Pharmacology Notes (Cardiovascular System)

**[Cardiovascular System ]** **[Anticoagulants]**\ **Heparin**: Treats clots (Stroke, Chronic a-fib): [Normal aPTT] = 30 -- 40. Risk for bleeding. [Complication] = HIT (discontinue heparin, give platelets). **Antidote** = Protamine Sulfate - **Enoxaparin** = LMW Heparin. DVT prophylaxis. [CAN] b...

**[Cardiovascular System ]** **[Anticoagulants]**\ **Heparin**: Treats clots (Stroke, Chronic a-fib): [Normal aPTT] = 30 -- 40. Risk for bleeding. [Complication] = HIT (discontinue heparin, give platelets). **Antidote** = Protamine Sulfate - **Enoxaparin** = LMW Heparin. DVT prophylaxis. [CAN] be given during pregnancy. **Warfarin**: DVT, PE, A-fb clots. Monitor for bleeding. [Normal INR] = 0.9 -- 1.2. **DO NOT GIVE** during pregnancy. **Antidote** = Vitamin K **Apixaban**: Treats clots. DVT, PE. Monitor for bleeding.\ **Rivaroxaban**: Treats clots. DVT, PE. Monitor for bleeding.\ **Fondaparinux**: Treats clots. Monitor for bleeding. (Prophylaxis treatment for DVT)\ **Clopidogrel** & **Aspirin** = Ischemia prevention. Discontinue 5-7 days before surgery. **tPA** (**Alteplase**) = Treats Ischemic Stroke ONLY (not hemorrhagic). Treats established clots. **[Beta-Blockers]: (end in "lol": Propranolol, Carvedilol)**: Treat HTN, Angina, Arrythmias, M.I and Anxiety. Beta blockers stop fight or flight response = [Decrease HR]. Beta Blockers like Carvedilol treat HF (Heart failure) by Decreasing HR = increased ejection fraction **DO NOT GIVE** Beta Blockers to patients with... **[ACE Inhibitors]: "pril" (Enalapril, Lisinopril, Captopril)**: Treat HTN, CHF. Discontinue if it causes dry cough. DO NOT GIVE during pregnancy. Monitor BP. (**Lisinopril** is best for HF). ACE inhibitors can increase K+ levels (monitor for hyperkalemia) **[ARBs]: "sartan" (Losartan)**: Treat HTN, CHF. Monitor BP and fluids (contraindicated with K+ sparing diuretics = hyperkalemia). DO NOT GIVE during pregnancy **[Calcium Channel Blockers]** (Contraindicate with HF. They will lower the CO) - CC Blockers that affect Heart & Vessels: **Diltiazem** & **Verapamil** = Treat HTN, Arrythmias (A-fib and A-flutter). Cause [CONSTIPATION] - **Verapamil**: Toxicity = Bradycardia, Hypotension, Constipation - CC Blockers that affect Vessels: (end in "dipine") **Amlodipine**, **Nifedipine**: Treat HTN, Angina. Gingival hyperplasia. Don't cause constipation. - **Nifedipine**: Toxicity = Flushing, HA, Tachycardia, Hypotension [**Antiarrhythmics**:] (AAA-D)\ **Adenosine**: Treats SVT. Can ONLY be given via [rapid push]. There is a period of [Asystole].\ **Amiodarone**: Treats V-tach & PVC's (blocks potassium), DO NOT GIVE during pregnancy **Atropine**: Treats Bradycardia. **DO NOT GIVE** to glaucoma patients. Treats excess secretions **Digoxin**: Treats HF, A-fib, A-flutter, Cardiogenic shock. Increases contractility. - Digoxin Toxicity = N, V, Vison changes (green-yellow halos) and Bradycardia. - DO NOT GIVE = Elderly, HR under 60, Potassium under 3.5 - **Antidote** = Digoxin Immune FAB **[Vasodilators]**\ **Isosorbide**: Long term angina, HF. Can cause dizziness = Increased fall risk\ **Nitroglycerin** & **Nitroprusside**: Treat HTN, HTN crisis and stable angina. Headache is common side effect. Increased fall risk (Store Nitroglycerin in a dark place). Take three Nitroglycerin tablets over 15 minutes (one tablet every 5 minutes) until angina subsides. **Hydralazine**: Treat HTN, HTN crisis, HF. Increased fall risk **Vasodilator**: (that end in "zosin": **Prazosin**) = Treat HTN, PTSD, BPH, Raynaud's. DO NOT GIVE during pregnancy, breastfeeding or to children. DO NOT TAKE any vasodilators with Sildenafil (Viagra) **[Vasopressors]** **Norepinephrine** & **Epinephrine** = Treat M.I, Shock, Hypotension. Cause fight or flight (sympathetic nervous system). DO NOT GIVE with MAOIs and TCAs. Monitor IV site. Epinephrine treats [Anaphylaxis] and is also given for Asystole. **Dopamine** & **Dobutamine** = Treat M.I and Shock. DO NOT GIVE with MAOIs and TCAs. These drugs treat HF & Hypotension by increasing Cardiac output = increased perfusion **[Statins]**: (end in "statin": **Atorvastatin** & **Simvastatin**) = Treat Hyperlipidemia and high cholesterol = risk for atherosclerosis. Can cause muscle pain and G.I upset. **[Diuretics]**: (Covered in Renal System section) **[Respiratory System\ ]** [**ASTHMA** Medications]: Bronchodilators, Anticholinergics, Antihistamines, Glucocorticoids. - **[Bronchodilators]** - Short acting (SABA): **Albuterol**, Long acting (LABA): **Salmeterol**): Treat Asthma and COPD. Relax the smooth muscles of the airway - **[Anticholinergics]**: (sound like: **Tiotropium bromide**): Treats Asthma and COPD. Dilates bronchioles. Treat excess secretions (Educate patient to hold their breath for 10 seconds after inhaling). **Tiotropium bromide** is long acting and used once a day - **[Antihistamines]**: (end in "ine": **Diphenhydramine**) = Treat allergy and anaphylaxis. Monitor for drowsiness. Take during the [day]. Take with [food] (to avoid G.I side effects) - **Theophylline**: Long term Asthma maintenance. **AVOID** caffeine, tobacco and marijuana **[Glucocorticoids]** **Prednisone**, **Prednisolone** & **Methylprednisolone** = PO **Budesonide** & **Fluticasone** = Inhaled - All these drugs Treat Asthma and COPD. Decrease inflammatory response. Perform oral hygiene for inhaled glucocorticoids. Oral glucocorticoids are best for acute attacks. DO NOT discontinue abruptly. - **Prednisone** causes Na [retention] = High fluid volume (but decreases K+ levels) - Corticosteroids cause Peptic Ulcer Disease. **DO NOT** take with [NSAIDS] = G.I bleeding **Montelukast**: Treats Asthma. Used for long term maintenance. Hepatotoxic (Monitor ALT) **[Endocrine System ]** **[Steroids]: (Cortisone, Hydrocortisone, Prednisone)**: Treat [Addison's Disease] and [Adrenal crisis] (both diseases = too little **cortisol**). Treats Inflammation and Allergy. [Increases] BP & Glucose. They increase water and sodium - **Ketoconazole** is an [**Anti**-**Fungal**] that treats Cushing's Disease (too much cortisol) - **Corticosteroids (Prednisone)**: Can cause weight gain. Take in morning with food. Do not take at night (these drugs can cause insomnia) **[Thyroid Drugs]** - **[HYPER-thyroidism]: Iodine**, **Propylthiouracil**, **Methimazole**: Reduces HIGH thyroid hormone. [Hyperthyroidism] (Everything is HIGH). Treats [Thyroid Storm] - **[HYPO-thyroidism]: Levothyroxine (HYPO)**: Increases LOW thyroid hormone levels. [Hypothyroidism] (Everything is LOW). Take same time every day on and empty stomach. DO NOT take with other medications. Treats [Myxedema] - **[HYPER-parathyroidism]**: HIGH calcium. **Alendronate** & **Calcitonin** reduce Calcium - **[HYPO-parathyroidism]**: LOW calcium. **Supplements** & **Calcitriol** increase Calcium **[Diabetes]** **Insulin:** (Rapid, Short, Intermediate & Long acting) Remember 3 letters (**O**nset-**P**eak-**D**uration) - **Rapid acting (Lispro, Aspart)**: **OPD** = 15, 30, 3-5 - **Short acting (Regular)**: **OPD** = 30, 2-4, 5-12 - **Intermediate acting (NPH)**: **OPD** = 1-4, 4-12, 10-24 - **Long acting (Glargine)**: **OPD** = 2-4, NO PEAK, 24 **Vasopressin** & **Desmopressin** = **Vasopressin** (The ADH hormone) = regulates fluid and Blood pressure. **Desmopressin** Treats [Diabetes insipidus] & Shock\ **Metformin**: Oral hypoglycemic. Nephrotoxic (AVOID giving with contrast & alcohol). Metformin Causes B12 deficiency (pernicious anemia) **[Gastrointestinal System\ ]** **Cimetidine, Famotidine (end in "dine")**: Treat gastric & duodenal ulcers, GERD, G.I distress from chronic NSAID use. Can be given with meals. (**Cimetidine** treats H. Pylori) [**Proton Pump Inhibitors (PPIs)**:] (end in "prazole": **Pantoprazole**): Treat GERD, ulcers. Give 30 minutes before meals. Monitor for black tarry stools. Cause Hypomagnesemia\ **Sucralfate**: Treats PUD. Helps heal stomach ulcers by creating a paste when reacting with stomach acid. Take on empty stomach, one hour before meals (not immediately) or at bedtime. DO NOT GIVE at the same time as other drugs like **Digoxin** (decreases absorption) **[Laxatives]**: (Surfactant, Stimulant & Osmotic laxatives): - **Docusate sodium** = Constipation. Give with full glass of water (Surfactant) - **Bisacodyl** & **Senna** = Opioid Constipation. Not given for long term use (Stimulant) - **Polyethylene glycol** = Chronic Constipation. Can cause dehydration (Osmotic) **[Anti-diarrhea]**: **Loperamide** = Treats diarrhea. MOST effective. Give naloxone for OD. **[Anti-vomiting]**: **Ondansetron** (end in "setron") = Nausea & Vomiting. DO NOT GIVE via rapid push. **Promethazine** = Nausea & Vomiting. **[Renal/Urinary System\ ]** **Diuretics** (Cause fluid diuresis/secretion and Treat [Blood Pressure]) - **[Loop Diuretics:]** (**Furosemide**, **Bumetanide**) = Treat CHF fluid overload, low urine output. Excrete ALL Electrolytes (Na, K, Cl, Ca). **DO NOT GIVE** with Digoxin. - **[Potassium Sparing Diuretics]**: (**Spironolactone**) = Treat HTN, edema, HF. They RETAIN Potassium only. Monitor for [Hyperkalemia]. **DO NOT GIVE** with ACE, ARBs and potassium supplements = risk for hyperkalemia. - **[Thiazide Diuretics]**: (**Hydrochlorothiazide**): Treat HTN & Edema. Excrete Na, K and water but RETAIN Calcium = Hypercalcemia. (Hydrochlorothiazide can cause GOUT flare ups which are treated by **Allopurinol**) - **[Osmotic Diuretics]**: (**Mannitol**): MOST effective to treat high ICP. Tends to crystalize at room temp so administer through a filtered IV tubing. If kidneys are - **[ACE inhibitors]** & **[ARBs]**: Decrease sodium [resorption] causing diuresis **[Reproductive System & Maternity]** **[Tocolytic]**: (Inhibit contractions) - **Terbutaline**: Treats Preterm labor and Bronchoconstriction. Can increase blood glucose levels - **Magnesium sulfate**: Treats Seizures, Hypomagnesemia, Pre-eclampsia, [Preterm labor] & last resort for Asthma. Monitor for Hypermagnesemia. [GIVE IV slowly] **Oxytocin** & **Pitocin** = Induce labor & Treat Post-partum Hemorrhage. Causes contractions. **[Psychiatric Medications\ ]** **[Benzodiazepines]**: (end in "lam" and "pam"): Treat Anxiety. **Midazolam** (Rapid use, for anxiety attacks, 2-5 min), **Lorazepam** (intermediate) and **Diazepam** (long term) - **Lorazepam**: Treats Anxiety. Used for FAST [Seizure] relief (reduces excitability). Monitor for respiratory depression. AVOID alcohol. **Antidote** = Flumazenil **[Antidepressants]**: (SSRIs, TCAs and MAOIs) - **[SSRIs]**: (**Fluoxetine**, **Sertraline**, **Citalopram**, **Escitalopram**) = Treat depression. Prevent serotonin reuptake causing high serotonin levels = [Serotonin Syndrome]. **Suicide precautions** for first 2 -- 3 weeks (symptoms can worsen) (**Fluoxetine** can help treat Bulimia Nervosa) - **[TCAs]**: (end in "triptyline": **Amitriptyline** & **Pregabalin, Gabapentin**) = Treat depression. Can cause sedation, tachycardia, and arrythmias. **Amitriptyline** can treat phantom limb pain - **[MAOIs]**: (**Phenelzine** and **Isocarboxazid**) = Treat depression. Blocks ALL neurotransmitters. Side effect is HTN crisis. **AVOID** foods high in Tyramine **Bupropion**: Antidepressant. Take in morning (gives more energy = [more weight loss]) Helps with quitting smoking. **DO NOT GIVE** to patients with epilepsy, anorexia or bulimia **[Mood Stabilizers]**: (**Lithium** and **Valproic acid (gold standard)**) = Lithium treats Mania. Monitor for toxicity. Normal range: 0.6 -- 1.2. **DO NOT GIVE** with NSAIDS **[Antipsychotics]**: (**Haloperidol**, **Clozapine**, **Olanzapine**, **Ziprasidone**, **Risperidone**) - **Haloperidol**: Treats [Schizophrenia]. Inhibits Dopamine. Monitor for Extrapyramidal Symptoms such as, [Dystonia] (involuntary muscle contraction), [Akathisia] (restlessness), [Tardive dyskinesia] (involuntary facial movement). - **Risperidone** = s/s: Treats Schizophrenia. Everything goes UP. Causes muscle ach and dry mouth. Can increase Prolactin levels causing gynecomastia - **Clozapine & Olanzapine =** Treats Schizophrenia, Aggressive behavior, Mood disorders and Autism. Can cause [metabolic syndrome] (hyperglycemia, hyperlipidemia, hypertension and weight gain) Monitor weight and neutrophils - **Ziprasidone** = Treats Schizophrenia. Causes QT prolongation. Take with food **CNS Stimulants (ADHD)**\ **Methylphenidate** = Treats ADHD. Administer during the day, AVOID caffeine. Monitor for weight loss and anorexia **[Neurological System\ ]** **[Pain Medications]** - **Local anesthetics:** (end in "caine": **Lidocaine**, **Cocaine**) = Localized painful procedures. Give with vasoconstrictors to prevent systemic absorption. - **Opioids:** (**Morphine**, **Codeine**, **Fentanyl** and end in "one") = Pain. Cause constipation and CNS depression. Monitor RR. **Antidote** = Naloxone (NARCAN) - **Codeine** & **Hydrocodone** = Anti-tussive (Prevent cough) - **Methadone**: Pain and Opioid withdrawal - **NSAIDs**: (**Naproxen**, **Ketorolac**, **Aspirin**, **Ibuprofen**) - **Ibuprofen** = Treats R.A and O.A, Pain and Fever. Can cause G.I ulcers and bleeding. Renal impairment (Monitor BUN/Creatinine) - **Aspirin** = Pain and Fever. Prevents M.I and Stroke (antiplatelet). Risk for bleeding. **DO NOT GIVE** to children under 16 = Reye's Syndrome - **Non-NSAID**: **Acetaminophen** = Pain and Fever. DO NOT take with alcohol (hepatotoxic). MAX dosage is 4 grams. **Antidote** = N-Acetylcysteine **[Alzheimer's]**\ **Cholinergic**: (end in "stigmine": **Rivastigmine**) = Treat Alzheimer's, Glaucoma, GERD and Urinary retention. Monitor for [bradycardia]. (Can cause flu like symptoms & weight loss)\ **Donepezil** and **Rivastigmine** = Treat Alzheimer's and Dementia. Prevent breakdown of acetylcholine. Donepezil causes bradycardia and syncope. **[Anti-Parkinson's]**: **Carbidopa** **Levodopa, Selegiline** & **Benztropine** = Increases dopamine. Treats Parkinson's. Can take months to work. Causes orthostatic hypotension. Take with low fat, low protein foods **[Anticonvulsants]**: **Phenytoin** and **Valproic acid** = Treats seizures. Therapeutic level for Phenytoin is 10 -- 20. **DO NOT GIVE** during pregnancy (phenytoin is a teratogen) **[Benzodiazepines]**: (end in "lam & "pam": **Alprazolam**, **Diazepam**, **Midazolam**) = Treat Anxiety and Seizures. Cause CNS and respiratory depression. **Antidote** = Flumazenil **[Musculoskeletal System\ ]** **[Muscle Relaxants]**: **Baclofen**, **Dantrolene**, **Cyclobenzaprine** = Treat spastic muscles. Monitor for orthostatic hypotension. DO NOT discontinue abruptly. (Dantrolene Sodium = Treats Malignant Hyperthermia) **[Immune System\ ]** **[Antibiotics:]** **[Penicillin's]**: (end in "cillin": **Penicillin**, **Ampicillin**, **Amoxicillin**) = Treat Infection. Allergies with these drugs are common (latex or other penicillin's) **[Cephalosporin's]**: (start in "cef ": **Cefazolin**, **Ceftriaxone**) = Treat Infections. Monitor for signs of C. diff. **DO NOT GIVE** to patients with a penicillin allergy. **Ceftriaxone** Treats Meningitis and is given immediately after lumbar puncture **[Tetracyclines]**: (end in "cycline": **Tetracycline**, **Doxycycline**) = Treats Lyme disease, Anthrax, Chlamydia etc. Causes teeth staining and photosensitivity. DO NOT take with Milk. **[Aminoglycosides]**: (end in "mycin"): **Gentamicin** = Treat Serious infections. Ototoxicity and nephrotoxicity. (they don't have "thro" in their names) **[Macrolides]**: (**Azi[thro]mycin**, **Ery[thro]mycin**): Treat Respiratory Infections. Give with meals to reduce G.I discomfort. **[Sulfonamides]**: (start in "sulfa": **Sulfamethoxazole**): Treat mostly UTIs. **AVOID** Sunlight and **DO NOT GIVE** to infants or during pregnancy. [Nephrotoxic] (Increase fluid intake) **[Fluoroquinolones]**: (end in "floxacin": **Ciprofloxacin,** **Levofloxacin**): Treat Infections. Cause tendon rupture. Phototoxic. **DO NOT GIVE** to patients under 18\ **Vancomycin**: Treats C. diff, [MRSA]. Nephrotoxic. Give over 60 minutes via central line.\ \ **[Anti- Tuberculosis]**: (**Isoniazid** and **Rifampin)**: Treat TB. Isoniazid is Hepatotoxic. Rifampin causes body fluids to turn [reddish orange]. **[Anti-Virals]** (end in "vir": **Acyclovir**, **Oseltamivir**): Treat viral infections such as HSV, Varicella, CMV, Influenza, Hep B and Hep C. **Acyclovir** treats Herpes & Varicella. **Oseltamivir** treats Influenza. **[Antifungals]**: (end in "azole") = The "azoles" treat fungal infections, can be given PO. **Amphotericin** is also an Anti-fungal = [Nephrotoxic] = Give with 1 L of NS **[Miscellaneous]**\ **Acamprosate**: (Alcohol addiction) **Allopurinol**: Treats GOUT (lowers uric acid levels) **Venlafaxine**: Antidepressant. Can cause suicidal thoughts, dry mouth and insomnia.\ **Isotretinoin** (Acne): Teratogenic (obtain a negative pregnancy test) **Dextromethorphan** (Non-opioids Antitussive): Prevent cough. **Saline** & **Acetylcysteine** (Mucolytic): Treat excess mucus. Don't give with Anti-tussive. **Tamsulosin**: Treats BPH. Can cause vasodilation (orthostatic hypotension) **Etanercept**: Treats Psoriasis and Rheumatoid Arthritis **Methotrexate**: Treats Rheumatoid Arthritis (maintenance drug for R.A), Cancer, Psoriasis, Crohn's disease and causes Pancytopenia (Low blood levels like RBC, WBC and Platelets). [AVOID] crowds & wash hands **Cyclosporine**: Treats Rheumatoid Arthritis. Can increase risk for infection **Sitagliptin**: Diabetes Type II medication. Can cause pancreatitis (monitor abdominal pain) **Dulaglutide**: Give once per week. Has no PEAK (don't need to take with food) **Buspirone**: Anxiety medication. Takes weeks to be effective. **Sumatriptan**: Treats Migraines. DO NOT GIVE to patients with history of HTN, M.I, Stroke **Modafinil**: Treats Narcolepsy and ADHD. **Betamethasone**: Helps with fetal lung development **Disulfiram**: Treats alcohol addiction. Causes severe reaction with alcohol-based products **Progestin**: Used for hormone replacement and contraception. Monitor for clots **Colchicine**: Treats GOUT and pericarditis. Can impair the liver and kidneys **Depot-medroxyprogesterone**: Long-acting contraceptive. Can cause osteoporosis **[Antidotes:]** **Acetaminophen** = Acetylcysteine **Benzodiazepine** = Flumazenil **Digoxin** = Digoxin immune FAB **Heparin** = Protamine Sulfate (aPTT) **Warfarin** = Vitamin K (INR) **Magnesium** **Sulfate** = Calcium Gluconate **Opioids** = Naloxone (Narcan) **Aspirin** = Sodium Bicarbonate **[Interactions:]** **ACE inhibitors** = **AVOID** K+ sparing diuretics = Risk for [Hyperkalemia] (ACE inhibitors cause kidneys to secrete water and sodium but not potassium) **Nitroglycerin** = **AVOID** erectile dysfunction medications (sildenafil) = Risk for Hypotension **Metformin** = Contrast dye = Risk for Nephrotoxicity (increase fluid intake to precent this) **MAOIs** (antidepressants) = AVOID other antidepressants & Tyramine based foods = Risk for Serotonin Syndrome **Calcium Channel Blockers, Statins & Anticoagulants** = **AVOID** grapefruit **Warfarin** = **AVOID** foods HIGH in Vitamin K (leafy greens) = Risk for increased clotting, Saw palmetto (risk for bleeding) **[DO NOT GIVE:]** **Beta blockers** to Asthma patients **Warfarin** to Chronic liver disease patients **Calcium channel blockers and NSAIDs** to CHF patients (Low CO) **NSAIDs** to patients who are taking Prednisone (risk for G.I bleeding) **NSAIDs** to Kidney failure patients (Nephrotoxicity) **ACE and ARBs** during pregnancy