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LPN Pharmacology2012

LPN Cardiacmeds 2012b

Hypertension is a common chronic disorder. How many Canadians are affected by this disorder? 4.1 million adults
What do antihypertensive drugs do? 1. Lower bp by dilating the size of arterial blood vessels
What do diuretics do? Increase the excretion of sodium
Name six classes of antihypertensive drugs. 1. Antiadrenergics (central and perpheral) 2. B-adrenergic blockers 3. Calcium channel blockers 4. angiotensin converting enzyme inhibitors (ACE Inhibitors) 5. Angiotensin converting enzyme inhibitors 6. Diuretics
What do ACE Inhibitors do/ Act primarily through suppression of the renin-angiotensin-aldosterone system. Prevent (or inhibit) the activity of angiotensin-converting enzyme, which converts angiotensin I to angiotensin II, a powerful vasoconstrictor.
What effect does prevention of the conversion of angiotensin 1 to angiotensin 11 have on the body? secretion of aldosterone is inhibited thus sodium and water are not retained, and the blood pressure decreases
Name three ACE Inhibitors. The pril family: captopril (Capoten), enalapril (Vasotec), ramipril (Altace)
What do Angiotensin 11 receptor blockers (ARBs)do? Block the binding of angiotensin II at the receptor sites found in smooth muscle and adrenal gland. This stops renin angiotensin system and lowers blood pressure.
Name three angiotensin 11 receptor blockers. Losartan potassium (Cozaar), telmisartan (Micardis), valsartan (Diovan)
Anti-Adrenergics include Sympatholytic drugs. What effect do sympatholytics have on the body? 1. inhibit activity of the SNS 2. Sympathetic response - increases in heart rate, force of myocardial contraction, cardiac output, and blood pressure that occur These two things Inhibiting this results in decreased BP
What is "First-dose" phenomenon? Palpitations, dizziness, syncope (temporary loss of consciousness)
Name two Alpha Adrenergic blockers. Clonadine (Catapres), Doxazosin (Cardura)
Name two Beta-adrenergic blockers. The "olol" family. metoprolol (Lopressor), propranolol (Inderal)
what three actions do peripheral vasodilaters do to the body? 1. Act on the smooth muscle layers of peripheral blood vessel, resulting in dilation and ↓ peripheral vascular resistance 2. Dilate vascular beds, particularly the femoral area 3. Used as adjunct drugs
what are two common adverse effects of antihypertensive meds? 1. Orthostatic hypotension (postural) 2. First dose phenomenon
what are four CNS adverse effects of antihypertensive drugs? 1. Dizziness and headache 2. Fatigue 3. Depression 4. Syncope
What are two respiratory effects of antihypertensive drugs? URI and cough
What are three common GI adverse effects of antihypertensive drugs? 1. Abdominal pain and gastric irritation 2. Nausea and anorexia 3. Diarrhea and constipation
ACE Inhibitors are contraindicated in what four conditions? Sodium depletion Hypovolemia Coronary or cerebral insufficiency Those receiving diuretics or dialysis
Common interaction for all antihypertensive drugs... Hypotensive effects of most antihypertensive drugs are increased when used with diuretics or other antihypertensive drugs
what four drugs decrease the effectiveness of antihypertensive drugs? Antidepressants MAOI's Antihistamines Sympathetic bronchodilators
WHO and ISofH advise the following 3 guidelines when treating hypertension. 1. start with single drug from lowest available dose 2. If ineffective change to a drug from a different class prior to same class higher dose. 3. Use long lasting drugs. (single dose effective for 24 hours)
What are five lifestyle factors to decrease bp? 1. Diet low in sodium and saturated fats and high in fresh fruit and veggies and low fat dietary products. DASH 2. 30-60 mins exercise 4-7 days a week. walking, jogging, cycling or swimming. 3. weight reduction 4. alcohol reduction 5. Smoke free
What three ways are antihypertensive drugs administered? PO, IV, transdermal(patch)
What class drug affects the rate of the heart? Chronotropics
What class of drug affects the rhythm of the heart? Antiarrythmics
What class of drug affects the output of blood? Inotropics
What class of drug affects the strength of the hearts contraction? Inotropics
what are the two causes of Heart Failure (HF) CAD and hypertension
What class of drugs constitutes first line therapy? Combination of ACEI's or ARB's and a diuretic
What two drugs are mentioned on our slides? Digoxin and Spironolactone
What two actions do inotropics have on the body? some increase cardiac output through positive inotropic activity some slow the conduction velocity through the atriventicular (AV) node in the heart and decrease the heart rate through negative chronotropic effect.
What plant is the source of inotropics? Foxglove plant
what is the greatest risk in administering inotropes? Digitalis Toxicity
What is digitalization? May be accomplished by two methods: 1. Rapid digitalization 2. Gradual digitalization It involves giving a series of doses until drug reaches therapuetic levels
What are 5 s/s of digitalis toxicity? 1. Anorexia/vomiting/nausea 2. Drowsiness/confusion 3. Muscle weakness 4. Yellow-Green halos around lights 5. Bradycardia
When should you hold inotropis? Hold if HR is under 60 and over 100 bpm
What is hyperlipidemia? Excess insoluble fats in the blood which contributes to atherosclerosis
what are two types of Lipids? Cholesterol and Triglycerides-hyperlipidemia occurs if one or both of these are elevated
Are Trglycerides and lipids soluble in water? No they are insoluble in water and must be bound to a lipid containing protein
what are HDL's and LDL's? High Density lipids are the good lipids and Low density lipids are the bad ones. Should have high HDL's and low LDL's
what two diseases are caused by high LDL's? Atherosclerotic plaque formation Heart Disease
What disease does HDL protect against? Heart diseases
Give two facts about hdL's Smallest lipoproteins and contain the greatest amount of protein and... Take cholesterol from the peripheral cells and transport it to the liver (metabolized and excreted)
Give two facts about LDL's Contain the greatest portion of cholesterol and... Transport cholesterol to the peripheral cells
What are elevated LDL’s and triglycerides associated with? Premature coronary artery disease and PVD.
what four counts are included in a serum evaluation or lipoprotein profile? 1. Total cholesterol 2. LDL (harmful) 3. HDL (protective) 4. Triglycerides
What should our total cholesterol levels be? Under 5
Give two functions of cholesterol. 1. It is a lipid required for hormone synthesis and cell membrane formation 2. Found in large quantities in brain and tissue.
what are two sources of cholesterol? 1. Diet - 20 percent 2. Liver - 80 percent
What four things lowers HDL levels? Smoking, obesity, diabetes and physical inactivity
What is included in non pharmacological treatment? Therapeutic Life Changes (TLC)includes: 1. cholesterol lowering diet 2. physical activity 30 mins -7 3. Weight reduction 4. Smoking cessation
What 4 classes of drugs are used to treat hyperlipidemia? 1. HMG-CoA reductase inhibitors (statins) 2. Bile acid resins or sequestrants 3. Fibric acid derivatives 4. Niacin
What are HMG-CoA's? Enzymes that is a catalyst during the manufacture of cholesterol
What are three actions of HMG-CoAs? 1. Inhibits the manufacture of cholesterol or promotes the breakdown of cholesterol 2. Lowers the blood levels of cholesterol and serum triglycerides 3. May increase blood levels of HDLs
Name three HMG-CoA's 1. Atorvastatin (Lipitor) 2. Lovastatin (Mevacor) 3. Simvastatin (Zocor)
what are two Bile Acid Resins? 1. Manufactured, secreted by liver 2. Stored in the gallbladder; emulsifies fat, lipids
what 4 things do Bile Acid Resins do in the body? 1. Bind to bile acids 2. Cannot be absorbed in the intestine and can be secreted in the feces 3. Liver uses cholesterol to make more bile 4. reduces cholesterol
Name one Bile acid resin. Colestid
How do Fibrates act in the body? 1. Act on VLDL (increase the breakdown) 2. Decrease plasma triglycerides and cholesterol 3. Increase excretion of cholesterol in feces 4. Reduces production of triglycerides
Name two Fibrates 1. Gemfibrozil (Lopid) 2. Fenofibrate (Lipidil Supra)
What is the most effective drug for increasing HDL Niacin
What is the main action of Niacin Decreases cholesterol and triglycerides by inhibiting mobilization of free fatty acids from peripheral tissues
What are some adverse reactions of Antilipidemic drugs GI: N&V, GI upset, diarrhea and constipation CNS: Headache and dizziness
What are two contraindications of antilipidemic drugs? 1. Hypersensitivity 2. Each antihyperlipidemic has it’s own
What are some precautions for antilipidemic drugs? Liver disorders and hx of alcohol abuse Acute infection and trauma Hypotension Endocrine disorders Myopathy Renal dysfunction
Created by: Sully45