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Pharmacology- Unit 7
| Question | Answer |
|---|---|
| Captopril | Angiotensin-Converting Enzyme Inhibitor |
| Lisinopril | Angiotensin-Converting Enzyme Inhibitor |
| Quinapril | Angiotensin-Converting Enzyme Inhibitor |
| Angiotensin-Converting Enzyme Inhibitor: Action | -Block conversion of angiotensin 1 to angiotensin 2 -Block effects on angiotensin on blood vessels |
| Angiotensin-Converting Enzyme Inhibitor: Indications | -Hypertension -Heart Failure -Diabetic nephropathy -Left ventricular dysfunctions after MI |
| Angiotensin-Converting Enzyme Inhibitor: Contraindications and Cautions | -Impaired renal function -CHF |
| Angiotensin-Converting Enzyme Inhibitor: Adverse effects | -Hypotension -HA, fatigue -Dry, non productive cough -Tickling in throat -Angioedema -GI irritation -Elevated serum K+, BUN, creatininine clearance -Renal insufficiency |
| Angiotensin-Converting Enzyme Inhibitor: Drug to Drug | -Allopurinal- Kidneys -NSAIDS - Motrin, Aleve (alters renal function) |
| Angiotensin-Converting Enzyme Inhibitor: Nursing Considerations | -Give 1hr before meals -Hold if: Fever, sore throat, hypotension, tachycardia -Assess for hyperkalemia if taking K+ sparing diuretics,supplements, or salt substitutes -Encourage fluid intake in summer -If patch, remove old then place new - Defibrilati |
| Losartan | Angiotensin II-Receptor Blocker |
| Valsartan | Angiotensin II-Receptor Blocker |
| Angiotensin II-Receptor Blocker: Actions | -Selectively blocks binding of angiotensin II to receptor sites in vascular smooth muscle and adrenal glands -Less vasoconstriction, less aldosterone secretion |
| Angiotensin II-Receptor Blocker: Indications | -Hypertension -Diabetic nephropathy |
| Angiotensin II-Receptor Blocker: Caution | -Hepatic or renal dysfunction -Hypovolemia |
| Angiotensin II-Receptor Blocker: Adverse Effects | -HA,dizziness,syncope,weakness -Cough of tickling in throat -GI complaints -Dry skin or rash |
| Angiotensin II-Receptor Blocker: Drug to Drug | -Phenobarbital -Fluconazole -NSAIDs -Rifampin -K+ -Lithium |
| Angiotensin II-Receptor Blocker: Nursing Considerations | -Be alert as can lower BP quickly (Sit up slowly, limit sudden movement) -Monitor BP, weight, kidney function (Daily wts best/cheapest regulate fluid intake) -Give w/ food: ok @ bedtime -If using patch, dif site each week -Remove patch bf difibrillati |
| Amlodipine | Calcium Channel Blocker |
| Diltiazem | Calcium Channel Blocker -Prototype |
| Nicardipine | Calcium Channel Blocker |
| Nifedipine | Calcium Channel Blocker |
| Verapamil | Calcium Channel Blocker |
| Calcium Channel Blocker: Actions | -Inhibits movement of calcium ions across membranes of cardiac and arterial muscle cells -Depresses impulse, slows conduction -Decreases myocardial contractility -Dilates arterioles |
| Calcium Channel Blocker: Indications | -Essential Hypertension -Route: IV and Oral |
| Calcium Channel Blocker: Contraindications | -Heart block or sick sinus syndrome -Renal or hepatic dysfunction |
| Calcium Channel Blocker: Adverse effects | -Hypotension,arrhythmias,bradycardia -HA, persistent peripheral edema -GI symptoms |
| Calcium Channel Blocker: Drug to Drug | -Cyclosporin |
| Calcium Channel Blocker: Nursing Considerations | -ECG monitor when therapy initiated -Assess before dosing: hold and notify (apical pulse<60; Systole BP <90) -Sustained release and extended release are not the same -Don't crush sustained release tablets -Watch for edema (Limit salt and H20 intake) |
| Nitroprusside | Vasodilator |
| Hydralazine | Vasodilator |
| Minoxidil | Vasodilator |
| Vasodilator:Actions | -Act directly on venous and arterial smooth muscle -Cause relaxation = Vasodilation = BP lower |
| Vasodilator: Indications | -Refractory hypertension: Hydralazine, minoxidil -Hypertensive crisis: Nitroprusside |
| Vasodilator: Contraindications and Cautions | -Cerebral insufficiency -Peripheral vascular disease -CAD -CHF -Tachycardia |
| Vasodilator: Adverse Effects | -Related to low BP: fatigue, HA, palpitations, hypotension -GI upset -Breast tenderness -Cyanide toxicity |
| Vasodilator: Nursing Considerations | -Monitor patch site for rash, assess for pruitis -Take w/food; ok @ bedtime -IV admin. -Wrap IV bag in aluminum foil (can be degraded by sunlight); discard after 24hrs -Check BP q 5min @ Beginning then q15min -Stop if severe hypotension |
| Vasodilator: Monitor for cyanide toxicity | -> 100mcg/ml was given too fast -Profound hypotension -Metabolic acidosis -HA and dyspnea -V, loss of consciousness |
| Midodrine | -Alpha-Specific Adrenergic |
| Alpha-Specific Adrenergic: Actions | -Activates alpha-receptors in arteries and veins -Increase in vascular tone = increase in BP |
| Alpha-Specific Adrenergic: Indications | -Orthostatic hypotension -Use in conjunction with supportive therapies |
| Alpha-Specific Adrenergic: Contraindications | -Supine hypertension -CAD -Pheochromocytoma |
| Alpha-Specific Adrenergic: Drug to Drug | -Cardiac glycosides -Beta Blockers -Alpha adrenergics -Corticosteroids |
| Digoxin | -Cardiac Glycoside |
| Cardiac Glycoside: Actions | -Inhibits sodium-potassium activated adenosine triphosphate (enzyme that regulates Na and K+ in cell) -Slow and strengthen heart |
| Cardiac Glycoside: Indications | -Heart Failure -Atrial fibrillation -Supraventricular tachycardia |
| Cardiac Glycoside: Contraindications | -Ventricular tachycardia or fibrillation -Heart block or sign sinus syndrome -Idiopathic hypertropic subaortic stenosis -Acute MI -Renal insufficiency -Electrolyte abnormalities (K,Ca,Na) |
| Cardiac Glycoside: Adverse effects | -NVD, abdominal pain -HA, weakness, drowsiness, vision changes -GI upset and anorexia -Arrhythmias, heart block |
| Cardiac Glycoside: Drug to Drug | -Verapamil, amidodarone, quinidine, quinine, erythromycin, tetracycline, cyclosporine -K losing diuretics -Cholestryamine, charcoal, colestipol, bleomycin, cyclophosphamide, methotrexate |
| Cardiac Glycoside: Nursing Considerations | -Withhold and report if apical pulse < 60 -Monitor levels: Therapeutic-0.5-2.0 Do 8h after last dose -Use loading doses for immediate effects: long half life, not for HF, if IV, give over at least 5 min. -If toxic dose give Digoxin Immune Fab |
| Cardiac Glycoside: Patient Education | -Always take pulse -Take dose same time each day -If miss a day, don't double dose -Don't switch brand/type -Can crush tablets but not capsules -Limit salt intake, eat adequate K+ avoid salt substitutes -Avoid St. Johns wart and ginseng (increase l |
| Inamrinone | Phosphodiesterase Inhibitor |
| Milrinone | Phosphodiesterase Inhibitor |
| Phosphodiesterase Inhibitor: Action | -Blocks enzyme phosphodiesterase -Increase in myocardial cell cyclin adenosine monophosphate -Increase Ca level in cell -Increase strength of contraction -Increase response to sympathetic stimulation -Relaxes vascular smooth muscle-decrease resist |
| Phosphodiesterase Inhibitor: Indications | -Short term treatment of HF -Unresponsive to digitalis, diuretics, vasodilators |
| Phosphodiesterase Inhibitor: Contraindications | -Severe aortic or pulmonic valvular disease -Acute MI -Fluid volume deficit -Ventricular arrhythmias -Elderly |
| Phosphodiesterase Inhibitor: Adverse Effects | -Arrhythmias -Hypotension -N,V -Thrombocytopenia -Pericarditis -Pleuritis -Fever -Chest pain -Burning @ injection site |
| Phosphodiesterase Inhibitor: Nursing Considerations | -If given with furosemide, can decrease K+ which leads to digoxin toxicity -Watch for increase urine output, adjust diuretic medication -Can aggravate outflow obstruction if hypertropic cardiomyopathy |
| Procaninamide | Class I Antiarrhythmics Ia |
| Class I Antiarrhythmics Ia: Actions | -Decrease depolarization -Decrease automaticity of ventricular cells -Increases ventricular fibrillation threshold |
| Class I Antiarrhythmics Ia: Indications | -Acute ventricular arrhythmias during cardiac surgery or MI |
| Class I Antiarrhythmics Ia: Contraindications | -Bradycardia or Heart Block -CHF, hypotension or sock -Electrolyte disturbances |
| Class I Antiarrhythmics Ia: Adverse Effects | -Slurred speech -Double vision -Respiratory depression |
| Class I Antiarrhythmics Ia: Nursing Considerations | -ECG monitoring when therapy starts -Always use IV pump, not over 4mg/min -Watch for toxicity: Nervousness, confusion, circumoral numbness, paresthesia -Don't crush SR tablets |
| Propranolol | Class II Antiarrhythmics |
| Class II Antiarrhythmics: Actions | -Competitively block beta receptor sites in heart and kidneys -Decrease heart rate, cardiac excitability output -Slow conduction through AV node |
| Class II Antiarrhythmics: Indications | -Supraventricular tachycardia -PVCs |
| Class II Antiarrhythmics; Contraindications and Caution | -Sinus bradycardia -AV block -Cardiogenic shock -CHF -Asthma -Resp. Depression -Diabetes -Thyroid dysfunction -Renal or hepatic dysfunction |
| Class II Antiarrhythmics: Adverse effects | -Arrhythmias -Bradycardia -Heart failure -Hypotension -NVD, anorexia -Loss of libido -Bronchoconstriction -Fatigue -Alter blood glucose levels |
| Class II Antiarrhythmics: Drug to Drug | -Verapamil (decrease BP,bradycardia) -Phenothiazine (decrease BP) -NSAIDS (fluid retention) |
| Class II Antiarrhythmics: Nursing Considerations | -Apical pulse and BP before giving med -Monitor VS frequently, ECG when start -If IV, dilute with normal saline -Watch for CNS reactions -Daily weights -Give with meals if po -Don't crush sustained release -Don't discontinue abruptly |
| Amiodarone | Class III Antiarrhythmics |
| Class III Antiarrhythmics: Actions | -Block K+ channels -Slow outward movement of K+ in phase 3 of action potential -Prolongs AP |
| Class III Antiarrhythmics: Indications | -Life threatening ventricular arrhythmias -Maintain sinus rhythm after conversion of atrial arrhythmias |
| Class III Antiarrhythmics: Cautions | -Respiratory depression -Prolonged QT interval -Renal or hepatic disease |
| Class III Antiarrhythmics: Adverse effects | -Hypotension, bradycardia, arrhythmias -NV -Pulmonary toxicity |
| Class III Antiarrhythmics: Drug to Drug | -Increase levels digoxin, quinidine, warfarin -Don't give within 4 hrs of class I or II |
| Class III Antiarrhythmics: Nursing Considerations | -Give with meals to decrease GI upset -Avoid grapefruit juice -If IV, monitor ECG -IV stable for 24 hrs room temp -If oral loading, give in 3 equal doses -Warn patient that vision may be affected |
| Diltiazem | Class IV antiarrhythmic |
| Verapamil | Class IV antiarrhythmic |
| Class IV antiarrhythmic: Actions | - Calcium channel blockers -Depress generation of AP -Delay phases 1 and 2 of repolarization -Slow conduction through V node |
| Class IV antiarrhythmic: Indications | -Supraventricular tachycardia -Control ventricular response to rapid atrial rates |
| Class IV antiarrhythmic: Contraindications | -Sick sinus syndrome or heart block -CHF or hypotension -Cuation in idiopathic hypertropic subaortic stenosis |
| Class IV antiarrhythmic: Adverse Effects | -Dizziness, weakness, fatigue -Depression, Constipation -Hypotension, CHF, shock |
| Class IV antiarrhythmic: Drug to Drug | -Anesthetics potentate effects -Antihypertensives cause hypotension -May decrease lithium levels |
| Class IV antiarrhythmic: Nursing Considerations | -If IV, use separate line for furosemide -No grapefruit juice -Monitor ECG when initiated - Daily I&O and weight -May need to restrict fluids and sodium -Assist with ambulation -Withhold and notify: Systolic <90 and HR <60 |
| Dobutamine | Adrenergic Agonists Vasopressors |
| Dopamine | Adrenergic Agonists Vasopressors |
| Adrenergic Agonists Vasopressors: Actions | -Heart Rate Increase -Bronchi Dilate -Vasoconstriction -Intraocular Pressure Decrease -Glygogenolysis |
| Adrenergic Agonists Vasopressors: Indications | -Shock |
| Adrenergic Agonists Vasopressors: Contraindications | -Pheochromocytoma -Tachyarrhythmias -Ventricular Fibrilation -Hypovolemia -Anesthetics -Peripheral Vascular Disease |
| Adrenergic Agonists Vasopressors: Adverse Effects | -Arrthmias -Hypertension -Palpitations -Angina -Dyspnea |
| Adrenergic Agonists Vasopressors: Drug to Drug | -Tricyclic Antidepressants -MAOI Inhibitors |
| Adrenergic Agonists Vasopressors: Nursing Considerations | -Check for excess cardiac system stimulation - Dilute IV &Phentolamine for extravasation -Go to BR b/f using drug - Light Sensitivity - Assess bowel function |
| Atenolol | Beta Blockers |
| Carteolol | Beta Blockers |
| Meoprolol | Beta Blockers |
| Nadolol | Beta Blockers |
| Timolol | Beta Blockers |
| Beta Blockers: Actions | -Blocks beta receptors in SNS – Heart and Juxtaglomerular (kidney) |
| Beta Blockers: Indications | -Hypertension -Angina -Migraine Headaches -Prevent infarction after MI |
| Beta Blockers: Contraindications | -Allergy -bradycardia -Heart Block -Shock -Congestive Heart Failure -Diabetes -Hepatic dysfunction |
| Beta Blockers: Adverse Effects | -Fatigue -Dizziness -depression -sleep disturbance -bradycardia -heart block -hypotension -NVD -decreased libido |
| Beta Blockers: Drug to Drug | -Clonidine -NSAID -Insulin -Anti-diabetic medications |
| Beta Blockers: Nursing Considerations | -Check for bronchospasm -monitor glucose for decrease -assess for thyrotoxicosis -Taper drug slowly |
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prettyinpink7
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