Exam 2 Pharm Dump Pt 2 PDF

# Ace inhibitors (-Pril) - **Indications:** - Hypertension - Heart failure - MI - Diabetic neuropathy - **Side effects:** - Hypotension - Hyperkalemia - Dry, nonproductive cough - Angioedema - First dose hypotension - **Contraindications:** - Pregnancy - H...

# Ace inhibitors (-Pril) - **Indications:** - Hypertension - Heart failure - MI - Diabetic neuropathy - **Side effects:** - Hypotension - Hyperkalemia - Dry, nonproductive cough - Angioedema - First dose hypotension - **Contraindications:** - Pregnancy - Hypotension - Hx of angioedema - **Side effects acc.:** - Angioedema - Cough - Hyperkalemia - **Outcomes:** - Decreased BP - Decreases by decreasing the SVR - Decreases preload - Decreases afterload as well - **Monitor/Observe:** - Electrolytes - Blood pressure - Respirations - Cough - **MOA:** - Stops the conversion of angiotensin I to angiotensin II, which increases BP - Cardio drug of choice for patients with diabetes # ARBs (-Sartin) - **MOA:** - Stops the conversion of angiotensin II from working - *Works Later* - **Side Effects:** - Hypoglycemia - Chest pain - Hypotension - *Hypertension* - **Indications:** - HTN - *Heart Failure* - Given with a cough and hyperkalemia - **Contraindications:** - *Hypotension* - Hypoglycemia - **Outcomes:** - Decreases BP - Decreases HR # Nitrates - **Indications:** - Treatment of angina - Prevention of angina - Given for active MI - **Side effects:** - Headaches - Hypotension - Orthostatic hypotension - Reflex tachycardia - **Outcomes:** - Decrease frequency and severity of angina - Treatment of heart failure with acute MI - Decrease preload - Decrease afterload - **Contraindications:** - Erectile dysfunction drugs - Severe angina - Hypotension - Severe head injury - **Special:** - **Patch:** - Take off every 8 hours or at night to prevent tolerance - **Sublingual:** - Tingling is normal - Headache is normal - **Monitor/Observe:** - Blood pressure - Hold if systolic is less than 100 systolic - S/S of tolerance # Calcium Channel Blockers (-Pine) - **Examples:** - Nifedipine - Felodipine - Amlodipine - **Indications:** - Angina - Hypertension - Coronary artery spasms - Post brain aneurysm spasms - **Contraindications:** - Acute MI - 2nd or 3rd degree AV block - Hypotension (SBP<100) - **Side Effects:** - Hypotension (SBP<100) - Tachy/bradycardia - Dyspnea - Constipation - Increased risk of stroke, arrhythmias, and stroke - **MOA:** - Prevents calcium from going to the channels in the heart - This decreases the heartrate and vasodilates the blood vessels - Improves blood flow to the heart - Decreases force of contraction - **Outcomes:** - Decreased BP - Decreased frequency and severity of angina attacks - **Special:** - Don't give with grapefruit juice - Hold if HR<60 - Hold if SBP<100 - **Chromotrope** Decreases HR - **Dromotrope** Decreases conductivity - **Ionotrope** Decreases contractility # Beta blockers (-Olol) - **Examples:** - Metoprolol (cardio-selective) - Atenolol (cardio-selective) - Propranolol - **Indications:** - Angina - Hypertension - Dysrhythmias - Cardio-protection - Heart failure - **Contraindications:** - HR<60 - Broncial asthma - Systolic heart failure - Hypoglycemia (can mask hypoglycemic symptoms) - **Side Effects:** - Decreased HR - Decreased BP - Dizziness - Impotence - Hyper/hypoglycemia - **Monitor/Observe:** - Blood sugar - BP, hold if SBP<100 - HR, hold if <60 - **Special:** - Get up slowly - Don't stop taking abruptly - Long-term angina treatment - Check vitals - **Outcomes:** - Decrease HR (primary) - Decrease BP (secondary) - Decrease frequency of angina - Prevention of MI - **MOA:** - Decrease heartrate resulting in a decreased myocardial oxygen demand; increased oxygen to the heart - Decrease myocardial contractility, which helps to conserve energy or decreasing demand/workload on the heart # Vasodilators - **Indications:** - Hypertension - Hypertensive emergencies - **Contraindications:** - Severe renal/hepatic disease - Low BP - Decreased cerebral perfusion - **Side Effects:** - Hypotension - Decrease SVR - Peripheral vasodilation - GI upset - Sudden BP drop - **Outcomes:** - Decreased BP - Control HTN crises - Decrease preload - Decrease afterload - **MOA:** - Directly relaxes the arterial and venous smooth muscle - **Examples:** - Hydralazine - common - Nitroprusside - HTN emergency - Diazoxide - rarely used - **Monitor/Observe:** - Blood pressure - Heartrate - S/S of toxicity (nitroprusside) - **Special:** - Cyanide toxicity can occur with nitroprusside - Fall risk due to hypotension - Avoid alcohol use - **Main Goal:** - To increase the supply of blood and decrease the demand on the heart # Cardiac Glycosides - **Indications:** - Heart failure - A-fib - Used with other drugs - **Contraindications:** - Uncontrolled A-fib - AV block - Known alcohol intolerance - **Side Effects:** - Brady/tachycardia - Vision changes (*Colored, halo vision*) - Hypotension - Fatigue - **Outcomes:** - Decrease severity of heart failure - Increase cardiac output - *Inotropic Effect* - *Chronotropic Effect* - *Dromotropic Effect* - **MOA:** - Induces an increase in intracellular sodium - This will drive an influx of calcium in the heart and cause an increase in contractility - Cardiac output increases with a subsequent decrease in ventricular filling pressures - **Examples:** - Lanoxin (Digoxin) is the prototype - **Monitor/Observe:** - Potassium levels (low potassium levels increase its toxicity) - Vitals - hold if HR<60 - Vision changes - S/S of toxicity - Creatine in elderly (increase toxicity risk) - **Special:** - Purple, yellow, green halos in vision - Very narrow therapeutic window (0.5-2 ng/mL) - Take at the same time every day - Used with other drugs (ACE, ARBs, beta blockers) # Anticoagulants - Heparin - **Indications:** - DVT - PE - A-fib - MI - Stroke - Indwelling devices - **Contraindications:** - Epidural catheter - Bleeding disorder - **Side Effects:** - Increased bleeding risk - Petechiae/Bruising easier - Vomiting - Shortness of breath - Chills - **Outcomes:** - Decreased risk for clotting - Prophylaxis - **Examples:** - Heparin IV - **Monitor/Observe:** - S/S of bleeding - PTT - Blood where it shouldn't be - **Special:** - Rotate subQ injection sites - Don't massage the site - **Antidote:** Protamine sulfate - **MOA:** - Inhibits specific clotting factors in the blood to reduce the risk of clotting # Fibrinolytics - Plases TPA - **Indications:** - Acute MI (active) - Ischemic Stroke (active) - DVT - PE - **Contraindications:** - Prior intercranial hemorrhage - Ischemic stroke within 3 months - **Examples:** - Alteplase - Reteplase - **Monitor/Observe:** - Neuro changes - S/S of bleeding - Adverse effects - **Special:** - Timely administration - Bleeding in gums and blood in stool can be a sign of a bleeding - TPA must be administered within 3 hours - **Must be administered in a controlled setting** - **Side Effects:** - Increased risk of bleeding - Including intercranial hemorrhage - Reperfusion injury risk - Potential damage to tissues due to sudden reperfusion - **Outcomes:** - Breakdown of existing blood clots - **MOA:** - Thrombolytics break down existing blood clots by activating the body's natural fibrinolytic system, which involves the conversion of plasminogen to plasmin - a substance that breaks down fibrin (a component of clots) to reestablish blood flow # Cholesterol Absorption Inhibitor (Antilipidemic) - **Indications:** - Increased LDL - **Contraindications:** - Liver disease - **Side Effects:** - Diarrhea - Abdominal pain - Headache - Muscle pain - **Outcomes:** - Increase in HDL and a decrease in LDL - **MOA:** - Cholesterol absorption inhibitors, such as ezetimibe (Zetia), work by inhibiting the absorption of dietary cholesterol in the small intestine. - **Examples:** - Ezetimibe (Zetia) - **Monitor/Observe:** - Liver function - Any signs of gallstones - Any unexpected pain - **Special:** - Give with food - Benefit vs risk drug - Don't use when pregnant or breastfeeding - Ok to take with statins - Fibrates may increase the risk of gallstones # Antilipidemics - HMG reductase inhibitors - **Indications:** - Increased LDL - **Contraindications:** - Poor liver function - Chronic muscle pain - Alcohol misuse - **Side Effects:** - Muscle pain - Rhabdomyolysis - Rapid muscle breakdown - Increased liver enzymes - GI issues - **Outcomes:** - Decrease in LDL and an increase in HDL - **MOA:** - Statins inhibit the enzyme HMG-CoA reductase, which plays a key role in cholesterol synthesis in the liver. By reducing cholesterol production they lead to lower hand cholesterol levels. - **Monitor/Observe:** - Liver function - Blood pressure - HDL and LDL levels - **Special:** - Grapefruit juice increases side effects - Takes a while to work - Avoid taking antifungals - Muscle pain is not good - **Examples:** - Simvastatin - Atrovastatin # Bile Acid Sequestrants - **Indications:** - Increases LDL levels - **Contraindications:** - GI issues - Liver or gallbladder issues - Biliary obstruction - **Side Effects:** - GI issue such as... - Bloating - Constipation - Belching - **Outcomes:** - Decreased LDL and increased HDL - **MOA:** - Interfears with the absorption of fat-soluble vitamins - Bile acid sequestrants bind to bile acids in the intestines preventing their reabsorption. This leads to increased excretion of bile acids, which the liver replaces by using cholesterol, thereby lowering blood cholesterol levels. - **Monitor/Observe:** - Vitamin levels (check for deficiencies) - Lipid levels - 1+0 for constipation - Liver function - **Special:** - Comes in a powder format - Interferes with fat-soluble vitamin absorption - Administer other meds 1 hour before or 4 hours after bile acid sequestrants. - Can be taken with statins - **Examples** - Colesevelam (Welchol) - Cholestyramine (Questran) # Anticoagulants - Warfarin - **Indications:** - DVT - PE - A-fib - MI - Stroke - Indwelling devices - **Contraindications:** - High vitamin K diet - Ginko - Lots of garlic and ginger - **Side Effects:** - Increased bleeding risk - Petechiae - Dizziness - Headache - Nausea - **Outcomes:** - Decreases risk of blood clots - **MOA:** - Inhibits specific plotting factors in the blood to reduce the risk of clotting - **Monitor/Observe:** - S/S of bleeding - INR - **Special:** - **Antidote:** Vitamin K - Avoid foods high in Vitamin K unless for toxic levels - Avoid lots of garlic, ginger, and ginko - **Examples:** - Warfarin # Antiplatelet - **Indications:** - Blood clots - Cardiac protection - **Contraindications:** - Reyes Syndrome - Bleeding issues - Surgery - **Side Effects:** - Increased bleeding risk - Increased bruising risk - GI upset - Ulcers - **Outcomes:** - Decreased clotting risk - Prevention of TIAs and MIs - **MOA:** - Antiplatelet agents prevent platelets from clumping together, reducing the risk of blood clot formation. They do so by inhibiting the activation of platelets or interfering with their ability to stick to each other. - **Monitor/Observe:** - S/S of bleeding - New bruises - 1+0 - Blood where it's not supposed to be - **Special:** - Don't give aspirin to kids - Consistent dosing - NOT given for A-fib - **Examples:** - Aspirin - 81 mg - Clopidogrel (Plavix) # Crystalloids - **Indications:** - Dehydration - Acute nephrosis - Fluid maintenance - Promote urinary flow - Fluid overload - **Contraindications** - Hypotonic (low electrolyte levels) - Hypertonic (high electrolyte levels) - Fluid overload - **Side Effects:** - Edema - Peripheral and pulmonary - Dilute plasma proteins - Prolonged infusions may worsen acidosis or alkalosis - **Outcomes:** - **Isotonic:** Increase fluids and treat dehydration without any electrolyte imbalances - **Hypotonic:** Cellular rehydration, decrease electrolyte loss - **Hypertonic:** Increase electrolyte levels - **MOA:** - Maintains the osmotic gradient between extravascular and intravascular compartments - **Examples:** - **Hypotonic:** - Normal saline 0.9% - Half and Quarter normal saline 0.45% + 0.25% - **Hypertonic:** - 3% and 5% sodium chloride - **Monitor/Observe:** - Vitals - Electrolyte levels - S/S of fluid overload - **Special:** - Prolonged infusion may worsen acidosis/alkalosis # Colloids (Contains Albumin) - **MOA:** - Increase colloid oncotic pressure - Moves fluid from interstitial compartment to plasma compartment in vessels (when plasma protein levels are low) - **Indications:** - Treating dehydration - Shock - Burns - Hypoalbuminemia - **Adverse Effects:** - Can alter coagulation system through dilution leading to bleeding - Dextran can cause anaphylaxis or renal failure (special) - **Examples:** - Albumin 5% and 25% - From human donors - Dextran 40, 70, or 75 - A glucose solution - Hetastarch - Synthetic, derived from cornstarch # Blood Products - **Indications:** - Increased clotting factors - Increasing O2 sat - Replaces up to 25% of total blood volume loss - Extreme blood loss over 25% - Increased hemoglobin - **Contraindications:** - Incompatibility - Can lead to an immune response (anaphylaxis) - **Side Effects:** - Fever - Chills - Urticaria (itching) - **Outcomes:** - Increased tissue oxygenation - Increased RBC production - Increased colloid osmotic pressure - Decreased fatigue - **MOA:** - Increase COP (colloid oncotic pressure) - Move fluid from interstitial compartment to plasma compartment in vessels (when plasma protein levels are low) - **Examples:** - Fresh frozen plasma - Packed RBCs - Whole blood - **Monitor/Observe:** - CBC - O2 sat - **Special:** - Cardiac output - Plasma volume - Clotting factors - Fresh frozen plasma or anything from a human donor is the most expensive and least available. - Blood types HAVE TO be compatible # Anemia Drugs - **Indications:** - Epoetin alfa stimulates RBC production - Iron deficiencies (give iron) - Folic acid deficiencies (give folic acid) - Pernicious anemia (give vitamin B12) - **Contraindications:** - Allergies - Surgeries - Alcohol abuse - Some antacids - Calcium with iron administration - **Side Effects:** - Constipation - Stomach cramps - HTN - Diarrhea - Headache - Rash - Bone pain - Injection site irritation - Fatigue - **Outcomes:** - Increased blood production - Increased fetal development - Decreased fatigue and headache - Increased well-being and nutrition - **Examples:** - Erythropoieses (stimulating agent) - Iron, folic acid, epoetin alfa - Vitamin B12, cyanocobalamin - **Monitor/Observe:** - Iron levels - Fetal development - H&H labs - 1+0 - Neurological status - **Special:** - Vitamin B12 has to be given IM - Iron mimics GI bleeds - black tarry stools - Epoetin alfa is given with iron - Take vitamin C to increase effects - Avoid calcium at med time - Take iron with food - Eat iron-rich foods - **Iron:** - Vitamin C = YES - Calcium = NO # Antidysrhythmic Drugs - **Indications:** - Dysrhythmias - A-fib - V-fib - Tachyddysrhythmias - **Contraindications:** - 2nd or 3rd degree AV block - Acute MI - Pulmonary congestion - **Side Effects:** - Dizziness - Headache - Blurred vision - Prolonged QT interval - Dysrhythmias (fix one cause another) - **Outcomes:** - Return of normal sinus rhythm - **Monitor/Observe:** - ECG - BP - HR - INR when talking amiodarone and warfarin (how long you take to clot) - **Special:** - No grapefruit juice - Have to be on a heart monitor - May feel discomfort - **Examples:** - Amiodarone (Class 3) - Procainamide (Class IA) - Ditiazem (Class IV) - Adenosine (stops your heart) # H2 Antagonists - **Indications:** - GERD - PUD - Erosive esophagitis - Adjunct therapy - Control GI bleed, Zollinger-Ellison Syndrome - **Contraindications:** - Allergy - Smoking - Renal/ Liver disease - **Side Effects:** - Confusion and disorientation in the elderly - Impotence - Gynecomastia - Thrombocytopenia - **Outcomes:** - Suppresses acid secretion in the stomach - Relieves GERD, PUD, and heartburn - **Monitor/Observe:** - Vitals - Liver function - Renal function - Observe 1+0 - GI discomfort - Administer 1-2 hours before antacids - **Special:** - Administer 1-2 hours before antacids - Encourage patients not to smoke - **Examples:** - Cimetidine (Tagamet) - Famotidine (Pepcid) - Ranitidine (Zantac) # Proton Pump Inhibitors - **Indications:** - Ulcers (stress, short term, NSAID induced) - H pylori induced - GERD, erosive esophagitis - Zollinger-Ellison syndrome - **Contraindications:** - Warfarin - Allergy - Pregnancy - Digoxin use (interaction) - **Side Effects:** - C diff - Osteoporosis - Pneumonia - **Outcomes:** - Less ulcers (decreased pain) - Less GI bleeding - Less heartburn - **Monitor/Observe Special:** - Liver labs - Bowel sounds and bleeding - Can be given through an NG tube (make sure it's not clogged) - Increased risk of C diff - Take with an antibiotic if it's for H pylori - **Examples:** - Lansoprazole (Prevacid) - Omeprazole (Prilosec) - Pantoprazole (Protonix) - Esomeprazole (Nexium) # Laxatives - **Indications:** - IBS - Chronic constipation - Acute constipation - Surgical & diagnostic prep - **Contraindications:** - Gl block - Renal insufficiency - Electrolyte imbalances - Dehydration - Chronic GI issues - **Side Effects:** - Electrolyte imbalances - Impaction - Skin rashes - Esophageal blockage - Lipid pneumonia - Abdominal bloating - Diarrhea - Nutritional malabsorption - **Outcomes:** - Increased water absorption - Bowel distention, increased peristalsis, and evacuation - Lubricate the fecal material and intestinal walls - **Monitor/Observe:** - Electrolytes - 1+0 - **Special:** - Should be taken with water, not juice or milk - **Examples:** - **Bulk forming:** - Psyllium (Metamucil) - **Emollient:** - Colace, Surfak - **Hyperosmotic:** - Lactulose - **Saline:** - Magnesium hydroxide - Milk of Mag - **Stimulant:** - Bisacodyl # Antacids - **Indications:** - Acute symptom relief of... - Peptic ulcers - Gastritis - Gastric hyperacidity - Heartburn - **Contraindications:** - Renal failure - Electrolyte imbalances - GI obstruction - **Side Effects:** - Constipation - Diarrhea - Kidney stones - Rebound Hyperacidity - Gas and belching - Metabolic alkalosis - **Outcomes:** - Neutralized stomach acid - **Monitor/Observe:** - Vitals - 1+0 - Pain levels - Make sure to give with water - **Special:** - Shouldn't be given to HF or HTN patients - **Examples:** - Aluminum salts - Basaljel - Magnesium salts - Milk of magnesia - Calcium salts - Tums - Sodium bicarbonate # Antidiarrheals - **Indications:** - Diarrhea - **Contraindications:** - GI obstruction - Narrow angle glaucoma - Paralytic ileus - Toxic megacolon - Allergy and drug interactions - **Side Effects:** - Increased bleeding time - Constipation - Dark stools - Confusion - Hypotension - Flushing - **Outcomes:** - Reduced pain - Decreases peristalsis - Fluid and electrolyte labs are normal - Reduced gastric secretions - **Monitor/Observe:** - Vitals - Fluid volume - 1+0 - Color of stool - Consistency and frequency - **Special:** - Be careful with older patients as this may cause confusion - **Examples:** - **Absorbent (mild):** - Pepto-bismol - **Antimotility (moderate):** - Anticholinergics - **Opiates:** - **Probiotics (antibiotic induced):** - BACID # Antimetic / Antinausea - **Indications:** - Nausea and vomiting - **Contraindications:** - Allergy - Pregnancy - **Side Effects:** - "Drying" effect - Headache - Dizziness - **Outcomes:** - Decreased nausea and vomiting - **MOA:** - Works on the vomiting center and CTZ to reduce nausea and vomiting - **Monitor/Observe:** - Frequency of nausea and vomiting - Vitals - Fluid and electrolytes - **Special:** - Given 30-60 min before chemo - Long term use can lead to tardive dyskinesia - **Examples:** - Anticholinergics - Antihistamines - Serotonin blockers - Tetra-hydrocannabis # Diuretics ## Fluid/HTN(HF) Up Reg Asterload - **Loop:** - Loop of Henle - Ex: Furosemide - SFX: Hypok. Deny dehydration - Ototoxic - ringing of ears - IV push SLOWLY! - **K+ wasting:** - **Thiazide:** - Distal Convoluted Tubule - Ex: Hydrochlorothiazide - SFX: Hypok. Dehydration - **Alclosterone Antagonist** - Distal Convoluted & Collecting duct. - Ex: Spironolactone - L: K+ Sparing - SFX: HyperK, Dehydration - **Osmotics:** - Proximal Convoluted Tubule - Ex: Mannitol, Urea - Indications: Cerebral edema - SFX: Pulm. Congestion