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Exam 1
hiazide
diuretics
Meds
affecting
urinary output · hydrochlorothiazide
purpose is to decrease the BP , ·
Chlorothiazide
(can be
given Oral 31v) excrete edematous fluid seen in HF. Loop diuretics work in the loop of · Chlorthalidone henle of the kidney . These are furosemide/Lasics
The
purpose
is to
block reabsorption
of sodium &
Furosemide Contraindications
Chloride
.
Blocks the reabsorption -
anuria
of sodium and chloride. It It
promotes
diuresis when renal function
isn't
impaired
prevents the
reabsorption
of water.
use caution :
gout
, CV disease , liver disease
, worksIn
the early
distal
convuluted
tube
causes extensive diuresis with DM ,
dehydration
, electrolute Severe
Kidney
damage
disturbance , lithium , NSAIDs
# I
chace
for essential
HIN
unlabeled use is
hyperkalemia
. can be
given
Oral , IV , IM Interactions
used
for
mild-moderate HF mu Another
drug
is bumentanide
Digoxin
will increase
used to reduce urine
production
lication hypokalemic effects & in ppl with diabetes cause ventricular
promotes
reabsorption of calcium
Dehydration
: monitor for
oliguria,
arrhythmias
dry
mouth ,
lethargy
. & can reduce risk of Osteoporosi Monitor electrolytes
Lithium carbonate blood levels can increase , which
Complications
If headache , Chest pain , calf or pelvic um pain occur it can indicate thrombosis / can lead to toxicity
Dehydration hyponatremia
embolism
NSAIDS decrease blood
Hypokalemia
hypochloremia
Hypotension
: monitor BP
flow
,
reducing
diuretic effects. *
Hyperglycemia
Ototoxicity
: avoid use of other ototoxic
drugs
like
aminoglycoside
Always monitor
Hyperuricemia
, M lipids , hypomagnesium antibiotics like
gentamicin
.
BP
,
US , ISO,
and
(monitor
uric acid ,
magnesium
, HDL , LDL) Tell them to report tinnitus
Thiazide
weight
indications can cause
Hypokalemia : monitor for S/S like
can cause
jaundice
in baby
jaundice
in muscle cramps , weakness
Don't use If there's renal impairement
babies
Foods in cause no risk of
ototoxicity
Potassium
bananas-nuts · Alternate day dosing
potatoes
Spinach ·
weigh
them the same time
dried fruits - citrus food
cantalopue Other adverse effects Diuretics are include hyperglycemia , to be
administered
hyperuricemia, hypocalcemia
,
first
thing in the
morning
hyponatremia
hypochloremia
& before
2 pm
to
prevent
nocturia
Potassium-sparing Osmotic
diuretics
Spironolactone
mannitol
keeps
K
while
excreting
reduces increased
Intracranial
pressured
Intraocular
Sodium
& H
pressure
by
raising
Serum
Osmolality
drawing
back fluid
Blocks
action
of
aldosterone
into
the vascular & extravascular
space
USES L
They're
combined with
other
prevents Kidney
failure
diuretics
for lit
sparring
Administered for the
oliguria
phase
of Ak
effects to
treat
hypertension
Zedema
nations
Complications * HF s
pulmonary
edema
um
Hyperkalemia
(meds like ACE
inhibitors ,
Rebound increased intracranial pressure
ARBs
,
direct
renin inhibitors cause
hyperkalemial
Fluid &
electrolyte
imbalances
,
metabolic acidosis
Endocrine effects
·
Deep
voice
Contraindications
·
Hirstuism
um
·
impotence
·
gynecomastia
active
intracranial bleed
,
anuria
,
severe
·
Irregularities
of
menstrual cycle
Pulmonary
edema
,
Severe
dehydration , renal
failure
Drowsiness ,
metabolic acidosis
Interactions
um
Contraindications
um
Lithium
excretion
through
Kidney
is increased
Fetal harm
Don't take if
you
have
hyperkalemia
Increased risk
for
hypokalemia
w/ cardiac
glycosides
Severe
Kidney
failure Zanuria
Administration
we
use filter needle when
drawing
from the vial
a a filter
ARBs
Direct
Renin inhibitors
Losartan
Aliskiren
Valsartan -
Binds
with renin
to inhibit
production
of
· The
purpose
is to block the
anglotensin
I
,
decreasing
production
of
both
action of
angiotensin
2 in the body
.
angiotensin
aldosterone
·
vasodilation
·
Excretion
of
sodium
water
usest
uses
Relieves HTN
when used alone
or w/
another
hypertension
antihypertensive
med
Heart failure
Stroke
Preventolosartan
a
plicato
a
rash
,
cough
for rash
nephropathy
angioedema
.
Stop
the
med
,
call all
Reduces
mortality
following
an acute MI
swelling
of
pharynx,
Pelications
tongue ,
glottis
Angloedema
Hyperkalemia
Fetal
Injury
Hypotension
Diarrhea : close related
,
seen more in
girls
&
older
adult clients
Dizziness
,
lightheadedness
traindications
Hypotension
Pregnant/Lactation
contradications
ring
and 3rd trimes
a
*Bilateral
renal
stenosis
u
single
Kidney
hyperkalemia
Interactions
u
use
with
caution :
asthma
other
respiratory
·
Antihypertensives
problems ,
history
of
angioedema
,
DM
,
renal
·
Increased risk for lithium
toxicity
Stenosis ,
hypotension ,
Kidney/hepatic disease
Interactions
un
Decreases
blood
levels
of
furosemide
↑ effects
of other
antihypertensives
Atorvastatin
& Ketoconazole ↑
levels of aliskinen
High
fat-food
reduce
absorption
Calcium Channel Blockers
Amlodipine
Nifedipine-Verapmil-Diltiazem
Contraindications
Nifedipine
purpose ~
Blocks
calcium
channels
in the
blood -
Nifedipine
is contraindicated
vessel
leads to vasodilation
of vascular In
ppl
who're
in
cardiogenic
shock
Smooth
muscle
arteries of heart
use with Caution
in clients who have
Verapmil/
Diltiazem
acute Ml , unstable
Angina
,
Gortic
Stenosis ,
.
Has the
same purpose
.
It also
hypotension
,
sick Sinus
syndrome,
2nd/3rd
Av block
blocks Calcium
channels in the
myocardium,
SA node
,
AV node leads
to a decreased
Verapmil
is contraindicated
force
of contraction
,
HR
,
slowing
of
Hypotension
,
Digoxin
Toxicity ,
Severe HF ,
Heart block
,
lactation
use with caution if
they
have
kidney
/ liver disorders
,
mild-moderate
the rate
of conduction
through
Avnode
HF
,
Gerd
They
are used for Cardiac
dysrhythmias
like
Afib
,
atrial flutter
,
SVT)
Interactions
u
Nifedipine
complicin
is
Nifedipine
·
cimetidine
,
famotidine
grapefruit juice
can
lead to
toxicity
ladminister
metropolo
to counteract
Verapmil/Diltiazem
tachycardial
concurrent use
of
beta blockers can
lead to
HF
,
AV block
,
bradycardia
Acute
toxicity
.
No
grapefruit
juice
(due
to excessive
doses
. Monitor USEECG.
Provide
gastric
lavage
E Cathartic If needed . Nursing
administration
Administer
(norepinephrine,
calcium
,
isoprotereno,
lidocaine
,
IV
fluids
.
Have cardioversion
IV
verapmil
needs to be administered
Slowly
over 2- min
Cardiac pacer
available) -
Withhold med
if
HRA50 & SBP is
mmHg
Orthostatic hypotension
peripheral
edema.
Verapmil
& Diltiazem
complications
Constipation
(mostly verapmill
Suppression
ofCardiac
function
(Bradycardia ,
HF
. Observe
for slow pulse
activity
intolerance
Dysrhythmias
(QRS
complex
is widened &QTinterval
is
prolonged
Acute toxicity
(Resulting
in
hypotension
, brady.
Al block,
Eventricular
dysrhythmias)
Centrally
acting
alpha
agonists
Clonidine
Methyldopa
Acts
within the CNS
to decrease
sympathetic
outflow
resulting
in decreased
stimulation
of
the
adrenergic
receptors
of heart
&
peripheral
vascular
system
usest
Interactions
primary
hypertension
concurrent
use of
prozosin
,
severe cancer
pain
MAOls
, tricyclic
antidepressants
can
counteract the effect
Management
of
ADHD
Additive
CNS
depressants
can occur with
Investigational
use
concurrent
use
of
other
CNS
depressants
Calcohol
migraine
flushing
from
menopause
manage
Tourette
Administration
manage
of
withdrawl
from
alcohol
,
tobacco
w
oploids
.
give
med
by
Gral
, epidural
,
Complications
transdermal
routes (clonidine
only
Take
larger
duse at
bedtime
Drowsiness
& Sedation
Dry
mouth
Rebound
hypertension
If
abruptly
discontinued
Contradications
Avoid
use
of
transdermal
patch
on
affected skin In Scleroderma
&
SLE
·
contraindicated
in
clients
who
have
a
bleeding
disorder or
are on
anticoagulants
·
use with
caution
: Asthma
,
Stroke
,
COPD
,
recent
M
, DM
, depressive
disorder
Beta
adrenergic
blockers
(sympatholytics
Cardioselective
metoprolo ,
atendol ,
esmolal
Nonselective
:
Proprandol
,
Nadolol
Alpha
E beta
blockers
Carvedilol
,
Labetalo
Contraindica
-tons
Negative
chronotropic , inotropic, dromotropic
metoprolol
, propranolol
,
labetolo
Alpha
blockade adds vasodilation
with caution
placenta
Reduces release
of renin -
Proprano
:
appears
in
breast milk
Therapeutic
uses↓
Don't
give
to
ppl
/
#V block & Sinus
Primary hypertension
bradycardia
Angina
,
tachy
Dysrhythmias ,
Hf ,
MI
-use with caution : myasthenia
gravis
,
hypotension,
suppresses
reflex tachy .
Hyperthyroidism,
peripheral
vasculardisease ,
DM
,
depression,
Migraine
, pheochromocytoma
,
glaucoma
Interactions
Complications
of
Beta
,
Metroprolo
E
Propranolol
Beta
Bradycardia
·
CB blockers
Verapmil
Ediltiazen intensify
effects
of
beta blockers
Hold if below
bpm
use
wi caution in DM be
it
masks tachycardia,
Betaz
early
manifestation of low
blood
glucose
can
mask
hypoglycemic
effect
of
insulin
Decreased
CO
prevent
the breakdown
of
fat in response
to
AV
block
(get
baseline ECG Monitor
hypoglycemia
Orthostatic
hypotension
Rebound
myocardium
excitation
Administration
~
(myocardium
becomes sensitized
to catecholamines
give
orally
once
or
twice a
day
with
long
term use of
beta blockers)
metoprolol ,
labetalo , Dropranool
can be
Elications
of
Betaz
given
IV
Take w food
toabsorption
Bronchoconstriction
Glycogenolysis
is
inhibited
(N
risk for harm from hypoglycemia
because
the
process
of
glycogen- glucose
Never
stop
is impaired.
taking
them
abruptly
Cardiac
Glycosides
Quinidine↑ risk of
toxicity
because it
reduces Kidney
excretion
Digoxin
Verapmil
Digoxin
=
toxicity
positive
inotropic
(* force of
contraction)
Administration
Negative
Chronotropic
(GHR)
IV
given
over
5 min. 10-15 if
pulmonary
edema
Usest -
Never double dose
If 1
is
missed
Treats
HF
but
shortens life
Span
in Females
Dysrhythmias
like
AFIB
How to manage
toxicity
stop digoxin
potassium
wasting
implication
a
cardiotoxicity
lidocaine
Treat
dysrhythmias
with
phenytoin
or
↓
caused
by
hypokalemia
blood
digoxin
Bradycardia
Give
atropine
levels
, heart disease
Activated
charcoal
, Cholestyramine
,
or
Optimal
therapeutic
level :
- 5-0. 8
ng/mL
digoxine
immune
fab
can bind
digoxins
Report
manifestations
of
hypokalemia
prevent absorption
GI
effects
like anorexia , nausea ,
vomiting
anorexia is first
sign
of
toxicity
CNS effects
·
headache
·
fatigue
/ weak
vision
changes (blurred vision
,
yellow-green
Or
white halos around
objects)
HR
under
Contraindications does
not
get
enters
breast milk
digoxin
contraindicated in ppl
w/
VFIB
,
VTACH
,
2nd
gard
degree
heart
block
Interactions
· ACE inhibitors
EARBs
↑ risk of
hyperkalemia
which can
lead to decreased
therapeutic
levels of
digoxin
·
Dopamine
Digoxin-heart
squeezes
to fight
·
Never take
wi Antacids
Organic
Nitrates
Nitroglycerin
In chronic
Stable
angina
it dilates the veins
decreases venous return whichI cardiac
oxygen
demand
In Prinzmetal
Angina
it prevents
Coronary
artery spasm ,
Increasing oxygen
supply
Complications
Headache (use
aspirin)
Orthostatic
hypotension
Tolerance
Contraindications
can effect maternal fetal circulation
contraindicated in Severe anemia ,
close-
angle
glaucoma,
traumatic head
Injury
be it
can * Intracranial
pressure
use caution in
ppl
taking
antihypertensive
meds , clients who have hyperthyroidism or
Kidney ,
liver
dysfunction
Do not take
phosphodiesterase type
5 with
Nitro. Severe
hypotension
Interactions
~
alcohol
contributes to
hypotensive
effect
Treatment of
anginal
attack
stop
activity
.
Sit or lie down
No relief after first tablet? Call all
Don't take
more than 3
Cholesterol
absorption
inhibitor
Ezetimibe
Inhibits reabsorption
of
cholesterol Secreted in
bile
absorption
ofCholesterol from food
can be used in combo w/ statins
complications
u
Hepatitis
Lobserve
for liver
dysfunction
like anorexia
,
jaundice
,
I
important
to obtain
Myopathy
baseline cholesterol
HDL
,
LDL
triglycerides
Contraindications
levels
,
liver a
kidney
Pregnant/Lactating
function tests
contraindicated
if
they
have active
Follow low-fat
,
low
moderate-severe
liver disorders
Cholesterol
diet
Interactions
mu
Bile acid
Sequestrants (cholestyramine)
interfere with
absorption. Take
ezetimibe Ihr before
or thr after
Stating
Can t risk of liver
dysfunction
myopathy
Concurrent
use with
fibrates
(gemfibrozil)
increases
risk of Cholelthiasis
Emyopathy
Levels
can be increased with
concurrent use
of
Cyclosporine
Bile Acid
Sequestrants
Prototype
:
Cholestyramine
Colesevelam ,
Colestipol
Nursing
Administration
Purpose
:
Decrease LDL
colesevalem should be taken we food
not
taken
with
other meds
can be taken with statins
Colestipol
shouldn't be
crushed
. Give 30
min before a meal
complicatio
a
Colestipol
is also in
powder
form
Contraindications
Don't use with
oral
contraceptives
Colesevelam is
contraindicated
in
clients who have bowel obstruction or
pancreatitis caused
by
high
triglycerides
use cautiously
If they
have
dysphagia
or 61
disorders
Interactions
They
interfere
with absorption
of
many
meds
levothyroxine
second-gen sulfonylureas
phenytoin (seizure med)
ADEK
vitamines
Oral
contraceptives
take
these
meds Ihr
before or
4hr after
Monoclonal Antibodies
Alirocumab-Evolocumab
Decreases
LDL
by
binding
to
receptors
used as
adjunct
to
dietary
modifications in
people
with
elevated
LDL
Complications
um
Hypersensitivity
Creport
rash
, Urticaria
,
vasculitis)
Local
injection
site reaction
(rotate
sites
,
avoid areas of inflammation
,
rashl
,
Contraindicated
Pregnancy
,
use
w/ caution
. Crosses
placenta
.
History
of
hypersensitivity
to
med
Administered
via
subcutaneous
route
.
~ huthmicMedicators
a
sopyramide
Class I
meds are sodium
channel
blockers
that
slow
cardiac
conduction
velocity
Purpose
is to slow
impulse conductions
in the Atria
,
ventricles
,
Divided
Into 1 A
,
IB
,
I
and
His-Purkinje
system
.
Delays repolarization
usest
SVT
VTACH
Atrial
flutter
Afib
Applications
Diarrhea
·
resolves after
stopping
med. Give wi food to reduce
gastric upset
Cinchonism
·
tinnitus
,
headache , nausea
, vertigo, disturbed
vision ·
can
develop
after I dose
cardiotoxicity
·
widening
of QRS
by
over 50 %,
increasing
the QT
Interval
,
Prolonging
of the PRInterval
are
indications of procainamide
cardiotoxicity
·
Therapeutic
quinidine
level is 2-
magimL
·
Monitor
for
confusion , drowsiness
,
vomit
·
Monitor vs &ECG
·
If
dysrhythmias continue
,
hold the med
Hypotension
Contradication
n,
a
harm
hypersensitivity
to
procaine , complete
heart block ,
atypical
ventricular tachy
. SLE
use with caution in ppl
with
partial
AV block ,
myasthenia Gravis , Iver/Kidney
disorder
,
Hf ,
digoxin
toxicity
Interactions
Antidysrhythms
have additive effects
E can increase
toxicity
Beta blockers & Cimetidine can t
quinidine
effects
Antihypertensives
have additive
hypotensive
effect
Class
2
Propranolol ,
Esmolo,
Acebutolo
usesd
AFIB
Atrial flutter
Paroxysmal
Sur
HTN
Angina
PVC
Severe recurrent
ventricular
tachydusrhutmias
Exercise
induced tachydysrhythmias
Paraxysmal
atrial
tachy
~
Complicatioef
,
Av block
,
Sinus arrest
,
bronchospasm ,
Hypotension
Contraindications
Propranolol
crosses
the
placenta
can cause
neonatal
bradycardia
,
hypotension
, hypoglycemia
.
can
decrease blood
supply to
placent
a
can
increase risk
for
premature
birth
or
Infant
death
can
cause
intrauterine
growth
retardation
,risk
ofCardiac
complications
use caution in DM
,
liver
,
thyroid
or
respiratory dysfunction
Wolft
Parkinson-white
syndrome
Administer
Give no faster
than
mg/min
Class 3
Amiodarone
Dotetilide
Potassium Channel blockers
prolong
the
action
potential
&
refractory
period
of
the cardiac
cycle
Action
Delays
repolarization
Amiodarone slows
Prolongs
action
potential the
ventricular
Reduced
automaticity
in the
SA node
HR
.
causes blue-gray
Reduced
contractility
conduction
In the
AV
,
ventricles
, Purkinje
Slin
color
.
Dilates
coronary blood vessels
uses
um
of
AFIB
: Oral route
Recurrent
VFIB EVACH
Atrial flutter
using
dronedarone
, sotalo which
is
also a
beta
blocker)
,
dofetilide ,
butilide
implicato
e
toxicity
(observe
for
Cough
,
dyspnea
,
e +c
Sinus Brady
and AV block (monitor
BP , ECG ,
Indications of HFl
Visual
disturbance
(photophobia
, blurred
Vision ,
Others
: liver Ethyroid dysfunction
,
Gl disturbance ,
CNS effects , photosensitivity ,
blue-gray
discolored skin
Phlebitis :
use of
central venous Catheter
Hypotension
: Brady
, Al
block
Contraindications
crosses
placenta
can harm fetus. Don't breastfeed
Newborns
,
Infants ,
clients with
AV block Ebradycardia
use
Cautiously
with liver
,
thyroid,
or
respiratory
dysfunction
,
HF
, Efluid
Selectrolyte Imbalances
Interactions
↑
Digoxin
levels
concurrent use of beta blockers
, verapmil ,
Diuretics ,
antibiotics Can
" risk of
dysrhuthmias
diltiazem can lead
to
bradycardia
Cholestyramne,
St John's Wort
,
rifamping levels of amiodarone
can *
plasma levels of
quinidine
,
procainamide ,
digoxin
,
diltiazem , warfarin
Administration
Highly
toxic
Obtain baseline
eg
, eye
exam
,
Chest
X-ray.
Along
W/ K
can
continue
weeks or months after meds discontinue
