Pharm Exam 4

Calcium Channel Blockers-

·         Verapamil can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.

·         Verapamil- used off label to treat migraine headaches.

·         amlodipine (Norvasc) most commonly used for hypertension.

Note: Calcium channel blockers and diuretics are recommended as first-line therapy for the management of HTN in African-American patients.

Ace Inhibitors

·         captopril (Capoten)- medication often used to treat hypertension in patients with liver disease

·         lisinopril (Zestril)- side effects include hypotension, dizziness, mood changes, headaches, characteristic dry nonproductive cough, hyperkalemia, angioedema, and renal impairment.

·         If your patient experiences a dry non-productive cough with the use of an ACE inhibitor, the medication should be discontinued by the provider. An angiotensin II receptor blockers (ARBs) may be a good replacement drug.

·         Drug interaction may occur in patients also taking Potassium sparing diuretics and potassium supplements (hyperkalemia), NSAIDs (renal impairment), and lithium (lithium toxicity)

Note: Lisinopril or Captopril are both acceptable medications for hypertensive patients that have a history of cirrhosis and liver failure.

Vasodilators

·         Hydralazine- given for hypertensive crisis- The onset of IV action is  5-20 minutes. After an IV dose, BP is checked q10-15 minutes until stable, then q1 hour per hospital protocol.

·         Sodium nitroprusside (Nipride)- given as an IV infusion for severe hypertensive emergencies. It is a potent arterial and venous vasodilator infused as mcg//kg/min to rapidly lower an extremely high b/p within 10 minutes

Beta Blockers

·         beta blockers- medication class to be used with caution for patients with asthma or COPD- At high doses they can cause SOB and respiratory distress due to bronchoconstriction.

Alpha-2 adrenergic agonist/ centrally acting alpha-agonist hypotensive agents

·         clonidine (Catapres)- can be given to your patient via topical patch (therefore the nurse needs to administer with caution)

Diuretics

·         hydrochlorothiazide (HCTZ) is a thiazide diuretic in which Digoxin toxicity should be monitored for along with hypokalemia

·         hydrochlorothiazide should be taken early in the day to avoid nocturia.

·         metolazone (Zaroxolyn)- A thiazide-like diuretic that appears to be more potent than the thiazide diuretics. This greater potency becomes important in patients with renal dysfunction.

·         Mannitol an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.

·         furosemide (Lasix) is a loop diuretic that promotes excretion of potassium and can cause hypokalemia, which can manifest as Leg cramps. The nurse should assess for hypokalemia and monitor the potassium level before and during treatment.

·         Spironolactone (Aldactone) is a potassium-sparing diuretic, therefore, your patient should avoid potassium-rich foods such as: tree fruits (avocados, apples, oranges and bananas), leafy greens, vine fruits (tomatoes, cucumbers, zucchini, eggplant and pumpkin), and root vegetables (carrots, potatoes and sweet potatoes)

·         Spironolactone inhibits the action of aldosterone, resulting in an increased excretion of sodium and therefore a decreased sodium level.

·         If your patient experiences illness with excessive loss of fluids (vomiting/diarrhea), they should call the dr and they will likely recommend the patient to stop taking the diuretic until they can tolerate a liquid diet and feel better

·         Home monitoring assessments your patient on a diuretic should be doing include Daily weights, BPs, I & O at home- Will also have routine labs to assess for electrolytes and renal function

Note: Patients taking diuretics should learn to monitor for hypokalemia. Signs of hypokalemia you will tell them to monitor for include lethargy and weakness, nausea, muscle weakness, mental confusion, and hypotension

Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors

·         simvastatin (Zocor)- most commonly prescribed HMG-COA reductase inhibitor to reduce LDL

·         atorvastatin (Lipitor) is NOT safe to take during pregnancy

·         Statins such as atorvastatin can cause liver damage and should not be taken by clients who have a history of liver disease. The client should undergo baseline liver function testing before beginning therapy, and every 6 to 12 months thereafter.

Selective cholesterol-absorption inhibitors

·         ezetimibe (Zetia) MOA- Ezetimibe selectively inhibits absorption in the small intestine of cholesterol and related sterols.

·         Zetia is the only drug in this class

Antilipemic Agents

·         nicotinic acid (niacin)- cholesterol lowering medication that can cause side effects such as pruritus and skin flushing

·         Strategies to minimize the adverse effects of nicotinic acid (niacin) that a nurse could educate her patient on include: starting with a low initial dose, taking the drug with meals, and taking small doses of aspirin or NSAID with the drug to minimize cutaneous flushing

·         Labs that are monitored for therapeutic effectiveness of an anti-lipidemia medications include: total cholesterol, LDL, VLDL, HDL, and triglycerides.

Fibrates

·         gemfibrozil (Lopid)- Fibric acid derivative that activates lipase and breaks down cholesterol

·         Contraindications to the use of fibrates include- Severe liver or kidney disease, Cirrhosis, Gallbladder disease

Bile acid sequestrant

·         cholestyramine (Questron)- necessary for absorption of cholesterol

Important To Remember:

If you have given a patient the first dose of a new hypertensive and you are concerned about orthostatic hypotension- some teaching/education points for safety can include: Changing positions slowly, Using call light before getting up for the first few times, and standing up and pausing before starting to walk.

It is NOT okay to crush or chew antihypertensives if needed

Hypokalemia can be a life-threatening condition if left untreated. Potassium is the primary electrolyte vital for cell metabolism and cardiac and neuromuscular function. Expected reference range for potassium is 3.5 to 5.0 mEq/L.