Direction: Rewrite the pharmacology of these drugs by creating a template for each drug group according to their classes.
Pharmacology
Cardiovascular System
Angiotensin Converting Enzyme Inhibitors
Generic Names end with – pril
Ex: Benazepril (Lotensin); Enalapril(Vasotec); Lisinopril (Prinivil, Zestril)
-These meds block the conversion of renin and angiotensin at the lungs preventing vasoconstriction, treat heart failure and help prevent strokes.
Must Know:
-These drugs can cause a permanent, dry cough
Warning: these drugs can cause angioedema (swelling of the tongue)that can block the airway and led to cardiac arrest. This reaction can occur up to 1 year from the time the drug is started
BUN/Creat must be checked because ACE inhibitor should be avoided in patients with poor renal functions. ARBS are better for these patients
ACE inhibitor increase K+ sparing level and should be avoided inpatients with renal disease. They also cannot be given with a K+ sparing diuretic such as Spironolactone (Aldactone). ARBS are better for those patients
ACE inhibitors are contraindicated in pregnant women because it decreases blood flow to the placenta.
Angiotensin Receptor Blockers (ARBS)
Generic names end with -sartan
EX: Irbersartan (Avapro), Olmesartan (Benicar), Valsartan (Diovan)
-Blocks the action of angiotensin II from binding to the receptors. As a result, blood vessels dilate and the blood pressure drops.
-Control high blood pressure and treat heart failure. Slows the progression of kidney disease caused by high blood pressure and diabetes
-Must Know:
-Often used for people who are unable tolerate ACE inhibitors
-This is a CAT D drug therefore it is contraindicated in pregnant women especially in the 2rd and 3rd due to increased risk of birth defects.
Beta Adrenergic Blockers (Beta Blocker)
Generic ends with -lol
Ex: Atenolol (Tenormin), Bisoprolol (Zebeta), Carvedilol (Coreg), Labetalol (Trandene), metoprolol (Toprol XL, Lo pressor), Propanolol (Inderal; Timolol (Timoptic)
-Used to treat HTN, heart failure, arrhythmias, chronic angina, stage fright, glaucoma, migraine headaches and future heart attack patients
Must Know:
-Avoid abrupt withdrawal. Can cause angina, heart attack or sudden death
– contraindicated in asthmatics, pregnant women (except Labetalol)- diabetes (increases risk of hypoglycemia because it blocks the liver from releasing sugar)
– if respiratory patient need a beta blocker, can cautiously take Atenolol or Metoprolol (cardio selective beta blockers).
-beta blocker helps reduce tremors and is used as first line treatment in hyperthyroid to reduce tremors associated with hyperthyroidism (propranolol)
Calcium channel Blockers
-Some have a generic ending -dipine
EX: Amiodipine (Norvasc Lotrel); Felodipine (Plendil); Nicardipine (cardene)
Diltiazem (Cardizem); Verapamil (Calan,Coveral)
used to treat HTN, angina, abnormal heart rhythms.
Used post MI in patients who cannot take Beta blockers
Must Know:
May act as a male contraceptive by stopping entry of sperm into the egg
Clients over the age of 60 should not take calcium
Channel blockers because of the risk of severe constipation
Vasodilate effects may lead to orthostatic hypotension
Warning: Grapefruit juice increases the risk of toxicity.
Norepinephrine (Levophed) must be administered in a large vein on a pump. High risk for tissue necrosis if it leaks into tissues This is why it is classified as a Vesicant. Causes major organs. Us Central Line Or PICC to administer.
Epinephrine increases blood sugar. Monitor blood sugar.
Antianginal Drugs: Nitrates
Some generics named isosorbide -trate
Ex: Isosorbide mononitrate (Monoket, Imdur); Nitroglycerin (Nitro-Dur, Nitro-Bid)
Uses: Potent vasodilators; Used to treat or prevent Angina (Chest Pain)
Must know:
If patient complains of headache, this is expected (med is working). Administer acetaminophen and document.
Store Nitro Tab in a cool, dry place in an airtight, dark bottle away from sunlight.
Tablets are good for 90 days if bottle is opened.
Most common complaint is headache because as the arteries dilate the blood rushes to the brain causing a sense of fullness in the head.
Can cause severe hypotension. Monitor blood pressure closely. May cause dizziness and falls in the elderly due to orthostatic hypotension.
If client is having chest pain, have client lie down before giving it to them.
Make sure client is in a position of safety because they may become dizzy and fall.
Can be taken prophylaxis for angina. Take 15 mins before provoking event.
In infants, hold if pulse is less than 90.
In adults, hold if pulse is less than 60 and/or systolic blood pressure is less than 90.
Nitro patch must be removed prior to an MRI.
Nitro Spray can be administered sublingual or on top of tongue.
Avoid Nitro for 24-48 hours after taking Sildenafil (Viagra), Vardenafil (Levitra), or Taldafil (Cialis). The combination can cause a dangerous drop in blood pressure resulting in cardiovascular collapse.
Anti Arrhythmics (Abnormal Heart Rhythms)
No specific generic endings.
Amiodarone (Cordarone), Digoxin (Lanoxin), Diltiazem (Cardizem), Propanolol (Inderal), Quinidine (Quinidine Sulfate), Sotalol (Betapace), Verapamil (Calan, Isoptin, Covera), Dronedarone (Multaq).
Lipid Lowering Agents
Some have a generic ending of -statin.
Atorvastatin (Lipitor), Provasatin (Pravachol), Rosuvastatin (Crestor), Simvastatin (Zocor), Colestipol (Colestid), Ezetimbe (Zetia), Fenofibrate (Tricor), Gemfibrozil (Lopid), Cholestyramine (Questran): Bile Acid Sequestrant.
Used to lower LDL along with diet and exercise
Herbs such as garlic, alfalfa root, omega-3 (fish oil), nuts, and niacin (vitamin B3) have all been shown to help lower cholesterol.
Prevents rupture of plaque and formation of clots
Statins prevent inflammation
Prevent cardiovascular disease in patients with elevated triglycerides and low HDL when lifestyle changes do not work
Statins usually taken at night because the body produces the most cholesterol between 12am-6am. Statins cause muscle pain and weakness due to the muscle enzyme, myoglobin, leaking in the blood. Pain is resolved when the medication is stopped. This causes Rhabdomyolisis.
If liver enzymes are elevated, statins are held. Monitor Liver Function Tests.
Cholestyramine(Questran) helps remove bile salt if patient has cholecystitis or liver disease.
Niacin (Vitamin B3 may cause flushing(redness of face) due to its vasodilative effect. Aspirin helps reduce this effect.
VASOPRESSORS Dopamine, Epinephrine (Epipen, Adrenalin), Midodrine (ProAmatine) Norepinephrine (levophed), Phenylephrine (Neo-Synephrine)
Action:
These medications are potent vasoconstrictors used to increase B/P in severe hypotensive situations, cardiogenic, anaphylactic, sepsis shock and anesthesia. Also used to treat certain heart arrhythmia.
Phenylephrine may be used to treat priaprism (prolonged erection).
Midodrine (ProAmatine) can cause severe systolic supine HTN. It should not be given after 6pm to prevent the patient from getting a stroke while asleep.
Norepinephrine (Levophed) must be must be administered in a large vein via pump. It’s classified as a Vesicant (causes tissue necrosis), use a Central or PICC line to administer. Epinephrine increases blood sugar.
ANTI ARRHYTHMICS (Abnormal Heart Rhythms)- No specific endings
Amiodarone (Cordarone), Digoxin(Lanoxin), Diltiazem(Cardizem), Propanolol (Inderal), Quinidine Sulfate, Sotalol (Betapace), Verapamil (Calan, Isoptin, Covera) Dronedarone (Multaq).
The meds increase contractions (positive inotropic) and slows the electrical impulse (negative chromotropic effect). Negative dromotropic(decrease rate)
Used to suppress lethal cardiac rhythms such as rapid A-Fib, rapid A-Flutter, Supraventricular Tachycardia, Ventricular Tachy with a pulse.
For Sinus Bradycardia with symptoms of heart blocks, Atropine is the drug of choice unless if the patient had a heart transplant. Transcutaneous pacing will be the appropriate treatment. Meds don’t stimulate the heart in case of transplant. Dopamine and Epinephrine can also be used to increase the heart rate.
Amiodarone may cause the skin to turn blue, avoid sun exposure.
Digoxin has a narrow therapeutic index of 0.5-2.0. clients taking Digoxin who have a low potassium level can quickly become toxic on Digoxin. Early signs and symptoms of Digoxin toxicity include: GI System such as anorexia, abdominal cramps, diarrhea and nausea and vomiting. If the toxicity is not addressed, the patient will develop neuro symptoms such as diplopia, halos around objects, and confusion.
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