Antihyperlipidemic and Anticoagulants Overview

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Questions and Answers

Which side effect is commonly associated with diphenhydramine?

Nausea

Rash

Dry mouth (correct)

Increased appetite

What is a nursing consideration for patients using intranasal glucocorticoids?

Take with food

Increase caffeine intake

Avoid sun exposure

Rinse mouth after use (correct)

What does LABA stand for in respiratory pharmacology?

Lipid Absorption Beta Agonists

Long Acting Beta Agonists (correct)

Long Acting Beta Antagonists

Low Absorption Beta Agonists

What can be an indicator of theophylline toxicity?

GI distress Signup and view all the answers

Which medication is used as a short-acting beta-2 agonist (SABA) for acute asthma attacks?

Albuterol Signup and view all the answers

What is the primary purpose of statins in the treatment of cardiovascular diseases?

To reduce high cholesterol levels Signup and view all the answers

What laboratory tests are critical to monitor in patients taking statins?

Liver enzymes like AST and ALT Signup and view all the answers

Which of the following is an absolute contraindication for the use of statins?

Pregnancy Signup and view all the answers

What is the most serious adverse effect associated with statin use, and what symptom indicates this complication?

Rhabdomyolysis - muscle pain Signup and view all the answers

Which dietary recommendations should patients on statins follow?

Limit alcohol consumption Signup and view all the answers

What laboratory test is routinely monitored for patients taking warfarin?

INR Signup and view all the answers

What is the recommended method of administration for enoxaparin?

Subcutaneous Signup and view all the answers

Which anticoagulant does NOT require regular lab monitoring?

Rivaroxaban Signup and view all the answers

What is the antidote for warfarin overdose?

Phytonadione (Vitamin K) Signup and view all the answers

What serious side effect is associated with the use of antiplatelet medications such as clopidogrel?

Bleeding risk Signup and view all the answers

Which diuretic type does Furosemide belong to?

Potassium-Wasting Diuretics Signup and view all the answers

What dietary consideration should be followed when taking potassium-sparing diuretics?

Avoid salt substitutes Signup and view all the answers

Which of the following effects can Spironolactone have?

Gynecomastia Signup and view all the answers

What is a common side effect of Ferrous Sulfate?

Black or dark stools Signup and view all the answers

Which factor primarily stimulates red blood cell production?

Erythropoietin Signup and view all the answers

What substance would require a decreased dose of theophylline due to increased blood levels?

Caffeine Signup and view all the answers

Which inhaler type is classified as a long-acting anti-cholinergic?

Tiotropium Signup and view all the answers

What is the mechanism of action for Montelukast?

It blocks leukotriene receptors. Signup and view all the answers

Which step is NOT part of the instructions for using a Metered Dose Inhaler (MDI)?

Do not shake Signup and view all the answers

When should Montelukast be taken for optimal effectiveness?

Two hours before exercise Signup and view all the answers

What is the effect of a negative inotrope on the heart?

Decreases the force of contraction Signup and view all the answers

Under what condition should a dose of metoprolol be held?

BP lower than 60 systolic Signup and view all the answers

Which statement about selective and non-selective beta blockers is true?

Selective beta blockers target specific receptors while non-selective do not Signup and view all the answers

What is a key teaching point for patients taking beta blockers?

They should not stop the medication abruptly Signup and view all the answers

What is the role of Angiotensin II in the body?

It stimulates aldosterone release Signup and view all the answers

What is the therapeutic range for digoxin levels?

0.5-2.0 ng/mL Signup and view all the answers

Which symptom is indicative of digoxin toxicity?

Yellow-green halos Signup and view all the answers

What lab value indicates that a patient on heparin may be at risk for bleeding?

APTT ↑ Signup and view all the answers

Which of the following is the antidote for heparin?

Protamine Sulfate Signup and view all the answers

How do low potassium levels affect digoxin therapy?

They increase the risk of digoxin toxicity Signup and view all the answers

What is a significant risk associated with high doses of codeine?

Respiratory depression Signup and view all the answers

Which of the following is a primary use for acetylcysteine?

To treat overdose on acetaminophen Signup and view all the answers

Which antihistamine is known for causing paradoxical excitation, especially in children?

Diphenhydramine Signup and view all the answers

What is a common side effect of dextromethorphan when taken in high doses?

Hallucinations Signup and view all the answers

What is a critical consideration when administering guaifenesin?

Avoid taking with CNS depressants Signup and view all the answers

Which condition is a contraindication for the use of the drug being discussed?

Bowel obstruction Signup and view all the answers

What is a side effect associated with fibrates?

Gall stones Signup and view all the answers

What lab values should be monitored for a patient taking gemfibrozil?

BUN and Creatinine Signup and view all the answers

How does ezetimibe help in cholesterol management?

It inhibits absorption of cholesterol in the small intestine. Signup and view all the answers

What effect do beta blockers have on adrenergic receptors?

Block stimulation of beta-1 and beta-2 adrenergic receptors. Signup and view all the answers

What side effect is specifically associated with amlodipine?

Gingival hyperplasia Signup and view all the answers

For which population group do calcium channel blockers show greater effectiveness compared to other antihypertensive classes?

African Americans Signup and view all the answers

What is an important consideration when using a transdermal nitroglycerin patch?

Remove the patch at bedtime for 8-12 hours Signup and view all the answers

How should sublingual nitroglycerin be administered?

Drink water after placing the tablet under the tongue Signup and view all the answers

Which symptom is common following the administration of nitroglycerin?

Headache Signup and view all the answers

Study Notes

Antihyperlipidemic

HMG-CoA reductase Inhibitors ("statins")
- Atorvastatin: Used for primary prevention of cardiovascular disease, and risk of MI or stroke
  - Take in the evening
- Important labs to monitor: Liver labs, AST, ALT
- Absolute contraindication: Pregnancy
- Diet recommendations: Avoid grapefruit juice, Avoid alcohol
- Side Effects: Rash, Diarrhea, Abdominal cramps, Rhabdomyolysis
- Most serious adverse effect: Rhabdomyolysis - muscle pain
- What do statins treat? High cholesterol
Bile Acid Resins
- Cholestyramine:
  - Side effects: Constipation, Headache, Gall stones, GI upset, Dyspepsia
  - Drug of choice for pregnant women
  - Treatment: High cholesterol
  - Mechanism: Works in the intestines
  - Considerations: Drink fluids (constipation)

Anticoagulants

Enoxaparin
- Monitoring: APTT (45 to 90 degrees)
- Administer: Subcutaneous tissue
- Considerations: Do not administer IM, Rotate injection sites
- Important to Know: Takes 2 to 3 weeks to work
Warfarin
- Mechanism: Interferes with hepatic synthesis of Vitamin K, Prolongs clotting time
- Antidote: Vitamin K
- Lab Monitoring: INR
Rivaroxaban
- Lab Monitoring: Not frequently needed
SE: SYNCOPE
- Lab Monitoring: ALT & AST

Antiplatelets

Clopidogrel
- Mechanism: Inhibits platelet aggregation
- Caution: Bleeding risk, hepatic impairment, History of GI bleeding
Aspirin
- Mechanism: Antiplatelet

Anticoagulant Antagonists

Phytonadione (Vitamin K)
- Antidote: Warfarin
Protamine Sulfate
- Antidote: Heparin

Renal Medications

Diuretics
Loop - Furosemide (Loop diuretic): Potassium-Wasting diuretic
Potassium-Sparing - Spironolactone: Potassium sparing diuretic, avoid potassium-rich foods
Thiazides - Hydrochlorothiazide (HCTZ): Thiazide diuretic

Dietary Considerations for Potassium-Wasting vs. Potassium-Sparing Diuretics

Potassium-Wasting: Encourage consistency of vitamin K intake
Potassium-Sparing: Avoid vitamin K foods, Avoid salt substitutes (like Mrs.Dash)

Potassium-Rich Foods

Leafy greens (spinach, cabbage, broccoli, squash)

Diuretic with Antiandrogenic Effects

Spironolactone (can cause gynecomastia and irregular menses)

Hematopoietic Growth Factors

Erythropoietin
- Mechanism: Stimulates erythropoiesis (red blood cell production)

Ferrous Sulfate (Iron)

Mechanism: Increases iron levels
Administration: Administer 1 hour before or after meals
Considerations: May cause constipation, May cause black/dark stools and stained teeth
Importance: Oral hygiene is important
Labs to monitor: Hematocrit, Hemoglobin

Role in RBC Formation

Erythropoietin and iron play a role in red blood cell formation

Inhaler Information

Theophylline
- Factors that increase theophylline blood levels (require decreased dose): Chocolate and caffeine
- Factors that decrease theophylline blood levels (require increased dose): Smoking

Inhaler Types and Instructions

Ipratropium: Short-acting anti-cholinergic
Tiotropium: Anti-cholinergic (long-acting)
Metered Dose Inhaler (MDI) Instructions:
- Exhale
- Shake
- Prime
- Inhale with spacer
- Hold breath for 10 seconds
- Rinse mouth
Dry Powder Inhaler (DPI) Instructions:
- Do not exceed dosage recommendations
- Wash mouth for thrush

Antiasthma/Anti-inflammatory Agents

Fluticasone/Salmeterol
Montelukast: Used when other options haven't been effective

Montelukast - Mechanism of Action, Nursing Considerations, and Teaching Reinforcement

Mechanism of Action: Blocks leukotriene receptors, decreasing inflammation
Nursing Considerations: Safe for 12 months, Can be chewable or granulated
Teaching Reinforcement: Take two hours prior to exercise

Considerations when multiple inhaler classes are ordered:

Check the order
See what it is used for

Beta-Blockers

Negative Inotropic: Force of contraction
Negative chronotropic: Timing
Negative Dromotropic: Electricity
Metoprolol (Selective) - Hold dose if BP lower than 60 systolic and pulse < 60 bpm
Propranolol (Non-Selective) - Monitor Blood Sugar because it masks signs & symptoms
Important to know: Selective beta blocker works on certain receptors, whereas a non-selective one will not bind to certain ones & will mask other systems
Carvedilol affects: Beta 1, Beta 2, and Alpha 1
Heart Failure: Don't want patients taking beta-blockers if they have acute heart failure
Important Teaching: Don't stop abruptly
Off label uses: Migraines and tremors

Explain the RAAS system:

Renin release: Triggers when blood pressure is low
What does renin do? Catalyzes the conversion of angiotensinogen to angiotensin I
What is ACE, where is it found, and what does it do?
- Angiotensin-converting enzyme is found in the lungs and converts angiotensin I to angiotensin II
Function of Angiotensin II: It vasoconstricts and increases aldosterone secretion
Aldosterone: Comes from the adrenal gland and causes sodium retention (and water retention) and potassium excretion
Angiotensin Converting Enzyme Inhibitors (ACE-I) "pril"
- Lisinopril

Cardiac Glycosides

Digoxin: No longer used as first-line therapy, Therapeutic range: 0.5-2.0 ng/mL
Relationship with Potassium Levels: Low potassium levels increase the risk of digoxin toxicity
Symptoms of Digoxin Toxicity: Bradycardia, Hypokalemia, Anorexia, Nausea/Vomiting (N/V), Yellow-green halos, Arrhythmias

Antiarrhythmic

Amiodarone

Anticoagulants

Heparin
- Mechanism: Prolongs clotting time
- Antidote: Protamine Sulfate
- Lab Monitored: Activated Partial Thromboplastin Time (APTT)
- APTT Interpretation:
  - ↑ APTT = Too long for clotting, risk for bleeding
  - ↓ APTT = Increase dosage because clotting is happening too fast
Fibrates
- Gemfibrozil: Decreases (↓) triglyceride production by the liver, ↑ good HDL levels
- Labs to monitor: BUN, Creatinine, ALT, AST
- Side effects: Abdominal pain, Nausea, Gall stones, Diarrhea, Epigastric pain, Renal/hepatic impairment, Gall bladder disease, Concurrent use of statins
Other
- Ezetimibe: Do not take if pregnant, Liver disease impairment
- Niacin: Contraindication if pregnant
Role in Cholesterol Management:
- Ezetimibe: Ezetimibe inhibits the absorption of cholesterol in the small intestine
- Niacin: Stops the removal of HDL- good cholesterol
- Vitamin B3
Common Side Effect of Niacin: Nausea, vomiting, dizziness
How to Manage Side Effects of Niacin: Drink flat soda, eat crackers

Antihypertensive: Beta Blockers

Metoprolol (selective): Beta 1 blocker
Propranolol (Non-selective): Beta 1 and Beta 2 blocker
Considerations: Monitor Blood Sugar because it masks signs & symptoms

What is a beta blocker blocking?

Blocks the stimulation of beta-1 (myocardial (heart)) and beta-2 (lungs) adrenergic receptors

Calcium Channel Blockers (CCB)

Side effects specific to CCB (calcium channel blockers) verapamil vs amlodipine:
- Amlodipine: Pedal edema, gingival hyperplasia
- Verapamil: Hypotension, palpitations, constipation
Effectiveness: For African Americans, CCB's have greater effectiveness as compared to other antihypertensive classes.
Dietary modifications: Drink fluids

Antianginal: Nitroglycerin (discuss forms)

Mechanism of Action of NTG: Increases coronary (heart) blood flow
Routes of administration: Patch (transdermal), IV solution, Pill (oral), Translingual sprays, Under the tongue (sublingual)
Transdermal patch considerations: Remove patch at bedtime for 8-12 hours, so there is no tolerance development
Sublingual NTG administration:
- Drink water before administering tablet
- Do not chew tablet
- Give 1 tablet every 5 minutes (3 times), call 911 if pain isn't relieved or if it worsens after first dose
- Store at room temperature, out of sun, remove cotton
Important to know about sublingual NTG: No first-pass effect when taking properly
Managing pain: Give acetaminophen for headache

Antititussives

Codeine:
- Mechanism: Relieves cough
- Considerations: Important to drink fluids, Monitor cough for 1 week, Increase fiber intake
- Important to know: Inhibits cough reflex and leads to respiratory depression if high doses are taken
Dextromethorphan:
- Mechanism: Depresses cough receptors in the throat, lungs, trachea
- Considerations May cause hallucinations in high doses
- Important to know: Encourage fluid intake, and monitor for dizziness
- Important to know: Avoid driving

Expectorants

Guaifenesin:
- Mechanism: Loosens mucus from respiratory tract
- Considerations: Avoid taking with CNS depressants or alcohol
- Side Effects: May cause skin rash, headaches, or difficulty breathing (NIV)
- Important to know: Safe in all ages, including pregnancy, and can be used during breastfeeding

Mucolytics

Acetylcysteine (oral, IV, topically by nebulizer):
- Considerations: Oral administration is better tolerated
- Important to assess: Bilirubin levels
- Indications: Overdose on acetaminophen, COPD, Asthma, cystic fibrosis

Antihistamines

Diphenhydramine:
- Side Effects: Dizziness, hypotension, dry mouth, nausea, photosensitivity, Paradoxical excitation in children, constipation
Cetirizine:
- Important to know: Anticholinergic effects minimal, and sedation is dose-related

Difference between Antihistamines:

First-generation (Diphenhydramine): More side effects
Second-generation (Cetirizine): Fewer side effects

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Description

This quiz covers important medications used to manage cholesterol levels and prevent blood clots. Key drug classes include statins and anticoagulants, along with their side effects, monitoring parameters, and dietary considerations. Perfect for students learning about pharmacology and clinical applications.