Pharmacy Exam 4 (3) PDF

Drugs affecting blood pressure ACE INHIBITORS ends on pril Benazepril Captopril Enalapril Enalaprilat Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril Therapeutic action: treating hyperte...

Drugs affecting blood pressure ACE INHIBITORS ends on pril Benazepril Captopril Enalapril Enalaprilat Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril Therapeutic action: treating hypertension, heart failure and diabetic nephropathy. (It helps improve survival rates post-myocardial infarction by reducing BP and workload on the heart) Contraindications: Hx of angioedema related to ACE inhibitors, bilateral renal artery stenosis. Caution with renal impairment Interactions: diuretics, potassium supplements, NSAIDs leading to ↑ risk of hyperkalemia or renal impairment Administration: administer 1hr before meals(↑absorption), B/V, potassium levels, BUN/creatinine. Interventions: monitoring BP, assessing renal function, monitor for cough, monitor for hyperkalemia. Education: - report pregnancy - Report cough/rash - Change positions slowly - Avoid activities that require alertness - Avoid foods high in potassium and salt Contraindication: - allergies, impair renal function, pregnancy and lactation. Caution: - cardiac heart failure (CHF) Adverse effect: - first dose orthostatic hypotension, hypotension, GI irritation, renal insufficiency, hyperkalemia, cough. - Stepped care management of hypertension - Interactions: allopurinol Education: - Report cough,rash, dysgeusia(altered taste), or indications of infections - Rise slowly from sitting - Avoid activities that require alertness - Avoid potassium containing foods and salt - Report if pregnancy is suspected. Administration of ACE inhibitors - Adm. ACE inhibitors orally EXCEPT enalaprilat(only ACE inhibitor for Iv use) - Monitor potassium levels (3.5 - 5) - Monitor BP after the first dose at least for 2hr to detect hypotension - Take captopril and moexipril at least 1 hr before meals. Other ACE are taken with or without food. ACE inhibitors treat hypertension, congestive heart failure (CHF), diabetic nephropathy, left ventricular dysfunction following an MI.  Calcium channel blockers ends on dipine Amlodipine Clevidipine Diltiazem Felodipine Isradipine Levamlodipine Nicardipine Nifedipine Nisoldipine Verapamil Therapeutic action: use to treat angina, hypertension and cardiac dysrhythmias (atrial fibrillation and, atrial flutter and supraventricular tachycardia (SVT) Adverse effect: orthostatic hypotension, peripheral edema, constipation, bradycardia, heart failure, dysrhythmias, acute toxicity. Contraindications: pregnancy/ lactation, hypotension, heart block, digoxin toxicity, severe heart failure. Caution in older adults with kidney and liver disorders, mild to moderate HF or GERD. Interactions: digoxin, beta blockers(ends in lol), grapefruit juice Administration: - Baseline vitals(B/V) - IV adm. Over 2-3min, - hold for HR less than 50 and BP less than 90 Interventions: - monitor BP, edema, and daily weight - Monitor for postural hypotension  - Monitor ECG, pulse rate and rhythm !For toxicity: Adm. meds( norepinephrine, calcium, isoproterenol, lidocaine and iv fluids) ! * Signs of toxicity: decreased in BP and HR, and arteriovenous (AV) block * Education: - Don’t crush or chew sustained release tablets - If with angina record pain frequency/intensity/duration/location. Notify the provider if attract increase in F/I/D - Change position slowly and avoid activities that require alertness - Increase intake of fiber food and oral fluids, if not restricted. - Hold for HR less than 50 - Hold for systolic BP less than 90 - No grapefruit juice Contraindication: - Allergy - heart block or sinus syndrome - renal or hepatic dysfunction - pregnancy and lactation. Adverse effect: - Dysrhythmias - orthostatic hypotension - Hypotension - GI symptoms- verapamil causes constipation - Bradycardia - AV block Interactions: cyclosporine, digoxin, grapefruit juice  Education: - Do not chew or crush sustained release tablets - Notify the provider if angina attacks increase in frequency/intensity/duration. - Change position slowly and avoid activities that require alertness. Administration for calcium channel blockers - adm. Verapamil slowly (2-3min). - teach clients to monitor BP and HR withhold and notify for pulses less than 50/min and systolic BP less than 90 mm Hg. Vasodilators Hydralazine Minoxidil Nitroglycerin(is a nitrate and vasodilator) Nitroprusside Therapeutic action: used for rapid reduction of BP in hypertensive emergencies. Adverse effect: - excessive hypotension - Cyanide poisoning / thiocyanate toxicity. - Bradycardia, tachycardia, ECG changes. Contraindications: - Pregnancy and lactation - Pts who have heart failure with reduced peripheral vascular resistance or an AV shunt - Cautiously in pts with liver and kidney disease, hypothyroidism, hypovolemia, fluid and electrolyte imbalances, and older adults. Interactions: do not adm, nitroprusside in the same infusion as any other med. *Thiosulfate is the antidote* Administration: - nitroprusside is light brown color ( don’t sue if other color) - Protect iv container from light - Discard after 24hr - Keep the pt supine during adm. - Should be adm. slowly. Interventions: - Monitor BP and ECG continuously - Monitor manifestations of cyanide poisoning ( weakness, disorientation, delirium), the risk for poisoning is reduced by adm. For no longer than 3 days at a rate of 5mcg/kg/min or less. - Monitor plasma levels should be maintained at less than 10mg/dl Caution: peripheral vascular disease, CAD, CHF or tachycardia. Adverse effect: hypotension, ECG changes, GI upset, Cyanide toxicity(nitroprusside only) Administration for vasodilators - Prepare medication be adding to diluent for iv infusion - Solution can be light brown in color(discard the solution of any other color) - Protect iv container and tubing from light. - Discard med after 24 hr, monitor vital signs and ECG continuously Antihypotensive agents  Sympathetic adrenergic agonist or vasopressor ends on ine Dobutamine Dopamine Droxidopa Ephedrine Epinephrine Isoproterenol Midodrine Norepinephrine Phenylephrine Vassopresin Therapeutic action: used to treat cardiac arrest, anaphylactic shock, acute asthma, and superficial bleeding. Adverse effect: - hypertensive crisis - Cardiac dysrhythmias - necrosis(from extravasation) - hyperglycemia Contraindications: - Pregnancy (except if benefit outweighs the risk) - Lactation (high soe can decrease milk production, low dose is safe) - Older adult are susceptible to adverse effects - Caution with hyperthyroidism, angina, cardiac dysrhythmias and hypertension. Interactions: MAOIs, TCAs, general anesthetics, alpha adrenergic blocker, beta adrenergic blockers. Administration: B/V, baseline ECG, Adm. IV/IM, use an IV pump to control infusion. Interventions: - Monitor ECG an dBP - Monitor urine output - If extravasation occurs, adm. Phentolamine (alpha blocker) - Monitor pt diabetes for hyperglycemia - Monitor profusion to extremities - Monitor for chest pain Education (how to administer Epi-pen) - Remove Epi-pen from case - Check expiry date - Ensure window in clear cloudy=expired, black=used - Hold it “Blue to the sky, orange to the thigh” - Remove blue cap - Press firmly till you hear a “click” and hold for 3(count) - Orange safety cap will extend over the needle when removed - Readminister second Epi-pen after 5 min if require Nursing steps for allergic reactions 1. Assess the client’s airway 2. Call the emergency response team (code) 3. Apply high-flow oxygen 4. Initiate iv access 5. Adm. iv epinephrine 6. Adm. iv antihistamines Cardiac glycosides Digoxin Therapeutic action: used to treat HF and atrial fibrillation Adverse effect: - Dysrhythmias, cardiotoxicity - Anorexia is usually the first sign of toxicity - nausea , vomiting, and abdominal pain - Fatigue weakness, blurred vision, yellow-green or white halos around object Contraindications: - Pregnancy/lactation - Ventricular dysrhythmias - Cautiously in pts with hypokalemia, partial AV block, advanced HF, and impaired kidney dysfunction. Interactions: thiazide and loop diuretics, ACE inhibitors, dopamine, Quinidine, verapamil, antacids. !**antidote is Digoxin immune Fab** for toxicity! Administration: - Baseline vitals - Baseline EKG - *assess apical pulse for 60sec* - *Baseline electrolytes (potassium)* - *Hold if HR is less than 60 BPM for adults, 70 BPM for children and 90 BPM for infants* - Take at the same time each day - Adm. iv digoxin at least for 5 min (10-15 id pt has pulmonary edema), and monitor pt for dysrhythmias. Interventions: - Monitor vital and EKGs - Monitor electrolyte( especially potassium) - Monitor for toxicity(nauseas, vomiting, anorexia, bradycardia) - Therapeutic level 0.5-2ng. Obtain specimen at least 6-8 hr after last dose(preferably before next dose) - Digoxin levels when toxicity is suspected:  3 toxicity likely Education: - Take at the same time each day - Teach how to assess apical pulse - Report palpitations/chest pain - First symptoms of toxicity usually include abdominal pain, anorexia, nausea, vomiting, visual disturbances, and bradycardia. - Frequent lab work is required - Report symptoms of hypokalemia (N/V, general weakness) - Consume high potassium foods or supplements ( green leafy vegetables, bananas, potatoes) Tx: HF, atrial fibrillation Adverse effects: headaches, weakness, drowsiness, vision changes, GI upset, anorexia, arrhythmia development. Contraindications: - Allergy - ventricular tachycardia or fibrillation - heart block - sick sinus syndrome - Idiopathic hypertrophic subaortic stenosis - Acute MI, renal insufficiency, and electrolyte abnormalities. Caution: pregnancy, lactation, pediatric and geriatric pts. Interactions: verapamil, amiodarone, quinidine, erythromycin, tetracycline, cyclosporine, potassium losing diuretics, cholestyramine, charcoal, colestipol, bleomycin, cyclophosphamide, methotrexate. Client education: Monitor pulses for rate and rhythm, and notify prescriber if changes occur. Take the medication as prescribed. If a dose is missed, the next dose should not be doubled. Administration for cardiac glycosides - Check pulse rate and rhythm before administration of digoxin and record. - Notify the provider if the heart rate is less than 60/min in an adult, less than 70/min in children, andless than 90/min in infants. - Administer digoxin at the same time daily. - Evaluate manifestations and the client’s digoxin level when toxicity is suspected.  - Avoid taking OTC medications to prevent adverse effects and medication interactions. - Instruct clients to observe for indications of digoxin toxicity (fatigue, weakness, vision - changes, GI effects nausea/ no appetite), and to notify the provider if they occur. - If administering IV digoxin, infuse over at least 5 min, (10 to 15 min in clients who have pulmonary edema) and monitor client for dysrhythmias - Monitor potassium levels to prevent toxicity (3.5 - 5 ) Digoxin toxicity - Stop digoxin and potassium wasting diuretics immediately. - Monitor K+ levels. For levels less than 3.5 mEq /L, administer potassium IV or by mouth. - Do not give any further K+ if the level is greater than 5.0 mEq /L or AV block is present. - Treat dysrhythmias with phenytoin or lidocaine. - Treat bradycardia with atropine. - For excessive toxicity, activated charcoal, cholestyramine, or digoxin immune Fab can be used to bind digoxin and prevent absorption. Diuretic agents Function of diuretic agents: increase the amount of urine produced by the kidneys, and increase sodium excretion. Thiazide Hydrochlorothiazide Chlorothiazide Methyclothiazide Therapeutic action: used to treat hypertension and edema associated with HF or kidney disorder. Adverse effect: - Dehydration and hyponatremia - Hypokalemia and hypochloremia - Hyperglycemia - Hyperuricemia, hypomagnesemia,increased lipids Contraindications: - Allergy - Acute kidney injury - Lactation - Pts with anuria - Caution in pts with diabetes, pregnant, taking digoxin, lithium, or antihypertensives Interactions: other antihypertensives, lithium, NSAIDs Administration: - baseline date, orthostatic BP, electrolytes, and location and extent edema. - Weigh BP and I&O - monitor potassium, if drops below 3.5 - Monitor ECG and supplement if needed Administer early in the day to avoid nocturia Interventions: - Monitor vitals - Monitor weight at the same time every day - Monitor intake and output - Monitor electrolyte(keep K+ 3.5-5) Education: - Take first thing in the morning( if twice a day,no more than1400) - Weight at the sametime daily ( notify if weightgain of 3 or more pounds a day)  - Monitor BP ( if diabetic monitor blood glucose carefully) - Observes for signs of hypokalemia or hypomagnesemia. Contraindications: - Allergy to thiazides or sulfonamides - Fluid and electrolyte imbalances - Renal and liver disease Caution: - Gout - SLE - Liver disease - Hyperparathyroidism - Bipolar disorder - Pregnancy and lactation - Diabetes or glucose tolerance abnormalities Adverse Effects: GI upset, fluid and electrolyte imbalances, hypotension, increased blood glucose levels, alkalinized urine Interactions: - Cholestyramine or colestipol - Digoxin - Antidiabetic agents - Lithium Education: - Take the medication first thing in the morning; if twice a day dosing is prescribed, be sure the second dose is taken by 1400 to prevent nocturia.  - Consume foods high in potassium and maintain adequate fluid intake (1,500 mL/day,unless contraindicated). - If GI upset occurs, take the medication with or after meals. - If the medication is used for hypertension, self monitor blood pressure and weight by keeping a log. - Report significant weight loss, lightheadedness, dizziness, GI distress, or general weakness to the provider. These can indicate hypokalemia or hypovolemia. - If with diabetes, monitor for elevated blood glucose levels. - Observe for manifestations of low magnesium levels (weakness, muscle twitching,tremors). Administration for thiazide and thiazide-like diuretics - Chlorothiazide is administered orally and IV; all others can are given orally. - Obtain baseline data, including orthostatic blood pressure, weight, electrolytes, and location and extent of edema. - Monitor potassium levels (3.5 5mEq/L) - Alternate day dosing can decrease electrolyte imbalances. - Weigh clients at the same time each day with the same amount of clothing and bed linen (if using a bed scale), usually upon awakening. - Monitor blood pressure and I&O. - If potassium level drops below 3.5 mEq /L, monitor the ECG, and notify the provider because the client might require a potassium supplement. - Advise clients to get up slowly to minimize postural hypotension, monitor blood pressure, and assess for hypovolemia. If faintness or dizziness occurs, instruct clients to sit or lie down - Take early in the day to reduce night time urination.  Loop diuretics Ethacrynic acid Bumetanide Furosemide Torsemide Therapeutic action: used to treat fluid retention and hypertension related to HF or liver disease. Adverse effect: - Dehydration, hypovolemia, electrolyte imbalance(hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypocalcemia) - Hypotension - Ototoxicity - Hyperglycemia, hyperuricemia - Decrease in HDL cholesterol, increase in LDL cholesterol, increase in triglycerides. Contraindications: digoxin, antihypertensives, lithium, NSAIDs Administration: IV, MI,PO - baseline vitals, weight and electrolytes - Document location and extent edema - Obtain orthostatic BP - Avoid adm. Late in the day to avoid nocturia Interventions: - Monitor BP, weight daily, electrolytes( glucose, uric acid and lipid levels) and edema - If K+drops below 3.5 monitor ECG and replace if needed - Initiate fall precautions in older pts - Monitor pain in chest, claves, pelvis and notify the provider if occur  - Avoid use of other ototoxic drugs(aminoglycosides) Education: - Monitor BP - Change positions slowly - Report significant weight loss, lightheadedness, dizziness, GI distress or general weakness(it can indicate hypokalemia or hypovolemia) - Eat foods high in potassium - If diabetic monitor blood glucose Manifestations of low magnesium ( weakness, muscle twitching, tremors) Manifestations of low calcium ( muscle twitching, muscle cramps, tingling in the hands and feet) Manifestations of ototoxicity (vertigo, ringing, buzziness, or sense of fullness in the ears) Contraindications: - Allergy - Electrolyte depletion - Anuria - Severe renal failure - Hepatic coma - Pregnancy and lactation Caution: - SLE, gout, and diabetes mellitus Adverse Effects: - Related to the imbalance in electrolytes and fluid - Hypokalemia - Alkalosis - Hypocalcemia - Ototoxicity Interactions: - Aminoglycosides or cisplatine - Anticoagulation - Indomethacin, ibuprofen, salicylates, or NSAIDs Client education: - If the medication is used for hypertension, self monitor blood pressure and weight by keeping a log. - Get up slowly to minimize postural hypotension and monitor blood pressure, and assess for hypovolemia. If faintness or dizziness occurs, instruct clients to sit or lie down. Administration for loop diuretics - Obtain baseline data, including orthostatic blood pressure, weight, electrolytes, and location and extent of edema. - Weigh clients at the same time each day with the same amount of clothing and bed linen (if using a bed scale), usually upon awakening. - Monitor blood pressure and I&O. - Avoid administering the medication late in the day to prevent nocturia. Usual dosing time is 0800 and 1400. - Administer furosemide orally, IM, IV bolus dose, or continuous IV infusion. Infuse IV doses at 20 mg/min or slower to avoid abrupt hypotension and hypovolemia. - If potassium level drops below 3.5 mEq /L, monitor the ECG, and notify the provider because the client might require a potassium supplement. Potassium-sparing diuretics  Amiloride Spironolactone Triamterene Therapeutic action: used to treat hypertension and edema (in combination with other diuretics) Adverse effect: - Hyperkalemia - Deepened voice,impotence,irregular menstrual cycle, gynecomastia - Drowsiness and metabolic acidosis Contraindications: - pregnancy /lactation - hyperkalemia(taking potassium supplements) - Severe kidney failure - Anuria - Cautiously in pts with kidney or liver disease, electrolyte imbalnces or metabolic acidosis. Interactions: concurrent use of ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, potassium supplements, salt substitutes, and other potassium sparing diuretics. Administration: - baseline vitals,weight,potassium. - Document location/extent of edema - Avoid adm. Late in the day Interventions: - Monitor vitals and weight at the same time daily - Monitor potassium (3.5.-5) and I&O - Monitor for sexual dysfunction - Assess EKG if K+ level is high Education: - Avoid salt substitutes and reduce intake of potassium rich foods  - Monitor BP and weight daily - Report cramps, diarrhea, thirst, altered menstruation, deepened voice Contraindications: - Allergy - Hyperkalemia, renal disease, or anuria - Patients taking amiloride or triamterene Caution: - Pregnancy and lactation Adverse Effects: - Hyperkalemia - Drowsiness - Impotence, gynecomastia, and hirsutism Interactions: - Salicylates Client education: - Avoid salt substitutes that contain potassium and reduce intake of potassium rich foods (oranges, bananas, potatoes, dates). - Self monitor blood pressure. - Keep a log of blood pressure and weight. - Triamterene can turn urine a bluish color. - Report cramps, diarrhea, thirst, altered menstruation, or deepened voice. - Avoid activities that require alertness until effects of medication are known. Administration for potassium-sparing diuretics  - Obtain baseline data. - Weigh clients at the same time each day with the same amount of clothing and bed linen (if using a bed scale), usually upon awakening. - Monitor blood pressure and I&O. - Monitor ECG periodically. - Monitor potassium levels. Osmotic diuretics Mannitol Therapeutic action: used to reduce ICP and treat oliguric renal failure Adverse effect: - Heart failure, pulmonary edema - Rebound increased ICP - Fluid and electrolyte imbalance, metabolic acidosis. Contraindications: - Active intracranial bleed, anuria, severe pulmonary edema, severe dehydration, and renal failure - Extreme caution in pts with HF, pregnancy/lactation, renal insufficiency and electrolyte imbalances Interactions: lithium, cardiac glycosides Administration: via IV. - use a filter needle and in the iv tubing - Baseline data (BP, weight, electrolytes, edema) Interventions: - monitor ( daily weight, I&O, electrolytes, BP) - Monitor potassium, replaced if needed - Monitor for ICP (changes in LOC, pupils, headaches, nausea,  vomiting) - Monitor for metabolic acidosis ( drowsiness and restlessness) - Monitor manifestations of dehydration and increased edema Education: - Change position slowly - Report severe GI distress, lightheadedness, dizziness, or weakness(it can indicate hypovolemia or hypokalemia) Contraindications: - Renal disease and anuria - Pulmonary congestion - Intracranial bleeding, dehydration - CHF Adverse Effects: - Related to sudden drop in fluid levels - Nausea, vomiting, hypotension, lightheadedness, confusion, and headache Client education: - Get up slowly to minimize postural hypotension, monitor blood pressure, and assess for hypovolemia. If faintness or dizziness occurs, sit or lie down. - Report significant weight loss, lightheadedness, dizziness, GI distress, or general weakness to the provider. These can indic ate hypokalemia or hypovolemia. Administration for osmotic diuretics - Administer mannitol by continuous IV infusion. - To prevent administering microscopic crystals, use a filter needle when drawing from the vial and a filter in the IV tubing. - Monitor daily weight, I&O, and blood electrolytes.  - Monitor for manifestations of dehydration, and increased edema. - Obtain baseline data, including orthostatic blood pressure, weight, electrolytes, and location and extent of edema. - Weigh clients at the same time each day with same amount of clothing and bed linen (if using a bed scale), usually upon awakening. - Monitor blood pressure. - If potassium level drops below 3.5 mEq /L, monitor the ECG, and notify the provider because the client might require a potassium supplement. - Monitor for increased ICP (change in level of consciousness, change in pupils, headache, nausea, and vomiting). Nitrates Amyl nitrate Isosorbide dinitrate Isosorbide mononitrate Nitroglycerin Therapeutic action: treats angina pectoris Adverse effect: - Headaches and dizziness (common with 1st doses) - Hypotension and orthostatic hypotension - Reflex tachycardia and tolerance are possible. Contraindications: pts with severe anemia, close-angle glaucoma, traumatic head injury ( it can increase ICP) and those using phosphodiesterase-5 inhibitors. Caution in pts with hypotension, pregnancy/lactation Interactions: antihypertensives and alcohol leading to hypotensive effects Administration: - Sublingual and translingual - rapid onset, short duration (used to treat acute attack, prophylaxis of acute attack when exertion is anticipated) - sustained-release oral capsule - slow onset, long duration ( long-term prophylaxis against anginal attacks) - Transdermal - slow onset, long duration ( long-term prophylaxis against anginal attacks) - Topical - slow onset, long duration ( long-term prophylaxis against anginal attacks) Intravenous - control of angina not responding to other medication, control of hypertension during perioperative period, HF resulting from acute MI Interventions: use nitro at first indication of chest pain, take capsule on an empty stomach with at least 8 oz of water, monitor HR and BP IV: start at a slow rate and nitrate to BP Education: - Notify the provider if headaches does not improve within a few wks - Sit or lie down if dizziness or faintness - Change position slowly - Avoid alcohol - Store tablets in origins; bottles and in cool dark place Spray translingual spray against oral mucosa and do not inhale Place patch on a hairless area and rotate sites, remove the patch and wash with soap and water, then dry before applying a new one Remove the patch at night to reduce tolerance Do not stop taking long-acting nitro abruptly Contraindications: - Allergy - Severe anemia - Head trauma or cerebral hemorrhage - Pregnancy and lactation Caution: - Hepatic or renal disease - Hypotension, hypovolemia, and conditions that limit cardiac output Adverse Effects: - Related to the vasodilatation and decreased in blood flow - Headache, dizziness, and weakness (common) - Nausea, vomiting - Hypotension - Flushing, pallor increased perspiration Interactions: - Sildenifil - Heparin How to take sublingual nitroglycerin - Use during an acute attack - Take at first onset of pain or before doing an activity that causes you chest pain - Place tablet under tongue and allow to dissolve ( can take 2nd dose if pain isn’t resolved in 5 mins after calling 911 take 3rd dose if pain isn’t resolved 5 min after 2nd dose no more) - Store tablets in original bottle in cool, dark place How to take use of topical/transdermal nitroglycerin - Prophylactic treatment - Place on hairless section of skin and rotate sites - Always check skin for a reaction - Remove patch after 12 14 hours and remain patch free for 10 12 hrs (I always think 12on - 12off) - Fold transdermal patch in half and dispose in special bin (do not flush) - When using topical creams/ointments use the provided applicator. When disposing fold the medication inward. - Avoid touching either with skin  HMG-CoA reductase inhibitors ends on statins Atorvastatin Fluvastatin Lovastatin Pitavastatin Pravastatin Rosuvastatin Simvastatin Therapeutic action: used to lower cholesterol levels in the blood Adverse effect: hepatotoxicity(increase in AST), myopathy ( muscle aches, pain, and tenderness Contraindications:pts with active liver disease, allergy, pregnancy/lactation Interactions: fibrates, niacin, warfarin, and certain antifungal meds, grapefruit juice. Administration: baseline creatinine kinase CK, if CK levels become elevated medication may need to be discontinued. Adm. PO, preferably in the evening. Interventions: monitor lipid levels, liver function test, and educating pts on lifestyle modifications Education: - Observe indications of liver dysfunction( anorexia, vomiting, nausea, jaundice) - Avoid alcohol - Report muscle aches, pain and tenderness - Important to obtain baseline cholesterol,high density lipoprotein HDL, low density lipoprotein LDL, triglyceride level,as well as liver and kidney function tests periodically during treatment. Contraindications: - Allergy - Active liver disease or history of alcoholic liver disease - Pregnancy or lactation Caution: - Impaired endocrine function Adverse Effects: - Flatulence, abdominal pain, cramps, nausea, vomiting, and constipation - Headache, dizziness, blurred vision, insomnia, fatigue - Liver failure - Myopathy causing rhabdomyolysis Interactions: - Erythromycin, cyclosporine, gemfibrozil, niacina  - Digoxin or warfarin - Estrogen - Grapefruit juice Client education: - It is important to obtain baseline cholesterol, HDL, LDL, and triglyceride levels. - Report any muscle aches/pain to your provider. - Report any signs of jaundice Administration for HMG-CoA reductase inhibitors - Administer statins via oral route. - Administer lovastatin with evening meal. Other statins can be taken without food, but evening dosing is best because most cholesterol is synthesized during the night. - Monitor LFTs (Alt/AST) - Monitor CK levels Anesthetic agents Propofol Therapeutic action: sedation during procedures and for general anesthesia. Also utilized in intensive care mechanically ventilated pts. Adverse effect: hypotension, respiratory depression, injection site pain. Can lead to more severe reactions like cardiac arrest. Contraindications: allergy, caution in pts with compromised airway or cardiovascular stability. Interactions: CNS depressants. Monitoring when co-administered with opioids or benzodiazepines. Administration: iv, dosing should be titrated based on pt response and surgical procedure Interventions: monitoring v/s, maintaining airway patency, assessing sedation levels. (have resuscitation equipment readily available to potential respiratory depression) Education: informed about the purpose of propofol, side effects and sedation process. ❖ Stepped care for management of hypertension 1. Lifestyle modifications are instituted ( weight reduction, smoking cessation, moderation of alcohol intake, reduction of dietary salt, increase in aerobic physical activity) 2. Inadequate response ( drug therapy added) 3. Inadequate response ( consider change in drug dose or class, or addition of another drug for combined effect)  4. Inadequate response ( second or third agent or diuretic is added if not already prescribed) Agents for treating heart failure ❖ Congestive heart failure (CHF), can occur with any of the disorders that damage or overwork the heart muscle: - Coronary artery - Cardiomyopathy - Hypertension - Vascular heart disease. S/S of CHF Tx for CHF: cardiotonic(inotropic) drugs; cardiac glycosides, phosphodiesterase inhibitors, HCN blockers.