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LPN Pharmacology2012
LPN Cardiacmeds 2012b
| Question | Answer |
|---|---|
| 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 |
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Sully45
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