PHARM: DRUG CARDS (EXAM 2)

Ezetimibe (Zetia)

• cholesterol absorption inhibitor; Blocks cholesterol in the small intestine; decreasing LDL

• Second line treatment; 2 weeks; treats dyslipidemia; PO; Pregnancy: C 

• Adverse: Nasopharyngitis, myalgia, hepatotoxicity, diarrhea

• Contradictions: Liver disease; caution with kidney disease

• Nursing considerations: Monitor lipids, liver function, muscle pain

• Goal: lower LDL

Atorvastatin (Lipitor)

• Statin; Inhibids HMD-COa reductase; decreasing LDL production; increasing LDL receptors; decreasing LDL 20-40%

• First line treatment; 2-4 weeks; treats hypercholesterolemia and prevents cardiovascular events; Pregnancy X; PO

• Adverse: Diarrhea, constipation, rhabdomyolysis, liver failure

• Contradictions: Pregnancy, lactation; caution with liver impairment

• Considerations: Monitor LFTs and signs of muscle injury

• Goal: Lower LDL and prevent heart attacks and strokes.

Colesevelam (Welchol)

• Bile acid sequestrant; binds bile acids, excretes them in feces, decreasing LDL

• PO; 1-2 days, 2 weeks for effects; treats hypercholesterolemia, elevated HbA1c in diabetes; second line often combined with statins; category B 

• Adverse: Constipation, bloating, belching, nausea, GI obstruction, hyperchloremic acidosis, hypertriglyceridemia

• Contradictions: Complete biliary obstruction; caution with GI disorders

• Nursing considerations: Monitor lipids, constipation, triglycerides, other medication absorption

• Goal: Lower LDL cholesterol 

Niacin (Niaspan)

• Nicotinic acid; decreases VLDL production and increases HDL

• PO; 30-60 min; dyslipidemia; second line; category B 

• Adverse: Facial flushing, hot flashes, nausea, gas, diarrhea, hepatotoxicity, gout

• Contradictions: Caution with diabetes and history of liver disease

• Considerations: Monitor liver function, glucose, uric acid; notes mention aspirin 30 min before dosing for flushing

• Goal: Lower VLDL and increase good cholesterol (HDL).

Gemfibrozil (Lopid)

• Fibrate: inhibits the creation of lipids in the fat tissue, decreasing fatty acids that are available for triglyceride production

• PO; 1-2 hours; hypertriglyceridemia; second line; category C

• Adverse: Abdominal cramps, diarrhea, nausea, dyspepsia, headache, dizziness, peripheral neuropathy, diminished libido, gallstones, anemia, rhabdomyolysis with statins

• Contradictions: Caution with gallbladder, liver, kidney disease

• Considerations: Monitor triglycerides, liver/kidney function, gallstones, muscle pain when combined with statins

• Goal: lower triglycerides

Furosemide (Lasix)

• Loop diuretic; Prevents reabsorption of sodium and chloride in the loop of Henle → ↑ urine output ↓ potassium

• PO: 30–60 min, IV: 5 min, IM: 10–30 min; Used for Acute edema, pulmonary edema in HF, HTN; category C

• Adverse: Orthostatic hypotension, syncope, tachycardia, hypokalemia-related dysrhythmias, ototoxicity

• Contradictions: Hypersensitivity, anuria (no urine production)

• Considerations: Monitor BP, potassium, intake/output, daily weight, kidney function, and hearing. Watch for Digoxin toxicity with hypokalemia.

• Goal: Remove excess fluid and lower BP.

Hydrochlorothiazide (Microzide)

• Thiazide diuretic; Decreases sodium reabsorption in the distal tube, decreasing potassium 

• PO: 2 hours, peak at 4 hours;Used for HTN, ascites/edema, HF; Category B

• Adverse: Hypotension, photosensitivity, electrolyte imbalances, gout

• Contradictions: Hypersensitivity, anuria, jaundiced neonates

• Considerations: Monitor BP, electrolytes (especially potassium), kidney function, hydration, and gout symptoms.

• Goal: Lower BP and reduce fluid retention.

Spironolactone (Aldactone)

• Potassium sparing diuretic; blocks aldosterone allowing Na/water excretion while saving potassium, increasing potassium

• PO: 2–3 days; maximum effect up to 2 weeks; Mild HTN, edema in HF, nephrotic syndrome, cirrhosis, hypokalemia; category C

• Adverse: Hyperkalemia, gynecomastia, impotence, reduced libido, menstrual changes, hirsutism, breast tenderness, decreased fertility

• Contradictions: Anuria, hyperkalemia (high potassium)

• Considerations: Monitor potassium, kidney function, BP, edema, daily weight, and intake/output.

• Goal: Remove excess fluid while keeping potassium.

Losartan (Cozaar)

• ARB; Blocks angiotensin II receptors → vasodilation, ↓ peripheral resistance, ↓ aldosterone, ↑ sodium/water excretion

• PO 1 hr, peak 6 hours; Used for HTN, stroke prophylaxis, HF (off-label); first line for HTN; Category C (1st trimester), D (2nd/3rd Trimester)

• Adverse: Dizziness, fatigue, hypotension, angioedema, acute renal failure, hyperkalemia

• Contradictions: Hypersensitivity, pregnancy/lactation

• Considerations: Monitor BP, K⁺, BUN/creatinine, angioedema

• Goal: Relax blood vessels to lower BP.

Lisinopril (Prinivil, Zestril)

• ACE Inhibitor; Inhibits ACE, Inhibits ACE → ↓ angiotensin II, ↓ peripheral resistance, ↓ aldosterone and blood volume

• PO 1 hour, peak 6–8 hours; Used for HTN, HF, acute MI;First-line for HTN; option for HFrEF; Category C (1st trimester), D (2nd/3rd Trimester)

• Adverse: Hepatotoxicity, dry cough, dizziness, orthostatic hypotension, rash, hyperkalemia, angioedema, blood dyscrasias

• Contradictions: Pregnancy, hyperkalemia, angioedema

• Considerations: Monitor BP, K⁺, kidney function, cough, angioedema

• Goal: Lower BP and reduce the heart's workload.

Amlodipine (Norvasc)

• Calcium channel blocker; relaxes vascular smooth muscle, causing vasodilation

• PO 30–60 min, 6 hours (ER); Used for HTN, chronic stable angina, CAD; first line for HTN; Category C

• Adverse: Hypotension, dizziness, headache, flushing, peripheral edema

• Contradictions: Hypersensitivity 

• Considerations: Monitor BP, dizziness, peripheral edema

• Goal: Relax arteries to lower BP and relieve angina.

Diltiazem (Cardizem)

• Calcium channel blocker; relaxes vascular smooth muscle, causing vasodilation

• PO 30–60 min, 6 hours (ER); Used for HTN, chronic stable angina, CAD; first line for HTN; Category C

• Adverse: Hypotension, dizziness, headache, flushing, peripheral edema

• Contradictions: Hypersensitivity 

• Considerations: Monitor BP, dizziness, peripheral edema

• Goal: Relax arteries to lower BP and relieve angina.

Sacubitril/Valsartan (Entresto)

• ARNI; Sacubitril inhibits neprilysin → ↑ natriuretic peptides → vasodilation and ↑ sodium/water excretion. Valsartan blocks angiotensin II receptors.

• PO 30 min-2 hr; Used for HF; Category D; First-line guideline-directed therapy for eligible HFrEF patients

• Adverse: Hypotension, dizziness, angioedema, hyperkalemia, renal failure

• Contradictions: ACE inhibitor/ARB use, hypersensitivity, liver disease 

• Considerations: Monitor BP, HR, daily weight, kidney function, CBC, and potassium. 36-hour washout from ACE inhibitors required.

• Goal: Reduce the heart's workload and fluid retention.

Dobutamine (Dobutrex)

• Beta 1 agonist; Stimulates β1 receptors → ↑ HR, contractility, conduction, cardiac output, BP, and renin release

• IV immediate; used for decompensated HF, cardiogenic shock; Short-term support for acute low-output HF; category C

• Adverse: Dysrhythmias, tachycardia, headache, palpitations

• Contradictions: Dysrhythmias, hyperthyroidism, fast HR, hypertension, CAD 

• Considerations: Monitor ECG, BP, HR, cardiac output, and signs of dysrhythmias.

• Dobutamine: Make the heart pump harder and increase cardiac output.

Digoxin (Lanoxin)

• Cardiac glycoside; Inhibits Na⁺/K⁺-ATPase → ↑ intracellular calcium and contractility; ↓ HR and AV conduction

• PO 30-90 min, IV 5-30 min; Used for HF and tachydysrhythmias; Second-line/add-on for selected HF patients; Category C

• Adverse: Ventricular dysrhythmias, AV block, malaise, dizziness, nausea/vomiting, visual changes (yellow colors or halos)

• Contradictions: AV block, bradycardia, ventricular dysrhythmias

• Considerations: Monitor HR, electrolytes, Digoxin level, and ECG for IV administration. Hypokalemia increases toxicity risk. Antidote: Digoxin immune Fab.

• Goal: Make the heart pump harder but beat slower.

Ranolazine (Ranexa)

• Antianginal; Inhibits inward sodium current during diastole → ↓ intracellular calcium → heart relaxes better and coronary blood flow improves

• PO 2-5 hr; used for chronic angina; Second-line/add-on for chronic angina; Category C

• Adverse: Headache, dizziness, tinnitus, blurred vision, orthostatic hypotension, renal failure

• Contradictions: Liver disease; caution with prolonged QT and kidney disease

• Considerations: Monitor angina frequency, BP, kidney function, and QT interval when indicated

• Goal: Prevent or reduce chronic chest pain.

Nitroglycerin (Nitrostat)

• Nitrate; Relaxes venous and arterial smooth muscle → vasodilation → ↓ cardiac workload

• PO, SL, buccal, transdermal; sprays, ointments, IV preparations (Varies by route; 1–60 minutes); Used for Acute angina, controlled HTN, HF, acute MI, acute pulmonary edema, hypertensive crisis; First-line for acute angina relief (SL); Category C

• Adverse: Facial flushing, headache, orthostatic hypotension, rash with transdermal forms

• Contradictions: Hypotension, shock, head injury, cardiac tamponade, glaucoma , PDE-5 inhibitors such as Viagra

• Considerations: Monitor BP, HR, and chest pain. For SL tablets: every 5 minutes for up to 3 doses; activate emergency services if pain persists 5 minutes after the first dose

• Goal: Quickly relieve chest pain by reducing cardiac workload.

Epinephrine (Adrenalin)

• Alpha and beta agonist; Stimulates α1 → vasoconstriction and ↑ BP; β1 → ↑ HR and contractility; β2 → bronchodilation

• SQ, IV, IM, inhaled, topical, ophthalmic (immediate- 5 min); Used for CPR, anaphylaxis, shock-related hypotension, local vasoconstriction, mydriasis; First line for anaphylaxis; Category C

• Adverse: Nervousness, tremors, tachycardia, hypertension, dysrhythmias, pulmonary edema, CNS stimulation, local tissue necrosis

• Contradictions: Hypersensitivity, closed-angle glaucoma, CAD. These do not prevent treatment of life-threatening anaphylaxis.

• Consideration: Monitor HR, BP, ECG, breathing, injection site; verify route and concentration

• Goal: Open airways and raise BP during anaphylaxis.

Albuterol (Proventil, Ventolin)

• Beta2 agonist; Stimulates β2 receptors in bronchial smooth muscle → bronchodilation

• Inhaled 5-15min, PO 30 min; used for relief/prevention of bronchospasm; first line rapid relief bronchodilator; Category C

• Adverse: Palpitations, headache, tremors, tachycardia, hypokalemia, nervousness, insomnia, numbness/tingling

• Contradictions: Hypersensitivity; caution with cardiac history 

• Consideration: Monitor lung sounds, HR, BP, potassium before/after administration.

• Goal: Open airways to make breathing easier.

Prazosin (Minipress)

• Alpha 1 blocker; Blocks norepinephrine at α1 receptors → vasodilation and ↓ BP

• PO 2 hours; used for hypertension and BPH; second line use for HTN; Category C

• Adverse: Orthostatic hypotension, first-dose phenomenon, dizziness, drowsiness, fatigue

• Contradictions: Hypersensitivity; caution with older adults, renal impairment, CAD

• Consideration: Monitor BP and orthostatic changes; watch for first-dose fainting.

• Goal: Relax blood vessels to lower BP.

Propranolol (Inderal)

• Nonselective beta blocker; Blocks β1 and β2 → ↓ HR, contractility, conduction, and BP

• PO 1-2hr, IV immediate; used for HTN, angina, dysrhythmias, anxiety, migraine prevention; Category C

• Adverse: Bronchospasm, bradycardia, fatigue, pulmonary edema, Stevens-Johnson syndrome; rebound tachycardia and myocardial ischemia with abrupt withdrawal

• Contradictions: Severe HF, bradycardia, COPD/asthma; caution with diabetes

• Consideration: Monitor HR, BP, fluid overload, glucose. Never stop abruptly

• Goal: Slow HR and reduce the heart's workload.

Metoprolol (Lopressor, Toprol)

• Selective B1 blocker; Blocks β1 receptors in the heart → ↓ HR, contractility, conduction, and BP

• PO 1-2hr, IV immediate; used for HTN, stable angina, stable HF, acute MI; option for angina; Category C

• Adverse: Dizziness, fatigue, bradycardia, pulmonary edema; rebound tachycardia and myocardial ischemia with abrupt withdrawal

• Contradictions: Cardiogenic shock, bradycardia, heart block

• Consideration: Monitor HR, BP, fluid overload, worsening HF. Never stop abruptly.

• Goal: Slow HR and reduce the heart's workload.

Bethanechol (Urecholine)

• Cholinergic agonist; Stimulates cholinergic receptors → bladder contraction and ↑ urine output

• PO 30 min, SQ 5-15min; used for nonobstructive urinary retention, neurogenic bladder; selected treatment for urinary retention; Category C

• Adverse: Diarrhea, abdominal cramps, nausea/vomiting, sweating, orthostatic hypotension, bradycardia, bronchospasm

• Contradictions: Hypersensitivity, cardiovascular disease, peptic ulcer disease, asthma

• Consideration: Assess HR, BP, intake/output, bladder emptying, bronchospasm.

• Goal: Make the bladder contract so the patient can urinate.

Atropine (Atropen, Atreza)

• Anticholinergic; Blocks acetylcholine at parasympathetic receptors → ↑ HR and ↓ secretions

• IV immediate, IM 15 min; used for symptomatic bradycardia, cholinergic poisoning, and reducing postoperative secretions; Category C

• Adverse: Tachycardia, palpitations, drowsiness

• Contradictions: Hypersensitivity, glaucoma, BPH; caution with older adults. Restrictions don't prevent emergency treatment for life-threatening poisoning.

• Consideration: Monitor HR, BP, ECG, intake/output.

• Goal: Increase a dangerously slow HR.