NUR 124 Pharmacology Finals 1 PDF

hi TABLE OF CONTENTS Drugs Acting on Renal...

hi TABLE OF CONTENTS Drugs Acting on Renal System p.2 Drugs Acting on Cardiovascular System p.11 Drugs Acting on GI System p.27 Drugs Acting on EndocrinePH System p.32 Emergency Agents p.46 Ear, Eye, and Skin Agents DEPUTY HEADS Picache, Ma. Lourine Kassandra p.51 C. Haum, Jazentha Kim G. Loyola, Tim A. TRANXCN TEAM Bondoc, Alissa S. Candelaria, Aisha Francine Brosas, Carmela Dawn C.​ De Jesus, Althaea Timothy Gonzales, Jaira Marielle M.​ Haum, Jazentha Kim G. NUR 124 Kobayashi, Samantha May B. Loyola, Tim A. Macha, Elaena Katrine P. Medrano, Ma. Samantha E. PHARMACOLOGY Pegarido, Khristel B. Perido, Kurt Cedrick L. Pescasio, Kirsten Marianne C. Pili, Edrik Gene M. Quiaz, Vanessa Mae Rafols, Kisha Belle M. Sanchez, Rayben William L. Solon, Cahn Zyrah L. A.Y. 2024-2025 Soquila, Reinne Haizen R. Tejero, Angela P. TranxCN: FINAL TERM RELEASE 1 Valdez, Mariah Richlyn E. 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The College of Nursing Faculty/Professors are not liable for any mistakes or false information that may inadvertently be included in this transcript.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 OUTLINE A.​ Anatomy and Physiology of the Genitourinary System B.​ Drugs for Renal System a.​ Diuretics i.​ Thiazides and Thiazide-like ii.​ Loop Diuretics / High Ceiling iii.​ Osmotic Diuretic iv.​ Carbonic Anhydrase Inhibitors v.​ Potassium-Sparing Diuretics Anatomy Recall: Which organs are affected in Upper C.​ Fluid and Electrolyte Imbalance and Lower UTI? a.​ Body Fluids ​ Upper UTI: Kidneys (Pyelonephritis) b.​ Types of Intravenous Solutions ​ Lower UTI: Bladder (Cystitis), Urethra (Urethritis), i.​ Crystalloids and Prostate Gland (Prostatitis) ii.​ Colloids ​ Causative Agent: E. Coli iii.​ Blood and Blood Products c.​ Electrolytes DRUGS FOR THE RENAL SYSTEM i.​ Potassium A.​ Diuretics ii.​ Sodium B.​ Parenteral Fluids iii.​ Calcium C.​ Electrolytes iv.​ Chloride D.​ Drugs for the Urinary Tract Disorders v.​ Phosphorus (Phosphate) a.​ Urinary Antiseptics D.​ Drugs for urinary tract disorders b.​ Urinary Analgesics a.​ Urinary Antiseptics c.​ Urinary Stimulants i.​ Nitrofurantoin d.​ Antispasmodics ii.​ Methanamine iii.​ Fluoroquinolones iv.​ Trimethoprim A. DIURETICS b.​ Urinary Analgesics ​ Diuretics - acts to increase the flow of urine. i.​ Phenazopyridine HCl and Dimethyl Purpose: Sulfoxide ​ Decrease hypertension c.​ Urinary Stimulants ​ Decrease edema i.​ Bethanechol chloride d.​ Urinary antispasmodics, Good-to-Knows: Urination decreases fluid volume in Antimuscarinics, Anticholinergics the body. As the fluid volume of the body decreases, ANATOMY AND PHYSIOLOGY OF THE the blood pressure decreases as well. GENITOURINARY SYSTEM ↓ Fluid Volume = ↓ Blood Pressure DIURETICS: DRUG CATEGORIES CATEGORY POTASSIUM WASTING OR SPARING? A.​ Thiazides Potassium-Wasting B.​ Loop Diuretics Potassium-Wasting C.​ K+ Sparing Diuretics Potassium-Sparing PILI, PERIDO 2 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 ​ Inform – certain herbal products may interact with D.​ Carbonic Anhydrase Potassium-Wasting thiazide diuretics. Inhibitor ​ Teach on how to take and record BP (daily) E.​ Osmotic Diuretics Potassium-Wasting ​ Prevent orthostatic hypotension ○​ by slowly changing position from lying to standing What’s the distinction between ​ Use sunblock – to prevent photosensitivity Potassium-Wasting and Potassium-Sparing ​ Eat foods rich in Potassium Drugs? ○​ Supplements may be prescribed ​ Taken with FOOD- to avoid GI upset (diarrhea, N/V, ​ Potassium-wasting: Leads to potassium loss in anorexia) the urine, "wasting" potassium from the body. Leads to Hypokalemia. B. LOOP DIURETICS/ HIGH CEILING ​ Potassium-sparing: Preserves potassium by ​ Examples: limiting its excretion, "sparing" it within the body. ○​ Furosemide (Lasix) Treats Hypokalemia. ○​ Bumetanide (Bumex) ​ Indication: Edema ​ MOA: Acts on the ascending loop of Henle by A. THIAZIDES & THIAZIDE-LIKE inhibiting Na reabsorption ​ Examples: ​ S/E: Hypokalemia, Na, Ca, Mg, Cl, dizziness, ○​ Chlorothiazide (Diuril) headache, N&V, orthostatic hypotension ○​ Hydrochlorothiazide (Hydrodiuril) ​ Indications: hypertension and peripheral edema. ASSESSMENT ​ MOA: Acts on the distal convoluted renal tubules to ​ Check for drugs that may cause drug interaction promote Na, Cl, and water excretion. (e.g. alcohol, aminoglycosides, anticoagulants, ​ S/E: Hypokalemia, hypomagnesemia, corticosteroids, lithium, amphotericin B, digitalis) hypercalcemia, dizziness, headache, N&V, ​ VS, serum electrolytes, weight, and UO constipation, orthostatic hypotension, ​ Note hypersensitivity to sulfonamides hyperglycemia, hyperuricemia NURSING CONSIDERATIONS A. THIAZIDES ​ Monitor VS (decrease BP) and UO (should be at ASSESSMENT least 30 mL/h or 600 mL/24 hr) ​ VS, Weight, Urine Output, Electrolyte values ​ Notify doctor – if UO does not increase (severe ​ Check: renal disorder may be present) ○​ Peripheral extremities – Edema ​ Weigh the patient ○​ History of drugs and herbal supplements ​ A loss of 2.2 lbs is equivalent to a fluid loss of 1 L taken daily/. ​ Administer IV furosemide SLOWLY ○​ Review drug-to-drug interactions (digoxin, ​ Hearing loss may occur if it is rapidly injected corticosteroids, antidiabetics, ginkgo, ​ Check for signs of hypokalemia (5.0 mEq/L) body fluids ​ Nausea, diarrhea, abdominal cramps, numbness ​ Normal serum osmolality: 275 to 295 mOsm/kg and tingling of the hands and feet, leg cramps, ​ Three (3) Types of fluid concentration (based tachycardia and later bradycardia, peaked narrow T on the osmolality of body fluids): wave on 1. Isoosmolar ​ ECG, oliguria 2. Hypoosmolar 3. Hyperosmolar PATIENT TEACHING ​ Take spironolactone with or after meals TYPES OF INTRAVENOUS SOLUTIONS ​ Do not discontinue without consulting the Doctor 1.​ Crystalloids ​ Spironolactone- can cause photosensitivity a.​ Isotonic ​ Use sunblock b.​ Hypotonic ​ Report rash, dizziness, weakness and GI upset c.​ Hypertonic PILI, PERIDO 4 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 HYPOTONIC SOLUTION ​ Examples: ○​ 0.45% NaCl ○​ 0.33% NaCl ○​ 0.225% NaCl ​ Uses: ○​ Treats intracellular dehydration (DKA, Hyperosmolar hyperglycemic State) ○​ Provides free water to allow excretion of body wastes ○​ Dextrose provides some calories ​ Contraindications: ○​ Do not use in patients with: known or suspected ICP, liver disease, shock, trauma, burns ​ Considerations: ○​ Monitor for signs of FVD and worsening of hypovolemia (due to decrease in vascular volume) HYPERTONIC SOLUTION ​ Examples: ○​ 3% NaCl​ ○​ 5% Dextrose ○​ 0.45% NaCl ○​ 5% Dextrose and 0.9% NaCl, ○​ % Dextrose in LR, 2.​ Colloids ○​ 10% Dextrose and water 3.​ Blood and blood products ○​ 50% Dextrose and water ​ Uses: A. CRYSTALLOIDS ○​ Corrects severe hyponatremia ISOTONIC SOLUTION ○​ Decreases ICP (cerebral edema) ​ Examples: ○​ Dextrose provides some calories ○​ LR ○​ Ringer’s solution HYPERTONIC SOLUTION ○​ 0.9% NaCl ​ Considerations: ○​ 5% Dextrose in water ○​ May cause intravascular volume overload and ​ Uses: pulmonary edema ○​ Corrects DHN and Na depletion ​ Administer slowly and carefully with ○​ Replace GI losses infusion control pump and constant ○​ Dextrose provide some calories monitoring ​ Cautions for use: ○​ Avoid prolonged use ○​ LR should be used cautiously to patients with: ○​ Higher concentrations of dextrose (>10%) ​ renal failure (contains K+), alkalosis, must be given through Central venous access liver disease device ○​ Isotonic solutions should be used cautiously ○​ May be added to amino acid solutions as TPN in patients with: ​ Contraindications ​ Cardiac or renal disease (risk of ○​ Cardiac or renal disease FVE) ○​ DHN or DKA ​ Note: DO NOT administer Isotonic solutions to TONICITY OF INTRAVENOUS SOLUTIONS patients with known or suspected ICP ​ Tonicity- used primarily as a measurement of the concentration of IV solutions compared with the osmolality of body fluids PILI, PERIDO 5 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 1.​ Hypotonic: 300 mOsm/kg electrolyte levels & serum osmolality ​ IV solutions are used to replace body fluid loss ​ Fluid Volume Excess ○​ Monitor for FVE B. COLLOIDS ​ Tachycardia, bounding pulse, ​ Volume expanders tachypnea, increased BP and pulse ○​ Dextran solutions pressure ○​ Amino acids ​ Altered mental status, generalized ○​ Hetastarch edema, anasarca ○​ Plasmanate ​ Constant, irritated cough; dyspnea, ○​ Colloidal gelatin orthopnea, crackles, pulmonary C. BLOOD AND BLOOD PRODUCTS congestion, muffled heart sounds ​ Examples: ​ Fatigue ○​ Packed RBCs (PRBC), plasma, platelets, ​ Increased ICP, jugular vein distention; cryoprecipitate increased UO ​ Considerations: ○​ Monitor lab results ○​ Proper products-to- patient identification ​ Elevated BUN, Hgb and Hct, Na, Serum ○​ Maximum rate of infusion – 4 hours per unit osmolality, urine specific gravity) ○​ Pre-medications (e.g. diphenhydramine) ○​ Daily weight ○​ Multiple Blood transfusions – check for serum ​ sudden increases ionized calcium levels ○​ Administer diuretics as ordered ○​ Never add medications to the unit of blood ○​ Fluid and sodium restrictions ○​ Head of the bed elevated 30 to 40 degrees IV FAT EMULSION ​ facilitate respiration ​ Known as lipid emulsion ○​ Monitor edematous areas for signs of pressure ​ Patient must have centrally or peripherally and altered skin integrity inserted vascular access device ○​ Meticulous skin care ​ N&V, elevated temperature- if given rapidly ○​ Repositioning ​ Cautions for use: ELECTROLYTES ○​ At risk for fat embolism (fractured femur) POTASSIUM (K) ○​ With allergy to eggs or soybeans ​ NORMAL LEVELS: 3.5–5.0 mEq/L ○​ Pancreatitis ​ Function: transmission and conduction of nerve ○​ Bleeding disorders impulses and for the contraction of skeletal, cardiac ○​ Liver failure and smooth muscles. ○​ Respiratory disease HYPOKALEMIA HYPERKALEMIA FLUID IMBALANCE ( 5.0 mEq/L) ​ Fluid Volume Deficit ○​ Strict I and O hourly S/SX: N&V, S/SX: Nausea, ○​ Oral Care Dysrhythmias, Abdominal Abdominal cramps, ○​ Encourage increase OFI distention; Soft, flabby Oliguria, Tachycardia, ○​ Monitor for skin breakdown and pressure muscle Later bradycardia, ○​ Monitor for s/sx of FVD due to hypovolemia Weakness, Numbness or ​ Thirst, restlessness, HA, inability to tingling in the extremities concentrate, dry mucous membranes, ——————————— ——————————— poor skin turgor, tachycardia, changes Tx: Tx: in mental status, slightly decreased BP ❖​ Foods High in K ❖​ Potassium ○​ Recognize late symptoms of hypovolemia: ❖​ K supplements restrictions ​ Cyanosis, cold clammy skins, weak ​ (PO [liquid, tablet or ❖​ IV sodium thready pulse, confusion and oliguria capsules]; and/or IV) bicarbonate ○​ Assess for orthostatic hypotension- safety in ❖​ 10% Calcium transferring and changing of positions gluconate ○​ Monitor lab results PILI, PERIDO 6 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 ​ Nursing Considerations: ❖​ Insulin and glucose ○​ Instruct on the s/sx of hyponatremia and (10% to 50%) hyponatremia ❖​ sodium polystyrene ○​ Monitor serum Na levels and report abnormal sulfonate levels ​ (PO or Rectally) ○​ Hypernatremia ​ Nursing Considerations: ​ avoid foods high in Na, using salt when ○​ For oral preparations: cooking, and adding salt to food at the ​ Tablets and capsules- with or after meals table followed by a large glass of water ○​ Emphasize the importance of reading labels on ​ Remain in upright position at least 30 mins after food products administration ○​ Monitor daily weights ​ Don’t chew or crush enteric-coated tablets or ○​ Assess for signs of circulatory overload and extended-release tablets or capsules deficit ​ Don’t suck on tablets to avoid oral ulceration ​ Avoid salt substitutes CALCIUM (Ca) ○​ For IV Potassium Administration ​ NORMAL LEVELS: 8.6–10.2 mg/dL ​ NEVER administer K+ via IV push or bolus ​ Function: ○​ For continuous Infusion K+ Acetate ○​ Nerve and muscle activity ​ Do not administer undiluted ○​ Increases contraction of the heart muscle ​ Infuse slowly; too rapid infusion may cause ○​ Cellular permeability fatal hyperkalemia ○​ Promotes blood clotting ○​ For continuous Infusion K+ Chloride ○​ Formation of bones and teeth ​ Do not administer undiluted ​ Infuse slowly HYPOCALCEMIA HYPERCALCEMIA ​ Monitor IV site – extravasation & infiltration 10.2 mg/dL ○​ For Toxicity: ​ slow, irregular heartbeat; fatigue, muscle S/SX: S/SX: weakness, paresthesia, confusion, dyspnea, Anxiety, Irritability, Fatigue, muscle cardiac dysrhythmias Tetany; twitching, weakness, depressed SODIUM (Na) hyperactive DTR, spasms DTR, confusion, impaired ​ NORMAL LEVELS: 135–145 mEq/L of hands, wrist, feet and memory, anorexia, n/v, ​ Function: Major role in fluid volume balance; ankles; spasmodic constipation, kidney Maintains neuromuscular irritability for conduction contractions; laryngeal stones of calcium of nerve impulses spasm, and seizures; (+) composition HYPONATREMIA HYPERNATREMIA Chvostek and Trousseau signs (tetany); dec. CO, < 135 mEq/L > 145 mEq/L dysrhythmias; dry and brittle nails, & dry skin S/SX: S/SX: and hair Muscular weakness, Dry and sticky mucous ——————————— ——————————— Headaches, Abdominal membranes; flushed, dry Tx: Tx: cramps, N/V, dec. DTR, skin; agitation; inc. body ❖​ Calcium supplements ❖​ Correct underlying lethargy, confusion, temp.; rough, edematous, (PO or IV) cause of serum Ca seizures, coma, dry tongue; n/v; anorexia, ❖​ CaCl and CaGl excess tachycardia, hypotension, tachycardia, ❖​ IV saline solution and pale skin, dry mucous hypertension, muscle drugs (calcitonin) and membranes twisting, hyperreflexia, loop diuretics (to seizures and coma promote rapid urinary ——————————— ——————————— excretion of calcium Tx: Tx: ❖​ Oral Na replacement; ❖​ Sodium restriction IV solution ❖​ IVF and diuretics PILI, PERIDO 7 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 ​ Nursing Considerations: CHLORIDE (Cl) ○​ Administer IVFs slowly with 10% CaGl or CaCl ​ NORMAL LEVELS: 96-106 mEq/L ○​ Check the IV site for infiltration - tissue necrosis ​ Function: and sloughing ○​ Major contributor to acid-base balance, ○​ Monitor serum total Ca and ionized Ca levels gastric juice acidity, & osmolality of ECF ○​ Monitor ECG HYPOCHLOREMIA HYPERCHLOREMIA ○​ Avoid overuse of antacids and chronic use of laxatives 106 mEq/L ○​ High-fiber foods S/SX: S/SX: ○​ Take with meals or after meals -​ Tremors -​ Weakness MAGNESIUM (Mg) -​ Twitching -​ Lethargy ​ NORMAL LEVELS: 2.4–4.4 mg/dL -​ Slow/shallow breathing -​ Deep/rapid breathing -​ Decrease BP (in severe -​ Unconsciousness (late) ​ Function: loss) ○​ Neuromuscular activity ○​ Mediator of neural transmission in the CNS PHOSPHORUS (P) ○​ Promotes contraction of the myocardium ​ NORMAL LEVELS: 2.4–4.4 mEq/L ○​ Responsible for transportation of Na and K ​ Function: across cell membranes ○​ For bone and teeth formation HYPOMAGNESEMIA HYPERMAGNESEMIA ○​ For neuromuscular activity ○​ Important component of nucleic acids (DNA 4.4 mg/dL and RNA) ○​ Assist in energy transfer in cells S/SX: S/SX: ○​ Helps maintain cellular osmotic pressure -​ Anorexia -​ Hypotension ○​ Supports acid-base balance of body fluids -​ N/V -​ Muscle weakness HYPOPHOSPHATEMIA HYPERPHOSPHATEMIA -​ Abdominal distention, -​ Lethargy -​ Depression -​ Drowsiness 4.4 mEq/L -​ Confusion -​ Loss of DTR (deep -​ (+) Chvostek and tendon reflexes) S/SX: S/SX: Trousseau sign -​ Muscle weakness -​ Tetany Convulsions -​ Tremors -​ (+) Chvostek and Mg Drugs: MgSO4, Milk of Magnesia, Magnesium -​ Paresthesia, Trousseau signs Citrate -​ Bone pain -​ Hyperreflexia ​ Nursing Considerations: -​ Hyporeflexia -​ Nausea ○​ Report to the Doctor if patient is ordered NPO and -​ Seizure -​ Diarrhea is receiving IVFs without Mg salts for a prolonged -​ Hyperventilation -​ Abdominal cramps period -​ Anorexia -​ Flaccid paralysis ○​ Report if UO – below 600 ml/day -​ Dysphagia -​ Muscular weakness ○​ Monitor for digitalis toxicity (n/v, bradycardia) -​ Tachycardia ○​ IV Ca gluconate - for emergency reversal of ——————————— ——————————— hypomagnesemia Tx: Tx: ○​ Hypomagnesemia - Eat foods rich in Mg (green ❖​ Phosphorus ❖​ Restrictions of vegetables, fruits, fish, grains and nuts) replacement dietary phosphorus, ​ (PO or IV) phosphorus binding medications (calcium acetate), or dialysis PILI, PERIDO 8 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 DRUGS FOR URINARY TRACT DISORDERS URINARY ANTISEPTICS/ANTI-INFECTIVES AND ANTIBIOTICS Function: Reduces bacterial growth in the bladder & renal tubules due to UTI Drug Class/Drugs Indication/Function S/E & AE Nx Consideration Nitrofurantoin ​ Used to treat cystitis and GI disturbances (anorexia, N/V, ​ Monitor UO and urine specific gravity ————————— UTIs diarrhea, abdominal pain; pulmonary ​ Urine C/S (Furadantin), ​ Effective against many reactions (dyspnea, chest pain & ○​ before drug initiation (Macrodantin) gram– positive and ​ cough) ​ Observe for peripheral neuropathy gram-negative organisms, (tingling, numbness of extremities)\ esp E. coli ​ Do not crush tablets or open capsules ​ Increase OFI ○​ To minimize GI upset Drug Interaction: ​ PO-nitrofurantoin can stain teeth - Avoid antacids rinse the mouth - can interfere with ​ Report pregnancy and superinfection absorption ​ Urine may turn a harmless brown color Methenamine ​ For cystitis and chronic UTI nausea, dysuria, hematuria, ​ Drink cranberry juice, eat plums, or ​ Produces bactericidal crystalluria take vitamin C ​ effect when the urine PH is (as ordered) less than 5.5 ○​ to keep urine acidic ​ Effective against gram-positive and gram-negative organisms ​ Do not take with Sulfonamides- crystalluria may occur Drug Interaction: Sodium bicarbonate inhibits action of this drug Fluoroquinolones ​ Effective against Ciprofloxacin and Ofloxacin: ​ Avoid operating hazardous machinery ————————— ○​ Acinetobacter -​ Headache or driving a car Ciprofloxacin Ofloxacin ○​ Chlamydia -​ photosensitivity ○​ Can cause dizziness Levofloxacin ○​ Clostridium -​ dizziness ​ Taken with food ○​ Klebsiella -​ n/v, ​ Check for superinfections ○​ Staphylococcus -​ diarrhea, ○​ Streptococcus species -​ visual impairment -​ rash Drug Interaction:​ -​ pruritus Avoid antacids -​ Exacerbate muscle weakness ○​ can interfere with (MG) absorption Trimethoprim- For cystitis, UTIs May cause Avoid excessive exposure to sunlight Sulfamethoxazole -​ anorexia, -​ n/v, -​ rash, -​ pruritus PILI, PERIDO 9 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 URINARY ANALGESICS ANTIMUSCARINICS/ANTICHOLINERGICS ​ Function: ​ Function: ○​ Used to relieve the urinary pain, burning ○​ Use to control an overactive bladder- w/c sensation, frequency, and urgency of urination causes frequency in urination that are symptomatic of cystitis ○​ Decrease urgency and urinary incontinence ​ Drugs for example: ​ Drugs for example: ○​ Phenazopyridine HCl and Dimethyl Sulfoxide ○​ Tolterodine tartrate, Trospium Chloride, ​ Side Effects: Solifenacin succinate, Darifenacin ○​ abdominal cramps hydrobromide ○​ hemolytic anemia ○​ renal Side effects of URINARY ANTISPASMODICS/ ○​ hepatic dysfunction ANTIMUSCARINICS/ ANTICHOLINERGICS include: ​ Nx. Considerations ○​ Blurred vision ○​ Urine becomes harmless reddish orange ○​ HA ​ Because of phenazopyridine dye ○​ Dizziness ○​ Dimethyl Sulfoxide ○​ Dry mouth ​ May cause garlic-like taste & skin ○​ Constipation hyperpigmentation ○​ Tachycardia URINARY STIMULANTS ​ Function: ○​ Also known as direct-acting parasympathomimetic ○​ Increase bladder tone by increasing the detrusor urinal muscle ​ Drug for example: ○​ Bethanecol chloride ​ Side Effects: ○​ GI distress ○​ HA ○​ Dizziness ○​ Nephrotoxicity ○​ Hepatotoxicity ​ Nx. Considerations ○​ DO NOT take if with peptic ulcer URINARY ANTISPASMODICS/​ ANTIMUSCARINICS/ ANTICHOLINERGICS ​ Function: treat conditions characterized by frequent urination, urgency, and sometimes urinary incontinence. URINARY ANTISPASMODICS ​ Drugs for example: ○​ Flavoxate HCL ○​ Oxybutynin Chloride ○​ Mirabegron ​ CI for these drugs: ​ if urinary or GI obstruction is present; glaucoma PILI, PERIDO 10 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 OUTLINE A.​ Anatomy and Physiology of the Cardiovascular System B.​ Drugs for Cardiovascular System a.​ Cardiotonic Antianginals b.​ Antidysrhythmics c.​ Antihypertensive d.​ Anticoagulants e.​ Antiplatelets f.​ Thrombolytics A.​ Lipid lowering agents B.​ Peripheral Vasodilators CARDIOTONIC, ANTIANGINALS, AND ANTIDYSRHYTHMICS DRUGS ​ These groups of drugs regulate ○​ Heart contraction ○​ Heart rate and rhythm ○​ Blood flow to the myocardium (heart muscle) ​ Heart ○​ Conduction of electrical impulse ○​ Regulation of heart rate and blood flow ○​ Circulation and blood CARDIOTONICS -​ increases efficiency and improve contraction of the heart CARDIAC GLYCOSIDES Digitalis Function: ○​ 1785: alleviates dropsy (edema of the extremities) ○​ Treats CHF ○​ Inhibits the Na-K pump thus increase intracellular Ca causes muscle fibers to contract more efficiently Effects on the heart muscle: Positive inotropic action Negative chronotropic action Negative dromotropic action (helps the heart beat with more (decreases heart rate) (decreases the speed of impulse) force) ​ Treatment of CHF ​ Treatment of A-Fib and ​ Treatment of A-Fib and A-Flutter A-Flutter VALDEZ, PILI 11 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 Drugs Function Side effects/ Contraindications Drug interactions Adverse reactions ​ Digoxin ​ Inhibits the ​ Anorexia ​ Dysrhythmias ​ Diuretics (Lanoxin) Na-K pump ​ Nausea and ​ Acute such as promoting vomiting Myocardial K+wasting increase ​ Headache Infarction (r: may lead to force of ​ Blurred vision ​ Renal digitalis toxicity) cardiac ​ Photophobia Disease contraction, ​ Fatigue ​ Hypokalemia ​ Cortisone cardiac ​ Confusion preparations output, tissue ​ Visual (r: “may cause perfusion, disturbances increased blood decreases ​ Bradycardia pressure, irregular ventricular ​ Cardiac heartbeats, light rate dysrhythmias "halos" around objects, green or yellow vision, fatigue, swollen hands, feet, or ankles”) ​ Antacids (r: decreases the therapeutic effect of digoxin) Signs and symptoms of Digitalis toxicity: -​ Anorexia -​ Bradycardia -​ Confusion -​ Delirium -​ Diarrhea -​ Nausea and Vomiting -​ Premature Ventricular Contraction (PVC) -​ Visual Illusions (white, green, or yellow halos) Therapeutic Range: -​ 0.8 to 2.0 ng/mL ANTIDOTE FOR DIGITALIS Digoxin Immune Fab (Ovine, Digibind) Binds to digoxin to form complex molecules that can be excreted in the urine VALDEZ, PILI 12 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 Nursing considerations Assessment 1.​ Assess signs of edema (in HF) Implementation 1.​ Check vital signs (apical pulse) 2.​ Do not administer if pulse rate is below 60 BPM 3.​ Monitor serum digoxin level 4.​ Monitor serum potassium level Diet -​ Food rich in potassium Evaluation -​ Effectiveness of the drug (decreased Heart rate and absence of side effects ANTIANGINALS -​ Treats chest pain Drugs Mode of action Dosage/ Form Side effects/ Drug interaction Adverse Reactions Nitrates ​ Increases ​ 0.4 mg SL ​ Headache ​ Beta-blocker blood flow repeated ​ Hypotensio s ​ Isosorbide through the every 5 n ​ Calcium Dinitrate coronary minutes for a ​ Dizziness channel (Isordil) arteries to the total of 3 ​ Weakness blockers ​ Isosorbide myocardial doses. ​ Faintness ​ Vasodilators Mononitrate cells through ○​ ​ Reflex ​ Alcohol (Imdur) vasodilation. ​ Nitroglycerin tachycardia ​ Heparin ​ Nitroglycerin (topical, (if given too transdermal rapidly) (r: patch, to capsule, compensate tablet, for blood aerosol pressure spray, IV decrease) forms) ○​ ○​ Beta-blockers ​ Decrease the - - - effects of the Types sympathetic A.​ Non-selectiv nervous e system by ​ Propranolol blocking the ​ Nadolol action of ​ Pindolol catecholamine s, which B.​ Selective decreases ​ Atenolol heart rate and ​ Metorprolol blood pressure. VALDEZ, PILI 13 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 Calcium channel ​ Decreases - - - blockers cardiac contractility Types ​ Decreases A.​ Long-term afterload Treatment ​ Decreases ​ Verapamil peripheral ​ Nifedipine resistance ​ Diltiazem ​ Reduces the workload of B.​ High-protein the heart bound ​ Nicardipine ​ Amlodipine ​ Felodipine ​ Nisoldipine ANTIDYSRHYTHMICS -​ Treats abnormal heart rhythms Drug classes Function Drugs I.​ Fast (Na) channel blockers ​ Decrease the fast Na influx to 1A - Quinidine, Procainamide, 1A, 1B, 1C the cardiac cells Disopyramide 1A - Slows conduction and prolongs 1B - Lidocaine repolarization 1C - Flecainide 1B - Slows conduction and shortens repolarization 1C - prolongs conduction with little to no effect on repolarization II.​ Beta-blockers ​ Decrease: ​ Propranolol (Inderal) 1.​ Conduction velocity ​ Acebutolol (Sectral) 2.​ Automaticity 3.​ Recovery time III. Drugs that prolong repolarization ​ Used in the emergency ​ Bretylium (Bretylol) (Potassium-channel blockers) treatment of ventricular ​ Amiodarone (Cordarone) dysrhythmias when other antidysrhythmics are not effective IV. Slow (Ca) Channel blockers ​ Blocks calcium influx thus ​ Verapamil (Isoptin) decreasing the excitability ​ Diltiazem (Cardizem) and contractility of the myocardium. VALDEZ, PILI 14 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 ANTIHYPERTENSIVE DRUGS ​ Hypertension ○​ Is an increase in blood pressure such that the systolic pressure is >140mmHg and diastolic pressure is >90mmHg ​ Essential hypertension ○​ The most common type affecting 90% of persons with HBP ​ 10% of hypertension cases ○​ Related to renal and endocrine disorders ○​ Classified as secondary hypertension ​ Contributing factors: ○​ Family history of hypertension ○​ Hyperlipidemia ○​ African American background ○​ Diabetes ○​ Obesity ○​ Aging ○​ Stress ○​ Excessive smoking and alcohol ingestion Categories of antihypertensive drugs Categories Function Drugs Side effects/ Adverse Reactions ​ Diuretics ​ Promote Na ​ Thiazide: - depletion, which hydrochlorothiazide decreases ECFV (HydroDiuril) ​ Effective as first-line drugs for ​ Loop diuretics: treating mild Furosemide (Lasix) hypertension Class and site of action 1.​ Thiazide/Thiazide-li ke: Distal convoluted tubule 2.​ Loop/High-ceiling: Ascending loop of henle 3.​ Osmotic: Proximal tubule and loop of henle 4.​ Potassium-sparing: Collecting duct ​ Sympatholytics - Five group of drugs - (sympathetic 1.​ Beta-adrenergic depressants) blockers 2.​ Centrally acting VALDEZ, PILI 15 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 alpha2-agonists 3.​ Alpha-adrenergic blockers 4.​ Adrenergic neuron blockers 5.​ Alpha1 and beta1 adrenergic blockers ​ Direct-acting ​ Relaxes the ​ Hydralazine ​ Tachycardia arteriolar smooth muscles of ​ Minoxidil ​ Palpitations vasodilators the blood vessels ​ Nitroprusside ​ Edema causing ​ Diazoxide ​ Nasal congestion vasodilation ​ Headache ​ Promotes an ​ Dizziness increase in blood ​ GI bleeding flow to the brain ​ Tingling/ and kidneys Numbness ​ Excess hair growth ​ Confusion ​ ACE inhibitors ​ Inhibits the ​ Captopril (Capoten) ​ Cough (Angiotensin formation of ​ Benazepril ​ Nausea/Vomiting converting enzyme) angiotensin II. (Lotensin) ​ Diarrhea ​ Blocks the release ​ Enalapril Maleate ​ Headache of aldosterone (Vasotec) ​ Dizziness ​ Fosinopril ​ Fatigue (Monopril) ​ Insomnia ​ Lisinopril (Zestril) ​ Hyperkalemia ​ Moexipril (Univasc) ​ Tachycardia ​ Perindopril (Aceon) ​ Quinapril (Accupril) Contraindication: ​ Ramipril (Altace) Pregnancy ​ Trandolapril (Mavik) Renal Insufficiency ​ Angiotensin II ​ Similar to ACE ​ Losartan (Cozaar) ​ Dizziness receptor inhibitors ​ Valsartan (Diovan) ​ Diarrhea Antagonists ​ Prevent the release ​ Irbesartan (Avapro) ​ Insomnia (blockers) of aldosterone ​ Candesartan ​ Occasional cough Cilexetil (Atacand) ​ Eprosartan Contraindication (Teveten) Pregnancy ​ Olmesartan Renal and hepatic Medoxomil impairments (Benicar) ​ Telmisartan (Micardis) ​ Calcium channel ​ Decrease calcium ​ Verapamil (Isoptin) -​ blockers levels and promote ​ Nifedipine ​ vasodilation (Procardia) ​ “Calcium ​ Felodipine (Plendil) antagonists and ​ Amlodipine VALDEZ, PILI 16 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 Calcium blockers” (Norvasc) ​ Nicardipine (Cardene) Review: Adrenergic Receptors Receptor Location Function A1 ​ Arteries ​ Constriction blood vessels ​ Smooth muscles ​ Dilates pupils (mydriasis) ​ Bladder relaxation and sphincter constriction A2 ​ Arteries ​ Dilates B1 ​ Heart ​ Increases heart rate and force ​ Juxtaglomerular cells ​ Releases renin B2 ​ Lung ​ Dilates bronchioles ​ GI ​ GI and uterine relaxation ​ Uterus ​ Increase blood glucose ​ Liver (glycogenolysis) ​ Skeletal muscles ​ Increase blood flow to skeletal muscle SYMPATHOLYTICS Drug class Mechanism of action Example drugs 1.​ Beta-adrenergic blockers ​ Block beta-adrenergic Non-selective: receptors, reducing heart rate ​ Propranolol (Inderal) and cardiac output Cardioselective: ​ Acebutolol (Sectral) ​ Atenolol (Tenormin) ​ Betaxolol (Kerlone) ​ Bisoprolol (Zebeta) ​ Metoprolol (Lopressor) 2.​ Centrally acting ​ Stimulate alpha2-adrenergic ​ Clonidine alpha2-agonist receptors in the brain, ​ Methyldopa reducing sympathetic outflow 3.​ Alpha-adrenergic blockers ​ Block alpha1-adrenergic ​ Prazosin receptors, causing ​ Terazosin vasodilation ​ Doxazosin 4.​ Adrenergic neuron blockers ​ Inhibit release of ​ Reserpine norepinephrine from ​ Guanethidine sympathetic nerve terminals 5.​ Alpha1 and beta1 adrenergic ​ Block both alpha1 and beta1 ​ Labetalol blockers receptors, causing ​ Carvedilol vasodilation and reduced VALDEZ, PILI 17 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 heart rate SYMPATHOLYTICS Group Function Types Contraindications Side effects/ Adverse reactions Beta-adrenergic ​ Reduce Nonselective ​ Should not ​ Bradycardia blocks cardiac ​ Propranolol be given with ​ Markedly output by (Inderal) 2nd or 3rd decreased diminishing degree BP the Cardioselective atrioventricul ​ Bronchospas sympathetic ​ Acebutolol ar block or m nervous (Sectral) sinus ​ Insomnia system ​ Atenolol bradycardia. ​ Depression response (Tenormin) ​ Nonselective ​ Nightmares thereby ​ Betaxolol beta-blocker ​ Sexual decreasing (Kerlone) s should not dysfunction basal ​ Bisoprolol be given to sympathetic (Zebeta) patients with tone ​ Metoprolol COPD. ​ (Lopressor) ​ Vascular resistance is diminished and BP is lowered Centrally Acting ​ Decrease the ​ Methyldopa ​ Impaired liver ​ Drowsiness Alpha2 Agonists sympathetic (Aldomet) function ​ Dry mouth response ​ Clonidine ​ Dizziness from the (Catapres) ​ Bradycardia brainstem to ​ Hypertensive the peripheral crisis vessels. ​ Na and H2O ​ Stimulates retention the alpha2 receptors which decreases sympathetic activity; increases vagus activity, decreases cardiac output, decreases epinephrine and norepinephrin e and renin VALDEZ, PILI 18 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 release. Alpha-Adrenergic ​ Blocks the ​ Prazosin ​ ​ Orthostatic Blockers alpha-adrene ​ Terazosin hypotension rgic ​ Doxazosin ​ Nausea receptors ​ Phentolamine ​ Drowsiness thus resulting ​ Noxybenzami ​ Nasal in ne Congestion vasodilation ​ Tolazoline ​ and ​ Drug decreased Interaction BP. ​ Anti-inflamm ​ Help maintain atory drugs the renal ​ Nitrates blood flow rate. ​ Useful to treat lipid abnormalities. Adrenergic Neuron ​ Blocks ​ Reserpine ​ ​ Orthostatic Blockers norepinephrin ​ Guanethidine hypotension e release ​ Vivid dreams “Peripherally Acting from the ​ Nightmares Sympatholytics” sympathetic ​ Suicidal nervous intention system. Alpha1 and Beta1 – ​ Blocks both ​ Labetalol ​ Severe ​ Orthostatic Adrenergic blockers the alpha 1 (Normodyne) asthma hypotension and beta 1 ​ Carteolol ​ GI receptors (Cartrol) disturbances results in ​ Nervousness dilation of the ​ Dry mouth arterioles and ​ Fatigue veins Receptor Type Location Primary effect Drug class targeting Side effects receptor A1 ​ Vascular ​ Vasoconstrict Alpha 1 blockers ​ Orthostatic smooth ion ​ Prazosin hypotension muscle, ​ Smooth ​ Terazosin ​ Nausea prostate, muscle ​ Doxazosin ​ Drowsiness bladder neck ​ Contraction ​ Nasal Congestion A2 ​ Presynaptic ​ Inhibition of Alpha-2 agonists ​ Drowsiness nerve norepinephrin ​ Clonidine ​ Dry mouth terminals, e release ​ Methyldopa ​ Dizziness central ​ Central ​ Bradycardia nervous sympathetic ​ Hypertensive VALDEZ, PILI 19 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 system outflow crisis (dilation of ​ Na and H2O arteries) retention B1 ​ Heart, ​ Increased Cardioselective ​ Bradycardia kidneys heart rate ​ Acebutolol ​ Markedly ​ Contractility (Sectral) decreased ​ Renin release ​ Atenolol BP (Tenormin) ​ Bronchospas ​ Betaxolol m (Kerlone) ​ Insomnia ​ Bisoprolol ​ Depression (Zebeta) ​ Nightmares ​ Metoprolol ​ Sexual (Lopressor) dysfunction B2 ​ Lung, blood ​ Bronchodilati Non-selective vessels, on ​ Propranolol uterus ​ Vasodilation (Inderal) ​ Uterine relaxation C.​Direct-Acting Arteriolar Vasodilators DRUGS MODE OF ACTION SIDE EFFECTS / ADVERSE REACTIONS ​ Hydralazine ​ Relaxes smooth muscles of the blood ​ Tachycardia ​ Minoxidil vessels causing vasodilation. ​ Palpitations ​ Nitroprusside ​ Promotes an increase in blood flow to ​ Edema ​ Diazoxide the brain and kidneys. ​ Nasal Congestion ​ Headache ​ Dizziness ​ GI Bleeding ​ Tingling / Numbness ​ Excess Hair Growth ​ Confusion D.​ Angiotensin Antagonists “ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS” DRUGS MODE OF ACTION SIDE EFFECTS / CONTRAINDICATIONS ADVERSE REACTIONS ​ Captopril (Capoten) ​ Inhibits the ​ Cough ​ Pregnancy ​ Benazepril (Lotensin) formation of ​ Nausea / Vomiting ​ Renal Insufficiency ​ Enalapril Maleate angiotensin II. ​ Diarrhea (Vasotec) ​ Promotes the ​ Headache ​ Fosinopril (Monopril) release of ​ Dizziness ​ Lisinopril (Zestril) aldosterone ​ Fatigue ​ Moexipril (Univasc) ​ Insomnia VALDEZ, PILI 20 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 ​ Perindopril (Aceon) ​ HyperK ​ Quinapril (Accupril) ​ Tachycardia ​ Ramipril (Altace) ​ Trandolapril (Mavik) “ANGIOTENSIN II RECEPTOR ANTAGONISTS” DRUGS MODE OF ACTION SIDE EFFECTS / ADVERSE CONTRAINDICATIONS REACTIONS ​ Losartan (Cozaar) ​ Similar to ACE ​ Dizziness ​ Pregnancy ​ Valsartan (Diovan) inhibitors. ​ Diarrhea ​ Renal and Hepatic ​ Irbesartan (Avapro) ​ Prevent the ​ Insomnia Impairments ​ Candesartan Cilexetil release of ​ Occasional cough (Atacand) aldosterone. ​ Eprosartan (Teveten) ​ Olmesartan Medoxomil (Benicar) ​ Telmisartan (Micardis) E.​ Calcium Channel Blockers “CALCIUM ANTAGONISTS AND CALCIUM BLOCKERS” DRUGS MODE OF ACTION SIDE EFFECTS / ADVERSE REACTIONS ​ Verapamil (Isoptin) ​ Decrease calcium levels and promote vasodilation. ​ Flushes ​ Nifedipine (Procardia) ​ Headache ​ Felodipine (Plendil) ​ Dizziness ​ Amlodipine (Norvasc) ​ Ankle edema ​ Nicardipine (Cardene) ​ Bradycardia ​ AV block Nursing Considerations BETA-BLOCKERS ALPHA-ADRENERGIC ANGIOTENSIN ANTAGONIST GENERAL BLOCKERS (ACE) INHIBITORS ​ Monitor BP & HR ​ Monitor VS ​ Check lab values for serum Emphasize: ​ Check lab values r/t ​ Check daily for fluid protein, albumin, BUN, ​ Stress-reduction renal and liver function retention in the creatinine & WBC techniques ​ Inform client that it may extremities ​ Instruct client not ​ Exercise cause sexual ​ Explain that before discontinue captopril ​ Salt restriction dysfunction rising, client shout sit abruptly ​ Decreased alcohol ​ Advise client to report and dangle feet ​ Instruct client to take ingestion constipation ​ Encourage client to captopril 20 minutes to 1 ​ Weight reduction decrease salt intake hour before meals ​ Inform client that the taste of food maybe diminished VALDEZ, PILI 21 of 53 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion.  NUR 124: PHARMACOLOGY FINAL TERM RELEASE 1 - NUR124 - 210-2027 during the 1st month of therapy ANTICOAGULANTS, ANTIPLATELETS, AND THROMBOLYTICS CLOTTING MECHANISM ​ Platelets ​ Thromboplastin ​ Prothrombin Activator ​ Prothrombin ​ Thrombin —------------ fibrinogen ​ Fibrin Clot GENERAL INDICATION ​ These are drugs used to maintain or restore circulation. 3 MAJOR GROUPS ​ Anticoagulants - prevent clot formation ​ Antiplatelets - prevents platelet aggravation ​ Thrombolytics - prevents lyse or dissolve clot formation THROMBUS FORMATION ​ Thrombus is the formation of a clot in an arterial or venous vessel. 1.​Anticoagulants GENERAL MODE OF ACTION ​ Prevent the formation of clots that inhibit circulation ​ It doesn’t dissolve clots that have already formed but act prophilactically to prevent new clots ​ Ex. Heparin HEPARIN ​ Introduced in 1938 ​ Administered oral, parenteral, subcutaneous, intravenous ​ A natural substance in the liver that prevents clot formation ​ Partial thromboplastin (PTT) and activated partial thromboplastin time (aPTT) ANTIDOTE FOR HEPARIN ​ Protamine Sulfate LOW-MOLECULAR-WEIGHT HEPARINS DRUGS DESCRIPTION CONTRAINDICATIONS