PHARMA-Compre.pdf

MODULE 1 TOPIC 1: » Usually for patient that takes pain medication. FUNDAMENTAL CONCEPTS OF PHARMACOLOGY Cumulative Effect Term » Increasing response to the re...

MODULE 1 TOPIC 1: » Usually for patient that takes pain medication. FUNDAMENTAL CONCEPTS OF PHARMACOLOGY Cumulative Effect Term » Increasing response to the repeated doses of a Drugs drug The effect of one alcohol bottle hasn’t worn off yet, and you drink another one. » Chemicals which when absorbed, exhibit specific response or action Is alcohol a Food or a Drug? » Come from the Dutch word “droog”, meaning Alcohol is classified as a Central Nervous System dried plant. Depressant, which means during alcohol slows down Pharmacology brain functioning, neural activity and further reduces the functioning of various vital functions of the body. » Science which is concerned with the history, Drug Abuse sources, physical and chemical properties of drugs as well as ways in which drugs effect living system » Inappropriate intake of a substance either » Science dealing with actions of drugs on the body continually or periodically Pharmacogenetics Drug Dependence » Study of genetic factors as determinants of drug » Refers to a person’s reliance or a need to take responses drug or substance » 1. Addiction Pharmacognosy » require the substance for a normal functioning » Study of drug derived from natural resources » you can’t live without Pharmacy 2. Habituation » Science of preparing, compounding and » emotional reliance on drug to maintain sense of dispensing medicines well-being; feelings / need / craving for the drug » Places where medicines are compounded or » It’s all in the mind dispensed. Controlled Drug Toxicology » Drugs that affect the mind or behavior which can » Study of harmful effects of drugs on living tissues be dispensed only with a prescription » Field of science that helps us under the harmful » Marijuana can help with Alzheimer’s effects that chemicals or substances can have on Idiosyncratic people, animals, and the environment » Drug reaction is different from what is expected Posology » Liver doesn’t function well, no absorption paracetamol to lower down fever but result is fever increased » The study of dosage or amount of drugs given in Drug Interaction the treatment of disease Therapeutic Effect »Effect of one drug are modified by the prior or concurrent administration of another drug » Desired or primary Drug Antagonism » Response after a treatment (paracetamol = fever) Side Effect » Conjoint effect of 2 drugs is less that the drug » Unintended; secondary effect acting separately » Adverse/undesirable effects (cetirizine = drowsiness) Summation Drug Allergy » The combined effect of 2 drugs produces a result » Immunologic reaction to a drug that equals the sum of the individual effect of each agent » Urticaria – itch Synergism » Hives – rash Anaphylactic Reaction » The combined effect of 2 drugs is greater than the sum of each individual agent acting separately » A severe reaction that usually occur immediately Potentiation following the drug administration Anaphylaxis – severe allergy reaction, life - threatening » The concurrent administration of 2 drugs in which Drug Tolerance one drug increases the effect of the other drug Drug’s General Properties » Decreased physiologic response to the repeated » Drugs do not confer any new function on a administration of a drug or chemically related tissue/organ in the body substance » Drug exert multiple actions rather that a single » Diminish response over course of repeated or prolonged exposure. effect (therapeutic/toxic) PREPARED BY: MEAGAN M.  » Drug interaction result from a physiochemical » Patient and insurance companies prefer generic drugs interaction between the drug and a functionally – help decrease cost of drug important molecule in the body Brand Name (synergism/ summation/potentiation) – drug commercial which may vary Therapeutic Actions Therapeutic Equivalent Palliative » Same chemical composition » Relieves the symptoms of a disease but does not » FDA conduct studies affect the disease itself Cancer patient who is in pain. You give medication to stop the pain, but does not treat cancer. » Generic drug is interchangeable with brand name drug Curative General Terms » Treat a disease or condition » Chemical Similarity Antibiotic – You give antibiotic to treat bacterial infection. » Biological Effect or Use Supportive (supplement) » Physiologic or Chemical Action » Sustains body function until other treatment of the body’s response can take over Females who menstruate. Prone for iron deficiency take iron supplements until body has enough Substitutive » Replaces body fluids or substances (IV Fluids) IVF color coding » Green – PNSS » Dark Blue – PLR How Drugs Are Classified? » Orange – D5NM (OB) Legal Classification » Pink – LR » Red – D5H20 » OTC/Non-prescription Drug Chemotherapeutic (aspirin, ibuprofen, paracetamol) » Destroys malignant cells » Prescription Drug (with medical prescription; metformin, albuterol, atorvastatin) Restorative » Illegal or Recreational Drugs » Returns the body to health (vitamins) (addictive; cannabis, cocaine, psychedelics) Categories of Drug Action IMPORTANT! Stimulation ✓ Learn drug by categories » Rate of cell activity or secretion is increased ✓ Don’t learn each drug individually Depression Prototype » Rate of cell activity or secretion is reduced » Drug providers commonly prescribed Replacement » Drug administration table » Replaces essential body compound, etc. Inhibition MODULE 1 TOPIC 2: » Killing or destroying organism MAJOR AREAS OF PHARMACOLOGY Irritation Pharmacokinetics » E.g. laxatives irritate the inner wall of the colon » Study of the processes of drug ADME increasing peristalsis and defecation Pharmacodynamics How are Drugs Classified? » Study of the biochemical and physiological Specific Names effects of the drugs as well as their MOA ampicill4-Thia-1-azabicyclo (3.2.0) heptane-2- Pharmacotherapeutics carboxylic acid, 6[(aminophenylacetyl) amino)]-3,3- » Study of how drugs may be used in the treatment dimethyl-7-oxo in Ampicin of the disease » Ampicillin – generic Pharmacokinetics » Ampicin – brand name Absorption – taken into the body Example: Distribution – move into the various tissues » Amblodipine – antihypertensive Metabolism/Biotransformation – changed into » Olol – betablocker a form that can be excreted » Zole - acid Excretion – removed from the body Generic vs. Brand Name Absorption Generic » The process by which drug passes from its site of » company develops drug and gives its official name administration into the bloodstream » Are usually cheaper than brand or trade name drugs » Factors affecting drugs absorption: PREPARED BY: MEAGAN M.  blood flow Excretion pain, stress, food (some medications are taken with/without food) » The primary process by which drugs are eliminated exercise from the body nature of absorbing surface » Drugs can be excreted by the kidneys, intestine, solubility of the drug lungs, mammary, sweat and salivary glands pH » Factors affecting renal excretion: drug concentration dosage form GFR Types of Absorption Tubular secretion rate Urine pH » Passive (happens through the transpiration) ↑-↓M Decreased blood flow to the kidneys » Active (solute/solvent against concentration gradient that require energy)↑-↓M Other drugs » Pinocytosis (cell takes in the fluids along with dissolved small molecules) Blood concentration levels Different Site of Absorption in GIT Half-life » Mouth or oral cavity Old Age and Drug » Stomach » Altered memory » Small intestine » Less acute vision Hepatic first pass/first pass effect » Decreased renal function ✓ only when you give medication orally » Less complete and slower absorption from the ✓ pass in the hepatic first pass / metabolized by the gastrointestinal tract liver (reduction in the concentration of drugs) » Increased proposition of the fa to lean body mass Distribution » Decreased liver function » The transportation of a drug from its site of absorption » Decreased organ sensitivity to its sites of action » Altered quality of organ responsiveness » Factors affecting drug absorption Pharmacodynamics Circulation (the slower blood flow, the slower distribution) Mechanism of Action (MOA) Permeability of cell membrane (barrier) » Explanation of how a drug produces its effect Plasma protein binding Bioavailability Indication percentage of the administered drug dose that » Intended use(s) of any drug reaches the systemic circulation Contraindication Metabolism » Refers to the situation or circumstance when a » Biotransformation of detoxification a sequence of particular drug should not be given chemical events that change a drug to a less active Maintenance Dose form after it enters the body » Exact amount of a drug that is administered to » Principal site is the liver maintain drug blood level in the therapeutic range SGTP - test to examine liver activity Loading Dose (pt w/ maintenance monitor every 6 months) » A large initial dose given to achieve immediate Creatinine – kidney absorption drug effect » Hepatic first pass effect Potency » Factors affecting drug metabolism » A measure of the strength of a drug required to Age produce a specific response Nutrients Amount of major body hormones Receptor Site Liver disease » Specific location on a cell membrane or within the Outcome of Metabolism cell where a drug attaches to produce an effect » Increased renal excretion of medication Receptor Theory » Inactivation of medications » Drugs act through receptors by binding to the » Increased therapeutic effects receptor site to produce or initiate and to block or » Activation of pro-medications (also called pro- prevent a response drug) into active forms Medication is the key and receptor is the lock. When the lock and key, medication either produces an effect or blocks the » Decreased toxicity when active forms of effect depending on the medication. medications become inactive forms » When the medication is given to the patient, » Increased toxicity when inactive forms of when it sticks to the receptor site, it will either medications become active forms open the key or could not open it outcomes depend on the function of the liver PREPARED BY: MEAGAN M. Agonist measures the margin of safety of a drug » Drugs that stimulate or produce a response; expressed as the ratio of LD50 to ED50 » Has 2 properties; Affinity (attached to receptors) therapeutic ratio = LD50/ED50 Efficacy (creates an effect) therapeutic range or window: range of plasma Antagonist concentration that produces the desired effect » Drug that block or do not stimulate a response without toxicity To calculate: multiply lethal dose to expected dose. Competitive Antagonist Pharmacotherapeutics » When both agonist and antagonist drug are given Acute Therapy together, they may compete with each other for » if the patient is critically ill and requires acute the same receptor site intensive therapy Partial Agonist Empiric Therapy » Act as agonist and antagonist, with limited affinity » based on practical experiences rather than on to receptor sites pure scientific data Onset, Peak, Duration » paracetamol not effective change to IV Onset Maintenance Therapy » The time it takes to reach the minimum effective » for the patients with chronic conditions that don’t concentration (MEC) after a drug is administered resolve Peak Supplemental or Replacement » Occurs when the drug reaches its highest blood » to replenish or substitute for missing substances or plasma concentration Supportive Duration » does not treat the cause of the disease but » The length of time the drug has a pharmacologic maintains other threatened body systems until effect the patient’s conditions resolves Dose Response and Maximal Efficacy Palliative » Dose response is the relationship between the » used for end-stage or terminal diseases to make minimal versus the maximal amount of drug dose the patient as comfortable as possible needed to produce the desired drug response » cancer and HIV » Some patients respond to a lower drug dose, other need a high drug dose to elicit the desired MODULE 1 TOPIC 3: response PRINCIPLES IN DRUG ADMINISTRATION » All drug have maximum drug effects (maximal efficacy) Important Things to Remember! Receptors » Observe the 12 Rights » Most are protein in structure and are found on » Practice asepsis cells » Nurses who administer medication are » Drug binding sites are primarily on protein, responsible for their own actions glycoproteins, proteolipids and enzymes » Be knowledgeable about the medications that » The “ligand binding domain” is the site on the you administer receptor in which drugs bind Side Effects, Adverse Reaction and Toxic Effects » Keep narcotics and barbiturates in locked place Side Effects: physiologic effects not related to » Use medications that are in clearly labeled the drug’s desired effect; all drugs have side containers effects, desirable or not 10 Right of Giving Medication Adverse Reactions: more severe than side 1. Right Client effects; range of untoward effects of drugs that » Verify clients’ identification before each cause mild to moderate side effects including medication administration. anaphylaxis; always undesirable » Acceptable identifiers include the client’s name, Toxic Effects or Toxicity: can be identified by an assigned identification number, telephone monitoring the plasma (serum) therapeutic range number, birthdate, or another person-specific of drug identifier, such as a photo identification card. Therapeutic Index » Check identification bands for name and the relationship between a drug’s desired identification number. therapeutic effect and its adverse effect PREPARED BY: MEAGAN M.  » Check for allergies by asking clients, looking for » To individualize the teaching, determine what the an allergy bracelet or medal, and reviewing the clients already know about the medication, need MAR. Use bar-code scanners to identify clients. to know about the medication, and want to know 2. Right Medication about the medication » Correctly interpret medication prescriptions, 8. Right to Refuse verifying completeness and clarity. » Respect clients’ right to refuse any medication. » Read medication labels and compare them with » Explain the consequences, inform the provider, the MAR three times: before removing the and document the refusal. container, when removing the amount of 9. Right Assessment medication from the container, and in the » Collect any essential data before and after presence of the client before administering the administering any medication. medication. » For example, measure apical heart rate before » Leave unit-dose medication in its package until giving digoxin administration. 10. Right Evaluation 3. Right Dose » Follow up with clients to verify therapeutic effects » Use a unit-dose system to decrease errors. If not as well as side and adverse effects. available, calculate the correct medication dose. Sources of Drug Information » Check a drug reference to ensure the dose is Drug Handbook within the usual range. » Medical reference text commonly used in practice » When performing medication calculations or by health professionals conversions, have another qualified nurse check Physician’s Desk Reference (PDR) the calculated dose. » Commercially published compilation of » Prepare medication dosages using standard manufacturer’s prescribing information (package measurement devices insert) on prescription drugs, updated annually 4. Right Time Package Insert » Administer medication on time to maintain a » Prescribing information; a document provided consistent therapeutic blood level. along with a prescription medication to provide » It is generally acceptable to administer the additional information about a drug medication 30 min before or after the scheduled Nursing Journal time. Refer to the drug reference or the facility’s » A magazine or periodical, especially one policy for exceptions. published by a nursing specialist or professional » Give priority to time-critical medications that must body of nurses containing information and act at specific times (preoperatively). contributions relevant to nursing 5. Right Route Medical Letter » Select the correct preparation for the route the » A scientific journal that provides independent provider prescribed. evaluations of drugs based on novel information » Always use different syringes for enteral and Monthly Index of Medical Specialist (MIMS) parenteral medication administration. » Contains information about drugs in a certain » Know how to administer medication safely and country; serves as medical advertising medium correctly. Legal Aspects of Drug Administration 6. Right Documentation USA » Immediately record the medication, dose, route, Food, Drug and Cosmetic Act (1938) time, and any pertinent information, empowered a governing body, the Food and Drug » including the client’s response to the medication. Administration (FDA) to monitor and regulate the Document the medication after administration, manufacture and marketing of drugs not before. FDA’s responsibilities include ensuring that all » For some medications, in particular to those drugs are tested for harmful effects, have labels that alleviate pain, evaluate the client’s response with accurate information, and enclose with the and document it later, perhaps after 30 min. drug packaging detailed literature that explains 7. Right Education adverse effects » Inform clients about the medication: its » purpose, what to expect, how to take it, and what to report. PREPARED BY: MEAGAN M. Durham-Humphrey Amendment to the 1938 Act (1952) Legal Aspects of Drug Administration distinguished drugs that can be sold with or Canada without prescription and those that should be Food and Drug Act (1953) refilled without a new prescription states that no drug, food, cosmetic nor medical Kefauver-Harris Amendment (1962) device can be fraudulently advertised or sold to made statements about adverse reactions and the public for use contraindications; introduced drug-testing Narcotic Control Act (1982) methodologies similar to US Controlled Substance Act; the act tightened controls on drug safety, especially requires prescriptions and strict record keeping experimental drugs and required that adverse for all narcotics reactions and contraindications must be labeled Philippines and included in the literature* Dangerous Drugs Act (2002) RA 9165; Controlled Substances Act (1970) (1972) RA 6425 categorized controlled substances based on their states that sale, administration, delivery, abuse potential distribution and transportation of prohibited drugs offered manufacturers incentives to develop are punishable by law* drugs for rare disorders that have limited market Generics Act (1988) RA 6675 designed to remedy the escalating problem of promotes, requires, and ensures identification of drug abuse medicines by their generic names** Provisions: Cheaper Medicines Act (2008) RA 9502 » promotion of drug education and provides for cheaper and quality medicines research into the prevention and Nursing Law (2002) RA 9173 treatment of drug dependence focuses on independent and coordinated function » strengthening of enforcement authority of the nurse pertaining to the application and » establishment of treatment and execution of written legal orders of physician rehabilitation facilities concerning treatment and medication » designation of schedules or categories Pregnancy Categories for Drugs for controlled substances according to Category A abuse liability no risk for fetus; studies have not shown evidence Schedules of Controlled Substances of fetal harm Schedule I Category B » high potential for abuse and with no currently insufficient data to use in pregnancy; no risk in accepted medical use animal studies; assumed there is little to no risk Schedule II in pregnant women » high potential for abuse with currently accepted Category C medical use; can lead to strong physical and benefits of the medication could outweigh the psychological dependence risks; animal studies indicate a risk to fetus; Schedule III controlled studies on pregnant women are not » high potential for abuse; requires a new available prescription after 6 months or 5 refills; medically Category D accepted drugs but may cause dependence risk to fetus exists but the benefits of the Schedule IV medication could outweigh probable risks; could » low potential for abuse compared to the first be used in life-threatening conditions three; abuse may lead to limited physical or Category X psychological dependence; medically-accepted avoid use in pregnancy or those who may be drugs pregnant; potential risks to the fetus outweigh the Schedule V potential benefits » low potential for abuse; dispensed as any other prescription or without prescription if the law allows; medically-accepted drugs with limited potential for dependence PREPARED BY: MEAGAN M. MODULE 2 TOPIC 1 » cough is nonproductive and irritating DRUGS ACTING ON THE RESPIRATORY SYSTEM » Major Antitussives: Antihistamines benzonatate, codeine, dextromethorphan, hydrobromide, » H1 blockers or antagonists hydrocodone bitartrate (It doesn’t allow the release of histamine, if it doesn’t allow histamine 3 types of Antitussives release, there is decrease in nasopharyngeal) » Nonnarcotic - action is direct in respiratory tract » Decrease nasopharyngeal secretions by blocking » Narcotic - direct action to the medulla the H1 receptors. » Combination Preparations » Commonly used to treat colds, allergic rhinitis but Pharmacokinetics not useful in emergency situations like Dextromethorphan anaphylaxis » is available in syrup or liquid form, chewable and » Rapidly absorbed in 15 minutes lozenges in numerous cold and cough remedy 2 Classification of Antihistamines preparations (Lozenges: the candies e.g., Strepsils) 1st Generation Antihistamines » rapidly absorbed and exerts its effects 15- 30 ✓ Cause drowsiness, dry mouth and other minutes after oral administration anticholinergic symptoms » unknown protein binding percentage and half- ✓ Diphenhydramine (Benadryl) OM or IV life 2nd Generation Antihistamines » metabolized by the liver and excreted by the ✓ Non – sedating antihistamines because they kidneys have little to no effect on sedation. ✓ Cause fewer anticholinergic symptoms. Pharmacodynamics ✓ Patients should be taught not to drink even » Dextromethorphan suppresses the cough center moderate amount of alcohol and not indicated to in the medulla; however, it does not depress those taking CNS depressants. respiration e.g., cetirizine, fexofenadine, loratadine, azelastine » causes neither physical dependence nor Pharmacokinetics tolerance Diphenhydramine » onset is relatively fast, and duration is 3-6 hours » IM, oral, IV; well absorbed from the GIT; highly » CNS depression may occur if used with alcohol, protein bound (98%) and has an average of half- narcotics, sedative-hypnotics, barbiturates or life of 2-7 hours; antidepressants » metabolized by the liver and excreted as Benzonatate metabolites in the urine - acts by anesthetizing stretch receptors throughout the bronchi, alveoli and pleura Pharmacodynamics codeine, dextromethorphan, and hydrocodone » Diphenhydramine blocks the effects of - suppress the cough reflex by direct action on the histamine by competing for and occupying H1 cough center in the medulla of the brain receptor sites Pharmacotherapeutics » has anticholinergic effects and should not be » Benzonatate relieves cough caused by used by patients with narrow-angle glaucoma Pneumonia, Bronchitis, the common cold, and » sometimes used in sleep-aid products and COPD like Emphysema as an antitussive » can be used during bronchoscopy when the onset is 15 minutes (oral) and immediate (IV & IM); duration is 4- patient needs to avoid coughing 8 hours; can be given bid / tid (8 hours) » narcotic antitussives (codeine and hydrocodone) » can cause CNS depression if taken with are used to treat intractable cough usually alcohol, narcotics, barbiturates or hypnotics associated with lung cancer Side Effects Antitussive should not be given long term, as these can also hide other » 1st generation: drowsiness, dizziness, fatigue, symptoms for other diseases. It is an OTC drug. If cough is continuous, got to the doctor and ask for antibiotics. and disturbed coordination; anticholinergic effects (dry mouth, urine retention, blurred vision) Drug Interactions To assess coordination: Finger to nose test, six cardinal gaze Codeine and Hydrocodone Antitussives » may cause excitation, an extremely elevated » suppress or inhibit coughing temperature, hypertension or hypotension, and » act on the cough control center in the medulla coma when taken with monoamine oxidase to suppress the cough reflex (MAO) inhibitors PREPARED BY: MEAGAN M.  bronchospasm by relaxing bronchial smooth muscle » onset for oral is 30 minutes; sustained-release Dextromethorphan capsule is 1-2 hours » use with MAOIs may produce excitation, an » duration for oral and IV is 6 hours approximately elevated body temperature, hypotension and and in sustained-release form is 8-24 hours coma Pharmacotherapeutics Codeine » Theophylline and its salts are used to manage » may increase CNS depression when taken with asthma (2nd or 3rd line), chronic bronchitis and other CNS depressants including alcohol, emphysema barbiturates, sedative-hypnotics and Methylxanthines phenothiazines Side Effects Asthma Drugs Methylxanthines » anorexia, nausea and vomiting, gastric pain caused by increased gastric acid secretion, » xanthine derivatives intestinal bleeding, nervousness, dizziness, » bronchodilators used in asthma to dilate the airway; coffee and chocolate are also a bronchodilator headache, irritability, cardiac dysrhythmias, » include theophylline and its derivative salts – tachycardia, palpitations, marked hypotension, aminophylline, theophylline sodium hyperreflexia and seizures » glycinate and oxtriphylline » adverse reactions are more often severe in » stimulate CNS and respiration, dilate coronary children and pulmonary vessels and cause diuresis. » to decrease the potential for side effects, clients Theophylline should not take other xanthines while taking » relaxes the smooth muscles of the bronchi, theophylline bronchioles, and pulmonary blood vessels Other Effects and Interactions by inhibiting the enzyme » toxicity occurs if serum concentration phosphodiesterase resulting in an exceeds 20 mcg/ml increased cAMP which thereby promotes » can cause hyperglycemia, decreased bronchodilation clotting time and rarely leukocytosis » should avoid taking with caffeinated » therapeutic range: 10-20 mcg/ml products because of its diuretic effect has a narrow therapeutic range; should not exceed nor lacking » IV preparations must be administered » prescribed for maintenance therapy slowly as rapid administration causes for clients with chronic stable asthma dizziness, flushing, hypotension, severe and COPDs (COPD is a progressive disease) bradycardia and palpitations. » not prescribed for clients with seizure Pirbuterol disorders, or cardiac, renal or liver » an aerosolized bronchodilator disease. » acts as beta 2 adrenergic receptor agonist to If not treated, if you are a smoker, you may have a heart relax the smooth muscle of the bronchi attack. It could also affect the brain, or lead to stroke » may be used alone or with theophylline or Pharmacokinetics steroid therapy Theophylline (Pirbuterol is considered to be sympathomimetic. It mimics the action » well absorbed after oral administration and from of the sympathetic system) oral liquids and uncoated plain tablets Adverse Reactions: » metabolized by the liver enzymes and readily nervousness, tremors, headache, palpitations, rapid excreted by the kidneys (90%) heart rate, chest pain or tightness, nausea, diarrhea » tobacco smoking increases metabolism thus and dry mouth (more on sympathetic) decreasing the half-life Cromolyn Sodium 7-9 hours non-smokers and older adults have average half-life » prevents the release of histamine and slow 4 – 5 hours smokers and children reacting substances of anaphylaxis by 12 hours patients with CHF, Cor Pulmonale, COPD or liver disease stabilizing the mast cell membrane Pharmacodynamics (More on the preventive asthma medication. When there is the presence of the attack, meaning there is histamine release. » Increases the level of cAMP resulting in Cromolyn sodium is no longer effective) bronchodilation » used primarily to prevent bronchial asthma » Decreases airway reactivity and relieves » not useful in acute asthma attacks or status PREPARED BY: MEAGAN M.  asthmaticus » hydration is the best expectorant » given by inhalation to improve breathing brand names: Robitussin, Anti-Tuss, Glycotuss Adverse Reactions: Pharmacokinetics bronchospasm, sneezing, wheezing, cough, nasal Guaifenesin congestion and throat irritation, dizziness, pain, » is absorbed through the GI tract, metabolized by nausea, headache and skin rash the liver and excreted primarily by the kidneys Mucolytics and Expectorants Pharmacodynamics Mucolytics » Guaifenesin by increasing the production of » liquefy and loosen thick mucus secretions so that respiratory tract fluids, expectorants reduce the they can be expectorated thickness, adhesiveness and surface tension of » act directly on mucus, breaking down sticky, thick mucus making it easier to clear from the airways secretions so they are more easily eliminated » provide a soothing effect on the mucous » most common example is acetylcysteine membranes of the respiratory tract mucolytic and expectorant are always partners Indications Acetylcysteine (Mucomyst) » for the relief of cough from minor bronchial » administered by nebulization » may be administered with bronchodilator for irritation; bronchitis, sinusitis, influenza; bronchial patients with asthma or hyperactive airway asthma and emphysema; other respiratory disease because increased secretions may disorders obstruct the bronchial airways Adverse Reactions side effects: nausea, vomiting, stomatitis (oral ulcers) and “runny nose” » vomiting, diarrhea, drowsiness, nausea, » can be used as an antidote for acetaminophen abdominal pain overdose if given within 12-24 hours after the Drug Interactions overdose ingestion » when administered with anticoagulants, may » other acetylcysteine's can be administered orally increase the risk of bleeding diluted in juice or water. In the Philippines, it is paracetamol MODULE 3 TOPIC 1 Pharmacokinetics DRUGS ACTING ON THE CARDIOVASCULAR SYSTEM Mucolytics Cardiotonic Drugs » inhaled acetylcysteine is absorbed from the pulmonary epithelium Digitalis Glycosides (Digitalis) » when taken orally, it is absorbed from the GIT » inhibit the sodium-potassium pump thus » metabolized in the liver and its excretion is increasing the intracellular sodium leading to the unknown influx of calcium Pharmacodynamics » effects on the heart » positive inotropic action » Mucolytics decreases the thickness of the (calcium enters the heart/increases heart rate) respiratory tract secretions by altering the » negative chronotropic action molecular composition of mucus (block the calcium/decreases heart rate) Dornase Alfa » negative dromotropic action » an enzyme that digests the DNA in thick (slows down contraction of heart/block calcium/decreases heart rate) sputum secretions of clients with cystic fibrosis » increases myocardial contractility which Problem in the DNA that secretes thick secretions this is given to liquefy their secretion increases cardiac, peripheral and kidney function » helps reduce respiratory infections and by increasing the cardiac output, decreasing improves pulmonary functions preload, improving blood flow to the periphery » improvement occurs in 3-7 days and kidneys, decreasing edema and increasing side effects: chest pain, sore throat, laryngitis and hoarseness fluid excretion. Expectorants » used to correct atrial fibrillation and atrial flutter. » thin mucus so it’s cleared more easily out of Digoxin (Lanoxin) airways » absorption in oral form is >70%; 90% in liquid » soothe membranes in the respiratory tract form and 90-100% in capsule form » loosen bronchial secretions so that can be » protein binding power is low, but half-life is 36 eliminated by coughing hours* » most common example is guaifenesin » 30% is metabolized in the liver and 70% is PREPARED BY: MEAGAN M.  excreted by the kidneys mostly unchanged cardiac dysrhythmias » kidney dysfunction can affect excretion and Pharmacokinetics thyroid dysfunction can alter metabolism » inamrinone is administered IV, distributed rapidly Digitalis Glycosides metabolized by the liver and excreted by the Pharmacodynamics kidneys » failing heart: increases myocardial contraction, » milrinone is administered IV and is distributed which increases cardiac output and improves rapidly and excreted by the kidneys, primarily as circulation and tissue perfusion; decreases unchanged drug conduction through AV node, thus decreasing Pharmacodynamics heart rate » improve cardiac output by strengthening Therapeutic range contractions 0.5 to 2 ng/ml (digoxin) » help to move calcium in the cardiac cell or to 10 to 35 ng/ml (digitoxin) increase calcium storage in the sarcoplasmic CHF needs lower serum therapeutic level while reticulum higher therapeutic level for atrial flutter and » relax vascular smooth muscle fibrillation » decrease peripheral vascular resistance Digitalis Toxicity (afterload) and the amount of blood returning to » overdose or accumulation of digoxin the heart (preload) S/Sx: anorexia, diarrhea, nausea and vomiting, Pharmacotherapeutics bradycardia, PVCs, cardiac dysrhythmias, » used for the management of heart failure to headaches, blurred visions, visual illusions, patients who haven’t responded adequately to confusion, and delirium treatments with other drugs » older adults are more prone » prolonged use may lead to risk of complications » cardiotoxicity and death antidote: digoxin immune fab (ovine, Digibind) may Drug Interactions be given to treat severe digitalis toxicity » PDE inhibitors reduce serum potassium levels; Drug Interactions taking them with a potassium-wasting diuretic » potent diuretics like furosemide and may lead to hypokalemia hydrochlorothiazide promote the loss of Antianginal Drugs potassium from the body Nitrates » cortisone preparations taken systematically » affect the blood vessels in the venous circulation promote sodium retention and potassium » and coronary arteries causing generalized excretion or loss and cause hypokalemia vascular and coronary vasodilation » patients on potassium wasting diuretics or » reduce myocardial ischemia but can cause cortisone should consume food rich in potassium hypotension or take potassium supplements to avoid » SL tablet absorbed under the tongue has an hypokalemia and digitalis toxicity average dose prescribed of 0.4 mg following » antacids can decrease digitalis absorption if cardiac pain, repeated every 5 minutes for a total taken at the same time of 3 doses Phosphodiesterase Inhibitors » should be kept in their original airtight glass » positive inotropic group of drugs given to treat containers acute HF or when there is no response to the use » patient may experience dizziness, faintness or of other agents headache as a result of peripheral vasodilation » inhibit the enzyme phosphodiesterase after taking a dose of nitroglycerin » inamrinone lactate (Inocor) and milrinone » available in SL preparation, topical (ointment, lactate (Primacor) transderm patch), buccal extended release » increase stroke volume and cardiac output and tablet, oral extended-release capsule and tablet, promote vasodilation aerosol spray (inhalation) and IV forms » administered intravenously for no longer than 48 » types of Organic Nitrates to 72 hours » isosorbide dinitrate (Isordil, Sorbitrate): SL by » ECG and cardiac status should be closely tablets and orally by chewable tablets, immediate monitored since the drug can result to severe release tablets, and sustained-release tablets PREPARED BY: MEAGAN M.  and capsules used as anti-anginal, antidysrhythmic and » isosorbide mononitrate (Monoket, Imdur): orally antihypertensive agents. by immediate-release and sustained-release Divisions tablets. Non-selective beta blockers 4 Types of Angina » block beta 1 and 2 ✓ Stable Angina » decrease pulse rate and cause ✓ Unstable Angina bronchoconstriction propranolol (Inderal), nadolol (Cogard), pindolol (Visken) ✓ Variant Angina Selective beta blockers ✓ Myocardial Angina » decrease the pulse rate; no activity at beta 2 Pharmacokinetics atenolol (Tenormin), metoprolol (Lopressor) » SL nitroglycerin is absorbed rapidly and directly Pharmacokinetics into the jugular vein and the right atrium » well-absorbed orally » 40-50% is absorbed through the GI tract and » half lies: propranolol (3-6 hours); atenolol (6-7 inactivated by the liver metabolism hours); metoprolol (3-7 hours) » Nitroglycerin in Nitro-Bid ointment and in the » half of atenolol is excreted unchanged by the transdermal patch is absorbed slowly through kidneys and half is excreted unabsorbed in the the skin; excreted primarily in the urine feces Pharmacodynamics Pharmacodynamics » Act directly on the smooth muscle of blood » decrease the force of myocardial contraction vessels causing relaxation and dilation leading to reduced oxygen demand by the » Decrease cardiac preload and afterload and myocardium reduce myocardial oxygen demand onset: non-selective (30 mins); selective (60 mins) Onset peak: non-selective (1-1.5 hrs); selective (2-4 hrs) SL and IV: rapid (1-3 minutes) duration: non-selective (4-12 hrs); selective (24 hrs) Transdermal: 30-60 minutes Side Effects and Adverse Reactions Duration » decrease in pulse rate and blood pressure Patch: 24 hours Ointment: 6-8 hours » non-selective: bronchospasm, behavioral response and impotence (Inderal) Side Effects and Adverse Reactions Calcium Channel Blockers » headaches are the most common; but may » relax coronary artery spasm (variant) and relax become less frequent with continued use peripheral arterioles (stable) decreasing cardiac » others: hypotension, dizziness, weakness and oxygen demand faintness » decrease cardiac contractility, decrease » ointment and patch: dose should be tapered afterload and reduce the workload of the heart, over several effects to prevent rebound effect of thus decreasing the need for oxygen severe pain caused by myocardial ischemia » effective in controlling variant (vasospastic) » reflex tachycardia may occur if nitrate is given angina by relaxing the coronary arteries and in too rapidly classic (stable) angina by decreasing the oxygen Drug Interactions demand (verapamil, nifedipine, diltiazem) » beta blockers, calcium channel blockers, Pharmacokinetics vasodilators and alcohol can enhance the » 80-90% is absorbed in the GI mucosa, highly hypotensive effects of nitrates protein bound (80-90%) and half life is 2-6 hours » IV nitroglycerin may antagonize the effects of Pharmacodynamics heparin Beta Blockers » onset: verapamil (10 mins); nifedipine and diltiazem (30 mins) » block beta 1 or both beta 1 and 2 receptor sites. » duration: verapamil (3-7 hrs for oral; 2 hrs for IV); nifedipine and diltiazem (6-8 hours) » decrease the effects to the sympathetic nervous system by blocking the action of Side Effects and Adverse Reactions the catecholamines epinephrine and » headache, hypotension, dizziness and flushing norepinephrine, thereby decreasing heart of the skin, reflex tachycardia secondary to rate and blood pressure. PREPARED BY: MEAGAN M.  hypotension, changes in liver and kidney » guanethidine: decreased heart contractility, function diarrhea, fluid retention, orthostatic hypotension Antihypertensive Drugs » reserpine: abdominal cramps, diarrhea, angina, » Maintenance drugs blurred vision, bradycardia, bronchoconstriction, » Doctor will change first the diet and lifestyle decreased libido, depression, drowsiness, before administering Antihypertensive drugs. weight gain Sympatholytic Drugs Vasodilating Drugs » block the sympathetic nervous system 2 Types » classification by site or MOA Direct Vasodilators – affects artieries and veins. » centrally acting sympathetic nervous system Calcium Channel Blockers – contractions inhibitors: clonidine hydrochloride, guanabenz acetate, guanfacine and methyldopa » decrease the systolic and diastolic blood » alpha blockers: doxazosin mesylate, pressures phentolamine, prazosin hydrochloride and » direct vasodilators act on arteries, veins or both terazosin and include mixed alpha and beta blockers: labetalol hydralazine, hydrochloride, minoxidil, nitroprusside sodium, diazoxide norepinephrine depletors: guanadrel sulfate, guanethidine » calcium channel blockers produce arteriolar monosulfate and reserpine relaxation by preventing the entry of calcium into ✓ Symphatolytic – stop or block the action of the cells symphathetic actions / Pro parasymphathetic meds Veins – towards the heart, Carries Deoxygenated blood, Has Valves ✓ Sympathommetic – Pro symphathetic meds Arteries – away from the heart, Carries Oxygenated blood, No valves Clonidine catapres – not a maintenance / can cause Pharmacokinetics shot up hypertension » most are absorbed rapidly and distributed well » Parasympathetic - acetylcholine » metabolized in the liver and most are excreted Alpha – blood vessels; Beta 1 – heart; Beta 2 – lungs by the kidneys Pharmacokinetics Pharmacodynamics » most are absorbed well from the GIT, distributed widely, metabolized in the liver, and excreted » direct vasodilators relax peripheral vascular primarily in the urine. smooth muscles causing the blood vessels to dilate Pharmacodynamics Pharmacotherapeutics » all types inhibit stimulation of the sympathetic nervous system causing dilation of peripheral » rarely used alone to manage hypertension blood vessels or decreased cardiac output, » calcium channel blockers are occasionally used thereby reducing the blood pressure alone to manage mild to moderate hypertension Pharmacotherapeutics Drug Interactions » beta blockers along with diuretics are the initial » effects of hydralazine and minoxidil are drugs for managing hypertension increased when given with methyldopa or » if BP fails to come under control, an alpha reserpine blocker or an alpha-beta blocker may be used » vasodilating drugs may produce additive effects » if patient fails to respond, the doctor may add a when given with nitrates, such as isosorbide drug from a different class, substitute a drug in dinitrate or nitroglycerin. the same class, or increase the dosage Adverse Reactions Drug Interactions » direct vasodilators commonly produce adverse » Clonidine + TCAs = increased BP reactions related to reflex activation of sympathetic nervous system » Clonidine + CNS depressants = worsen CNS Ace Inhibitors depression » reduce blood pressure by interrupting the renin Adverse Reactions angiotensin aldosterone system » alpha blockers: hypotension » commonly prescribed: benazepril hydrochloride, » centrally-acting drugs: depression, captopril, enalapril, fosinopril sodium, lisinopril, drowsiness, edema, liver dysfunction, quinapril hydrochloride, ramipril numbness, vertigo » guanadrel: DOB, excessive urination, fainting, orthostatic hypotension PREPARED BY: MEAGAN M.  Pharmacokinetics » suppress automaticity (spontaneous » absorbed from the GIT, distributed to most body depolarization to initiate beats) tissues, metabolized somewhat in the liver and Class I: Na Channel Blockers excreted by the kidneys » decrease sodium influx into the cardiac cells Pharmacodynamics » responses to the drug: decreased conduction velocity in cardiac tissues; suppression of » interfere with the RAAS RAAS – renin angiotensin aldosterone system automaticity; increased recovery time Renin to liver to convert angiotensin 1 then converted to angiotensin 2 (repolarization or refractory period) converted by Ace located in lungs to increase BP. IA: slows conduction and prolongs repolarization No convertion No increase in BP. » (quinidine, procainamide, disopyramide) Pharmacotherapeutics IB: slows conduction and shortens repolarization » used alone or with combination with another » (lidocaine, mexiletine hcl) drug such as thiazide diuretics to treat Note: slows heart beat then slow relaxation hypertension IC: prolongs conduction with little to no effect on » commonly used when beta blockers or diuretics repolarization (flecainide) are ineffective Note: rapid heart beat to slow start heart beat Class II: Beta Blockers Drug Interactions » decrease conduction velocity, automaticity and » all enhances the hypotensive effects of diuretics recovery time (refractory period) and other antihypertensive agents like beta » propranolol (Inderal), acebutolol (Sectral), esmolol blockers (Brevibloc) and sotalol (Betapace) » can increase lithium level resulting to toxicity » more frequently prescribed than Class I » can lead to hyperkalemia when used with K- Class III: Drugs that Prolong Repolarization sparing diuretics, K supplements or K containing » prolong repolarization and used in emergency salt substitutes treatment of ventricular dysrhythmias when Side Effects and Adverse Reactions other antidysrhythmic agents are ineffective » primary side effect: constant, irritating cough » bretylium (Bretylol) and amiodarone » others: nausea, vomiting, diarrhea, headache, (Cordarone): increase refractory period dizziness, fatigue, insomnia, tachycardia (recovery time) and prolong the action potential » major AR: hypotension and hyperkalemia duration (cardiac cell activity) Antidysrhythmic Agents Class IV: Ca Channel Blockers » Class I: fast (sodium channel) blockers » verapamil (Calan, Isoptin) and diltiazem » Class IA, IB and IC (Cardizem) » Class II: beta adrenergic blockers » blocks calcium influx, thereby decreasing the » Class III: drugs that prolong repolarization excitability and contractility of the myocardium » Class IV: slow (calcium channel) blockers » increases the refractory period of the AV node ✓ P – atria contracts / atrial depolarization which decreases ventricular response ✓ Q – ventricle contracts/ depolarization » contraindicated for clients with AV block or heart ✓ R – ventricle contracts / depolarization ✓ S – ventricle contracts / depolarization failure ✓ T – ventricular repolarization / relaxation Side Effects and Adverse Reactions Electrophysiologic Properties » quinidine (1st drug used to treat cardiac » Contractility – Contraction of Heart dysrhythmias): nausea and vomiting, diarrhea, » Conductivity – SA and AV Node confusion and hypotension, heart block, » Automaticity (Rhythmicity) – Ability of heart to neurologic and psychiatric symptoms beat » high doses of lidocaine: cardiovascular » Refractoriness depression, bradycardia, hypotension, seizures, » Excitability blurred vision and double vision, dizziness, Mechanisms of Actions lightheadedness and confusion » block adrenergic stimulation of the heart » all is potentially prodysrhythmic » depress myocardial excitability and contractility » decrease conduction velocity in cardiac tissue » increase recovery time (repolarization) of the myocardium PREPARED BY: MEAGAN M. MODULE 4 TOPIC 1 Folic Acid DRUGS ACTING ON THE HEMATOLOGIC SYSTEM » treats folic acid deficiency Hematic Drugs » absorbed rapidly in the first third of the small » Provide essential building blocks for RBC intestine and distributed into all body tissues production by increasing the hemoglobin » metabolized in the liver necessary for oxygen transportation » excess folate is excreted unchanged in the urine RBC – Carries O2, 120 days of life; Hematopoiesis – process of RBC and small in the stool, also in the breast milk Anemia » preventive folic acid therapy: pregnancy, » a clinical condition that results from an undergoing treatment for liver disease, hemolytic insufficient supply of healthy RBCs, the volume anemia, alcohol abuse, skin disease and renal of packed RBC and/or the quantity of failure and cancer hemoglobin Epoetin Alfa Iron » stimulates RBC production » used to treat Iron Deficiency Anemia (IDA) » peak serum levels for SQ occur within 5-24 » ferrous sulfate, ferrous gluconate, ferrous sulfate hours; IV and iron dextran » unknown distribution, metabolism and excretion Pharmacokinetics » boosts the production of erythropoietin » absorbed primarily form the duodenum and » decreased erythropoietin can lead to chronic upper jejunum of the intestine normocytic anemia, necessitating epoetin alfa Pharmacodynamics administration » production of hemoglobin; 80% of iron in the Pharmacotherapeutics plasma goes to the bone marrow where they are » normocytic anemia caused by chronic renal used for erythropoiesis failure Pharmacotherapeutics » anemia associated with zidovudine therapy in » oral iron therapy is used to prevent IDA patients with HIV infection » pregnant women may need supplements to » to decrease the need for transfusion in patients replace the iron used by the developing fetus with certain types of leukemia » parenteral iron therapy (iron dextran): used for Adverse Reactions patients who can’t absorb oral preparations, » Most common is hypertension; others include aren’t compliant with oral therapy or with bowel headache, joint pain, nausea, edema, fatigue, disorders diarrhea, vomiting, chest pain, skin reactions at Drug Interactions and Adverse Reactions the administration site, weakness and dizziness » absorption is reduced by antacid and food Anticoagulant Drugs (coffee, tea, eggs, and milk) Heparin » tetracycline, oxytetracycline, methacycline, » prepared commercially from animal tissue doxycycline, methyldopa, ciprofloxacin, » prevents blood clot formation ofloxacin, chloramphenicol, and penicillin » cannot dissolve already formed clots absorption may be reduced when taken with oral » dalteparin sodium and enoxaparin sodium were iron preparations developed to prevent deep vein Thrombosi in » cimetidine and other H2 receptor antagonists surgical patients may decrease GI absorption of iron » absorbed parenterally » most common adverse reaction: gastric irritation » IV and SQ » darkens the stool and liquid ones can stain the » metabolized in the liver and metabolites are teeth excreted in the urine Vitamin B12 Pharmacodynamics » used to treat pernicious anemia » prevents formation of new thrombi » cyanocobalamin and hydroxocobalamin » inhibits the formation of thrombin and fibrin by » available in oral and injectable forms activating antithrombin III » can get in meat or protein products » antithrombin III inactivates factors IX, X, XI and Pharmacodynamics XII in the intrinsic and common pathways » replaces Vitamin B12 » end result: prevention of stable fibrin clot PREPARED BY: MEAGAN M.  » low dose: increases the activity of antithrombin Antiplatelet Drugs III against factor X and thrombin and inhibits clot » used to prevent arterial thromboembolism, formation particularly in patients at risk for MI, stroke and » large doses: inhibit fibrin formation after a clot arteriosclerosis has been formed » aspirin, dipyridamole, sulfinpyrazone, and » heparin therapy: prolongs blood clotting time, ticlopidine thrombin time and partial thromboplastin time Pharmacokinetics Pharmacotherapeutics » all are taken orally, absorbed very quickly and » Prevention and treatment of venous reach peak concentration between 1 and 2 hours thromboembolism characterized by after administration inappropriate or excessive intravascular » aspirin maintains its antiplatelet effect activation of blood clotting approximately 10 days or as long as platelets » Treatment of disseminated intravascular normally survive coagulation, a complication of other diseases » sulfinpyrazone may require several days of resulting in accelerated clotting administration » Treatment of arterial clotting and preventing Pharmacodynamics embolus formation in patients with atrial » interfere with platelet activity in different drug fibrillation specific and dose-related ways » Prevention of thrombus formation and promotion » low doses of aspirin inhibit clot formation by of cardiac circulation in an acute MI by blocking the synthesis of prostaglandin, thus preventing further at the site of the already preventing the formation of the platelet- formed clot aggregating substance thromboxane A2 » Useful for preventing clotting during orthopedic » dipyridamole inhibits platelet aggregation surgery (DOC) » sulfinpyrazone inhibits several platelet functions Drug Interactions » ticlopidine inhibits the binding of fibrinogen to » acts synergically when taken with oral platelets during the first stage of the clotting anticoagulation cascade » risk of bleeding increases when taken with Pharmacotherapeutics NSAIDs, iron dextran or an antiplatelet drug » aspirin: previous MI or unstable angina to reduce Adverse Reaction the risk of death and in men to reduce risk of TIA » most common is bleeding – can be revered by » sulfinpyrazone: after MI to decrease the risk of administering sudden cardiac death » Andidote: protamine sulfate Drug Interactions Oral Anticoagulants » aspirin + heparin, oral anticoagulants and » major anticoagulants: coumarin compounds dipyridamole = increased risk of bleeding warfarin sodium and dicumarol sulfinpyrazone + aspirin and oral anticoagulants = increased risk of bleeding Pharmacokinetics » Warfarin toxicity antidote: Vit. K » absorbed rapidly and almost completely when Thrombolytic Drugs given orally »“Clot – busting” drugs that break up and » warfarin and dicumarol are both bound dissolve blood clots that get in the way of your extensively to plasma albumin, metabolized in blood flow. the liver and excreted in the urine Pharmacokinetics Pharmacodynamics » IV and intracoronary administration: distributed » Oral drugs alter the ability of the liver to immediately throughout the circulation, quickly synthesize vitamin K dependent clotting factors activating plasminogen including prothrombin and factors VII, IX and X » alteplase is cleared rapidly from circulating Pharmacotherapeutics plasma, primarily by the liver » treat thromboembolism* » anistreplase is metabolized in the plasma » drugs of choice to prevent deep vein thrombosis » streptokinase is removed rapidly from the circulation by the antibodies androgen the Side Effect reticuloendothelial system » primary SE is minor bleeding PREPARED BY: MEAGAN M.  Pharmacodynamics » Absorption of many other drugs that normally are » convert plasminogen to plasmin which dissolves absorbed from the GIT – including tetracyclines – thrombi, fibrinogen, and other plasma proteins also may be decreased Pharmacotherapeutics » patients whose blood cholesterol levels indicate a severe risk of coronary artery disease are most » used to treat certain thromboembolic disorders likely to require one of these drugs to supplement and have also been used to dissolve thrombi in the diet arteriovenous cannulas and IV catheters to Fibric Acid Derivatives reestablish blood flow » produced by several fungi » drugs of choice to break down newly formed » clofibrate and gemfibrozil thrombi » alteplase: acute MI, pulmonary embolism, acute Pharmacokinetics ischemic stroke » absorbed readily from the GIT and are highly » anistreplase: acute MI protein bound » streptokinase: acute MI, pulmonary embolus, » clofibrate is hydrolyzed, and gemfibrozil DVT, arterial thrombosis, arterial embolism and undergoes extensive metabolism in the liver thrombosis » both are excreted in the urine Drug Interactions Pharmacodynamics » interact with heparin, oral anticoagulants, » reduce cholesterol production early in its antiplatelet drugs, and NSAIDs thus increasing formation; mobilize cholesterol from the tissues; the patient’s risk for bleeding increase cholesterol excretion; decrease » antidote: aminocaproic acid inhibits synthesis and secretion of lipoproteins; decrease streptokinase and can be used to reverse its synthesis of triglycerides fibrinolytic effects » gemfibrozil produces other 2 effects: increases Adverse Reactions HDL levels in the blood and the serum’s capacity to dissolve additional cholesterol » bleeding and allergic responses, especially with streptokinase and anistreplase Pharmacotherapeutics Antilipemic Drugs » used primarily to reduce triglyceride levels, Bile-Sequestering Drugs especially very low-density triglycerides, and » cholestyramine and colestipol hydrochloride secondarily to reduce blood cholesterol levels Pharmacokinetics » useful in treating patients with types II, III, IV, and