Drug Descriptions - pharmacology 2 final exam notes PDF

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pharmacology 2 final exam notes ...

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Cardiovascular Medications: 1.    

Inderal (Propranolol) [non-selective beta-blocker] Prototypical NON-SELECTIVE b1 and b2 blocking drug. Use for tachydysrhythmias associated with cardiac glycoside intoxication. Use for treatment of: pheochromocytoma, thyrotoxicosis, migraine headaches, ect. Contraindicated for patients with ASTHMA.

2. Tenormin (Atenolol) [beta-blocker]  These drugs are the gold standard for treatment of MI because it decreases mortality and has a cardio-protective effect  They also prevent the recurrence of tachyarrhythmias and MI  Cardio-protective effect: takes out the extra catecholamines after a heart attack, because extra catecholamines will stimulate the heart  Treats high BP & angina 3.    

Zestril (Lisinopril) [Antihypertensive ACE inhibitor] First-line drug for HTN Can cause angioedema (swelling of the tongue) Can be used in patients with liver dysfunction Monitor for orthostatic hypotension

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Catapress (Clonidine) [Aplha-2 receptor agonist, Antihypertensive] Used primarily to DECREASE BP Alpha 2 receptor agonist Useful in the management of opioid withdraw (e.g. brain). Must not be discontinued abruptly or it may cause rebound hypertension.

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Vasotec (Enalapril) [Antihypertensive ACE inhibitor] Only Ace inhibitor currently available in oral and parental form. Does not require cardiac monitoring when given IV. Is a prodrug, pt must have a working liver to convert the drug. Reduces BP by causing decrease systemic vascular resistance. Contraindications: potassium level of 5 mEq or higher. Side effects: dizziness, mood changes, headaches, ****DRY NON-PRODUCTIVE COUGH***, HYPERKALEMIA. Interactions: NSAIDS.

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6. Capoten (Captopril) [ACE inhibitor]  FIRST LINE DRUG to treat HF and HTN  Blockage of ACE prevent angiotensin 2 to get formed, causing decreased afterload, vasodilation and decreased BP  Adv. Effect: dry mouth, non-productive cough (reversed when medicine is stopped)  Hypotension could happened with first dose

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Check with Dr. if dose is missed Keep journal of regular BP Change position slowly to avoid orthostatic hypotension Impotence is an expected side effect BP should be maintained at least at 140/90

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Lopressor (Metoprolol) [Beta blocker] B1 located primarily on the heart B2 located on smooth muscles, bronchioles, and blood vessels Reduced SNS stimulation to the heart, causing deceased heart rate, prolong SA node, slow conduction through AV node, decreased myocardial contractility, which would decreased myocardial oxygen demand Rebound HTN if medicine is stopped abruptly Adv. Effect: decreased in tolerance to exercise, dizziness, fainting. Gain more than 2lb within a week, edema, SOB.

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8. Nitroglycerin [Anti-anginal]  Cause vasodilation because of relaxation of smooth muscles  Potent dilating effect on coronary arteries  Used for prevention and treatment of angina  Vasodilation results in reduced myocardial oxygen demand  Nitrates cause dilation of both large and small coronary vessels  Result: oxygen to ischemic myocardial tissue  Nitrates alleviate coronary artery spasms  Large first-pass effect with oral forms  Used for symptomatic treatment of ischemic heart conditions (angina) IV form used for:  BP control in perioperative hypertension  treatment of HF, ischemic pain  pulmonary edema associated with acute MI  hypertensive emergencies Teaching:  Instruct patients in proper technique and guidelines for taking sublingual nitroglycerin for anginal pain  Instruct patients never to chew or swallow the sublingual form  Instruct patients that a burning sensation felt with sublingual forms indicates that the drug is still potent  Instruct patients in the proper application of nitrate topical ointments and transdermal forms, including site rotation and removal of old medication  To reduce tolerance, the patient may be instructed to remove topical forms at bedtime and apply new doses in the morning, allowing for a nitrate-free period If anginal pain occurs:  Stop activity and sit or lie down  Take a sublingual tablet, and call 911/Emergency Services immediately!

 If no relief in 5 minutes, take a second sublingual tablet  If no relief in 5 minutes, take a third sublingual tablet  Do not try to drive to the hospital  IV forms of nitroglycerin must be given with special non-PVC tubing and bags  Discard parenteral solution that is blue, green, or dark red Side Effects:  The most common undesirable adverse effect is headaches. Other side effects include tachycardia and postural hypotension 9.        

Digoxin (Lanoxin) [Heart failure, A-Fib and flutter, supraventricular dysrhythmias] Level is 0.5-2, if used for A-Fib it’s up to 2.5 Increased myocardial contractility. Decreased electrical conduction and prolong refractory period in the conduction (between SA node and AV node) Used primarily for systolic heart failure and atrial fibrillation Contraind.: 2nd or 3rd degree heart block, ventricular tachycardia or fibrillation Low potassium can increase digoxin toxicity Adv. Effect: color vision changed (green, yellow, purple), anorexia, nausea, bradycardia, tachycardia. Monitor pulse apical and radial for one minute and if lower than 60 or higher than 100, withhold medication.

10. Digibind (Digoxin immune fab) [Antidote for digoxin overdose]  Use to treat digoxin overdose and also indicated for reversal life threatening effects as severe bradycardia, advance heart block, ventricular tachycardia or fib.  The criteria for giving Digibind are bradycardia, advanced heart block, ventricular tachycardia or fibrillation and severe HYPERkalemia.  Monitor the clinical S&S of digoxin toxicity rather than the lab levels 11. Quinidex (Quinidine) [Anti-dysrhythmia]  Block sodium (fast) channels  Delay repolarization  Increase APD (action potential duration)  Indication: atrial fibrillation (A-fib)  premature atrial contractions (PAC)  premature ventricular contractions (PVC)  ventricular tachycardia (VT)  Wolff-Parkinson-White syndrome (WPW)  Side Effects: asystole and ventricular ectopic beats, tinnitus, loss of hearing, blurred vision, GI upset. 12. Lidocaine [Anti-dysrhythmia]  Block sodium channels  Accelerate repolarization

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Increase or decrease APD Used for ventricular dysrhythmias only Premature ventricular contractions ventricular tachycardia ventricular fibrillation Administered IV because of its high first pass. Side Effects: Twitching, convulsions, confusion, respiratory depression or arrest

13. Procardia (nifedipine) [Calcium-channel blocker, anti-hypertensive]  Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction  This causes decreased peripheral smooth muscle tone and decreased systemic vascular resistance  Result: decreased blood pressure Indications  Angina  Hypertension  Dysrhythmias  Migraine headaches  Raynaud’s disease  Side Effects: Hypotension, palpitations, tachycardia, constipation, nausea, rash, flushing, peripheral edema, dermatitis ANS Drugs: 1.    

Mestinon (pyridostigmine) [Cholinergic agent, PSNS] Used to reverse anticholinergic poisoning Taken for MG, take at the same time each day Don’t double up on dosages Improve muscle strength and is used to relieve symptoms of MG

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Atropine [Cholinergic-blocking drug/ Anti-cholinergic] Increases HR, use for bradycardia and ventricular asystole. Use for as an antidote for cholinergic poisoning. Use pre-op to reduce salivation and GI secretions. Contraindicated for pts. with open angle glaucoma. Overdose causes: flushing, dry skin, mydriasis, alter mental status, and fever. Sinus tachy, urinary retention, HTN, hallucinations, respiratory depression. Antidote for atropine is physostigmine.

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Dopamine (Intropin) Potent dopaminergic as well as a1 and b1 receptor activity. Dose dependent Low dose: dilates blood vessels in the heart, kidneys and brain.

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Moderate/High Doses: Increases cardiac contractility and output (b1 activity) Highest doses: Causes vasoconstriction (a1 activity) Contraindicated in pt with catecholamine secreting tumors. Treats hypotension, IV pump, dosage is based on kg Do a fluid challenge first before giving this medication for hypotension

4. Prostigmin (Neostigmine) [Cholinergic agent/ Anticholinesterase]  Treats myasthenia gravis. Also given after surgery to help reverse the effects of certain types of anesthesia on your muscles.  Reverses the effect of neuromuscular blocking drugs Diuretics: 1.      

Lasix (furosemide) [Loop diuretic] Most commonly used loop diuretic Indications: Edema associated with HF or hepatic or renal disease Control of hypertension Increase renal excretion of calcium in clients with hypercalcemia Contraindicated in pt.’s with allergies to sulfonamides also, anuria, hypovolemia, Monitor potassium levels, can cause HYPOKALEMIA (give K supplement) and HYPERGLYCEMIA

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HydroDiuril (hydrochlorothiazide) [Thiazide diuretic] This drug lowers peripheral vascular resistance Most prescribed agent for the treatment of hypertension Decreases effectiveness of anticoagulants, sulfa, insulin & antibiotics Do not consume excessive amounts of licorice, can cause hypokalemia

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Zaroxolyn (Metolazone) [Thiazide-like diuretic] Same as thiazide diuretic Can cause hypokalemia Treats CHF and HTN

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Aldactone (spironolactone) [Potassium-sparing diuretic] Mechanism of Action: Interfere with sodium-potassium exchange Competitively bind to aldosterone receptors Block the resorption of sodium and water usually induced by aldosterone Prevent potassium from being pumped into the tubule, thus preventing its secretion Hyperaldosteronism Hypertension Reversing the potassium loss caused by potassium-losing drugs Side Effects: Dizziness, headache GI: Cramps, nausea, vomiting, diarrhea, urinary frequency, weakness **HYPERKALEMIA**, Gynecomastia, Amenorrhea

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Irregular menses, Postmenopausal bleeding

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Osmitrol (Mannitol) [Osmotic diuretic] Reduced cellular edema Increased urine production, causing diuresis Rapid excretion of water, sodium, and other electrolytes, as well as excretion of toxic substances from the kidney Reduced excessive intraocular pressure Indications: Used in the treatment of clients in the early, oliguric phase of ARF To promote the excretion of toxic substances Reduction of intracranial pressure, use Foley catheter to monitor I&O Treatment of cerebral edema Side Effects: Convulsions Thrombophlebitis Pulmonary congestion Also headaches, chest pains, tachycardia, blurred vision, chills, and fever

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Diamox (Acetazolamide) [Carbonic anhydrase inhibitor diuretic] Contraindicated for pts with liver and kidney dysfunctions, low serum potassium. Indications: Open angle glaucoma, edema secondary to CHF. May cause hyperglycemia in diabetics. Adverse effects: hypokalemia, drowsiness, hematuria, photosensitivity. May cause digoxin toxicity.

Anticoagulants and Thrombolytics: 1.        

Coumadin (warfarin) [anti-coagulant] Use orally. Use of this drug requires careful monitoring of the PT/INR INR(without warfarin): 1.0 INR(with warfarin): 2-3.5 Interacts with sulfa Amiodarone will increase warfarin by 50%. VITAMIN K is used as an antidote. Side effects: bleeding, lethargy, muscle pain, and purple toes

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Heparin [anti-coagulant] Monitored by activated partial thromboplastin times (aPTTs) Parenteral Short half-life (1 to 2 hours) Effects reversed by PROTAMINE SULFATE Intravenous doses (double-checked with another RN) Ensure that SC doses are given SC, not IM

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SC doses should be given in areas of deep subcutaneous fat, and sites rotated Do not give SC doses within 2 inches of: the umbilicus, abdominal incisions, or open wounds, scars, drainage tubes, stomas Do not aspirate SC injections or massage injection site May cause hematoma formation IV doses may be given by bolus or IV infusions Anticoagulant effects seen immediately Laboratory values done daily to monitor coagulation effects (aPTT) Protamine sulfate can be given as an antidote in case of excessive anticoagulation

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Lovenox (enoxaparin) [low-molecular weight heparin] More predictable anticoagulant response Do not required laboratory monitoring Given SUBQ Monitor for bleeding

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TPA [Antithrombotic] This drug lyses or destroys existing clots, similar to Retavase Acute MI Arterial thrombolysis DVT Occlusion of shunts or catheters Pulmonary embolus Acute ischemic stroke Side effects: Bleeding Nausea, vomiting, hypotension, anaphylactic reactions Cardiac dysrhythmias; can be dangerous

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Anti-lipids: 1.       

Mevacor (Lovastatin) [HMG COA reductase inhibitor] Most potent LDL reducer Inhibit HMG-CoA reductase which is used by the liver to produced cholesterol First line drug to treat hypercholesterolemia Adv. Effect: Mild GI disturbance, rash, headache Pt with long term treatment may need fat soluble vitamin A D E K Take with meals to reduced GI upset. Never take dry powder Other medications should be taken 1 hour before or 3-4 hours after meal to allow absorbance

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Niacin (Nicotinic acid, vitamin B3) Increased activity of lipase, which breaks down lipids. Lower triglyceride, serum cholesterol, and LDL. Increase HDL Adv. Effect: flushing, pruritus, GI distress

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Aspiring could be taken 30 min before Niacin to avoid flushing Pt with long term treatment may need fat soluble vitamin A D E K Take with meals to reduced GI upset. Never take dry powder Other medications should be taken 1 hour before or 3-4 hours after meal to allow absorbance

Respiratory Drugs: 1.   

Advair (Fluticasone/Salmeterol) [Intranasal steroid] Decrease inflammation, so decreased decongestion. Relief nasal stuffiness Adv. Effect: local mucosa dryness, wash mouth after Opens airway and decreases inflammation

2. Albuterol (Proventil) [Beta-Adrenergic Agonist]  Used for short-term use only of acute bronchospasm  Side effects: hypertension, nervousness, tachycardia, hypokalemia, hypotension Musculoskeletal Drugs: 1. Naprosyn (naproxen) [NSAID, Propionic acids]  This drug is safe to give to children 2. Motrin (Ibuprofen) [NSAID, Propionic acids]  Safe to give to children  Thermal regulatory center in the brain, analgesic, antipyretic, antinflammatory, antithrombotic, rheumatoid arthritis, osteoarthritis  Adv. Effect: GI bleed, mucosal lesion (Misoprostol (Cytotec) is used to reduce GI problems)  Perform labs: cardiac, renal, liver, CBC, platelet count  Drug interaction: Heparin, Phenytoin, Steroids, alcohol  Enteric-coated tablets should not be crushed or chewed 3. Aspirin (ASA) [NSAID, Acetylated]  Antiplatelet aggregation, thermal regulatory center in the brain, analgesic, antipyretic, anti-inflammatory, antithrombotic.  Use also for gout  Adv. Effect: GI bleed, mucosal lesion (Misoprostol (Cytotec) is used to reduce GI problems)  Adult: tinnitus and hearing loss (OTOTOXIC)  Children: hyperventilation and CNS effects like behaviors changes, diarrhea, metabolic acidosis  Perform labs: cardiac, renal, liver, CBC, platelet count  Drug interaction: Heparin, Phenytoin, Steroids, alcohol  Not to give to children under 12 because of risk of Reye’s syndrome

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Enteric-coated tablets should not be crushed or chewed

Anti-gout Drugs: 1.   

Colcrys (Colcechine) [Anti-gout] Uric acid levels: 3-7 Reduces inflammatory response to the deposits of urate crystals Used for SHORT-TERM of acute attack of gout

2. Allopurinol (Zyloprim) [Anti-gout]  Used to REDUCE PRODUCTION of uric acid  Prevention of gout, long term Osteoarthritis: 1. Boniva [Bisphosphonate]  To treat postmenopausal osteoporosis  Administer orally monthly or as an IV push over 15-30 seconds every 3 months 2. Fosamax [Bisphosphonate]  Treatment and prevention of osteoporosis in post-menopausal women. Also for man osteoporosis. Client with Paget disease  Decreased absorption if taken with anything else that is not water  Inhibit bone reabsorption, reduce Ca and phosphate concentration  Client must be able to stand or sit upright for at least 30 min  Adv. Effect: abdominal pain, musculoskeletal pain, GI irritation  Wait 30 min after taking Fosamax to take another medication  Check Ca and vitamin D  Half-life is 10 years

Parkinson’s Drugs: 1. Cogentin (benzatropine) [Anti-Parkinson’s]  Used in the treatment of PD to cause smooth muscle to relax, resulting in reduced muscle rigidity and akinesia  Side Effects: Drowsiness, confusion, disorientation, constipation, nausea, vomiting, urinary retention, pain on urination, blurred vision, dilated pupils, photophobia, dry skin, decreased salivation, dry mouth  Use with caution in hot weather and during exercise because it may cause hyperthermia. 2. Levodopa  Levodopa crosses the BBB and then is converted into dopamine.

 Levodopa must be combined with carbidopa in order to become more effective.  Carbidopa prevents the breakdown of levodopa.  Cheaper than Sinemet Adverse Effects:  Confusion  Involuntary movement  GI distress  Hypotension  Contraindications:  Angle closure glaucoma  Levodopa and Carbidopa can activate malignant melanoma. Assess skin first.  Reduces Time Off. 3. Eldepryl (Selegiline) [Anti-Parkinson’s]  Selective MAO-B inhibitor.  Used with levodopa to reduce the dosage to reduce the level of levodopa for symptom control.  Adverse effect increase with dosages greater than 10 mg Interactions:  Meperidine, opioids, dextromethorphan, carbamazepine, ect.  CHEESE EFFECT (consuming aged cheese, wine, beer, and yogurt that cause severe increase in hypertension) 4. Sinemet (Cardibopa-Levodopa)  Must not be crush due to sustained release.  Interaction occurs with tricyclic antidepressant. May interact with Vit. B6 as well as protein.  Combination of Levodopa and Cardibopa  Is given to control symptoms, not cure Antiepileptic Medications: 1.         

Dilantin (Phenytoin) Fist line drug for tonic-clonic seizures. Contraindicated for bradycardia and heart block. The most common adverse effect is gingival hyperplasia. (Good dental care should be performed). Can cause acne, hirsutism, and hyperplasia of the subcutaneous tissue. Therapeutic drug level: 10-20 mcg/ml Dilantin toxicity can cause: nystagmus, ataxia, and encephalopathy. Low serum albumin can cause Dilantin toxicity. When given IV must be given through a large needle (20 gauge) slow IV push (50mg/min) due to its high irritability. Its anti-dysrhythmic properties are the same as Lidocaine. Levels: 10-20

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Interacts with Tagamet (antiulcer medication)

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Valproic acid [Anti-epileptic] Use primarily for generalize seizure Contraind.: liver impairment, urea cycle disorder Adv. Effect: drowsiness, nausea, vomiting, GI disturbance. Most serious adverse effect are hepatotoxicity and pancreatitis Orally: take it at the same time each day, take with meals, don’t crush, chew, or open it. If pt. NPO, ask Dr. IV: follow manufacturer Levels: 50-100

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Phenobarbital [Anti-epileptic] Levels: 10-40 or 15-40 Most common adverse effect is sedation Once a day dosing Orally: take it at the same time each day, take with meals, don’t crush, chew, or open it. If pt. NPO, ask Dr. IV: follow manufacturer Shouldn’t be discontinued abruptly because it could cause rebound seizure Pt. should keep journal Therapy is lo...