pharm exam 3 drugs
Beta-Adrenergic Antagonist/Blockers: -olol:
Always prescribed by a Cardiologist.
Don’t give to stage 1 hypertension
Targets beta adrenergic receptors
Given during abnormal HR
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Cardioselective | Metoprolol, Atenolol, esmolol, bisoprolol | blocks Beta 1 Beta 1: Targets the heart rate | Hypotension (Monitor Bp), Heart failure, AV blocks, Sinus arrest | Check the HR & BP | - Aunt “mae” -OLOL: |
Nonselective | Propranolol & Timolol | blocks Beta 1 & 2 receptors Beta 2: affects the lungs | Bronchoconstriction, hypoglycemia | Ask Past Medical History, Check Respiratory rate and HR | Worsens Asthma & COPD patients |
Alpha & Beta Blockers | Labetalol | Blocks Beta 1, 2 and Alpha | AE: COPD, vasodilator, decrease BP | Check HR, BP (hypotension), kidney/liver functions | Stronger and more potent |
Antihypertensives: Ace Inhibitors. 20%
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Ace Inhibitors | Captopril | Reduces level of Angiotensin II. Decreases aldosterone Blood vessel dilation | AE: Hypotension (Check First), hyperkalemia, angioedema (swelling in the mouth - can’t breathe ) ALWAYS PROTECT AIRWAY, SE: Cough | Check blood pressure and Check potassium. | - end in -PRIL 20% Rule - (Ace took Pearl to the dance) |
Antihypertensives: ARBs
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
ARBS - Cousin of Ace Inhibitors | Losartan | Blocks the receptors of angiotensin II Dilates the vessels, not constrict & Decrease the secretion of aldosterone | AE: angioedema (swelling in the mouth - can’t breathe ) ALWAYS PROTECT AIRWAY, Hyperkalemia, hypotension | Check for angioedema, potassium and BP, then Heart Rate. | - end with -ARTAN (i am SARTAN about ARBS) 20% rule - no more than 20% to decrease BP |
Antihypertensives: Calcium Channel Antagonist - Dihydropyridine & Nondihydropyridine
CCBs are Very Amazing Drugs: Verapamil, Amlodipine, Dilatiazem
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Dihydropyridine (Relaxes smooth muscle) Potent vasodilators - little or no effect upon cardiac contractility | Amlodipine | Selective blockage of calcium channels in blood vessels. Helps to relax and dilate blood vessels | AE/SE: Peripheral Edema, Bradycardia, Hypotension Be careful with ACES and Fluconazole, Rifampin (TB) | Head to toe assessment - To prevent lack of blood supply to legs, make sure the patient is walking | - end in DIPINE TU: Treat hypertension (20% rule) |
Nondihydropyridine Calcium Channel blockers | Verapamil, Diltiazem | Block calcium channels obstructing movement of calcium into conductive and contractile myocardial cells. | AE: Tachycardia, Hypotension, SE: N/V or constipation | Assess Blood pressure & HR | Avoid grapefruit juice. No more than 20%. Less Potent - |
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Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Centrally Acting Alpha Agonists | Clonidine, Guanfacine, Methyldopa | Blocks signal to the brain to the nervous system Lowers BP & HR | SE: Dizziness, Drowsiness, Dry mouth | Check BP & HR | Doesn’t target the heart rate. Targets Brain stem. |
Diuretics for Fluid Volume Excess
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Loop Diuretics | Furosemide | Acts on the ascending loop of Henle to block reabsorption of Na, Cl and H2O Works specific parts of the nephron to remove fluid from the blood. | AE: Hypokalemia
| Monitor Intake and Outputs Monitor electrolytes, BUN or creatine, BP | In a brown container, cannot be exposed to light Beware when taken with Digoxin |
Thiazides | Hydrochlorothiazide | Blocks the reabsorption of Na, Cl, HCO3 & H20 in the distal convoluted tubule Works specific parts of the nephron to remove fluid from the blood. | AE:
| TU: Treat hypertension, edema | |
Potassium-Sparing | Spironolactone | Blocks the actions of aldosterone in the distal nephron resulting in retention of K and increased excretion of Na and H2O. Works specific parts of the nephron to remove fluid from the blood. | AE:
(risk of tumors)
| Used a lot for acne | |
Osmotic diuretics | Mannitol | Given for cerebral edema or increased head injuries | Works even in poor renal circulation/low GFR. |
Anti-Dyslipidemics: HmG-CoA
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Reductase Inhibitors | Atorvastatin | Inhibits the enzyme required for hepatic synthesis of cholesterol | AE: Myopathies (muscle pain) Hepatic impairment, rhabdomyolysis (increased creatine kinase, dark urine or kidney damage) | Tell patient not to take meds with grapefruit juice Assess Liver & Kidney | - end with STATINS. TE: Lower total cholesterol, LDL, raise HDL Could lead to Alzheimer's STAT: S- sore muscles T - Toxic Liver A - Avoid Grapefruit Juice T - Take at night |
Anticoagulant Drugs: Heparins
Anticoagulants - prevent future clotting
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Anticoagulant Drugs | Heparin By IV only | Enhances the activity of antithrombin, reducing activity of thrombin and factor Xa(10) | AE: Bleeding(thinning of blood), Myocardial Infarction (thrombosis) SE: Hypersensitivity ( allergy response) | Don’t play contact sports, prevent falling Check for stool | For Pulmonary embolism. Antidote - Protamine Sulfate - end in PARIN (Heparin needs Help from a PROtamine sulfate) Lab monitoring: aPTT (2xs normal 20-30 seconds) Safe during pregnancy. HHH - Heparin, Hemorrhage, Hypersensitivity |
LMWH Heparins | Enoxaparin Sub-Q | Preferentially inactivates Factor Xa (10), suppressing the formation of fibrin | AE: Bleeding SE: Reduced mobility | Assess for stool, color of stool | Longer half life, Antidote - Protamine Sulfate - end in PARIN |
Vitamin K Antagonists (ORAL) | Warfarin Oral Medication | Suppresses coagulation by decreasing production of four clotting factors, (VII, IX, X, Prothrombin) Highly bound to Albumin | AE: Bleeding (thinner membranes or eyes) Osteoporosis | Check for Stool(black) Assess their diet. Monitor Bone health | Long half Life. Antidote: Vitamin K (during WAR, VITAMIN K kills (Numbers too high = patient will die; increased bleeding) (Numbers too low = clots with grow) Watch for PT/INR levels |
Direct Factor Xa Inhibitors | Rivaroxaban | Directly inactivated factor Xa, inhibiting production of thrombin - like heparin | AE: bleeding | Give blood products to stop further absorption. | End with -XABAN - GATRAN - RUDIN |
Antiplatelet Drugs: Adenosine Diphosphate, Receptor Antagonists
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Receptor Antagonist | Clopidogrel | Block receptors and prevent ADP-stimulated platelet aggregation - target platelet Prevents platelet from clumping together | AE: Bleeding SE: Diarrhea | Assess for Aspirin - because Aspirin is thinner. Monitor for low platelet count | Long term effects take up to 10 days to reverse Specific for people who have had stent placement for coronary stenosis |
Aspirin | Inhibit the synthesis of prostaglandins and prevents formation of Thromboxane A2 - which prevents platelet aggregation Prevents platelet from clumping together | AE: Bleeding SE: Nausea, vomiting, GI upset | Take it because it thins the blood. Not for Pediatric populations - risk of Reye's syndrome |
Thrombolytic Drugs:
Thrombotic will break down the thrombus (clot)
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Thrombolytic drugs | Alteplase Given (IV) | Promotes conversion of plasminogen to plasmin, an enzyme that degrades the fibrin matrix of thrombi | AE: Bleeding, Acute MI | Pre & Post assessment. | Short-half life Clot busters - use drugs for people who have strokes for 3 hrs. Antidote: Aminocaproic acid or tranexamic acid |
Classic II - Beta-Adrenergic Blockers
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Beta-Adrenergic Blockers | Propranolol | Blocks beta adrenergic receptors, preventing sympathetic stimulation, resulting in decreased SA node automaticity | Heart failure, Hypotension, Bronchospasm | Teach patient can mask signs or hypoglycemia and not stop medication abruptly | Non-selective - properties on lungs Not safe for pregnancy Avoid in COPD Taking BP meds in the morning. |
Drugs for Coronary Heart Disease: Organic Nitrates
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Organic Nitrates | Nitroglycerin | Potent Vasodilator, relaxing smooth muscles in blood vessel walls. Decrease BP & cardiac workload | SE: Headaches, Flushing (feeling too hot) AE: hypotension, tachycardia | Monitor BP, assess chest pain | TE: Venous dilation decrease preload. MONA B - Morphine, oxygen, Nitroglycerin & Aspirin |
Drugs for Heart Failure: Cardiac Glycosides( Contractility)
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Cardiac Glycosides | Digoxin | Inhibits the activity of the myocardial Sodium potassium pump & stimulates the Parasympathetic nervous system - Decreasing HR | AE: Dysrhythmias (Bradycardia), toxicity, headache SE: N/V, dizziness | Assess HR FIRST, then BP Hold meds before administering to a patient with a HR of 58 or lower Make sure Potassium electrolytes are within range. | Early sign of digoxin toxicity - (halo of lights) Low therapeutic range (0.5 -2.0) Serum Labs: 0.8-2.0 Antidote: digibind/Digifab |
PDE Inhibitors | Milrinone | Increases levels of cAMP in myocardium by inhibiting PDE. cAMP increases contractility, HR & Velocity | AE: Dysrhythmias, hypotension | Beware with IV Lasix | |
ARNIs | Sacubitril/Valsartan | Sacubitril is a neprilysin inhibitor & blocks the breakdown of natriuretic peptides produced in the body Valsartan is an ARB, blocking the angiotensin receptors. | AE: hypotension | Assess HR & BP. |
Drugs for Nasal Congestion & Cough
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Nasal Decongestants | Pseudoephedrine | Activation of adrenergic receptors & Increased norepinephrine - lead to vasoconstriction - decreased nasal congestion | AE: Tachycardia, Hypertension SE: nervousness Think “Fight/Flight” | Check for hyperlipidemia, and hypertension. | Not safe for children <4 years. |
Antitussives | Dextromethorphan (like a smaller dosing of morphine) | Increase cough threshold by acting on the CNS - suppressing cough | Rare - hallucinations and dissociation CNS depressant | No alcohol, Used for non-productive cough | |
Expectorants | Guaifenesin - Guaf sound like cough | Moistens and increases volume of secretions - loosens congestion | AE: N/A - relatively benign. | Thin secretions do drink water Used for Productive cough | |
Mucolytics | Acetylcysteine | Decrease mucus viscosity. | AE:Bronchospasm, ciliary dysfunction SE: Drowsiness | Hydration, coughing to clear up airway | Antidote for Acetaminophen |
Drug Therapy for Asthma, Airway Inflammation and Bronchoconstriction
Grouping | Prototype | MOA | side/adverse effects | Nursing implications | Other Info |
Adrenergic Bronchodilators | Albuterol | Activates B2 receptors in lung smooth - bronchodilation. Suppresses histamine release and increase ciliary motility | AE: increased HR, angina & tremor | Avoid caffeine with meds. Albuterol AMMPS up HR | - end in -erol, Short acting AAA - Acute Asthma Attacks Use Bronchodilator 1st, then glucocorticoid |
Anticholinergics | Ipratropium | Blocks muscarinic receptors - decrease bronchoconstriction & mucus secretion | Dry mouth, cough, nervousness | -tropium; you can’t pee w/ em | - end in - tropium Long-term/maintenance therapy for asthma/COPD |
Xanthines | Theophylline | Relaxes smooth muscles of the bronchi by blocking adenosine receptors | AE: Hypertension, twitching or nervousness | Avoid caffeine or tobacco, | Has a therapeutic range of 5-15 MCG/ML/ Toxic above 20 |
Corticosteroids | Beclomethasone | Decrease inflammatory mediators & mucosal edema - suppress inflammation | Oropharyngeal candidiasis, dysphonia (alteration of voice) | Inhaled - immediate. Long-term/maintenance therapy for asthma/COPD | |
Leukotriene Modifiers | Montelukast | Suppress effects of leukotrienes - decrease bronchoconstriction and inflammation | Neuropsych (depression, SI) | Long-term/maintenance therapy for asthma/COPD By Mouth |