

• rash

lisinopril: nursing considerations

• assess BP before administration

• monitor renal function

• may take 2-3 weeks to reach max effectiveness

• often used concurrently with thiazide diuretics

lisinopril: contraindcations

• kidneys not functioning properly

• pregnancy

• hyperkalemia (use cautiously with potassium sparing diuretics)

losartan: therapeutic class

drug for hypertension

losartan: pharmacologic class

angiotensin ll receptor blocker (ARB)

losartan: action

blocks angiotensin receptor in vascular smooth muscle causing vasodilation and reduced blood volume (due to its effects on blocking aldosterone release by angiotensin)

losartan: adverse effects

angioedema and acute kidney injury

losartan: side effects

• hypoglycemia

• dizziness

• stuffy nose

• fatigue

• hypotension

losartan: nursing considerations

get up slowly from a sitting or lying position

losartan: contraindications

• pregnancy (fetal injury or death)

• when given with potassium sparing diuretics, there is an increased risk for hyperkalemia

losartan: interactions

• similar to ACE

• grapefruit juice increases antihypertensive events

metoprolol: therapeutic class

drug for hypertension and heart failure

metoprolol: pharmacologic class

beta-adrenergic blocker (beta blocker); selective to beta-1

metoprolol: action

reduces sympathetic stimulation of the heart thus decreasing cardiac workload

metoprolol: use

preferred for patients with respiratory disease due to cardio-selective beta-1

metoprolol: side effects

hypotension and bradycardia

metoprolol: nursing considerations

• assess pulse and blood pressure before administration

• don’t give if HR <60 bpm or patient is hypotensive

• acute withdrawl from drug may make angina worse or cause MI. Taper off for a few weeks

• monitor for hypoglycemia with diabetes patients

metoprolol: contraindications

• heart block

• cardiogenic shock

• hypotension

• overt cardiac failure

metoprolol: interactions

• use with digoxin causes bradycardia

• use with other antihypertensives may enhance the hyperglycemic effects of insulin and oral diabetic meds

nifedipine: therapeutic class

drug for hypertension and angina

nifedipine: pharmacologic class

calcium channel blocker (CCB)

nifedipine: action

• selective for calcium channels in arterioles

• blocks calcium channels in myocardial and vascular smooth muscle

• results in coronary artery dilation, reduced oxygen utilization by heart, increased cardiac output and decrease peripheral resistance

nifedipine: side effects

• fatigue

• dizziness

• hypotension

• peripheral edema

• headache

nifedipine: interactions

• other antihypertensives

• alcohol can potentiate vasodilation

• increased serum digoxin levels can lead to bradycardia and drug toxicity

• don’t take with grapefruit juice

• can increase the effect of statin drugs by messin with liver enzymes

digoxin: therapeutic class

drug for heart failure

digoxin: pharmacologic class

cardiac glycoside

digoxin: actions

• increase contractility of heart (positive inotrope)

• inhibits Na+K+ ATPase (enzyme responsible for pumping out Na+ of myocardial cell in exchange for K+)

  • as Na+ accumulates, calcium is released from storage areas in the cell. This produces a more forceful contraction

• increases cardiac output, which increases urine production, which then decreases blood volume, relieves distressing symptoms of pulmonary congestion and peripheral edema

• suppresses the SA node (decreases HR)

digoxin: adverse effects

concurrent use of digoxin and diuretics can lead to hypokalemia which can lead to dysrhythmias

digoxin: nursing considerations

• take apical pulse for 1 full minute. Note rate, rhythm, and quality.

• if HR is less than parameters (usually <60 bpm), withhold med and notify HP

• check serum digoxin levels before admin because of narrow therapeutic range

• use cautiously in elderly and pediatric patients due to renal and hepatic immaturity or decreased function

digoxin: contraindications

• AV block

• ventricular arrhythmias unrelated to HF

digoxin: interactions

• MANY!

• concurrent use with ACE can cause hyperkalemia and reduce therapeutic action of digoxin

digoxin:

digoxin: antidote

digibind

milrinone: therapeutic class

drug for acute heart failure

milrinone:

milrinone: pharmacologic class

phosphodiesterase (PDE) inhibitor

milrinone: actions

• blocks enzyme phosphodiesterase in cardiac and smooth muscle

  • increases force of cardiac contraction and increases cardiac output

  • heart: increases calcium availability to heart muscle, which increases contraction

  • vessels: PDE inhibition prevents cGMP metabolism in the smooth musculature, causing vasodilation

milrinone: adverse effects

• ventricular dysrhythmia which occurs in every 1 in 10 patients

• increase risk of dysrhythmias due to hypokalemia

milrinone: side effects

• headache

• nausea

• vomiting

milrinone: nursing considerations

• continuous monitoring of ECG to prevent hypotension

• correct hypokalemia

• very short half-life (given IV)

milrinone: antidote

vasopressor and administration of normal saline