Pathopharm II: Unit 1 meds

Thiazide Diuretics

Ex: Hydrochlorothiazide (HCTZ)

Action: inhibits Na+ & Cl- reabsorption

SE: Hypokalemia, Orthostatic Hypotension

Specific nursing considerations: Monitor for BP, I&O, daily weights, K+ levels , Assess for dehydration and hyperglycemia

ACE Inhibitors

End in “-pril”

Action: Inhibit conversion of angiotensin I to angiotensin II

SE: Dry cough, postural hypotension, elevated K+, angioedema

Specific nursing considerations: Monitor cough, angioedema, K+ levels , Assess BP after FIRST dose, preferred for diabetics

Angiotensin II Receptor Blockers (ARB’s)

End in “-sartans”

Action: Prevent angiotensin II from binding to receptors on blood vessels

SE: NO COUGH, dizziness, headaches, GI distress, orthostatic hypotension

Specific nursing considerations: Alternative to ACE, Full therapeutic effects take 3-6 wks, Monitor BP & kidneys

Calcium Blockers

End in “-dipine”

Action: Inhibits calcium influx into muscle cells, causing smooth muscle relaxation in blood vessels (vasodilation) & lower BP; decreases contractility & conductivity, causing a decrease in myocardial oxygen demand

SE: Hypotension, bradycardia, headache, constipation, nausea, peripheral edema

Specific nursing considerations: AVOID GRAPEFRUIT JUICE, Monitor HR & BP

What are the first line medications for hypertension?

Thiazide diuertics, ACE inhibitors, ARBs, CC blockers

What are the second line medications for hypertension?

Loop diuretics, Beta Blockers, Alpha-1 Blockers

Loop Diuretics

Action: Inhibits Na+, Cl-, & H2O reabsorption

SE: Severe hypokalemia, orthostatic hypotension

Specific nursing considerations: FAST ACTING + most potent diuretic, Monitor BP, I&O, daily weights, hydration status, K+

Beta Blockers

End in “-olol”

Action: blocks beta-1 & 2 receptor sites; decreases HR.

• Selective action: blocks β1

• Non-selective action: blocks β1 & β2

SE: Bradycardia (β1 only), lethargy, GI disturbance, CHF (coughing, SOB, edema, fatigue), hypotension, depression

Specific Nursing Considerations: Take before meals or with meals, Assess HR before giving & hold if HR less than 60 bpm, Caution w/ asthma, diabetes, COPD

Selective Beta Blockers

Ex: Atenolol, metoprolol

Action: Blocks β1 (heart)

Non-selective Beta Blocker

Ex: Propanolol

Action: Blocks β1 (heart) & β2 (lungs)

Alpha-1 Blockers

Ex: Clonidine

Action: Blocks peripheral alpha-1 receptors, decreases SNS, causing vasodilation

SE: Orthostatic hypotension, vertigo, palpitations, sexual dysfunction

Specific nursing considerations: Administer at NIGHT (less risk for injury), Rebound hypertension can occur if stopped suddenly

Atropine

Action: Anticholinergic drug (works w/ CNS), inhibits acetylcholine. Increase HR

SE: Blurred vision, dizziness, drowsiness, dry cough, dilation of the eyes, constipation, difficulty urinating

Specific nursing considerations: Max dose for IVP 0.5 mg / Endotracheal 3.0 mg; if ineffective, use transcutaneous pacing, dopamine, or epinephrine; permanent pacemaker therapy,

What drug is used to treat symptomatic Sinus Bradycardia?

Atropine

Atropine Overdose

Hot as Hare

• decreased sweating = increased temp

Mad Hatter

• Confusion / delirium

Red as Beet

• Flushed face

Dry as bone

• decreased secretions / thirsty

How would an RN treat symptomatic sinus tachycardia?

Metoprolol (Beta-Blocker) if clinically stable

What is the first drug choice for SVT?

IV adenosine

Adenosine

Action: Slows down electrical conduction time to AV node; decreases HR

SE: Flushing, dizziness, chest pain, or palpitations

Specific nursing considerations: Must administer to a site close to heart (antecubital), must give rapid IV 1-2s then push with 20 mL normal saline flush; monitor ECG

What are other drug choices after adenosine when treating SVT?

IV beta-blocker

• Sotalol

CC blockers

• Diltiazem

Amiodarone

Class: Antidysrhythmic drug

Action: blocks potassium channels and delays repolarization; negative chronotropic (decreases HR)

SE: GI upset, headache, excessive thirst, blurred vision

Specific nursing considerations: Monitor ECG, BP, HR; PO must be taken with food; Pt should avoid alcohol, caffeine, and tobacco

What drug is given to treat atrial flutter, atrial fibrillation, PVC, VT, and VF?

Amiodarone

Digoxin (digoxin)

Action: increases contractility mildly (weak pos. inotrope) & lowers HR (negative chronotrope)

SE: Hypotension, headache, colored vision (yellow), N/V/D

Specific nursing considerations: Monitor vitals, K+; full apical pulse & withhold if HR below 60 bpm; Hypokalemia can lead to dig toxicity; Caution with loop diuretics

Enoxaparin (Lovenox)

What are signs & symptoms of digoxin toxicity?

bradycardia, headache, confusion, visual disturbances, heart block, nausea

What are the the anticoagulants used to treat chronic A-fib?

Enoxaparin (Lovenox) & Warfarin (Coumadin)

Warfarin (Coumadin)

What drug is used to treat Type II AV block?

Atropine

Iidocaine

Which drug is used to treat PVC?

Lidocaine

Spironlactone