Pharmacology- Unit 7
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| Captopril | Angiotensin-Converting Enzyme Inhibitor
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| Lisinopril | Angiotensin-Converting Enzyme Inhibitor
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| Quinapril | Angiotensin-Converting Enzyme Inhibitor
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| Angiotensin-Converting Enzyme Inhibitor: Action | -Block conversion of angiotensin 1 to angiotensin 2
-Block effects on angiotensin on blood vessels
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| Angiotensin-Converting Enzyme Inhibitor: Indications | -Hypertension
-Heart Failure
-Diabetic nephropathy
-Left ventricular dysfunctions after MI
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| Angiotensin-Converting Enzyme Inhibitor: Contraindications and Cautions | -Impaired renal function
-CHF
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| 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
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| Angiotensin-Converting Enzyme Inhibitor: Drug to Drug | -Allopurinal- Kidneys
-NSAIDS - Motrin, Aleve (alters renal function)
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| 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
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| Losartan | Angiotensin II-Receptor Blocker
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| Valsartan | Angiotensin II-Receptor Blocker
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| 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
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| Angiotensin II-Receptor Blocker: Indications | -Hypertension
-Diabetic nephropathy
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| Angiotensin II-Receptor Blocker: Caution | -Hepatic or renal dysfunction
-Hypovolemia
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| Angiotensin II-Receptor Blocker: Adverse Effects | -HA,dizziness,syncope,weakness
-Cough of tickling in throat
-GI complaints
-Dry skin or rash
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| Angiotensin II-Receptor Blocker: Drug to Drug | -Phenobarbital
-Fluconazole
-NSAIDs
-Rifampin
-K+
-Lithium
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| 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
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| Amlodipine | Calcium Channel Blocker
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| Diltiazem | Calcium Channel Blocker
-Prototype
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| Nicardipine | Calcium Channel Blocker
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| Nifedipine | Calcium Channel Blocker
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| Verapamil | Calcium Channel Blocker
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| 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
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| Calcium Channel Blocker: Indications | -Essential Hypertension
-Route: IV and Oral
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| Calcium Channel Blocker: Contraindications | -Heart block or sick sinus syndrome
-Renal or hepatic dysfunction
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| Calcium Channel Blocker: Adverse effects | -Hypotension,arrhythmias,bradycardia
-HA, persistent peripheral edema
-GI symptoms
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| Calcium Channel Blocker: Drug to Drug | -Cyclosporin
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| 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)
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| Nitroprusside | Vasodilator
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| Hydralazine | Vasodilator
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| Minoxidil | Vasodilator
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| Vasodilator:Actions | -Act directly on venous and arterial smooth muscle
-Cause relaxation = Vasodilation = BP lower
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| Vasodilator: Indications | -Refractory hypertension: Hydralazine, minoxidil
-Hypertensive crisis: Nitroprusside
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| Vasodilator: Contraindications and Cautions | -Cerebral insufficiency
-Peripheral vascular disease
-CAD
-CHF
-Tachycardia
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| Vasodilator: Adverse Effects | -Related to low BP: fatigue, HA, palpitations, hypotension
-GI upset
-Breast tenderness
-Cyanide toxicity
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| 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
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| Vasodilator: Monitor for cyanide toxicity | -> 100mcg/ml was given too fast
-Profound hypotension
-Metabolic acidosis
-HA and dyspnea
-V, loss of consciousness
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| Midodrine | -Alpha-Specific Adrenergic
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| Alpha-Specific Adrenergic: Actions | -Activates alpha-receptors in arteries and veins
-Increase in vascular tone = increase in BP
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| Alpha-Specific Adrenergic: Indications | -Orthostatic hypotension
-Use in conjunction with supportive therapies
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| Alpha-Specific Adrenergic: Contraindications | -Supine hypertension
-CAD
-Pheochromocytoma
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| Alpha-Specific Adrenergic: Drug to Drug | -Cardiac glycosides
-Beta Blockers
-Alpha adrenergics
-Corticosteroids
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| Digoxin | -Cardiac Glycoside
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| Cardiac Glycoside: Actions | -Inhibits sodium-potassium activated adenosine triphosphate (enzyme that regulates Na and K+ in cell)
-Slow and strengthen heart
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| Cardiac Glycoside: Indications | -Heart Failure
-Atrial fibrillation
-Supraventricular tachycardia
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| 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)
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| Cardiac Glycoside: Adverse effects | -NVD, abdominal pain
-HA, weakness, drowsiness, vision changes
-GI upset and anorexia
-Arrhythmias, heart block
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| Cardiac Glycoside: Drug to Drug | -Verapamil, amidodarone, quinidine, quinine, erythromycin, tetracycline, cyclosporine
-K losing diuretics
-Cholestryamine, charcoal, colestipol, bleomycin, cyclophosphamide, methotrexate
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| 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
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| 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
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| Inamrinone | Phosphodiesterase Inhibitor
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| Milrinone | Phosphodiesterase Inhibitor
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| 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
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| Phosphodiesterase Inhibitor: Indications | -Short term treatment of HF
-Unresponsive to digitalis, diuretics, vasodilators
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| Phosphodiesterase Inhibitor: Contraindications | -Severe aortic or pulmonic valvular disease
-Acute MI
-Fluid volume deficit
-Ventricular arrhythmias
-Elderly
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| Phosphodiesterase Inhibitor: Adverse Effects | -Arrhythmias
-Hypotension
-N,V
-Thrombocytopenia
-Pericarditis
-Pleuritis
-Fever
-Chest pain
-Burning @ injection site
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| 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
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| Procaninamide | Class I Antiarrhythmics Ia
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| Class I Antiarrhythmics Ia: Actions | -Decrease depolarization
-Decrease automaticity of ventricular cells
-Increases ventricular fibrillation threshold
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| Class I Antiarrhythmics Ia: Indications | -Acute ventricular arrhythmias during cardiac surgery or MI
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| Class I Antiarrhythmics Ia: Contraindications | -Bradycardia or Heart Block
-CHF, hypotension or sock
-Electrolyte disturbances
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| Class I Antiarrhythmics Ia: Adverse Effects | -Slurred speech
-Double vision
-Respiratory depression
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| 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
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| Propranolol | Class II Antiarrhythmics
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| Class II Antiarrhythmics: Actions | -Competitively block beta receptor sites in heart and kidneys
-Decrease heart rate, cardiac excitability output
-Slow conduction through AV node
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| Class II Antiarrhythmics: Indications | -Supraventricular tachycardia
-PVCs
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| Class II Antiarrhythmics; Contraindications and Caution | -Sinus bradycardia
-AV block
-Cardiogenic shock
-CHF
-Asthma
-Resp. Depression
-Diabetes
-Thyroid dysfunction
-Renal or hepatic dysfunction
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| Class II Antiarrhythmics: Adverse effects | -Arrhythmias
-Bradycardia
-Heart failure
-Hypotension
-NVD, anorexia
-Loss of libido
-Bronchoconstriction
-Fatigue
-Alter blood glucose levels
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| Class II Antiarrhythmics: Drug to Drug | -Verapamil (decrease BP,bradycardia)
-Phenothiazine (decrease BP)
-NSAIDS (fluid retention)
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| 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
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| Amiodarone | Class III Antiarrhythmics
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| Class III Antiarrhythmics: Actions | -Block K+ channels
-Slow outward movement of K+ in phase 3 of action potential
-Prolongs AP
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| Class III Antiarrhythmics: Indications | -Life threatening ventricular arrhythmias
-Maintain sinus rhythm after conversion of atrial arrhythmias
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| Class III Antiarrhythmics: Cautions | -Respiratory depression
-Prolonged QT interval
-Renal or hepatic disease
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| Class III Antiarrhythmics: Adverse effects | -Hypotension, bradycardia, arrhythmias
-NV
-Pulmonary toxicity
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| Class III Antiarrhythmics: Drug to Drug | -Increase levels digoxin, quinidine, warfarin
-Don't give within 4 hrs of class I or II
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| 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
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| Diltiazem | Class IV antiarrhythmic
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| Verapamil | Class IV antiarrhythmic
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| Class IV antiarrhythmic: Actions | - Calcium channel blockers
-Depress generation of AP
-Delay phases 1 and 2 of repolarization
-Slow conduction through V node
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| Class IV antiarrhythmic: Indications | -Supraventricular tachycardia
-Control ventricular response to rapid atrial rates
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| Class IV antiarrhythmic: Contraindications | -Sick sinus syndrome or heart block
-CHF or hypotension
-Cuation in idiopathic hypertropic subaortic stenosis
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| Class IV antiarrhythmic: Adverse Effects | -Dizziness, weakness, fatigue
-Depression, Constipation
-Hypotension, CHF, shock
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| Class IV antiarrhythmic: Drug to Drug | -Anesthetics potentate effects
-Antihypertensives cause hypotension
-May decrease lithium levels
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| 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
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| Dobutamine | Adrenergic Agonists Vasopressors
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| Dopamine | Adrenergic Agonists Vasopressors
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| Adrenergic Agonists Vasopressors: Actions | -Heart Rate Increase
-Bronchi Dilate
-Vasoconstriction
-Intraocular Pressure Decrease
-Glygogenolysis
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| Adrenergic Agonists Vasopressors: Indications | -Shock
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| Adrenergic Agonists Vasopressors: Contraindications | -Pheochromocytoma
-Tachyarrhythmias
-Ventricular Fibrilation
-Hypovolemia
-Anesthetics
-Peripheral Vascular Disease
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| Adrenergic Agonists Vasopressors: Adverse Effects | -Arrthmias
-Hypertension
-Palpitations
-Angina
-Dyspnea
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| Adrenergic Agonists Vasopressors: Drug to Drug | -Tricyclic Antidepressants
-MAOI Inhibitors
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| 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
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| Atenolol | Beta Blockers
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| Carteolol | Beta Blockers
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| Meoprolol | Beta Blockers
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| Nadolol | Beta Blockers
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| Timolol | Beta Blockers
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| Beta Blockers: Actions | -Blocks beta receptors in SNS – Heart and Juxtaglomerular (kidney)
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| Beta Blockers: Indications | -Hypertension
-Angina
-Migraine Headaches
-Prevent infarction after MI
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| Beta Blockers: Contraindications | -Allergy
-bradycardia
-Heart Block
-Shock
-Congestive Heart Failure
-Diabetes
-Hepatic dysfunction
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| Beta Blockers: Adverse Effects | -Fatigue
-Dizziness
-depression
-sleep disturbance
-bradycardia
-heart block
-hypotension
-NVD
-decreased libido
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| Beta Blockers: Drug to Drug | -Clonidine
-NSAID
-Insulin
-Anti-diabetic medications
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| Beta Blockers: Nursing Considerations | -Check for bronchospasm
-monitor glucose for decrease -assess for thyrotoxicosis
-Taper drug slowly
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