final exam meds

immunomodulators- b-interferon (rebif, pledgridy, avonex)

-given IM (weekly) or subQ (daily to 3X weekly)

- reduce the frequency of excerbations and stablize the course of the disease

- patient should wear sunscreen and protective clothing in the sun

- flu-like symptoms common

- injection site reactions common

immunomodulators- glatiramer acetate (copaxone)

-given SubQ either daily or 3 times a week

- injection site reactions

skeletal muscle relaxants-baclofen

- acts on spinal cord nerves and decreases the number and severity of muscle spasms caused by MS

corticosteroids

- inhaled: flovent

- oral- prednisone

- IV- solumedrol, decadron

- mechanism of action: works by suppressing inflammation and decreases bronchial hyperactivity

- side effects: thrush, increased appetite and mood swings

- nursing implications: must wash mouth out after inhaled admin

dopaminergic precursors- carbidopa/levodopa (sinemet)

- enhance the release of dopamine

- mechanism of action: may take weeks for effect, may need vacation from med due to loss of effectiveness, take in the AM for functional ability

antiviral agent- amantidin

- weak antagonist of NMDA type glutamate receptors

- it may ease the involuntary movements that can happen when you take levodopa

anti-epileptics/sedative- lorazepam

- mechanism of action: reduce of metabolic demand to reduce ICP (preventive for seizures)

- nursing implications: use with caution, the client may need to be off sedation to adquately assess neuro function (time seziure and assess safety)

anti-claudication- pentoxifylline

to reduce leg pain caused by poor circulation

statins- lipitor/atorvastin, niacin

- decrease cholesterol levels

- used to decrease bad (LDL) and increase good (HDL) and decrease triglyceride levels

morphine

works as a vasodilator as weel as an anxiety and pain aid

- great for preload and afterload reduction

aspirin

in people who think thye may be having an attack need an extra 325 mg of aspirin, they need it quickly

- acts to inhibit platelet aggregation

clopidogrel

the addition to this drug with aspirin reduces the risk of major ischemic events by a further 1/3 in patients with STEMI treatment

nitrates- nitrogylcerine

- first line for chest pain and can be taken orally, nasal spray or IV

- dilates the arteries and the veins not only in the heart but also elsewhere in the body

- reduce the stress on the heart by improving blood flow to the heart

- relieve angina symptoms

- side effects: HA, hypotension, dizziness, N/V, flushing, skin irritation from topical forms

anti-thrombolytics

- offer advantage of availablity and rapid intervention when no PCI available

- clot buster therapy works by lysing infarcted artery thrombi and acheiving reperfusion, thereby reducing infarct size, preserving LV function and improving stimuli

folic acid/folate

increase RBC production to make up for anemia

hydroxurea ( a chemotherapy)

- increase production of fetal hemoglobin

- alters adhesion of RBC's to the endothelium

- reduces hemolysis

- increases hemoglobin concentration

- decrease sickle crises and painful crises

calcium channel blockers

(Nondihyydropyridines- dilitiazem and verapamil)

(Du=ihydropyridines- amlodipine and nefedipine)

- mechanism of action: inhibit movement of calcium across the cell membrane resulting in vasodilation

- side effects: decrease HR and BP, dizziness

- effect on EKG, bradycardia, prolonged PR and AV blocks

- decrease automaticity of the SA node and delays AV node conduction and reduces myocardial contractility

Potassium channel blockers- amiodarone

- delays repolarization resulting in prolonged duration of refractory phase

- use filter, only compatible with D5

- effect on EKG, prolonged PR and QT intervals, bradycardia

Sodium channel blockers- procainamide and lidocaine

- decrease impulse conduction and delay repolarization

- effect on EKG widened QRS and prolonged QT

atropine

- used for sinus bradycardia

- treat signs and symptoms of slow HR, reduce salivation

- 2nd degree heart block- Mobitz= progressive PR prolongation till QRS drops use atropine

adensosine

- used for SVT

- expect asystole after admin

- slows down HR

- terminates tachycardia involving the AV node

epinephrine

- adrenergic agonists causes stimulation of the Alpha 1, Beta 1 and 2 effects

- used in cardiac arrest and shock

- causes- vasodilation, increased BP, cardiac stimulate (bronchodilator)

Dobutamine (IV infusion)

- beta 1 effect, mild beta 2 effect (vasodilation of arteries)

- increased force contraction

- uses: increased CO with positive inotropic effects, does no cause vasoconstriction

- side effects: dysrhythmias, HTN, hypokalemia, angina, tachycardia, N/V and headache

dopamine (IV)

- Beta 1 stimulation (increase contractility), Alpha 1 effect at increase doses

- positive inotopic effect used in ADHF, and shock

- uses: sever CHF, cardiogenic shock, increase renalm coronary, cerebral blood flow at low doses

- side effects: dysrhythmias, tachycardia, hypotension, angina, N/V, headache

phophodiesterase inhibitors- milirone

- reduces afterload

- positive inotropic and arterior vasodilation

- uses: short term, used in HF

- side effects: ventricular dysrythmias, hypotension, angina, headache, tremors, hypokalemia, thrombocytopenia

b-type natriurtic peptide (BNP)- nestiride (IV infusion)

- balance arteroliar and venous dilation

- promotes natriuresis

- uses: used with HF alone or with dopamine

- side effects: clammy skin, dizziness, weakness, chest pain, hypotension, headache, blurred vision, dyspnea, palpitations, N/V, abdominal pain

ACE inhibitors (lisinopril, captopril, enalapril)

- mechanism of action- inhibits the conversion of angiotensin 1 to angiotensin 2

- decreases preload and afterload reducer

- side effects: dry hacking cough, lost of taste, hyperkalemia, renal impairment, ANGIOEDEMA

beta blockers (propranolo, metoprolol)

- mechanism of action- beta-adrenergic blocker reduces BP and decreases sympathetic effects and decrease HR

- side effects- dont give if HR is below 60bpm, bradycardia, orthostatic hypotension, dizziness, lethargy

ARBS (losartan, valsartan)

-mechanism of action- prevents action of all and produce vasodilation and sodium (decrease preload and afterload reducer)

- side effects- dry hacking cough, lost of taste, hypokalemia, renal impairment, angioedema

alpha/beta blockers- carvedilol, labetalol

- mechanism of action- alpha and beta blockers produce peripheral vasodilation and decrease HR

- side effects: decrease BP, orthostatic hypotension

loop diurectics - furosemide

- K WASTING

- side effects: k fluid depleted and ringing ears

thiazide diurectics- hydrocholorothiazide

- inhibit the NaCl reabsorption in the distal convoluted tubule

potassium sparing diurectics- spironolactone

- K SPARING

- reduces preload

digoxin

- levels needs to be under 2mg/dl

- check k levels need to > 4

- N/V, and auras sign of toxicity

- digibind used for toxicity

anticholinergic bronchodilators

- short acting- ipratropium (atrovent)

- long-acting- tiprorium (spirva)

- mechanism of action- cause bronchial dilation

- side effects- dry mouth hoarseness

- nursing implication- may be given with albuterol, tiprorium has a longer acting effect

beta 2 adrenergic agonists bronchodilators

- short acting beta 2- albuterol

- long acting beta 2- salmeterol

- mechanism of action- most effect drug for relieving bronchospams

- act on beta 2 receptors to promote bronchodilation

- side effects- tachycardia, anxiety and tremors

- nursing implications- patient must know the difference between short and long acting

theophylline (theo-24)- amiophyilline

- mechanism of action- CNS excitation

- side effects- dysrythmias, seizures, nausea, diarrhea, restlessness

- nursing implications- half life is decrease by smoking, many drugs can increase drug levels

- used when long term bronchodilators arent available

pancrealipase

- admin before meals and snacks

- amount of enzymes depends on severity

- usually 1-5 capsules a day

- enteric beads should not be crushed or chewed

antitumor antibiotics- doxorubicin

- mechanism of action- cell cycle nonspecific, binds directly to DNA, inhibit synthesis of DNA, interfere with transcription of RNA

- side effects- cardiotoxicty, myelosupression, N/V, alopecia, mucositis

- nursing implications- need injection fraction before giving, drug is red in color, first void will be pink

alkalating agents- cyclophasphamide (cytoxan)

- mechanism of action- nonspecific damage of DNA and cause breaks in double-stranded helix

- side effects- myelosuppression, N/V, alopecia, hemorragic cysitis

- nursing implications- increase fluids, give early in day, empty bladder frequently

HER-2 receptor- herceptin (trastuzumab)

- mechanism of action- binds human epidermal growth factor receptor 2

- side effects- cardiotoxicty, hypersensitivy reactions, flu-like symptoms

- nursing implications- monitor for S/S for cardiotoxicity

estrogen receptor blockers- tamoxifen

- mechanism of action- competes with estrogen for binding sites

- side effects- vaginal bleeding, decreased visual acuity, hot flashes, weight gain, fluid retention, blood clots