Quiz 4 SG Pharm: HF, Respiratory & Antidysrhythmic Drugs PDF

*Quiz 4 SG Pharm: HF, respiratory & antidysrhythmic drugs* HF Ch. 24: \*\***MOST** common clinical manifestations of HF are dyspnea, fatigue, fluid retention & pulmonary edema (all the blood gets backed up) LV is responsible for taking blood away from the heart and oxygenate it- consequently the...

*Quiz 4 SG Pharm: HF, respiratory & antidysrhythmic drugs* HF Ch. 24: \*\***MOST** common clinical manifestations of HF are dyspnea, fatigue, fluid retention & pulmonary edema (all the blood gets backed up) LV is responsible for taking blood away from the heart and oxygenate it- consequently the LV does not pump enough to the heart Best way to prevent HF is to control risk factors *HTN, CAD, obesity and diabetes* +-----------------------------------+-----------------------------------+ | Left ventricle or left sided HF: | Right ventricle or right sided | | | HF: | | \*\*[Comes] from the | | | lungs affects lungs | \*\*[Away] from the | | | lungs | | - Pulmonary edema | | | | - Congestion | | - Coughing | | | | - Edema | | - Dyspnea | | | | - Ascites | | - Shortness of breath | | | | - Hepatomegaly | | S/S: | | | | - JVD | | - Pulmonary congestion | | | | - Enlarged spleen/ liver | | Cough, crackles, pink-tinged | | | sputum, tachypnea | - Weight gain (fluid retention) | | | | | - Tachycardia | - Increased peripheral venous | | | pressure | | - Fatigue | | | | Everything coming back in | | - Cyanosis | | | | | | - External dyspnea | | +-----------------------------------+-----------------------------------+ **\*\*Both occur because of increase in hydrostatic (water retention) pressure from ventricles into pulmonary & or systemic circulation (affecting circulation)** HF pts retain fluid causing weight gain= right sided HF **\*\*Happens to both right side and left HF = fatigue/ tired\*\*** +-----------------------+-----------------------+-----------------------+ | **Inotropic**: | **Chronotropic**: | **Dromotropic**: | | | | | | (+) increased force | (+) increased HR bpm | (+) accelerate | | of myocardial | | conduction of the | | contraction | (-) decrease HR bpm | heart | | | | | | (-) reduce | | (-) decrease | | contraction | | conduction of the | | | | heart | +-----------------------+-----------------------+-----------------------+ **\*\*(+) increases contraction, conduction and force** For HF what kind of drugs will you be using (+) or (-) types of drugs that affect the heart? **POSITIVE- the heart is failing we need to increase the contraction, conduction and HR** ACE inhibitors: **-pril** Adverse effects: \- Dry cough \- Angioedema \- Hyperkalemia (K) Prevent sodium and water resorption by inhibiting aldosterone secretion "a-pril doesn't leave the house" ARBS: **-sartan** Adverse effects: \- Dry cough \- Angioedema \- Hyperkalemia (K) "sartan leaves the house but gets blocked" How many medications do we have for HF? **(3)** **pril, sartan, cardiac glycosides** Cardiac glycosides: "Sugar needs energy" Help with HF & help control ventricular response to a-fib **Digoxin**: only cardiac glycosides (Rx for HF) MOA: Increase myocardial contraction because it inhibits the action of sodium potassium adenosine triphosphate pump Indications: Primarily treatment **of HF & a-fib/ a-flutter** Adverse effects: Cardiovascular CNS N/V & ocular (halo vision = **Digoxin** toxicity) GI effects - Low therapeutic index - Levels are monitoring at the beginning of treatment - Normal therapeutic levels are [0.5-2 nanograms]/ mL VERY NARROW INDEX - Toxicity = antidote **Digoxin immune fab Digifab** **ANTIDOTE = DIGIFAB FOR SEVERE TOXICITY** 1^st^ sign of toxicity = anorexia **\*\*When administering Digoxin take the apical pulse for a whole minute; do NOT administer if its \100-150 bpm Sinus bradycardia = \ v-fib (responds to magnesium sulfate) **V-fib is fatal if not reversed often requires defibrillator** "When the pt is in v-fib, we need to d-fib (defibrillator)" Antidysrhythmic Drugs: - BB (lol) titrate slow; lower BP - CCB (-pine) also **Verapamil & Diltiazem** - **Amiodarone & Dronedarone** (-one) 4 classes: Class I: block sodium channels: delay/ accelerate action potential duration Class II (**BB**): block SNS stimulation of the heart and slow conduction of cardiac tissues Class III: MOST used **antidysrhythmic drugs (Amiodarone/ Dronedarone)** Increasing action potential Class IV (**CCB**): (**Verapamil/ Diltiazem**) inhibit calcium channels MOA: Correct abnormal cardiac EKG function Indications: Help cardiac dysrhythmias +-----------------------+-----------------------+-----------------------+ | **Contraindications** | **Adverse effects:** | **Interactions**: | | : | | | | | \- N/V/D | \- Anticoagulants | | \- Second-third | | (Warfin/ Coumadin = | | degree AV block | \- Dizziness | vit K PT INR) | | | | | | \- BB | \- Headache & blurred | Heparin= protamine s. | | | vision | PTT | | \- Cardiogenic shock | | | | | \- New dysrhythmias | \- Grapefruit juice | | \- Sick sinus | | (-satin, CCB, | | syndrome & other EKG | | antidysrhythmic) | | changes | | | +-----------------------+-----------------------+-----------------------+ **\ ** **Drugs that prolonged the QT interval:** QRST- which part of the heart gets affect the atrium or ventricles? **Prolonged QT affects the ventricles** **Antibiotics**: **-cin & -mycin** **Anticancer: Tamoxifen & Sunitinib** **Antidepressants:** - **Amitriptyline \*\*MAOI** - **Imipramine \*\*MAOI** - **Fluvoxamine \*\*MAOI** - **Nefazadone** - **Sertraline (Zoloft) \*\*SSRI** - **Citalopram (Celexa)** \*\*Antidepressants, anticancer, antibiotics cause the QT wave to prolongate to take a little more time to happen- THIS IS AN ISSUE\*\* **Antidysrhythmic:** - **Amiodarone** - **Quinidine** - **Sotalol** **Antifungal: -zole** - **Fluconazole** - **Itraxonazole** **Antinauseants:** - **Dolasetron** - **Droperidol** - **Ondansetron (Zofran)** **Antipsychotic:** - **Haldoperidol** - **Resperidone** - **Clozapine (CCB)** **Bronchodilators: BB: -LOL** **\ ** - **Procainamide (Pronestyl)**: management of tachycardia & V-tach - **Quinidine (Quinidex**): affects electrical activity Adverse effects: cardiac a-systole & ventricular ectopic (tubes) beats **Black box warning: Torsade de Pointes "v-fib time to d-fib"** - **Lidocaine (Xylocaine)** analgesic treats ventricular dysrhythmias; reduces by 50% for liver failure pts or cirrhosis Adverse effects: CNS toxic effects, twitching, convulsions & confusion, respiratory depression or arrest - **Flecainide (Tambocor):** FIRST LINE OF A-FIB Adverse effects: dizziness, visual disturbances, dyspnea Contraindications: second- or third-degree AV block - **Propafenone (Rythmol):** reduces fast inward sodium current in Purkinje fibers treating a-fib Adverse reactions: dizziness/ metallic taste, constipation, headache, N/V **BB**- antidysrhythmic but because they lower the HR they are often prescribed as an antihypertensive - **Amiodarone (Cordarone, Pacerone "pace")** pacemaker of the **♥**is the SA node Rx works in the atrium/ SA node **-one = antidysrhythmic working in the SA node** \*\*Blocks alpha/ beta adrenergic receptors of SNS Can cause hypo or hyperthyroidism Adverse effects: Visual halos Photophobia & dry eyes **SERIOUS ADVERSE EFFECTS:** Pulmonary toxicity Dyspnea Cough Pulmonary fibrosis Hepatoxicity Long ½ life therapeutic index 2-3mo adverse effects **\ ** - **Ibutilide (Convert):** treat atrial dysrhythmias (a-fib/ a-flutter) for rapid conversion to normal sinus rhythm NSR. "Converts a-fib to NSR" \*\*USED with caution to prevent Torsade de Pointes - **Sotalol (Betapace):** BB new antidysrhythmic drug - **Diltiazem (Cardizem**)- temporary control of rapid ventricular response in a-fib & a-flutter & PSVT \*\*CCB - **Verapamil**- prevents & converts recurrent PSVT & control a-fib/ a-flutter - **Adenosine (Adenocard):** slows electrical conduction time through AV node Indicated: conversion of PSVT to NSR *Respiratory Drugs Ch.37* Plays a role in speech, smell & regulation of pH (acid balance) Diseases: - URT: upper respiratory tract- colds, rhinitis, congestion & hay fever - LRT: lower respiratory tract- asthma & COPD (emphysema & chronic bronchitis) If the person is hyperventilating? **CO2 is accumulating** If there is more O2 coming in then CO2 going out in our body, then we will have **oxygen toxicity** For the appropriate exchange of CO2 and O2 the muscles and organs all need to come together Exhale -- CO2 Inhale -- O2 All these conditions obstruct the airflow through the airway \- COPD is applied collectively to all respiratory disorders Other disorders that affect the LRT = cystic fibrosis & infant respiratory distress syndrome Crackles: expiration/ LRT Ronchi: inspiration/ URT Wheezing: expiration/ LRT Stridor: inspiration/ URT **IM & IV work the fastest** **\ ** **Asthma**: Bronchial asthma- recurrent & **reversable** SOB Airways of the lungs become **[narrow]** because of the lack of O2... - Bronchospasm - Inflammation - Edema of bronchial mucosa - Production of mucus preventing CO2 from leaving airspaces & O2 from entering \*\*They need O2 but not a lot because CO2 is not coming out = toxic Types: - Intrinsic or idiopathic - Extrinsic- comes from the outside usually do to an allergen, makes or triggers asthma attack Allergic asthma Clinical manifestations: - **Wheezing** - Chest tightness (broncho constrict) - Difficulty breathing Allergen: Substance that brings out an allergic reaction (pollen, dust) **Long-term (maintenance): LABAS** *prevention use medication* Long actin beta 2 agonists (inhaled) Inhaled corticosteroids \*\*LIMA - Leukotriene receptor antagonist - Inhaled corticosteroids - Mast cell stabilizers - Anticholinergic agents **Rescue (quick relief): SABAS** *relief med emergency* Short acting inhaled beta 2 agonists \*\*SABA SOS RESCUE SAVE MY SHIP - Intravenous IV systemic corticosteroids Which would you administer if a pt isn't breathing? **SABAS rescue that person- either IV corticosteroid or inhaler** **COPD: Chronic obstructive pulmonary disease** **Not reversible** Lung disease that interferes with normal breathing Managing S/S Bronchitis & emphysema are precipitated by a prolonged exposure to irritants \*\*Unknown/ idiopathic genetics may be responsible for the developing of these conditions Treatment for both Asthma and COPD: Drugs that DILATE airways - Bronchodilators: relax bronchial smooth muscle, which dilate the bronchi & bronchioles - Steroids are for inflammation - **Beta adrenergic agonist**: (SNS enhance/ increase) BB lower the HR but contraindicate with asthma Used: acute asthmatic attack to quickly reduce airway constriction & restore airflow AKA OPEN UP \*\*Helps the breathing but increase the HR; BB lower the HR but affect the respiratory system Agonist of the adrenergic receptors in the SNS: SABAs= recuse ONLY LABAs= maintenance & NEVER be used for rescue/ acute treatment Effects: stimulates SNS & bronchodilation Side effects: Tachycardia Hypertension Tremors Shakiness N/ V \*\*tightness of chest is expected due to breathing treatment administered MOA: Relax & dilate airways by stimulating the beta2 adrenergic receptors in the lungs **Nonselective adrenergic agonist drugs:** (Epinephrine) reduce edema/ swelling in mucous membrane & limit secretions production [\*\*Increases HR, force contraction & BP ] Indications: Prevention & relief of bronchospasms \*\*HTN & shock +-----------------------+-----------------------+-----------------------+ | Contraindications: | Adverse effects: | Interactions: | | | | | | Uncontrolled HTN or | (anything affecting | MAOIs = depression | | cardiac dysrhythmias | SNS) | (food high in | | | | thiamine) | | \*\*HIGH RISK of | Insomnia | | | stroke | | Diabetic pts need to | | | Restlessness | adjust their meds | | | | | | | Anorexia | | | | | | | | Cardiac stimulation | | | | | | | | Hyperglycemia | | | | | | | | Tremors | | | | | | | | Vascular headache | | +-----------------------+-----------------------+-----------------------+ **Albuterol: SABA (SOS)** If used to frequently, dose related adverse effects (tachycardia, high BP) Educate: how to use an inhaler (if you don't find relief go to hospital don't keep using inhaler could lead to HTN crisis) **Salmeterol (Servant Diskus)- LABA** In conjunction with inhaled corticosteroid Adverse effects: (tachycardia & high BP) Anticholinergic: **LAMAs** *maintenance long term* -**sin** Long actin muscarinic antagonists Treat COPD MOA: works with acetylcholine Prevent spasms, airway dilates and helps with breathing \*\*Prevent bronchospasms (for prevention & maintenance) +-----------------------------------+-----------------------------------+ | Contraindications: | Adverse effects: | | | | | Allergic to peanut or soy | Dry mouth/ throat | | | | | Acute narrow- angle glaucoma | Nasal congestion | | | | | Prostate enlargement | Heart palpitations | | | | | | GI distress | | | | | | Urinary retention | +-----------------------------------+-----------------------------------+ Alpha 1 and BB are going to dilate= lower BP= pt will be able to pee= cause a constriction in the sphincter causing retention **Ipratropium (Atrovent):** oldest anticholinergic bronchodilator Like atropine (vasoconstrictor) **\*\*Atropine in a code= increase the heart rate** Non-bronchodilating drugs: **Leukotriene receptor antagonists (LTRAs):** Treat asthma s/s caused by immune system at a cellular level \*\*Maintenance MOA: block inflammatory process in asthma, prevent muscle contractions of bronchial airways- decrease muscle secretions Indications: long term & prevention of asthma Contraindications: allergies to povidone, lactose, titanium dioxide Adverse effects: headache, N, dizziness, insomnia Interactions: phenobarbital (antiepileptic) & rifampin **Montelukast (singular):** Approved for children (\>1 yr) PO (maintenance Rx) \*\*Rx as prescribed because it's a L term Corticosteroids & Glucocorticoids (maintenance & rescue) -**sone** Natural or synthetic drugs used in pulmonary diseases for their anti-inflammatory effects MOA: Reduce inflammation, beta agonist Indications: Treat bronchospastic & asthma Contraindications: Hypersensitivity to glucocorticoids Fungal infection Sputum test (+) Candida **\*\*Rinse mouth after used of inhaled steroids** **Fluticasone Propionate (Flonase):** intranasally Adverse effects: Osteoporosis Sad Sick (suppress immune system) Salt & water retention = hypertensive Sex (no libido) Psych (Cataracs) Steroids: -**sone** Increase CBG Decrease immune system & libido Weight gain Titrate them slowly How are you going to recognize if it's a glucocorticoid or a corticosteroid? **-sone = corticosteroid** If your pt is going to start taking a steroid or med that ends in -sone what's some education? **CBG** **Rinse your mouth** **Salt intake (monitor)** **Brittle skin**