Pharmacology: Metoprolol, Propranolol, Prazosin

• Phar 2 exam (HTN, HF, dysrhythmias, HLD, PUD, GERD, N/V, Motion sickness, Urologic, Sex Meds, Gender Affirming Care

Metoprolol/Propranolol

• Mechanism of Action (MOA): Blocks beta receptors.
• Uses: Hypertension (HTN), Heart Failure (HF), post-Myocardial Infarction (MI), migraine, angina, dysrhythmias.
• Adverse Effects (AE): Bradycardia, low blood pressure (BP), bronchospasm, masked hypoglycemia, CNS effects like depression, insomnia, and vivid dreams.
• Cautions: Use with caution in patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma.
• Drug-Drug Interactions (DDI): Interacts with Calcium Channel Blockers (CCBs). Has a first-pass effect.
• Nursing Implications (NI): Check heart rate (HR) before administration, must be above 60 bpm.
• Monitoring: HR, EKG, BP, and blood sugar levels.

Prazosin

• Mechanism of Action: Blocks alpha 1 receptors.
• Uses: Benign Prostatic Hyperplasia (BPH), Hypertension (rarely used).
• Adverse Effects: Orthostatic hypotension, reflex tachycardia.
• Drug-Drug Interactions: First-dose effect.
• Nursing Implications: Change positions slowly, start with a small first dose, avoid abrupt discontinuation, and consider using compression socks.
• Monitoring: BP and pulse.

Spironolactone/Eplerenone (Aldosterone Antagonists)

• Mechanism of Action: Antagonizes the effects of aldosterone at the collecting tubule, acting as a potassium-sparing diuretic.
• Uses: Hypertension, Heart Failure (used in feminizing medication therapy).
• Adverse Effects: Hyperkalemia, increase in serum creatinine, angioedema, endocrine effects like gynecomastia.
• Drug-Drug Interactions: Interacts with potassium supplements and food.
• Nursing Implications: Check serum creatinine (SCr) and potassium (K) levels within the first week of starting the medication. Educate patients never to use potassium supplements and foods.
• Monitoring: Potassium levels, renal function, and Blood Pressure.

Clonidine

• Mechanism of Action: Activates alpha 2 receptors, which decreases sympathetic outflow.
• Uses: Hypertension (Resistant), CNS indications such as narcotic withdrawal, ADHD, anxiety, and pain.
• Adverse Effects: Dry mouth, sedation, rebound hypertension with abrupt discontinuation, orthostatic hypotension.
• Nursing Implications: Do NOT stop abruptly, change positions slowly, suggest sipping water/candy for dry mouth, and address patch issues if applicable.
• Monitoring: Blood Pressure.

Lisinopril (ACE Inhibitor)

• Mechanism of Action: Blocks ACE, leading to decreased production of angiotensin II and aldosterone release.
• Uses: Hypertension, Heart Failure, post-MI, nephropathy, diabetic retinopathy.
• Contraindications: Use is contraindicated during the 2nd and 3rd trimesters of pregnancy, in cases of renal artery stenosis, and a history of angioedema.
• Adverse Effects: Angioedema, cough (nonproductive, improves with time), electrolyte imbalance (high K/low Na), increased SrCr.
• Nursing Implications: Watch for angioedema symptoms (swollen throat, face, lips).
• Monitoring: Renal function (especially in HF patients), SrCr, Blood Pressure, and Glomerular Filtration Rate (GFR).

Losartan (ARB)

• Mechanism of Action: Directly blocks angiotensin II receptors.
• Uses: Hypertension, Heart Failure, post MI, nephropathy, diabetic retinopathy.
• Adverse Effects: Angioedema, cough (less than with ACE inhibitors), electrolyte imbalance, SrCr increases.
• Nursing Implications: Monitor for signs/symptoms of angioedema.
• Monitoring: Renal function, SrCr, Blood Pressure, GFR.

Verapamil (Non-dihydropyridine CCB)

• Mechanism of Action: Blocks Calcium (Ca2+) channels in blood vessels and the heart.
• Uses: Hypertension (1st line), angina, dysrhythmias.
• Contraindications: Sinus sick syndrome, 2nd/3rd degree heart block.
• Adverse Effects: Constipation, bradycardia, AV block.
• Drug-Drug Interactions: Grapefruit juice, Beta-blockers, digoxin increases toxicity.
• Nursing Implications: Do not mix up Immediate Release (IR) and Extended Release (ER) formulations. First-pass effect. Educate to avoid grapefruit juice and caution with fall risk.
• Monitoring: Blood Pressure and Heart Rate. NEVER used in HF patient.

Nifedipine (Dihydropyridine CCB)

• Mechanism of Action: Blocks Ca2+ channels in blood vessels.
• Uses: Hypertension, angina.
• Contraindications: Heart Failure patient; can be taken if pregnant.
• Adverse Effects: Reflex tachycardia, peripheral edema, flushing.
• Drug-Drug Interactions: Sometimes used with a beta-blocker because nifedipine doesn't work directly on the heart.
• Nursing Implications: NEVER administer IR for hypertension, NEVER crush ER, warn patients about peripheral edema and fall risk.
• Monitoring: Monitor edema, blood pressure, and heart rate.

Hydralazine (Direct Vasodilator)

• Mechanism of Action: Directly dilates arterioles.
• Uses: Hypertension; Heart Failure (with nitrates); hypertensive crisis.
• Adverse Effects: Reflex tachycardia, fluid retention, SLE-like syndrome, hypotension.
• Caution: Can be confused with hydroxazine due to look-alike/sound-alike names.
• Nursing Implications: Watch for signs/symptoms of hypotension, change positions slowly.
• Monitor: Blood Pressure (BP) and Heart Rate (HR).
• Profound vasodilation of arterioles.

Sodium Nitroprusside

• Mechanism of Action: Directly vasodilates venous and arterioles
• Use: Hypertensive emergency
• Adverse Effects: Hypotension, cyanide poisoning, thiocyanate toxicity
• Drug-Drug Interactions: ER/ICU drug (used for rapid situations)
• Nursing Implications: Continuous EKG Monitoring
• Monitor: EKG, BP

Hydrochlorothiazide (Thiazide Diuretic)

• Mechanism of Action: Blocks sodium (Na+) reabsorption in the distal convoluted tubule. Is used for Hypertension (HTN), Heart Failure (HF).
• Adverse Effects: Hypokalemia, hyperglycemia, hyperuricemia, hyponatremia, hypochloremia.
• Nursing Implications: Give once per day in the morning to prevent nocturia; educate patients on minimizing hypokalemia (e.g., consume bananas, citrus, or supplements).
• Monitor: Daily weight, BP, Intake & Output (I&Os), Potassium (K), uric acid, sugar.

Hydralazine & Isosorbide Dinitrate (Vasodilator)

• Mechanism of Action: Direct vasodilator.
• Used for Heart Failure (HF), specifically indicated for African Americans (AA) and is an alternative if ACE/ARB is not tolerated.
• Adverse Effects: Orthostatic hypotension, headache, increased heart rate, SLE-like syndrome.
• Nursing Implications: Change positions slowly. Monitor: Heart Rate and Blood Pressure.

Furosemide (Loop Diuretic)

• Mechanism of Action: Blocks sodium and chloride reabsorption.
• Uses: Heart Failure, edema.
• Contraindications: Pregnancy.
• Adverse Effects: Hypokalemia, hypotension, ototoxic (exacerbated by rapid IV admin).

Digoxin

• Uses: Heart Failure (2nd line) and dysrhythmias (increases myocardial contractile force), decreases hospitalizations, increases exercise tolerance, decreases symptoms, increases quality of life. Narrow therapeutic index.
• Adverse Effects: Cardiac dysrhythmias.
• Predisposing factors include: low potassium, increased serum digoxin, and heart disease.
• Early toxicity: GI upset, CNS effects (yellow tinge/halo).
• Drug-Drug Interactions: Diuretics (low potassium), ACE/ARBs (high potassium), quinidine, verapamil. Nursing Implications: The apical pulse should be checked for 60s before administration.
• Monitoring: Potassium, EKG, serum electrolytes, Ejection Fraction (EF).
• Education: Take exactly as prescribed, don't double dose.
• Digifab is the antidote.

Dopamine/Dobutamine

• Uses: Acute decompensated Heart Failure (stage D).
• Adverse Effects: B1 (altered HR or rhythm, angina) and alpha 1 (vasoconstriction, necrosis).
• Drug-Drug Interactions: Beta-blockers and ACE inhibitors worsen the condition of acute decompensation.

Nitroglycerin

• Uses for all types of angina and acts as a vasodilator.
• Headache, orthostatic hypotension, reflex tachycardia, and tolerance.
• Drug-Drug Interactions: Use with hypotensive drugs (Beta Blockers, Calcium Channel Blockers), and viagra is contraindicated.
• When administering IV nitroglycerin, use special non-permeable tubing and administer in an ICU setting.
• Rotate the patch in the morning after a shower; have the patient lie down, allow five minutes between doses, and call EMS if the first dose doesn’t work.
• ECG needs to bemonitored.

Lidocaine (1B Dysrhythmia Drug)

• It’s primarily used for ventricular arrhythmias and as a local anesthetic. Narrow Therapeutic Index; can cause heart block or bradycardia.
• Neurotoxicity leading to convulsions, confusion, and psychosis can occur.
• Respiratory depression and arrest Drug-Drug Interactions occur with quinidine/lidocaine.
• Available in forms IV, IM, SC, ETT.
• Monitor: hemodynamics, EKG/ prolonged PR or QRS interval

Propanolol (Type 2 Cardiac Rhythm Drug)

• Used for supraventricular arrhythmias and ventricular tachycardia.
• May result in HF, reduce HR, cause bronchoconstriction, mask hypoglycemia, AV block, and sinus arrest.
• Significant 1st pass effect, lidocaine and Quinidine can elevate Propanolol levels.
• Monitoring: Hemodynamic and respiratory systems and blood sugar. ECG, HR, sugar and BP need to be monitored.

Amiodarone

• Primarily manages supraventricular and ventricular arrhythmias. Pregnancy category D. Photosensitivity, N/V/D, malaise, lethargy
• May cause pulmonary (10% die), cardio-, and hepatotoxicity.
• Inhibits P450, affecting warfarin, digoxin, phenytoin, and grapefruit juice
• Give with food via IV pump; check for prior amiodarone use

Verapamil (IV CCB --> Dysrhythmia Drugs)

• Used for SVT, atrial fibrillation, atrial flutter, angina, and HTN.
• First-pass effect.
• Bradycardia, AV heart block, HF, hypotension, and constipation
• Increased digoxin levels may occur.
• Potentiates hypotension in patients on antihypertensives and may affect EKG/electrolytes.

Adenosine (Chemical Cardioverter)

• Used for paroxysmal Supraventricular Tachycardia (SVT) and Wolff-Parkinson-White (WPW) Syndrome
• May cause hypotension, facial flushing, dyspnea, headache, chest discomfort.
• Administer IV bolus close to the heart (central line)

Digoxin (Cardiac Glycoside --> Dysrhythmia drugs)

• Used to treat supraventricular dysrhythmias (atrial fibrillation, atrial flutter).
• Anorexia, NV, CNS issues (yellow halo, fatigue)
• Cardiotoxicity from AV block, ventricular tachy.
• Quinidine, verpamil and low K + levels
• HR greater than 60s apical; Monitor renal function

Atorvastatin (Hyperlipidemia Med)

• Used for hypercholesterolemia and prevention of CVD events. Hepatitis and pregnancy patients should not use
• Diarrhea, new-onset diabetes, myopathy, liver toxicity (rare) Grapefruit juice, niacin, and fibrates interact
• Administer. Evening: cholesterol overnight

Ezetimibe (Cholesterol Absorption Inhibitor)

• Used for treating hypercholesterolemia.
• Contraindicated in pregnancy and liver disorders.
• May be tolerated, causing diarrhea, hepatitis, and myopathy. Alcohol interacts
• Used at night to sleep through myopathy

Colesevelam (HLD Med, Bile Acid Sequestrant)

• Treats hypercholesterolemia by coating GI tract.
• Bowel obstruction and pancreatitis patients can't use
• Causes GI upset, leading to constipation, bloating, and nausea. Many drugs interact, decreases absorption
• Never absorbed in bloodstream, stays in GI tract
• Take other meds 1 hr before of 4 hrs after; mix granules with 4-8 oz of water Avoid esophageal damage.

Niacin (B3)

• Use: hypercholesterolemia (3rd/4th line)
• Contraindicated: Liver disease/gout
• Intense flushing of the face (aspirin 30 min before dose), liver toxic, hyper-uricemia, hyperglycemia
• Asprin 30 min before diet to avoid alcohol-GI upset
• Sugar, uric acid, renal/hepatic function Forms: IR=3x/day ER=1x/evening OTC

Fish oil (Omega 3 fatty acid)

• Dietary supplement, CAM
• Diarrhea, nausea, dysgeusia, belching
• Increased bleeding risk with anticoags/antiplatelets.

Unfractionated Heparin (Antithrombin Activator)

• prophylaxis and treatment of DVT/PE; VTE in pregnancy, procedure, DIC, MI Contraindicated: liver and kidney dysfunction Risk of bleeding, osteoporosis, spinal hematoma, and thrombocytopenia
• Drugs affect platelet function w/ NSAIDS. 1/4 standard dose, no titration.
• aPTT, CBC, VS, S/S bleeding

Low Molecular Weight Heparin (LMWH)

• prevention of DVT/PE; pregnancy, MI Contraindicated: reduce dose or frequency if CrCL <30mL/min
• Risk of bleeding, HIT, severe injury in pt's.
• Available as prefilled syringes or vials. Proper subq injection (rotate, don't bubble out) aPTT, PT/INR, CBC, BMP Protamine is an antidote

Warfarin (Vit K Antagonist)

• Long-term venous thrombosis, Afib, heart valves. Contraindicated: liver disease Bleeding, skin necrosis, thrombocytopenia.
• CYP -smx/tmp, amiodarone, metronidazole, vit K Eat diet consistently: Taken in same time intervals daily. CBC platelets (bleeding), Vit K antidote

Dabigatran (Direct Thrombin Inhibitor)

• Stroke for afib prevention Increase of bleeding Bleeding GI Upset

Rivaroxaban (Direct Factor Xa Inhibitor)

• Inhibits thrombin production DVT/PE Risk of bleeding, renal impairment No monitoring Take @ same time

Aspirin (Antiplatelet)

• Prevent Ischemic stroke for prevention of MI GI Bleeding Monitor for renal and liver assessmets.

Clopidogrel (P2YADP Receptor Antagonist)

• Prevent platelets from aggregating to prevent MI/stroke. Risk of bleeding, DDIS, avoid NSAIDS.

TPA (clot buster)

• Treatment for stroke, MI Timley Intervention is essential within 90 min
• Reduce Bleeding risk + reduce risk of high risk patients Monitor changes: APPT, PT/INR, Fibrinogen.

Antibiotics and acid suppression

• Antibitics: Amoxicillin, clarythromycin, tetracycline, metronidazole.
• Acid suppressant: PPI, H2 blocker:

Bismuth subsalicylate (pepto bismol)

• Peptic Ulcers, and Dyspepsia Aspirin Allergy
• Black Stool hearing and losses Ed Pt. About Black Stool 1st check for GI bleeding

famatodine (pepcid)

• PUD, GERD, Zollinger Ellison syndrome, H. Pyloria Renal/ hepatic dysfunction rare CNS Effects Separate from antacids

Omeperazole PPI

• PUD/GERD, Zolinger Elliason, stress ulcer prophy
• Short Term for AE: short AE
• Take medications. Dont seperate tab, warn sides affects.

Sucralfate

• Used for PUD Does not get absorbed so few side effects Increase H20 + hiber intake

Calcium carbonate (TUMS)

• PUD GERD OTC Heartburn Idigestion.
• Monitor adherance , 802 +milk or +2hrs after
• Electrolyte abnormalities

Ondansetron (zofran)

• N/V Supression, caused to Radiation or Anesthia
• Monitor - EKG

Prochloroperzine/promethazine

• Vertigo, motion sickness, N/V CNS Uses
• No subC!! I.V. Dilute

Aprepitant

• Post op N/V- delayed acte chemo induced NY.

Dronabinol (cannabinoid)

• Chemio induced nlv line, aids induced.
• Schedule II

Scopolamine

• Prevent/Treat Motion Side Effects
• Oral, S.Q.

Dimenhydrinate (dramamine)

• Prevent + Treat Motion Sickness.

Testosterone

• Male hypopnadism, repalceement therapy:
• Hepatoxicity, HTN, incerased LDL, polycythemia priasism. Rotate I, and wash hands after.

Sildenafil (viagra)

• Treatment for Erection, Ed Pulomanry, arterial ,HTM
• Ask about nitrates.

Finasteride

• Reduce prostate size and hair growth increase the BPh size.
• Sx Resolution takes over 6 months, and pregnant should use it if safety hazards with the precaustion and handl it.
• The Monitor (ask about it) pregnant individuals should not donate.

Block smooth contractions and BPH.

Problems with ejaculations.

• 30 Min+ after males and show positions, same wQ
• BP starts with dose.

Oxybutynin

• bladder and inter bits.
• Dont Crush ER tablet

Cunjagted Equine Estrogen

• Hormonem and Female Huperconadism and Acne.
• Take at Bedrime and Prevent Nause Report a monthly basis.

Medroxxxproges-

• Har Combined ( estrogen, 1tact Uterus a menorhhea.
• Take with food & breast exam
• Monitor test positive

Ethiny Estradoil, noritindrone

• Thicken crevic and Mucus, prevent, acene Cycle reulation.