Exam 2 Part 1

Losartan (Cozaar)

• Angiotensin II Receptor Blocker
• The generic name is Losartan, and the brand name is Cozaar.
• Chemical Name: 2-butyl-4-chloro-1-[[2'-(1H-tetrazol-5-yl)[1,1'-biphenyl]-4-yl]methyl]-1H-imidazole-5-methanol
• Blocks angiotensin II receptors, which reduces vasoconstriction and aldosterone secretion
• Lowers blood pressure, reduces risk of stroke, and treats diabetic nephropathy
• May cause dizziness, hyperkalemia, hypotension, and renal impairment
• Contraindicated in pregnancy, hypersensitivity, and severe renal impairment
• Comes in tablet form

Adenosine

• Antiarrhythmic medication
• Generic name Adenosine, brand names Adenocard, Adenoscan
• Chemical Name: 6-Amino-9-β-D-ribofuranosyl-9H-purine
• Slows conduction through the AV node, restoring normal sinus rhythm
• Treats supraventricular tachycardia (SVT)
• May cause flushing, chest pain, hypotension, and dizziness as adverse effects
• Contraindicated in second- or third-degree AV block and sick sinus syndrome.
• Given via IV injection

Amiodarone (Cordarone, Pacerone)

• Medication Group: Class III Antiarrhythmic
• Generic name is Amiodarone; brand names include Cordarone and Pacerone.
• Chemical Name: (2-butyl-3-benzofuranyl)[4-(2-diethylaminoethoxy)-3,5-diiodobenzoyl]methanone
• Blocks potassium channels, prolonging repolarization
• Treats ventricular and supraventricular arrhythmias.
• Potential side effects: pulmonary toxicity, thyroid dysfunction, liver toxicity, corneal deposits.
• Contraindicated in severe bradycardia and iodine allergy.
• Available in tablet and IV injection forms

Heparin

• Anticoagulant medication
• Generic name is Heparin
• Chemical name: Unfractionated heparin
• Enhances antithrombin III activity, inhibiting thrombin and factor Xa.
• Prevents and treats deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction (MI)
• May cause bleeding, thrombocytopenia (HIT), and osteoporosis (long-term use)
• Contraindicated in active bleeding, severe thrombocytopenia, and hypersensitivity
• Protamine sulfate is the antidote
• Available in IV and subcutaneous injection forms

Nitroglycerin (Nitrostat, Nitro-Bid)

• Nitrate/Vasodilator
• Generic name is Nitroglycerin
• Chemical name: 1,2,3-Trinitroxypropane
• Converts to nitric oxide, causing vasodilation and reducing myocardial oxygen demand
• Treats angina and hypertensive emergencies
• May cause headache, hypotension, dizziness, and reflex tachycardia
• Contraindicated in hypotension and concurrent sildenafil use
• Available as a sublingual tablet, IV, and transdermal patch

Atenolol (Tenormin)

• Beta-blocker (Beta-1 selective)
• Generic name is Atenolol, brand name Tenormin
• Blocks beta-1 receptors, reducing heart rate and myocardial oxygen demand
• Treats hypertension, angina, and arrhythmias
• May cause bradycardia, fatigue, hypotension, and dizziness
• Contraindicated in bradycardia, heart block, and severe heart failure
• Comes in tablet form

Digoxin (Lanoxin)

• Cardiac Glycoside medication group
• Digoxin is the generic name; Lanoxin is the brand name
• Inhibits Na+/K+ ATPase, increasing intracellular calcium and cardiac contractility
• Treats heart failure and atrial fibrillation
• Can cause bradycardia, nausea, and visual disturbances (yellow halos) as adverse effects.
• Contraindicated in ventricular fibrillation and myocarditis
• Available in tablet and IV forms

Diltiazem (Cardizem, Tiazac)

• Calcium Channel Blocker (CCB)
• Generic name is Diltiazem; brand names are Cardizem and Tiazac
• Inhibits calcium influx into myocardial and vascular smooth muscle, reducing cardiac workload and blood pressure
• Treats hypertension, angina, and atrial fibrillation/flutter
• May cause bradycardia, hypotension, peripheral edema, and dizziness
• Contraindicated in severe hypotension, heart block, and acute MI
• Available in tablet and IV forms

Furosemide (Lasix)

• Loop Diuretic class
• Inhibits sodium-potassium-chloride cotransporter in the loop of Henle, causing diuresis
• Treats edema and hypertension
• May cause hypokalemia, dehydration, hypotension, and ototoxicity
• Contraindicated in anuria and severe electrolyte imbalance
• Available in tablet and IV forms

Insulin

• Antidiabetic medication group
• Promotes glucose uptake into cells and inhibits glucose production
• Treats diabetes mellitus
• Adverse effects may include hypoglycemia, weight gain, and lipodystrophy
• Contraindicated in hypoglycemia
• Administered via subcutaneous injection or IV

ACE Inhibitors (e.g., Lisinopril)

• Inhibit angiotensin-converting enzyme (ACE), reducing angiotensin II and lowering blood pressure
• Treats hypertension, heart failure, and post-MI
• May cause cough, hyperkalemia, angioedema, and hypotension
• Contraindicated in pregnancy and a history of angioedema

Glucagon

• Hypoglycemia Antidote medication group
• Stimulates hepatic glucose production via glycogenolysis
• Treats severe hypoglycemia
• May cause nausea, vomiting, and hypersensitivity reactions
• Contraindicated in pheochromocytoma and insulinoma
• Administered via injection

Metformin (Glucophage)

• Biguanide Antidiabetic medication group
• Metformin is the generic name, Glucophage is the brand name.
• Decreases hepatic glucose production and increases insulin sensitivity
• Treats Type 2 diabetes mellitus
• May cause lactic acidosis and GI disturbances
• Contraindicated in severe renal impairment and metabolic acidosis
• Tablet form

Anticholinergic Drugs

• Mechanism of action: Blocks acetylcholine in the central and peripheral nervous system
• Therapeutic effects: Treats bradycardia, asthma, Parkinson’s disease, motion sickness, and overactive bladder
• Adverse effects: Dry mouth, constipation, urinary retention, blurred vision, and confusion
• Contraindications: Glaucoma, urinary retention, and myasthenia gravis

Antihypertensive Drugs - Adverse Effects

• Common adverse effects: Hypotension, dizziness, fatigue, bradycardia, electrolyte imbalances, cough (ACE inhibitors), peripheral edema (CCBs)
• Severe adverse effects: Angioedema (ACE inhibitors), rebound hypertension (beta-blockers if abruptly stopped), and kidney dysfunction

Diuretics - Discharge Teaching

• Monitor: Daily weight, signs of dehydration, electrolyte imbalances
• Diet: Increase potassium intake if using loop or thiazide diuretics (unless on potassium-sparing diuretics)
• Hydration: Maintain adequate fluid intake
• Symptoms to Report: Dizziness, muscle cramps, weakness, irregular heartbeat

Diuretics - Fast-Acting vs. Slow-Acting

• Fast-acting diuretics work quickly with effects beginning within an hour, while slow-acting diuretics take longer to take effect.
• Furosemide (Lasix) is a common example of a fast-acting loop diuretic, while thiazide diuretics are generally slower acting.
• Fast-acting diuretics like Furosemide (Lasix) and Bumetanide are often used in emergency situations like pulmonary edema or acute heart failure where rapid fluid removal is needed.
• Slow-acting diuretics like hydrochlorothiazide and chlorthalidone are typically preferred for managing chronic conditions like hypertension or mild heart failure due to their longer-lasting effects.
• Fast-acting diuretics often have a shorter duration of action, while slow-acting diuretics can provide sustained diuresis.

Type 1 Diabetes

• Autoimmune destruction of pancreatic beta cells.
• Usually diagnosed in childhood or adolescence
• Requires lifelong insulin therapy
• Symptoms: Polyuria, polydipsia, polyphagia, weight loss

Type 2 Diabetes

• Insulin resistance and relative insulin deficiency
• Often associated with obesity and lifestyle factors
• Managed with oral medications, lifestyle changes, and sometimes insulin
• Symptoms: Fatigue, frequent infections, slow wound healing

Hemoglobin A1C (HgbA1C)

• Measures the average blood glucose levels over 2-3 months
• Normal Range: <5.7%.