HTN and Angina medications

HTN

• ACE Inhibitors (ACE-I) Lisinopril and Captopril inhibit angiotensin-converting enzyme, reducing angiotensin II levels, leading to vasodilation and decreased aldosterone secretion.
  • Adverse effects (AEs) include hypotension, hyperkalemia, dry cough which is specific to ACE-I, and angioedema.
  • Nursing implications (NIs) include monitoring blood pressure (BP), renal function, and potassium levels, and educating patients on signs of angioedema.
  • Drug-drug interactions (DDIs) include avoiding NSAIDs and caution with potassium-sparing diuretics and lithium.
• ARBs: Losartan blocks angiotensin II receptors, preventing vasoconstriction and aldosterone secretion.
  • AEs include dizziness and hyperkalemia, though dry cough is not attributed to ARBs unlike ACE-Is.
  • NIs include monitoring BP, renal function, and potassium levels, and educating on signs of hyperkalemia.
  • DDIs mirror ACE-Is while avoiding potassium supplements.
• Aldosterone Antagonists: Spironolactone inhibits aldosterone in the kidney, increasing sodium excretion and potassium retention.
  • AEs include hyperkalemia, gynecomastia, and menstrual irregularities.
  • NIs include monitoring potassium levels and renal function.
  • DDIs: Utilize cation when combined with ACE-Is, ARBs, and potassium supplements.
• Beta Blockers (Selective): Metoprolol and Propranolol reduce heart rate and myocardial oxygen demand by blocking beta-adrenergic receptors.
  • AEs include bradycardia, fatigue, dizziness, sexual dysfunction, and bronchospasm with non-selective BBs.
  • NIs include monitoring heart rate (HR), BP, and signs of heart failure. Treatment mustn't be stop abruptly.
  • DDIs: Caution is advised with other drugs that lower BP or HR, such as calcium channel blockers.
• Alpha Blockers: Prazosin blocks alpha-1 receptors, reducing vascular resistance and lowering BP.
  • AEs include orthostatic hypotension, dizziness, and reflex tachycardia.
  • NIs include educating patients on slow position changes to prevent falls.
  • DDIs include enhanced hypotension with PDE-5 inhibitors.
• Alpha-2 Agonists: Clonidine reduces sympathetic outflow from the central nervous system (CNS), decreasing BP.
  • AEs include sedation, dry mouth, and rebound hypertension upon abrupt withdrawal.
  • NIs include BP monitoring with education on gradual withdrawal.
• Calcium Channel Blockers (CCBs) has DDIs that advise caution with CNS depressants.
  • Non-Dihydropyridines (Verapamil) reduce cardiac contractility and HR.
  • Dihydropyridines (Nifedipine) dilate blood vessels.
  • AEs: Bradycardia with non-dihydropyridines, reflex tachycardia with dihydropyridines, constipation, and edema
  • NIs include monitoring BP and HR.
  • DDIs include increased risk of heart block with concomitant use of beta blockers.
• Thiazides: Hydrochlorothiazide (HCTZ) reduces sodium and fluid retention.
  • AEs include hypokalemia, hyperglycemia, and hyperuricemia.
  • NIs include monitoring electrolytes and kidney function.
  • DDIs include reduced efficacy with NSAIDs.
• Direct Vasodilator: Hydralazine relaxes vascular smooth muscle directly.
  • AEs include reflex tachycardia and lupus-like syndrome.
  • NIs include monitoring BP and HR.
  • DDIs may interact with other antihypertensives.
• HTN Crisis Treatment: Nitroprusside
  • A potent vasodilator via nitric oxide release, directly relaxing smooth muscle and causing rapid vasodilation.
  • AEs include cyanide toxicity with prolonged use.
  • NIs include BP monitoring with cyanide toxicity signs.
  • DDIs include enhanced hypotensive effects with other vasodilators.

Angina

• Antianginal medications involve increasing nitric oxide, leading to vasodilation, reduced preload, and increased oxygen supply.
  • AEs include headache, hypotension, and reflex tachycardia.
  • NIs include educating on nitrate-free intervals and avoiding use with PDE-5 inhibitors to not risk severe hypotension.
  • DDIs include severe hypotension if taken with sildenafil.

Antidysrhythmics

• Class 1B (Lidocaine) blocks sodium channels, reducing ventricular excitability.
  • AEs include CNS effects (tremors, seizures), and hypotension.
  • NIs include monitoring ECG and avoiding use in patients with heart failure.
  • DDIs include increased toxicity with beta blockers.
• Class 2 (Propranolol) acts as a beta-blocker to slow AV conduction and reduce sympathetic stimulation.
  • AEs include bradycardia, fatigue, and bronchospasm.
  • NIs include monitoring HR and BP
  • DDIs include caution when using calcium channel blockers.
• Class 3 (Amiodarone) blocks potassium channels, prolonging repolarization.
  • AEs include pulmonary toxicity, hepatotoxicity, and thyroid dysfunction.
  • NIs include monitoring liver, lung, and thyroid function.
  • DDIs: Avoid grapefruit juice, as this increases warfarin effects.
• Class 4 (Verapamil) acts as a calcium channel blocker, slowing conduction through the AV node.
  • AEs include bradycardia, constipation, and hypotension.
  • NIs include monitoring HR and BP.
  • DDIs include avoiding beta blockers.
• Adenosine slows AV node conduction and is indicated for supraventricular tachycardia (SVT).
  • AEs include flushing, chest pain, and transient asystole.
  • NIs involves rapid IV administration.
  • DDIs: Caffeine reduces effectiveness.
• Digoxin increases contractility and slows AV node conduction.
  • AEs include nausea, arrhythmias, and visual disturbances.
  • NIs include digoxin and potassium level monitoring.
  • DDIs: Diuretics increase toxicity.

Hyperlipidemia

• HMG-CoA Reductase Inhibitors (Statins): Atorvastatin inhibits cholesterol synthesis in the liver.
  • AEs include muscle pain, liver toxicity, and rhabdomyolysis.
  • NIs include monitoring liver enzymes and educating on muscle pain.
  • DDIs include avoiding grapefruit juice, as it interacts with CYP3A4 inhibitors.
• Niacin increases HDL and reduces LDL and triglycerides.
  • AEs include flushing, hepatotoxicity, and hyperglycemia.
  • NIs include taking with aspirin to reduce flushing.
  • DDIs include increased risk of statin-induced myopathy.
• Bile Acid Sequestrants (Colesevelam) binds bile acids, preventing cholesterol absorption.
  • AEs include GI upset and constipation.
  • NIs include taking with meals and separating from other medications.
  • DDIs include reduced absorption of fat-soluble vitamins.
• Cholesterol Absorption Inhibitor (Ezetimibe) inhibits cholesterol absorption in intestines.
  • AEs include diarrhea and increased liver enzymes.
  • NIs include monitoring liver function and concomitant use of statins.
  • DDIs include increased risk of liver toxicity with statins.
• Fish Oil lowers triglycerides.
  • AEs include GI discomfort and bleeding risk.
  • NIs include caution of use in patients on anticoagulants.
  • DDIs include increases bleeding risk

Heart Failure

• Loop Diuretics (Furosemide) inhibits sodium and water reabsorption in the loop of Henle.
  • AEs include hypokalemia, dehydration, and ototoxicity.
  • NIs include monitoring electrolytes and daily weighing.
  • DDIs include increased digoxin toxicity risk.
• Cardiac Glycosides (Digoxin) increases contractility and slows AV node conduction.
  • AEs include nausea, visual disturbances, and arrhythmias.
  • NIs include monitoring potassium and digoxin levels.
  • DDIs: Caution with diuretics. Digibind is an available antidote.
• Beta Blockers (Metoprolol) reduces heart rate and myocardial workload.
  • AEs include bradycardia, fatigue, and dizziness.
  • NIs include slow titration to avoid worsening HF.
  • DDIs include caution with CCBs.
• ACE Inhibitors (Lisinopril) reduces afterload and preload by vasodilation.
  • AEs include cough, hyperkalemia, and hypotension.
  • NIs include monitoring BP and renal function.
  • DDIs include caution with potassium-sparing diuretics.
• ARBs (Losartan) contains similar function to ACE-Is, without a relating cough side-effect.
  • AEs include hyperkalemia and dizziness.
  • NIs include monitoring potassium and kidney function.
  • DDIs include avoiding potassium supplements
• Aldosterone Antagonists (Spironolactone) blocks aldosterone to reduce sodium retention.
  • AEs include hyperkalemia and gynecomastia.
  • NIs include monitoring potassium levels.
  • DDIs include avoid with ACE-Is/ARBs.
• Dopamine/Dobutamine stimulates beta-adrenergic receptors, increasing contractility.
  • AEs include arrhythmias and tachycardia.
  • NIs include use in acute HF.
  • DDIs include cation with beta blockers.

Thromboembolic Disorders

• Unfractionated Heparin (UFH): Heparin activates antithrombin III, inhibiting clotting factors Ila (thrombin) and Xa.
  • AEs include bleeding, heparin-induced thrombocytopenia (HIT).
  • NIs include monitoring aPTT, platelets, and bleeding signs.
  • DDIs include increased bleeding risk with anticoagulants and NSAIDs.
• Low Molecular Weight Heparin (LMWH): Enoxaparin, inhibits clotting factor Xa, with some effect on thrombin.
  • AEs include bleeding and thrombocytopenia.
  • NIs include monitoring renal function and platelets.
  • DDIs include increase bleeding risk with other anticoagulants.
• Direct Thrombin Inhibitors (DTIs): Dabigatran inhibits thrombin directly, preventing clot formation.
  • AEs include bleeding and GI upset.
  • NIs include monitor bleeding and renal function.
  • DDIs is advised against the use with rifampin because of the risk of effect reduction.
• Direct Factor Xa Inhibitors: Rivaroxaban inhibits factor Xa, reducing clot formation.
  • AEs include bleeding.
  • NIs include monitor renal function.
  • DDIs: Avoid CYP3A4 inducers (e.g., rifampin) and inhibitors (e.g., ketoconazole).
• Vitamin K Antagonist: Warfarin inhibits vitamin K-dependent clotting factors.
  • AEs include bleeding and skin necrosis.
  • NIs: Monitor PT/INR, and also dietary input of vitamin K.
  • DDIs are numerous. Caution with antibiotics, NSAIDs, and antifungals. Antiplatelet Agents: Aspirin, Clopidogrel inhibits platelet aggregation.
  • AEs includes bleeding and GI ulcers.
  • NIs includes keeping watch for any bleeding.
  • DDIs include increased risk of using anti-coagulants while using this medication.
• Thrombolytic Agent: Alteplase converts plasminogen to plasmin, dissolving clots.
  • AEs include severe bleeding.
  • NIs include emergency settings use only, with close monitoring.
  • DDIs include increased bleeding risk with anti-coagulants.

PUD/GERD

• H. pylori Treatment uses combination therapy (antibiotics + acid suppression).
  • Eradicates H. pylori infection, reducing recurrence of ulcers.
  • AEs include GI upset, antibiotic resistance, and diarrhea.
  • DDIs includes monitor interactions with anticoagulants; increased bleeding risk.
• H2 Blockers (Famotidine) blocks histamine-2 receptors in the stomach, reducing acid secretion.
  • AEs include confusion (elderly), headache, diarrhea.
  • NIs: Monitor for mental status changes, especially in elderly.
  • DDIs may reduce absorption of drugs requiring acidic environment.
• Proton Pump Inhibitors (PPIs - Omeprazole) inhibits gastric proton pumps, reducing stomach acid production irreversibly.
  • AEs include fractures, Clostridium difficile infection, hypomagnesemia risks are increased while using this drug.
  • DDIs reduces calcium levels.
• Antacids neutralizes stomach acid.
  • AEs include and hypercalcemia (calcium carbonate) , constipation, black stool (bismuth) risks must be examined while using this drug. Mucosal Protectants (Sucralfate) creates protective barrier for the ulcers.
  • AEs include constipation.
  • NIs is empty stomach administration

GI: N/V

• 5-HT3 Antagonists (Ondansetron) blocks serotonin receptors in the brain and gut .
  • AEs includes QT prolongation headache and constipation .
  • NIs includes ECG heart monitor, particularly for high risk patients.
  • DDIs and increased risk of risk because it prolongs QT.
• • Dopamine Antagonists (Prochlorperazine & Promethazine) blocks dopamine receptors in the chemoreceptor trigger zone.
  • AEs include hypotension, extrapyramidal symptoms, and sedation
  • NIs includes watching for any kind of movement disorders that manifest, or extrapyramidal symptoms.
  • DDIs includes sedative increase.
• Anticholinergics (Scopolamine, Dimenhydrinate) - for Motion Sickness blocks muscarinic receptors.
  • AEs includes blurred vision, drowiness, and dry mouth. -NIs includes application of the transdermal patches to the body , as instructed.

Urologic and Gynecologic Conditions; Gender-Affirming Hormone Therapy

• Non-Contraceptive Hormone Therapy:
  • Conjugated Equine Estrogen, Medroxyprogesterone
  • Uses include hormone replacement therapy, and menstrual disorders.
  • AEs include increased clotting risk, and breast tenderness.
  • NIs include monitoring risks of DVT, and also educational use tips.
  • DDIS includes increased clotting from smoking.
• Contraceptive Use:
  • Estrogen-Progestin COCs, Progestin-Only "Mini-Pills"
  • Emergency Contraception: Levonorgestrel
  • AEs include Nausea, and weight changes.
  • NIs includes education on adherence.
  • DDIs involves reduced Antibiotics, and an effectiveness reduction.
• Testosterone Therapy :
  • Uses include Gender-affirming therapy, and hypogonadism.
  • AEs includes acne Liver dysfunction, and polycythemia.
  • NIs includes monitoring of hemoglobins, and liver enzymes.
  • The DDIs includes Warfarin interaction.
• PDE-5 Inhibitor increases nitric oxide increasing blood flow.
  • AEs includes hypotension, headache, and priapism.
  • NIs includes no nitrates consumption.
  • DDIs involves a greater risk of hypotension, and therefore a high consideration for monitoring.
• Alpha-1 Adrenergic Antagonist relieves smooth muscle inside of the prostate.
  • AEs includes hypotension, and dizziness.
  • NIs includes bedtime consumption.
  • DDI should be cautioned, particularly with patient who take antihypertensive medication.
• Anti-Androgen which blocks androgen receptors.
  • AEs includes gynecomastia, and hyperkalemia.
  • NIs includes potassium levels monitor.
  • DDI includes caution with diuretics.