Pharmacology Flashcards

Antilipemic Drugs

Hypercholesteremia

Hypercholesteremia involves high levels of cholesterol, which can increase the risk of heart disease and cardiovascular problems.

Uses of Antilipemic Drugs

These drugs aim to lower lipid levels to prevent the progression of diseases associated with hypercholesterolemia. Expected outcomes include:

• Increase in HDL (high-density lipoprotein) levels.

• Decrease in LDL (low-density lipoprotein) levels.

• Decrease in triglyceride levels.

• Slowing or prevention of coronary artery disease (CAD).

General Patient Teaching

• Diet: Eat a healthy diet, increasing fiber intake and decreasing fat intake.

• Exercise: Regular exercise is important.

• Fat-Soluble Vitamins: Be aware of possible decreased absorption of fat-soluble vitamins.

• Constipation: Increase fiber and fluid intake to manage constipation.

• Not a Cure: These medications do not cure hypercholesterolemia.

• Pregnancy: Do not use during pregnancy.

• Monitoring: Lipid, cholesterol, and triglyceride levels will be checked regularly.

HMG-CoA Reductase Inhibitors ("-statins")

• Medications: Pravastatin, atorvastatin, simvastatin, lovastatin.

• Patient Teaching:

  • Rhabdomyolysis: Report any muscle pain or weakness to the healthcare provider.

  • Administration: Take with 8 oz of water.

  • Onset: It takes several weeks to be therapeutic.

  • Monitoring: Monitor renal and liver function.

  • Grapefruit Juice: Avoid grapefruit juice.

  • Timing: Take in the evening.

  • Metabolism: Metabolized by cytochrome P-450.

  • Pregnancy Category: X (contraindicated in pregnancy).

Bile Acid Sequestrants

• Medication: Cholestyramine

• Patient Teaching:

  • Administration: Take with meals.

  • Mixing: Mix in water.

  • Drug Interactions: Take other medications 1 hour before or 4-6 hours after cholestyramine.

Niacin

• Medication: Niacin

• Patient Teaching:

  • Administration: Take with food.

  • Flushing: May initially cause cutaneous flushing; give ibuprofen 30 minutes before to prevent discomfort.

  • Contraindications: Active bleeding, peptic ulcer disease (PUD), gout, liver disease.

Fibric Acid Derivatives

• Medications: Gemfibrozil, fenofibrate

• Patient Teaching:

  • Rhabdomyolysis: Can cause rhabdomyolysis.

  • Contraindications: Severe hepatic (liver) dysfunction.

Diuretic Drugs

Uses of Diuretic Drugs

Used in the treatment of:

• Hypertension

• Heart failure (HF)

• Renal failure

Diuretics result in the removal of sodium and water and accelerate the rate of urine formation

Types of Diuretic Drugs

• Loop diuretics

• Osmotic diuretics

• Potassium-sparing diuretics

• Thiazide and thiazide-like diuretics

Loop Diuretics

• Medications: Furosemide, Bumetanide, Torsemide, Ethacrynic Acid

• Mechanism: Potassium and sodium depletion; decreased fluid volume causes a reduction in blood pressure, pulmonary vascular resistance, systemic vascular resistance, central venous pressure, and left ventricular end-diastolic pressure.

• Effect: Potent, rapid diuresis and subsequent loss of fluid.

Furosemide (Lasix)

• Onset: Rapid onset, fast/large amounts of diuresis

• Uses: Pulmonary edema and edema associated with HF, liver disease, nephrotic syndrome, ascites, HTN.

• Adverse Effects: Hypokalemia, ototoxicity, dizziness, hypotension, photosensitivity, Stevens-Johnson Syndrome (SJS).

• Nursing Considerations and Patient Education:

  • Monitor for hypokalemia; check potassium levels before administration.

  • Best taken in the morning.

  • Eat potassium-rich foods.

  • At risk for photosensitivity; avoid prolonged sun exposure.

  • Monitor for sulfonamide allergy due to cross-sensitivity.

  • Monitor weight once a week; report to provider if -/+ 3lbs.

Osmotic Diuretics

• Medication: Mannitol (IV)

• MOA: Inhibits resorption of water and solutes causing rapid diuresis.

• Uses: Cerebral edema, increased ICP, acute renal failure in oliguric phase, promote excretion of toxic substances.

• Contraindications: Severe renal disease, pulmonary edema, active intracranial bleeds.

• Nursing Indications:

  • Stop if severe cardiac or renal impairment develops.

  • IV infusion only. May crystallize at low temperatures, must use a filter. Vials stored in warmer.

  • Daily weights / Strict I&O.

Thiazide and Thiazide-Like Diuretics

• Medication: Hydrochlorothiazide

• MOA: Inhibits tubular resorption of sodium, chloride, and potassium ions, resulting in excretion of water and electrolytes (i.e., sodium, chloride, potassium).

• Uses: First-line treatment to reduce blood pressure if hypertensive, heart failure, diabetes insipidus, edematous states.

• Adverse Effects: Hypokalemia, hyperglycemia, hyperuricemia, dizziness, headache, blurred vision, anorexia, nausea, vomiting, diarrhea.

• Nursing Considerations:

  • May cause depletion of sodium, water, and potassium, so monitor labs during therapy.

  • Should not be used if creatine clearance is less than 30-50ml/min.

Potassium-Sparing Diuretics

• Medication: Spironolactone (Aldactone)

• MOA: Competitively block aldosterone receptors and inhibit their action to block resorption of sodium and water, which then promotes the excretion of sodium and water; also prevents potassium secretion.

• Contraindications: Hyperkalemia, renal failure.

• Adverse Effects: Hyperkalemia, hyponatremia, can increase risk for lithium toxicity.

• Nursing Indications:

  • Monitor labs - AT risk for hyponatremia and hyperkalemia.

  • Avoid eating foods high in potassium.

  • Daily weights.

General Nursing Implications for Diuretics

• Timing: Take diuretics in the morning. ## Diuretic Drugs ### Uses of Diuretic Drugs Used in the treatment of: - Hypertension - Heart failure (HF) - Renal failure <!-- --> Diuretics result in the removal of sodium and water and accelerate the rate of urine formation ### Types of Diuretic Drugs - Loop diuretics - Osmotic diuretics - Potassium-sparing diuretics - Thiazide and thiazide-like diuretics <!-- --> ### Loop Diuretics - **Medications**: Furosemide, Bumetanide, Torsemide, Ethacrynic Acid - **Mechanism**: Potassium and sodium depletion; decreased fluid volume causes a reduction in blood pressure, pulmonary vascular resistance, systemic vascular resistance, central venous pressure, and left ventricular end-diastolic pressure. - **Effect**: Potent, rapid diuresis and subsequent loss of fluid. <!-- --> #### Furosemide (Lasix) - **Onset**: Rapid onset, fast/large amounts of diuresis - **MOA**: Loop diuretics work by inhibiting the sodium-potassium-chloride cotransporter (NKCC2) in the thick ascending limb of the loop of Henle in the kidneys. This inhibition prevents the reabsorption of sodium and chloride, leading to increased excretion of these electrolytes and water. - **Indications**: Pulmonary edema and edema associated with HF, liver disease, nephrotic syndrome, ascites, HTN. - **Route**: Oral, IV, IM - **Adverse Effects**: Hypokalemia, ototoxicity, dizziness, hypotension, photosensitivity, Stevens-Johnson Syndrome (SJS). - **Contraindications**: Hypersensitivity to furosemide or sulfonamides, electrolyte imbalances, severe renal impairment. - **Patient education**: - Monitor for hypokalemia; check potassium levels before administration. - Best taken in the morning. - Eat potassium-rich foods. - At risk for photosensitivity; avoid prolonged sun exposure. - Monitor for sulfonamide allergy due to cross-sensitivity. - Monitor weight once a week; report to provider if -/+ 3lbs. - **Nursing considerations** - Monitor fluid status, electrolyte levels, and renal function. - Administer cautiously in patients with diabetes, as it may increase blood glucose levels. - Be aware of potential drug interactions, such as increased risk of ototoxicity with aminoglycosides. <!-- --> ### Osmotic Diuretics - **Medication**: Mannitol (IV) - **MOA**: Osmotic diuretics work by increasing the osmolarity of the glomerular filtrate, which reduces water reabsorption in the proximal tubule and loop of Henle. This results in increased urine volume and decreased sodium and water reabsorption. - **Indications**: Cerebral edema, increased ICP, acute renal failure in oliguric phase, promote excretion of toxic substances. - **Route**: IV - **Contraindications**: Severe renal disease, pulmonary edema, active intracranial bleeds. - **Adverse effects**: Fluid and electrolyte imbalances, pulmonary edema, dehydration, headache, nausea, vomiting. - **Nursing Indications**: - Stop if severe cardiac or renal impairment develops. - IV infusion only. May crystallize at low temperatures, must use a filter. Vials stored in warmer. - Daily weights / Strict I&O. - **Patient education**: - Report any signs of chest pain, difficulty breathing, or fluid overload. - Understand the importance of strict adherence to fluid intake and output monitoring. <!-- --> ### Thiazide and Thiazide-Like Diuretics - **Medication**: Hydrochlorothiazide - **MOA**: Thiazide diuretics work by inhibiting sodium and chloride reabsorption in the distal convoluted tubule of the nephron. This leads to increased excretion of sodium, chloride, and water, resulting in decreased blood volume and blood pressure. - **Indications**: First-line treatment to reduce blood pressure if hypertensive, heart failure, diabetes insipidus, edematous states. - **Route**: Oral - **Adverse Effects**: Hypokalemia, hyperglycemia, hyperuricemia, dizziness, headache, blurred vision, anorexia, nausea, vomiting, diarrhea. - **Contraindications**: Hypersensitivity to thiazides or sulfonamides, severe renal impairment, electrolyte imbalances. - **Nursing Considerations**: - May cause depletion of sodium, water, and potassium, so monitor labs during therapy. - Should not be used if creatine clearance is less than 30-50ml/min. - **Patient education**: - Monitor for signs and symptoms of electrolyte imbalances, such as muscle weakness or cramps. - Take medication in the morning to avoid nocturia. - Use sunscreen and protective clothing due to increased photosensitivity. <!-- --> ### Potassium-Sparing Diuretics - **Medication**: Spironolactone (Aldactone) - **MOA**: Potassium-sparing diuretics work by blocking the action of aldosterone in the distal tubule and collecting duct of the nephron. This prevents sodium and water reabsorption and potassium excretion, resulting in increased urine output without significant potassium loss. - **Indications**: Heart failure, hypertension, ascites, hyperaldosteronism. - **Route**: Oral - **Contraindications**: Hyperkalemia, renal failure. - **Adverse Effects**: Hyperkalemia, hyponatremia, can increase risk for lithium toxicity. - **Nursing Indications**: - Monitor labs - AT risk for hyponatremia and hyperkalemia. - Avoid eating foods high in potassium. - Daily weights. - **Patient education**: - Report any signs of muscle weakness, palpitations, or irregular heartbeats. - Avoid salt substitutes containing potassium. - Monitor blood pressure regularly. <!-- --> ### General Nursing Implications for Diuretics - **Timing**: Take diuretics in the morning. - **Illness**: Patients who have been ill with nausea, vomiting, or diarrhea should notify their primary care providers because fluid and electrolyte imbalances can result. - **Potassium**: Eat potassium foods with Loop, Thiazide, Osmotic diuretics but avoid potassium food with Spironolactone. - While taking this diuretic, be sure to monitor the patient for hyponatremia and hyperkalemia. - Furosemide is a potent, rapid diuretic can result in the loss of water and electrolytes such as potassium, sodium, magnesium. Signs and symptoms of hypokalemia include: muscle weakness, irregular pulse rate, constipation, overall feeling of lethargy. <!-- --> ### Audience Response System Question #3 While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. What is the most appropriate action by the nurse? - Obtain a filter and then infuse the solution. <!-- -->

• Illness: Patients who have been ill with nausea, vomiting, or diarrhea should notify their primary care providers because fluid and electrolyte imbalances can result.

• Potassium: Eat potassium foods with Loop, Thiazide, Osmotic diuretics but avoid potassium food with Spironolactone.

• While taking this diuretic, be sure to monitor the patient for hyponatremia and hyperkalemia.

• Furosemide is a potent, rapid diuretic can result in the loss of water and electrolytes such as potassium, sodium, magnesium. Signs and symptoms of hypokalemia include: muscle weakness, irregular pulse rate, constipation, overall feeling of lethargy.

Audience Response System Question #3

While preparing an infusion of mannitol (Osmitrol), the nurse notices small crystals in the IV tubing. What is the most appropriate action by the nurse?

• Obtain a filter and then infuse the solution.

Anemia Drugs

Hematopoiesis

• Formation of new blood cells

• Red blood cells (RBCs) - Erythropoiesis

• White blood cells (WBCs)

• Platelets

Anemias

Underlying causes of anemia are red blood cell (RBC) maturation defects and factors secondary to excessive RBC destruction.

Some examples:

• Hemolytic anemia

• Pernicious anemia

• Folate (folic acid) deficiency.

• Iron deficiency

• Vitamin B12 deficiency

Erythropoiesis-Stimulating Agents

• Medication: Epoetin alfa (Epogen)

• MOA: Promotes synthesis of erythrocytes by stimulating RBC progenitor cells in bone marrow.

• Used for: Anemia

• Contraindications: Known drug allergy. Use of epoetin and darbepoetin is contraindicated in cases of uncontrolled hypertension or when hemoglobin levels are above 10 g/dl. Use in patients with head or neck cancers or those at risk for thrombosis is controversial.

• Adverse effects: Hypertension, fever, headache, pruritis, rash, nausea, vomiting, arthralgia, and injection site reaction.

• Nursing Considerations:

  • Medication is ineffective without adequate body iron stores and bone marrow function.

  • Most patients receiving epoetin alfa need to also receive an oral or intravenous (IV) iron preparation.

Iron

• Essential mineral in the body

• Oxygen carrier in hemoglobin and myoglobin

• Stored in the liver, spleen, and bone marrow

• Dietary sources: meats, certain vegetables, and grains

• Some foods enhance iron absorption:

  • Orange juice

  • Veal

  • Fish

  • Ascorbic acid

• Some foods impair iron absorption:

  • Eggs, Corn, Beans, Cereal products containing phytates

Supplemental Iron

• Supplemental iron may be given as a single drug or as part of a multivitamin preparation.

• Oral iron preparations are available as ferrous salts.

  • Ferrous fumarate (Femiron), ferrous gluconate, ferrous sulfate (FeSO_4)

• Parenteral

  • Iron dextran (INFeD)

  • Iron sucrose (Venofer)

  • Ferric gluconate (Ferrlecit, Nulecit)

  • Ferumoxytol (Feraheme)

Adverse Effects

• Most common cause of pediatric poisoning deaths

• Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain

• Causes black, tarry stools

• Liquid oral preparations may stain teeth.

• Injectable forms cause pain upon injection.

Toxicity

• Symptomatic and supportive measures

  • Suction and maintenance of the airway; correction of acidosis; control of shock and dehydration with IV fluids or blood, oxygen, and vasopressors

• In patients with severe symptoms of iron intoxication, such as coma, shock, or seizures, chelation therapy with deferoxamine is initiated.

• Deferiprone is used in iron overload.

Oral Iron supplement

• Ferrous Fumarate (Femiron)

  • Oral use only

  • Most frequently used oral iron

  • 300 mg BID or TID for adults

  • Each tablet contains 65 mg of elemental iron.

• Ferric gluconate (Ferrlecit)

  • Indicated for repletion of total body iron content in patients with iron-deficiency anemia who are undergoing hemodialysis

  • Risk of anaphylaxis is much less than with iron dextran, and a test dose is not required.

  • Doses higher than 125 mg are associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching.

Parenteral Iron supplement

• Iron dextran (INFeD, Dexferrum) IV/IM

  • May cause anaphylactic reactions, including major orthostatic hypotension and fatal anaphylaxis

  • A test dose of 25 mg of iron dextran is administered before injection of the full dose, and then the remainder of dose is given after 1 hour.

  • Used less frequently now; replaced by newer products ferric gluconate and iron sucrose

• Venofer
  * Injectable Iron: Iron Sucrose
  * Indicated for anemic patients with chronic renal failure
  * Less risk for precipitating anaphylaxis than with iron dextran
  * No test dose required
  * Adverse effects: hypotension (related to infusion rates)
  * Infuse over 2.5 to 3.5 hours

• Ferumoxytol (Feraheme)

  • Newer parenteral iron

  • Can be given undiluted IV push over 1 minute

Iron Nursing Considerations

• Oral forms of iron should be taken between meals for maximum absorption but may be taken with meals if GI distress occurs.

• Oral forms should be given with juice but not with milk or antacids.

• Patients should remain upright for 15 to 30 minutes after oral iron doses to avoid esophageal corrosion.

• Instruct the patient to take liquid iron preparations through a straw to avoid staining tooth enamel.

• Patients should be encouraged to eat foods high in iron and folic acid.

• Early symptoms of iron toxicity; e.g., nausea, vomiting, diarrhea, abdominal pain Seek medical attention immediately

• Keep iron supplements out of the reach of children Common cause of fatal poisoning

Other Anemia Drugs: Folic Acid

• Water-soluble, B-complex vitamin

• MOA: Converted in the body to tetrahydrofolic acid which is used for erythropoiesis

• USE: Folic acid deficiency, pregnancy to prevent neural tube defects

• NURSING CONSIDERATIONS

  • Determine the cause of anemia before administering folic acid.

  • Administer oral folic acid with food.

  • Folic acid may also be given IV and added to total parenteral nutrition solutions.

Other Anemia Drugs: Cyanocobalamin (Vitamin B12)

• Used to treat pernicious anemia and other megaloblastic anemias

• Administered orally or intranasally to treat vitamin B12 deficiency

• Usually administered by deep intramuscular injection

Quick Questions: Iron

• Do you need to sit upright after taking me? Yes, for 15-30 minutes

• Uh oh, my stools have turned tarry and dark, is this expected? Yes

• When should I be taking oral iron during the day? Taken between meals for maximum absorption

• Oh no, your stomach hurts when taken this way, well what do you suggest? Taken with meals if GI distress occurs

• Can you take me along with your morning orange juice? Yes, you can take with OJ

Yes, I have added the details for medication MOA, Indication, route, side effects, adverse effects, contraindications, patient education, and nursing considerations as requested.