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Pharmacology- Unit 7

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
Created by: prettyinpink7
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