Pharmacology Exam 3 Medications PDF
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This document includes questions and answers on various medications used to relieve angina and other related issues. The topics covered include nitroglycerin, digoxin, and calcium channel blockers, among others.
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Pharmacology Exam 3 Medications 1) nitroglycerin (Nitro) Use: 1st agents used to relieve angina Action: Generalized vascular and coronary vasodilation Side Effects & Adverse Reactions: Headache, hypotension,dizziness, weakness, faintness...
Pharmacology Exam 3 Medications 1) nitroglycerin (Nitro) Use: 1st agents used to relieve angina Action: Generalized vascular and coronary vasodilation Side Effects & Adverse Reactions: Headache, hypotension,dizziness, weakness, faintness Route: Sublingual, topical (ointment, transdermal patch), buccal extended-release tablet, oral extended-release capsule & tablet, aerosol spray (inhalation), & IV 2) digoxin (Lanoxin) Action: Positive inotropic Increases myocardial contractility Increases stroke volume Decreases preload Increases blood flow Negative chronotropic Decreases HR Negative dromotropic Decreases heart cells conduction Atrial fibrillation Atrial flutter Interactions: Diuretics Glucocorticoids Antacids Digitalis Toxicity Overdose or Accumulation: Antidote: digoxin immune Fab (ovine, Digibind) Action: Binds w/ digoxin forming complex moleculesexcreted in urine Side Effects: Anorexia, N/V/D, bradycardia, PVCs,cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions, confusion, delirium Nursing Interventions: Check apical pulse rate >60 Monitor serum digoxin level Therapeutic level 0.5 to 2 ng/mL Monitor serum K+ & report if Hypokalemia Avoid taking antacids 3) antianginal drugs Nitrates: reduction of venous tone, decreased workload of heart, vasodilation Beta Blockers: decrease workload of heart & decrease oxygen demands Calcium Channel Blockers (CCBs): decrease workloadof heart & decrease oxygen demands Side Effect: hypotension Nitrates & CCBs are effective in treating variant (vasospastic) angina pectoris. 4) Calcium Channel Blockers Action: Block Ca+ levels & promote vasodilation Relax coronary artery spasm (variant angina) Relax peripheral arterioles (stable angina) Decrease cardiac oxygen demand Decrease cardiac contractility (negative inotropic effect that relaxes smooth muscle) Decrease afterload Decrease peripheral resistance Reduce the workload of the heart Side Effects: Dizziness, flushing, headache, hypotension,reflex tachycardia, peripheral edema, fatigue, AV block, bradycardia Examples: Phenylalkylamine (verapamil), Isoptin, Calan, Verelan,Covera-HS, Benzothiazepines (diltiazem), Cardizem, Dilacor, Tiazac,Diltia XL, Dihydropyridine (amlodipine), Norvasc, Plendil (felodipine), DynaCirc (isradipine) Cardene (nicardipine), Procardia XL,Adalat (nifedipine), Sular (Nisoldipine) 5) amlodipine (Norvasc) See Calcium Channel Blockers 6) nifedipine (Procardia) See Calcium Channel Blockers 7) diltiazem (Cardizem) See Calcium Channel Blockers 8) Angiotensin II Receptor Blocker (ARBs) Action: Prevent release of aldosterone Act on renin – angiotensin – aldosterone system Block angiotensin II from angiotensin I receptors Suffix: –sartan losartan (Cozaar) valsartan (Diovan) irbesartan (Avapro) candesartan cilexetil (Atacand) eprosartan (Teveten) olmesartan medoxomil (Benicar) telmisartan (Micardis) azilsartan (Edarbi) Less likely to cause an irritating cough. 9) valsartan (Diovan) For CHF patients who cannot tolerate ACE inhibitors. See Angiotensin II Receptor Blockers. 10) losartan (Cozaar) See Angiotensin II Receptor Blockers. 11) ACE Inhibitor Action: Inhibits formation of angiotensin II Blocks release of aldosterone Suffix: -pril benazepril (Lotensin) captopril (Capoten) enalapril maleate (Vasotec) fosinopril (Monopril) lisinopril (Prinivil, Zestril) moexipril (Univasc) quinapril (Accupril) ramipril (Altace) trandolapril (Mavik) African-American & older adults do not respond with ACEI monotherapy. Side Effects: Irritating dry cough, insomnia, hyperkalemia,tachycardia Contraindications: Pregnancy Potassium sparing diuretics - spironolactone (Aldactone) Salt substitutes that contain potassium 12) lisinopril (Zestril) See Angiotensin Converting Enzyme Inhibitors. 13) enalapril (Vasotec) See Angiotensin Converting Enzyme Inhibitors. 14) Beta Blockers Suffix: -olol or -ilol atenolol (Tenormin) carvedilol (Coreg) metoprolol succinate (Toprol-XL) metoprolol tartrate (Lopressor) bisoprolol (Zebeta) propranolol (Inderal) nadolol (Corgard) Nursing Intervention: Doses should be low initially& gradually increased to avoid rebound hypertension. Beneficial Effect: 1 to 3 months Action: Block beta 1 and beta 2 receptor sites Block action of catecholamines (epinephrine & norepinephrine) Decrease HR & BP Selective Beta Blockers: atenolol (Tenormin) metoprolol tartrate (Lopressor) metoprolol succinate (Toprol-XL) Use: Treatment of angina & history of COPD Side Effects: Bradycardia, hypotension, dizziness,depression, fatigue, erectile dysfunction, peripheral edema, vasoconstriction, bronchospasms Nonselective Beta Blockers: Action: Inhibit beta 1 and beta 2 receptors propranolol (Inderal) carvedilol (Coreg) Cardioselective Beta Blockers: Action: Mainly blocks beta 1 receptors acebutolol (Sectral) atenolol (Tenormin) betaxolol (Kerlone) bisoprolol (Zebeta) metoprolol tartrate (Lopressor) 15) metoprolol (Lopressor) See Cardioselective Beta Blockers. 16) atenolol (Tenormin) See Cardioselective Beta Blockers. 17) loop (high-ceiling) diuretic Action: Act on ascending loop of Henle Excrete Na+, K+, H2O, Ca+, Mg+ Examples: ethacrynic acid (Edecrin) furosemide (Lasix) bumetanide (Bumex) Lab Changes: Hypokalemia (most common) Hyponatremia Hypocalcemia Hypomagnesemia Hypochloremia Hyperglycemia in diabetic patients Hyperuricemia Elevated BUN & creatinine Elevated lipids Thrombocytopenia & Leukopenia Side Effects & Adverse Reactions: Fluid & electrolyte imbalances Metabolic alkalosis Orthostatic hypotension Hearing loss Skin disturbances Dizziness, HA, weakness 18) furosemide (Lasix) See Loop Diuretics. 19) spironolactone (Aldactone) Classification: Potassium Sparing Diuretics ction: A Improves heart rate variability Decreases myocardial fibrosis cardioprotective effect of Blocking aldosterone in heart & blood vessels to promote cardiac remodeling Promote Na/H2O & K+ retention Use: Edema due to HF Liver Cirrhosis Side Effects: Hyperkalemia, hyperuricemia, dizziness, HA, GI distress 20) hydrochlorothiazide (HCTZ) Classification: Thiazide Diuretics Use: HTN & peripheral edema Action: Act on distal convoluted renal tubule Promote Na+, Cl-, H2O excretion Lab Changes: Hypokalemia Hypomagnesemia Hypercalcemia Hypochloremia Hyperuricemia Hyperglycemia Hyperlipidemia Side Effects & Adverse reactions: Electrolyte imbalances Hyperglycemia Hyperuricemia Hypotension, dizziness, headache, N/V, constipation, urticaria Contraindications: Renal failure 21) mannitol (Osmitrol) Classification: Osmotic Diuretics Action: Potent osmotic K+ wasting diuretic Increase Na+ reabsorption in proximal tubule & loop of Henle Excrete Na, Cl-, K+, & water Use: revent kidney failure, decrease ICP, decrease IOP P Frequently used in emergency situations Side Effects & Adverse Reactions: fluid & electrolyte imbalance pulmonary edema N/V, tachycardia, acidosis Crystallization of mannitol Contraindications: Heart failure & Renal failure 22) heparin Examples: Low-molecular-weight heparin (LMWH) enoxaparin sodium (Lovenox) dalteparin sodium (Fragmin) tinzaparin sodium (Innohep) Contraindications: Stroke, GI ulcer, blood anomalies, eye, brain, or spinal surgery Routes: Heparin drip = DVT/PE; stroke 23) protamine sulfate Antidote for Heparins 24) warfarin (Coumadin) Classification: Oral Anticoagulants Action: Inhibit hepatic synthesis of vitamin K, affecting clotting factors II, VII, IX, X Used to prevent thromboembolic conditions such as thrombophlebitis, PE, & embolism formation caused by A.fib., which can lead to stroke Nursing Intervention: Monitor therapeutic range PT 1.25 to 2.5 times control value(11 to 15 seconds) INR 2 to 3 (normal 1.3 to 2) Vitamin K: Antidote for warfarin overdose 24 to 48 hours to be effective For acute bleeding, FFP is indicated 25) phytonadione (vitamin K) Use: for warfarin overdose or uncontrollable bleeding Dose: Usually 1 to 10 mg of vitamin K1 is given atonce If Vitamin K Fails: resh whole blood F Fresh-frozen plasma (FFP) Platelets 26) aspirin Use: Prevention of MI and thromboembolism Prevention and treatment of stroke Long-term, low-dose therapy Action: Inhibits cyclooxygenase enzyme needed by platelets to synthesize thromboxane A 27) clopidogrel (Plavix) Classification: Antiplatelet Action: Inhibit platelet aggregation Use: decrease vascular clotting, MI, stoke, acute coronary syndrome Side Effects: Rash, GI upset Contraindications: Kidney and liver problems, history of bleeding 28) rivaroxaban (Xarelto) Classification: Xa Inhibitors (Anticoagulants) Do not require routine coagulation monitoring. Administered daily or BID. 29) thrombolytic drugs (alteplase) Action: Promotes conversion of plasminogen to plasmin Examples: streptokinase (Streptase) urokinase (Abbokinase) alteplase tPA (Activase) reteplase rPA (Retavase) tenecteplase TNK-tPA (TNKase) Use: Dissolve clot Myocardial infarction (Thrombus, or blood clot, disintegrates when a thrombolytic drug is administered within 4 hrs) Thrombolic stroke (Thrombolytic drug should be administered within 3 hrs) PE DVT Noncoronary arterial occlusion from an acute thromboembolism 30) statins / atorvastatin (Lipitor) Classification: HMG CoA Reductase Inhibitors Action: inhibit enzyme HMG CoA reductase in cholesterol biosynthesis Examples: atorvastatin calcium (Lipitor) fluvastatin (Lescol) lovastatin (Mevacor) pravastatin sodium (Pravachol) rosuvastatin calcium (Crestor) simvastatin (Zocor) Side Effects & Adverse Effects: Liver impairment Rhabdomyolysis (skeletal muscle disorder) Cataracts Nursing Interventions: Monitor liver enzymes. Report unexplained muscle tenderness or weakness, fever, malaise. Teach pt importance of compliance with health care regimen. 31) metoclopramide (Reglan) Classification: Antiemetics Action: Suppress impulses to CTZ Use: Used in treatment of postop emesis, CA chemotherapy, radiation therapy Side Effects: High doses can cause sedation & diarrhea Occurrence of EPS is more prevalent in children than in adults Contraindications: GI obstruction, hemorrhage, or perforation 32) ondansetron (Zofran) Classification: Serotonin Antagonists (Antiemetics) Action: Block nausea & vomiting by blocking serotonin receptor in CTZ & blocking vagal nerve terminals in upper GI tract Side Effects: Headache, Diarrhea, Dizziness, Fatigue 33) bisacodyl (Dulcolax) Classification: Stimulant Laxatives Action: Increase peristalsis by irritating sensory nerve endings in intestinal mucosa Results: Orally 2 to 8 hours, Rectally 15 to 60 min Side Effects: Abdominal cramps, weakness, reddish brown urine, diarrhea 34) proton pump inhibitors Examples: omeprazole (Prilosec OTC) lansoprazole (Prevacid) rabeprazole (Aciphex) pantoprazole (Protonix) esomeprazole (Nexium) dexlansoprazole (Dexilant) Use: Peptic ulcer disease (PUD) drug therapy from H. pylori ( omeprazole & clarithromycin) Action: Reduce gastric acid by inhibiting hydrogen/potassium ATPase Side Effects: HA, insomnia, dizziness, dry mouth, flatulence, abdominal pain hypomagnesemia 35) pantoprazole (Protonix) See Proton Pump Inhibitors. 36) H2 receptor antagonist (Antiulcer) Examples: ranitidine (Zantac 360) famotidine (Pepcid) Action: Reduce gastric acid by blocking H2 receptors of parietal cells in stomach Use: Promote healing of ulcer by eliminating cause Side Effects: headaches, dizziness, diarrhea/constipation, erectile dysfunction, gynecomastia, Vitamin B12 deficiency Interactions: oral anticoagulants, theophylline, caffeine, phenytoin (Dilantin), diazepam (Valium), propranolol (Inderal), phenobarbital, & CCB, increase in BUN, creatinine, & alkaline phosphatase Interventions: Neither cimetidine nor ranitidine should be taken with antacids – at least 1hr Eat foods rich in vitamin B12 to avoid deficiency Advise pt to avoid smoking. Avoid foods that cause gastric irritation. Separate famotidine & iron dosage by at least 1 hour. 37) cimetidine (Tagamet) See H2 Receptor Agonists. 38) ranitidine (Zantac) See H2 Receptor Agonists. 39) sucralfate (Carafate) Classification: Pepsin Inhibitors (Antiulcer Drug) Action: Combines with protein to form thick paste covering ulcer protects from acid & pepsin Side Effects: Constipation & Dry mouth Interventions: Given 1 hour ac/hs 40) lactulose Classification: Osmotic (saline) Laxatives Use: With liver disease it decreases ammonia (NH3) level Action: Hyperosmolar salts pull water into colon & increase water in feces to increase bulk, which stimulates peristalsis & defecation Side Effects: fluid & electrolyte imbalances, hypotension, weakness, abd 41) aluminum hydroxide (Amphojel) Classification: Antacid Side Effect: Constipation 42) polyethylene glycol (Golytely) Classification: Osmotic (saline) Laxatives Use: Bowel prep for surgery or diagnostics Action: Hyperosmolar salts pull water into colon & increase water in feces to increase bulk, which stimulates peristalsis & defecation Side Effects: fluid & electrolyte imbalances, hypotension, weakness, abd 43) treatments for Helicobacter pylori omeprazole & clarithromycin 45) types of insulins Rapid-acting Insulin lispro (Humalog) Insulin aspart [rDNA origin] (NovoLog) insulin glulisine (Apidra) Onset of action (5 to 15min) Peak (30 minutes to 1 hr) Duration (2 to 4 hrs) Patient has a meal & is ready to eat Short-acting Regular (Humulin R, Novolin R, regular insulin) Onset of action (30 to 60 minutes) eak (2 to 3 hours) P Duration (3 to 4 hours) Intermediate-acting Insulin isophane NPH (Humulin N, Novolin N) Onset of action (2 to 4 hours) Peak (4 to 12 hours) Duration (18 to 24 hours) Long-acting Onset of action (1 hour) Duration (24 hours) Administered at bedtime Combinations Composed of short- & intermediate-acting or rapid- & intermediate-acting Humulin 70/30 (isophane NPH 70%, regular 30%) Insulin isophane NPH 50/50 (Humulin NPH 50%, regular 50%) Humalog 75/25 (lispro protamine 75%, lispro 25%) 46) insulin glargine (Lantus) See types of insulin (long-acting). 47) D50% An intravenous sugar solution composed of 50% dextrose. 48) metformin (Glucophage) Classification: Non-sulfonylureas (Antidiabetic) Action: Decreases hepatic production of glucose from stored glycogen Diminishes increase in serum glucose after meals Blunt postprandial hyperglycemia Decrease glucose absorption from small intestine Increase insulin receptor Sensitivity Increase peripheral glucose uptake at the cellular level Side Effects: Bitter/metallic taste 49) glipizide (Glucotrol) Classification: Second Generation Sulfonylureas Use: treat type 2 diabetes Action: Stimulate pancreatic beta cells to secrete more insulin Increase tissue response to insulin Decrease glucose production 50) glucagon Hyperglycemic hormone secreted by alpha cells of islets of Langerhans Action: Increases blood sugar by stimulating glycogenolysis Use: Treat insulin-induced hypoglycemia when other methods of providing glucose are not available Route of Administration: Parenteral use (sub-Q, IM, IV)
