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Pharmacology
Unit 8
| Question | Answer |
|---|---|
| Nitroglycerin | Nitrate |
| Amyl Nitrate | Nitrate |
| Isosorbide Dinatrate | Nitrate |
| Nitrate: Actions | -Act directly on smooth muscle -Cause relaxation and depress muscle tone -Increase blood flow in healthy arteries |
| Nitrate: Indications | -Prevent and treat attacks of angina pectoris -Taper off over 4-6 weeks (risk of MI) |
| Nitrate: Contraindications and Cautions | -Severe anemia (decreased Cardiac Output) -Head Trauma -Renal or Hepatic disease -Hypotension -Hypovolemia |
| Nitrate: Adverse Effects | -Hypotension -HA,N,V -Dizziness -Tachycardia -Rash,Flushing,Sweating -Chest Pain |
| Nitrate: Drug-Drug | -Ergot derivatives (hypotension) -Sildenafil,Tadalafil,Vardenafil (Hypotension) |
| Nitrate: Routes | -Sublingual, Transbuccal, Translingual spray, Oral SR tablet, IV, Topical ointment, Transdermal patch |
| Nitrate: Patient Education | -Sublingual - Unstable, purchase small quantities, store in dark glass in dark, dry place, Keep in original container, Don't combine with other meds, Carry in jacket or purse, not on body,Replace every 3 months |
| Nitrate: Instructions | -Put tablet under tongue: wait 5 minutes -Repeat, wait 5 minutes -Repeat, if no relief call HCP or go to ER -Should sit or lie down -Likely to cause HA |
| Nitrate: Nursing Considerations | -Can take a dose if stress anticipated -Can take at bedtime for nocturnal angina -Should avoid alcohol -If IV: use special tubing as drug binds to plastic, don't use filter, use infusion pump |
| Meoprolol | Beta Blockers |
| Propanolol | Beta Blockers |
| Beta Blockers: Actions | -Block beta adrenergic receptors in heart/kidney -Decrease influence of SNS on heart/kidneys -Decrease cardiac output and release of renin |
| Beta Blockers: Indications | -Treat stable angina pectoris and hypertension -Prevent reinfarction in MI patients -Treats stable CHF |
| Beta Blockers: Contraindications and Cautions | -Bradycardia, heart block -Cardiogenic shock -Asthma, COPD -Diabetes -Peripheral vascular disease -Thyrotoxicosis |
| Beta Blockers: Adverse Effects | -Dizziness -Vertigo -HF -Arrhythmias -Gastric pain -Flatulence -D,V -Impotence -Decrease exercise tolerance |
| Beta Blockers: Drug-Drug | -Clonidine (paradoxial hypertension) -NSAID -Antidiabetic agents |
| Beta Blockers: Nursing Considerations | -Angina dose smaller than for hypertension -Assess apical pulse -Don't stop dose abruptly -Food may increase absorption -Use atropine or isoproterenol for overdose |
| Dilitiazem | Calcium Channel Blocker |
| Nifedipine | Calcium Channel Blocker |
| Verapamil | Calcium Channel Blocker |
| Piperazineacetamide | Calcium Channel Blocker |
| Calcium Channel Blocker: Actions | -Inhibit movement of calcium ions across membranes of myocardial and arterial muscle cells -Alters action potential=block muscle contraction so decrease workload of heart |
| Calcium Channel Blocker: Indications | -Prinzmetal's Angina -Verapamil - tachycardia |
| Calcium Channel Blocker: Contraindications | -Heart block, sick sinus syndrome -Renal or hepatic dysfunction |
| Calcium Channel Blocker: Adverse Effects | -Dizziness, light headedness -HA,N -Peripheral edema -Bradycardia -Heart block -Flushing -Rash |
| Calcium Channel Blocker: Nursing Considerations | -Used for long term prevention, not short term relief angina -Hold dose: Systolic <90 & HR <60 -Assess for HF -Assess for dizziness, esp if ambulating |
| Cholestryramine | Bile Acid Sequestrants |
| Bile Acid Sequestrants: Actions | -Bind bile acids in intestine -Allow excretion in feces instead of reabsorption -Causes cholesterold to be iodized in liver -Serum cholesterol levels fall |
| Bile Acid Sequestrants : Indications | -Primary hypercholesterolemia -Pruitis associated with partial billary obstructions |
| Bile Acid Sequestrants: Contraindications | -Complete billary obstruction -Abnormal intestinal function |
| Bile Acid Sequestrants: Adverse effects | -HA,anxiety,vertigo,dizziness -Cramps, flatulence, N, fecal impaction -Vit. A & D deficiency -Muscle and Joint pain -Rash -Increased bleeding tendencies |
| Bile Acid Sequestrants: Drug-Drug | -Fat-Soluble Vitamins (A,D,E) -Thiazide diruetics -Digoxin -Warafarin -Thyroid hormones -Corticosteroids |
| Bile Acid Sequestrants: Nursing Considerations | -Monitor Creatine Kinase (CK) levels every six months -Muscle weakness, pain -Take b/f meals; Drink 2-3 L daily -Take other meds 1h b/f or 4-6 h later -Decrease absorption of Vit A,D,K,E |
| Atorvastatin | HMG-CoA inhibitors |
| HMG-CoA inhibitors: Actions | -Inhibit HMC-CoA -Decreases serum cholesterol, LDL. triglyceride levels -Increase HDL levels |
| HMG-CoA inhibitors: Indications | -Adjunct to diet -Increase HDL-C in primary hypercholeserolemia -Treat familia hypercholesterolemia |
| HMG-CoA inhibitors: Contraindications and Cautions | -Active liver disease -Alcoholic liver disease -Impaired endocrine function |
| HMG-CoA inhibitors: Adverse Effects | -HA -Flatulence -Ab pain, cramps, constipation |
| HMG-CoA inhibitors: Drug-Drug | -Erythomycin, cyclosporine, gemfibrozil, niacin -Digoxin or Warfarin -Estrogen -Grapefruit juice |
| HMG-CoA inhibitors: Nursing Considerations | -Should be on low cholesterold diet -Assess: liver function every 6 wks; CK every 6 months; Myopathy; Rhabdomyolysis -Periodic eye exam - cataracts -If constipation, use stool softener |
| Ezetimibe | Cholesterol absorption inhibitors |
| Cholesterol absorption inhibitors: Actions | -Works in brush border of small intestine -Inhibits absorption of cholesterol |
| Cholesterol absorption inhibitors: Indications | -To lower serum cholesterol levels -Treat homozyhous familia hypercholesterolemia |
| Cholesterol absorption inhibitors: Cautions | -Pregnancy, lactation -Elderly -Liver disease |
| Cholesterol absorption inhibitors: Adverse Effects | -HA,D -Dizziness -Ab Pain -URI -Back pain |
| Cholesterol absorption inhibitors: Drug-Drug | -Cholestyramine -Antacids -Cyclosporine -Warfarin -Fibrate lipid lowering agents |
| Cholesterol absorption inhibitors: Nursing Considerations | -Monitor cholesterol and lipid levels, CK -Severe constipation, stool softener and decrease dose |
| Fenofibrate | Fibrates |
| Gemifibrozil | Fibrates |
| Fibrates: Actions | -Produced by fungi -Likely to reduce cholesterol during formation -Inhibits triglyceride synthesis in liver |
| Fibrates: Indications | -Reduce triglyceride levels, esp VLDT -For adults with very high triglycerides |
| Fibrates: Adverse Effects | -HA,dizziness,blurred vision -Epigastric pain,dyspepsia, NVD or C -Rash -Gi and muscle discomfort -Arrhythmias -Thrombocytopenia |
| Fibrates: Drug-Drug | -Barbiturates, Phenytoin, thyroid derivvatives, caridac glycosides -Oral anticoagulants -Statins |
| Fibrates: Nursing Considerations | -Teaching: take fenofibrate w/ meals, take gemifibrozil 30m b/f meals, take b/f or 4-6hrs after bile acid resin -Monitor cholesterol, lipids, CK levels, muscle pain -Stop after 2 months if no improvement |
| Niacin | Vitamin B |
| Vitamin B: Actions | -Water soluble vitamin -Inhibits release of free fatty acids from adipose tissue -Increase rate of triglyceride removal from plasma -Reduces LDL and increases HDL |
| Vitamin B: Indications | -Hyperlipidemia -Help meet LDL and HDL goals |
| Vitamin B: Adverse Effects | -Vasodilation, intense cutaneous flushing -N, abdominal pain -Increase uric acid levels = gout |
| Vitamin B: Caution | -Hypersensitivity to nicotinic acid -Hepatic dysfunction -Active peptic ulcer disease -Arterial bleeding -Diabetes |
| Vitamin B: Drug-Drug | -HMG-CoA reductase inhibitor -Bile sequestering drugs -Kava may cause hepatotoxicity |
| Vitamin B: Nursing Considerations | -Vasodilation and flushing -Aspirin 30 mins b/f dose -Change to extended release form at bedtime -Take w/ low fat snack -Avoid Alcohol, hot beverages, hot shower or exercise -Take w/ meals to decrease GI effects |
| Fenofibric Acid | Peroxisome Proliferator Receptor Alpha |
| Peroxisome Proliferator Receptor Alpha: Actions | -Activates hepatic receptor that increases breakdown of lipids -Reduces production of enzyme that inhibits lipid breakdown |
| Peroxisome Proliferator Receptor Alpha: Indications | -Increases HDL |
| Peroxisome Proliferator Receptor Alpha:Contraindications | -Renal Impairment |
| Peroxisome Proliferator Receptor Alpha:Adverse Effects | -HA,N,D -Back and muscle pain -Runny nose, resp infections |
| Peroxisome Proliferator Receptor Alpha:Drug-Drug | -Warfarins -Can be used with statins |
| Asprin | Antiplatelet Agents |
| Antiplatelet Agents: Actions | -Inhibit platelet adhesion and aggregation by blocking receptor sites on platelet membrane -Blocks production of platelets in the bone marrow |
| Antiplatelet Agents: Indications | -Reduce risk of recurrent TIAs or stroke -Reduce death of nonfat MI -MI prophylaxis -Anti-inflammatory, analgesic, antipryretic effects |
| Antiplatelet Agents: Contraindications and Cautions | -Allergy -Pregnancy -Lactation -Bleeding disorder -Recent surgery -Closed head injury |
| Antiplatelet Agents: Adverse Effects | -Toxicity -Fever -Coma -N -GI bleeding -Dizziness -Tinnitus |
| Antiplatelet Agents: Drug-Drug | -Other drugs affecting clotting |
| Antiplatelet Agents: Nursing Considerations | -Monitor Patient: Bruising, bleeding, tinnitus, hearing loss -Take w/food, water, milk, antacid -Withhold 5-7 days before surgery -Don't crush enteric coated tabs |
| Heparin | -Anticoagulant -Inhibits conversion of prothrombin to thrombin |
| Warfarin | -Anticoagulant -Maintain a state of anticoagulation when patient susceptible to potentially dangerous clot formation -Take home med |
| Anticoagulant:Actions | -Interfere with normal cascade of events involved in clotting process |
| Anticoagulant: Contraindication | -Any condition compromised by increase bleeding tendency -Cerebral aneurysm, intracranial hemorrhage, uncontrolled hemorrhage -Pregnancy, renal and hepatic disorders |
| Anticoagulant: Cautions | -Hypertension, CHF -Thyrotoxicosis -Senility, psychosis -Surgery, lumbar puncture, spinal anesthesia |
| Anticoagulant: Adverse Effects | -Bruising -Chills -Fever -Loss of hair -Decrease renal functioning -Osteroporosis |
| Anticoagulant: Drug-Drug | -Oral anticoagulants -Salicylates -Penicillin -Cephalosporin -Nitroglycerine |
| Anticoagulant:Nursing Considerations | -Used to prevent clots, not dissolve -Protamine sulfate to reverse effects -Avoid other IM injections -Should wear ID tag if long term therapy with anticoagulants -Warfarin takes 3-4 days to be effective -Don't increase Vit K -Avoid alcohol |
| Urokinase | Thrombolytic Agents |
| Thrombolytic Agents: Actions | -Activate plasminogen to plasmin -Breaks down fibrin threads in a clot to dissolve a formed clot |
| Thrombolytic Agents: Indications | -Acute MI -Pulmonary embolism -Ischemic stroke -Dissolve thrombi in arteriovenous cannula and IV catheter |
| Thrombolytic Agents: Contraindications | -Conditions that would worsen by the disssolution of clots |
| Thrombolytic Agents: Adverse Effects | -HA -Edema -Hypotension -Rash -Bleeding -Breathing difficulties -Bronchospasm -Pain, Fever -Anaphylactic shock |
| Thrombolytic Agents:Drug-Drug | -Anticoagulants -Antiplatelets |
| Thrombolytic Agents: Nursing Considerations | -Assess: stool, emesia, urine for blood, bruises, hematoma, cardiac status -Administer: infusion pump, avoid excessive injections if possible |
| Antihemophilic Factor | Antihemophilic Agents |
| Antihemophilic Agents:Actions | -Replace clotting factors that are either genetically missing or low in a particular type of hemophilia |
| Antihemophilic Agents: Indications | -Prevent blood loss form injury or surgery -Treat bleeding disorders |
| Antihemophilic Agents: Contraindications and Caution | -Factor IX in presence of liver disease -Pregnancy |
| Antihemophilic Agents: Adverse Effects | -Allergic reaction -Stinging @ injection site -HA, N -Rash -Chills -Hepatitis -AIDS |
| Antihemophilic Agents: Nursing Considerations | -Risk of hepatitis, HIV exposure -Decrease rate of infusion if patient experiences HA, fever, chills,tingling, lethargy -Wear ID if have clotting disorder |
| Aminocaproic Acid | Hemostatic Agents |
| Hemostatic Agents: Actions | -Stop natural plasminogen clot-dissolving mechanism by blocking activation or by directly inhibiting plasmin |
| Hemostatic Agents: Indications | -Prevent body wide breakdown |
| Hemostatic Agents: Contraindications and Cautions | -Disseminated Intravascular Coagulation -Cardiac disease -Renal or hepatic dysfunction -Pregnancy, lactation |
| Hemostatic Agents: Adverse Effects | -Dizziness -Tinnitus -HA,N,D -Weakness -Hypotension -Cramps -Elevated serum levels |
| Hemostatic Agents: Drug-Drug | -Heparin -Oral contraceptives -Estrogen |
| Hemostatic Agents: Nursing Considerations | -Watch for arrhythmias and thrombosis -Monitor clotting factors -Be alert to hypersensitivity reaction -Provide comfort measures |
| Epoetin alfa | -Erythropoiesis Agents |
| Erythropoiesis Agents: Actions | -Acts like natural glycoprotein erythropoietin to stimulate the production of RBS in bone marrow |
| Erythropoiesis Agents: Indications | -Anemia in chronic renal failure -Reduce need for allogenic blood transfusions |
| Erythropoiesis Agents: Contraindications | -Uncontrolled hypertension -Allergy to mammalian cell-derived products -Allergy to human albumin |
| Erythropoiesis Agents: Adverse Effects | -HA,N,V,D -Fatigue -Dizziness -Hypertension -Edema -Chest pain |
| Erythropoiesis Agents: Nursing Considerations | -Encourage high iron diet (eggs, beets, supplements) -Monitor H&H, reticulocyte count |
| Ferros Sulfate | -Iron Preparations |
| Iron Preparations: Actions | -Elevates the serum iron concentration and is then converted into hemoglobin or stored for eventual conversion to a usable form of iron |
| Iron Preparations: Indications | -Prevention and treatment of iron-deficiency anemia -Dietary supplement for iron |
| Iron Preparations: Adverse Effects | -GI upset -N,V,D -Anorexia -CNS -Constipation |
| Iron Preparations: Nursing considerations | -Absorption reduced by: coffee, tea, spinach, whole grains, eggs, mild products -Safety - store out of children's reach, take with straw if liquid form, don't leave tablets at bedside, don't give iron dextran if taking oral iron |
| Folic Acid | Folic Acid Derivatives |
| Folic Acid Derivatives: Actions | -Essential for cell growth and division for production of strong stroma in RBC -B12 necessary for maintenance of myeline sheath |
| Folic Acid Derivatives: Indications | -Replacement therapy for dietary deficiencies, pregnancy -Rescue drug for cells exposed to certain toxic chemotherpeutic agents -B12 for pernicious anemia |
| Folic Acid Derivatives: Contraindications and Caution | -Allergy -Pregnancy -Other anemias |
| Folic Acid Derivatives: Adverse Effects | -Allergic reactions -Pain and discomfort at injection site -Nasal irritation |
| Folic Acid Derivatives: Nursing Considerations | -Prevents neural tube defects -Part of prenatal vitamins -May need supplement if anemic |
| Hydroxocobalamin | -Vitamin B12 |
| Vitamin B12: Actions | -Essential for nucleic acid and protein synthesis -Need for growth, cell reproduction, hematopoeisis, and nuclear protein and myelin synthesis |
| Vitamin B12: Indications | -Treatment of vitamin B12 deficiency to meet increased vitamin B12 requirements related to disease, pregnancy blood loss |
| Vitamin B12: Adverse Effects | -Itching -D -HF -Pulmonary edema -Hypovolemia -Pain at injection site |
| Vitamin B12: Nursing Considerations | -Cell growth and myelin sheath maintenance -Need if partial gastrectomy or ileal resection -Injection, oral or nasal spray -Most is stored in liver -Watch for itching, rash, hives, anaphylaxis |
| Hydroxyurea | Sickle Cell Anemia |
| Hydroxyurea: Actions | -Increases fetal hemoglobin production in the bone marrow and dilutes the formation of abnormal hemoglobin S. |
| Hydroxyurea: Indications | -Reduction of frequency of painful crisis and need for blood transfusion in adult patients with sickle cell anemia |
| Hydroxyurea:Adverse Effects | -Dizziness -HA,N,V -Rash -Erythema -Anorexia -Stomatitis -Bone marrow depression -Cancer |
| Hydroxyurea: Nursing Considerations | -Encourage patients to drink 10-12 glasses of water daily |
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prettyinpink7
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