Walsh's Pharmacology Review PDF - 7/12/23

**[Walsh's Pharmacology Review - 7/12/23]** **[Stains]** - There class is HMG-CoA reductase inhibitors - End with statin - Treat cholesterol and prevent cardiovascular disease in clients with risk factors - HTN - Dm - Smoking - Adverse effect - Rhabdomyol...

**[Walsh's Pharmacology Review - 7/12/23]** **[Stains]** - There class is HMG-CoA reductase inhibitors - End with statin - Treat cholesterol and prevent cardiovascular disease in clients with risk factors - HTN - Dm - Smoking - Adverse effect - Rhabdomyolysis - breakdown of muscle fibers - s/s - Severe muscle pain, weakness and dark urine - Always check lipid AST, ALT prior to starting to determine effectiveness of medications - Do not take if pregnant - What to assess prior to education? - Ability to learn   **[Fibrates]** - Cholesterol medication - Gemfibrozil - Take with food to prevent heartburn - Complication is gallstones - s/s - RUQ pain notify physician   **[Pcsk9 inhibitors]** - They prohibit the pcsk9 protein decreasing the number of LDL receptors in the liver therefore more LDL is excreted from the body, decreasing cholesterol   **[Selective cholesterol absorption inhibitor]** - Ezetimibe - AE - Nasopharyngitis - Upper respiratory infections - Diarrhea - Know normal LDL, HDL, total cholesterol and triglycerides   **[ACE inhibitors]** - \"pril\" - Contraindicated in pregnancy - Do not double dose if your dose is missed   **[Phosphodiesterase enzyme inhibitor]** - Milrinone - Used for heart failure patients usually in ICU it is IV [ONLY] - Inotropic agent - increases contractility therefore increasing cardiac output - AE - Hypotension - Patient needs to be on continuous ECG monitoring - Chronotropic agent - heart rate - Dromotropic agent - electrical conduction   **[Cardiac glycoside]** - Digoxin - Used to treat HF and arrythmias - Lowers HR so you\'d want to hold it for HR less than 60 and notify physician - Must take apical pulse for a full minute prior to admin - Can cause toxicity - s/s - visual disturbances, anorexia, vomiting and fatigue - Antidote - digibind - Anytime you\'re starting a patient on a new med, prior to admin, always assess HR, dysrhythmias, loss of appetite and potassium levels   **[Beta Blockers]** - They end in \"lol\" - Propranolol, metoprolol - Used to treat arrythmias, thyroid storms, PTSD, angina, and HF - Slows HR decrease Bp - always assess prior to admin - Can cause fatigue, weakness, dizziness, and drowsiness - Do not stop abruptly - Use cautiously in COPD patients   **[Antiplatelets]** - Clopidogrel - Assess for bleeding - First indication of bleeding is bruising - assess - PO only - Needs to be stropped prior to surgery - Used in patients with MI, post stent and prevention of strokes - AE - Bleeding gums - Black tarry stools - Flu like symptoms - Petechiae   **[Anticoagulants]** - Warfarin - PT, INR is monitored - Between 2 and 3 for patients on warfarin - Reversal agent is vitamin K - Teach patient not to add or decrease any foods with vitamin K - Green leafy vegetables and bananas - Several drug to drug reactions - Antibiotics - Educate on t - take at the same time each day - Avoid decreasing or increasing vitamin K foods - Need to have regular blood tests to ensure correct dosage - Notify MD of signs of bleeding - Heparin - APTT lab - Titrate to achieve the prescribed APTT - Monitor platelets for HIT - Heparin induced thrombocytopenia - Reversal agent - Protamine sulfate   **[Direct Thrombin Inhibitor]** - Aka DTIs - Dabigatran - Reversal agent - Idarucizumab   **[Factor Xa Inhibitors]** - PO anticoagulant - Tell patient to report any other medication that may inhibit or potentiate this medication; ex: aspirin - These medications are apixabin (eloquis), rivaroxaban - Meds to treat life threatening uncontrolled bleeding (like a reversal) - Andexanet alfa   **[Thrombolytics]** - Clot busters - Alteplase   **[Class III Antiarrhythmics aka potassium channel blockers]** - Amiodarone - Half life is up to 50 days - Used to treat atrial arrythmias - Contraindicated in pregnancy - ensure they have reliable birth control - Decrease HR - adverse effects include blurred vision, photosensitivity and anorexia - Before giving check potassium is within normal     **[Calcium Channel Blockers]** - Verapamil - No grape fruit juice - Used to treat - HTN - Angina - Dysrhythmias   **[Class I B Antiarrhythmic Agent]** - Aka sodium channel blocker - Lidocaine - Black box warning: can cause CNS toxicity - s/s - Confusion and psychosis   **[Class V Antiarrhythmic]** - Adenosine - Push really fast - 10 second half life - Slows conduction through AV node and decreases automaticity of the SA node   **[Crystalloids]** - Can rapidly expand circulating blood volume - Monitor HF s/s f   **[Diuretics]** - Cause polyuria - Loop diuretics - Furosemide - Bumetanid - Monitor potassium (3.5 to 5)   **[Vasodilators]** - Nitroglycerin - Common SE - Headaches - Can be used for exacerbations of HF because it dilates the veins and coronary arteries   **[Hypertensive Emergency]** - Systolic greater than 180 - Diastolic greater than 120   **[Decreasing afterload will improve cardio output in HF patients]**   **[Medications used to tx HF]** - ARBs - \"sartan\" - Beta blockers - \"lol\" - Vasodilator - isosorbide dinitrate   **[Steps to assess an accurate apical pulse]** - Gather supplies - Position stethoscope directly on skin - Listen for a full minute to the apical pulse - Write down results   **[Steps to self-admin subcutaneous heparin]** - Clean the site with alcohol - Inject the needle - Do not pull back on plunger - Do not massage the site   **[Education for a newly dx with hyperlipidemia]** - Most common medication is a statin - May need to be on medication the rest of your life - Could avoid medications with lifestyle changes   **[Advantages of factor Xa inhibitors over warfarin]** - Does not require INR monitoring - Fewer drug to drug interactions - The effect clears in 1 to 2 days after stopping medication