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Pharmacology_Review

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					Second Semester Pharmacology
         Orientation
           Mrs. Adams
            Mrs. Angell
            Mrs. Bowler
           Mrs. Kovacic
           Ms. Stockwell
      Pharmacology Expectations
       (What you need to know.)
•   Classification
•   Names
•   Action
•   Desired Benefit (I will teach my patient…)
•   Indications (This drug will…)
•   Side Effects
•   Nursing Interventions (I will monitor the
    following…)
         Cardiac Medications
•   ACE Inhibitors
•   Angiotensin Receptor Blockers
•   Beta Adrenergic Blockers
•   Calcium Channel Blockers
•   Antiarrthymics
•   Vasodilators
•   Diuretics
•   Antiplatelet Aggregration
•   Anticoagulants
             ACE Inhibitors
• Generic ends in “pril”
• Works in the kidney (renin system)
• Generic names/trade name:
  quinapril (accupril), ramapril (altace),
  benazepril (lotensin), captopril (capoten),
  enalapril (vasotec), fosinopril (monopril),
  lisinopril (prinivil), ramipril (altace)
This drug will:                          Side Effects
Lower BP                                 hypotension
Raise pulse                              hyperkalemia
                                         AceInduced renal insufficience/failure
                                          Angioedema
                                         dry hacking cough
                                         CAN CAUSE FETAL DEATH




I teach my patient that the              I monitor the following
benefit of this drug is:                 blood pressure
Lowers BP                                 (what are my parameters)
Strengthens a weak heart muscle           Renal Function: BUN&Creatinine
Slows the progression of renal disease    Potassium level (K) =
 Angiotensin Receptor Blockers
• Generic ends in “sartan”
• Works in the kidney – cousin to the ACE
• Generic names/trade name:
  candesartan (atacand), irbesartan
  (avapro), olmesartan (benicar),
  losartan (cozaar), valsartan (diovan),
  telmisartan (micardis), eprosartan
  (teveten)
This drug will:                          Side Effects
Lower BP                                 hypotension
Raise pulse                              hyperkalemia
                                         AceInduced renal insufficience/failure
                                         Angioedema
                                         CAN CAUSE FETAL DEATH




I teach my patient that the              I monitor the following
benefit of this drug is:                 blood pressure
Lowers BP                                 (what are my parameters)
Strengthens a weak heart muscle           Renal Function: BUN&Creatinine
Slows the progression of renal disease    Potassium level (K) =
     Beta Adrenergic Blockers
• Generic names end in “olol”
• Beta cells in heart, lungs and pancreas
• Generic/trade name:
Atenolol (tenormin), nebivolol (bystolic),
  metoprolol tartrate (lopressor), metoprolol
  succinate (toprol xl), bisoprolol (zebeta),
 carvedilol, (coreg).
This drug will:                 Side effects:
Lower BP                        hypotension
Lowers pulse                    bradycardia
                                 may worsen copd and DM




I teach my patient               I will monitor the following:
the benefit of this drug:         BP
Lowers BP                        Pulse
Antiarrythmic
Strengthens weak heart muscle
Lowers risk of second MI
    Calcium Channel Blockers
• Slows passage of calcium between
  myocardial cells
• Generic/trade name:
diltiazem (cardizem), nifedipine (procardia),
  verapamil, felodipine (plendil), amlodipine
  (norvasc),
This drug will:             Side effects:
Lower BP                    hypotension
Lower pulse                 bradycardia
                            ankle edema




I teach my patient          I will monitor
The benefit of this drug:    BP
Lowers BP                    pulse
Mild antiarrythmic
             Antiarrhythmics
• These can have mild to strong antiarrhythmic
  effect
• Drug will slow heart rate and hopefully keep the
  heart in normal sinus rhythm
• Common ones you will see:
• Lanoxin, betapace, sotalol, pacerone, flecainide,
• The two most common and effective are:
  amiodarone and Multaq(this is the newest
  one)
This drug will:                                Side effects are drug specific
slow the heart rate                              All can cause: bradycardia.

is used to help maintain                         Used with caution in heart failure.

    sinus rhythm .                               Caution with any 2nd or 3rd degree heart block if

                                                   no pacemaker present.

                                                  Amiodarone: causes hypothyroid, interstitial lung
                                                  changes, visual disturbances, and potentiates coumadin

                                                  Digoxin: Watch for toxicity, especially in elderly. S/S:
                                                  bradycardia, N/V, yellow-green visual halos




I teach my patient                                   I will closely monitor:
That the benefit of this drug is:                    Heart rate
Helps rate control your heart                        If on coumadin INR
Helps to maintain sinus rhythm                       Digoxin – level



****Amiodarone is very effective anti arrhythmic with many side effects will see it often due to
    it is cheap
    Multaq newer but more expensive used with extreme caution with anyone with hx of CHF
    you wont see this one as often due to cost.
                Vasodilators
• Dilate vessels centrally &/or systemically
• Includes:
  – Nitrates
     • Nitroglycerine (NTG-SL) – fast acting – q5min x3
     • Isosorbide Mononitrate (ImDur) – lasts 24 hours
     • Isosorbide Dinitrate (Isordil) – lasts 8 hours
  – Other
     • Hydralazine
     • Clonidine (Catapress)
This drug will:                   Side effects:
Lower BP by dilating vessels      hypotension
Nitrates – treat/prevent angina   headache




I teach my patient                I will monitor
The benefit of this drug:          BP
Nitrates – prevent chest pain      Nitrates – chest pain response
Lowers BP
                              Diuretics
•   Potassium wasting versus potassium sparing.
•   Thiazide - mild used genererally first for HTN treatment (minimal effect on K
    but still check)
     – HCTZ
     – Metazolone (zaroxolyn) boosts loop use with caution will really make them
       increase urine output and waste K must give 30 minutes prior to loop to
       work!!!!!!
•   Loop
     –   Furosemide
     –   torsemide(demadex)
     –   Bumetanide(bumex)
     –   lowers bp and decreases edema
• Potassium sparing: triamterene, Spironolactone
  (aldactone) Aldactone used in CHF with
  decreased EF < 35-40 patients it increases long
  term survival used to decrease aldosterone
  levels in CHF patients
This drug will:                     Side effects:
Increase urine output               hypokalemia

                                    hyperkalemia w/k sparing

                                    hypotension

                                    dehydration

I teach my patient                  I will closely monitor:
That the benefit of this drug is:   Urine Output (I’s & O’s)
                                    BP
Decrease blood pressure             K
Decrease edema (lungs and legs)     BUN
                                    Creatinine
                                    Skin Turgor/Hydration Status
                                    Weight
       Antiplatelet aggregration
• Aspirin (ASA) 81mg, 162mg or 325mg
• Clopidogrel (plavix) 75mg
• Prasugrel (effient) 10mg daily (5mg if wt<60kg)
• If s/p PCI with Stent placement must remain on above
  for at least 12 months minimum generally ASA325 +
  plavix or effient x 90 days, then ASA 81mg + plavix or
  effient. Do not stop unless you speak with cardiologist
  and are told to do so. If they are stopped high risk for re-
  stenosis of drug eluting stent
• Effient and plavix cost about $185 dollars for 30 day
  supply very expensive.
This drug will:                     Side effects:
Prevent clot formation              Risk for bleeding




I teach my patient                  I will closely monitor:
That the benefit of this drug is:   For S/S of bleeding
Prevents MI & CVA                   Labs for bleeding
Maintains stent patency             - H/H
                                    Labs for clotting
                                    - Platelets
                Anticoagulants
• IV/SQ – Heparin; Lovenox (enoxaparin); Arixtra
  (fondaparinux); Fragmin (dalteparin)
  – Typically used post-operatively and short-term
  – Must have stop date
• PO – Coumadin (warfarin, jantoven); Pradaxa
  (dabigatra)
  –   Inhibit liver production of clotting factors
  –   May take a few days to be effective
  –   Used for longer time periods
  –   Necessary for preventing complications in atrial
      fibrillation and dvt’s
This drug will:                       Side effects:
Prevent clot formation                Risk for bleeding




I teach my patient                    I will closely monitor:
That the benefit of this drug is:     For S/S of bleeding
Prevents DVT                          Labs for bleeding
Prevents formation of new thrombi     - H/H
   if thrombi is present              - Coumadin – PT/INR
Prevents extension of any present                - Therapeutic INR: 2-3
   thrombi                            - Heparin IV gtt – PTT

                                      Coumadin Diet: Maintain consistent
                                      leafy green intake



Antidotes:
Coumadin – Vitamin K (Aquamephyton)
Heparin – Protamine Sulfate
       Respiratory Medications
•   Adrenergic Bronchodilators
•   Xanthine Bronchodilators
•   Glucortico-Steroids
•   Expectorants
   Adrenergic Bronchodilators
• “Fight or Flight”
• Sympathetic Nervous Response
• Epinephrine; Albuterol (Proventil);
  Xopenex (levalbuterol); Serevent
  (Salmeterol); Alupent (metaproterenol);
  Isuprel (Isoproterenol); Brethine
  (Terbutaline)

    *****Give before steroid inhalers*****
This drug will:                     Side effects:
Dilate bronchi & bronchioles        Tachycardia
                                    Hypertension
                                    Tachypnea
                                    Anxiety
                                    Tremors



I teach my patient                  I will closely monitor:
That the benefit of this drug is:   Airway patency
Fast acting to open airway          Breathing rate
                                    Pulse
      Xanthine Bronchodilators
•   Relaxes smooth muscles
•   Need to monitor for toxicity
•   May be inhaled, PO, IV or SQ
•   Theophylline (Theo-Dur; Aminophylline)
This drug will:                     Side effects:
Dilate bronchi & bronchioles        Tachycardia
                                    Hypotension
                                    Anxiety/Tremors




I teach my patient                  I will closely monitor:
That the benefit of this drug is:   Airway patency
Open airway                         Breathing rate
Maintain open airway                Blood Pressure
                                    Pulse
                                    ***Medication Laboratory Level***
        Glucortico-Steroids
• Reduce inflammation
• Act on entire body
• Can be oral, IV, topical or inhaled
• Prednisone; Solumedrol
  (methylprednisone); hydrocortisone;
  dexamethasone; betamethasone
• Inhaled: Pulmocort; Advair (combined
  medications); Flovent; Symbicort
  (combined medications)
This drug will:                     Side effects:
Decrease inflammation               Oral candida
- open airway                       Increased blood sugar
                                    Increased risk for infection
                                    Anxiety/Tremors
                                    Long-term: Osteoporosis; buffalo
                                    hump, gynecomastia, hirtuism…




I teach my patient                  I will closely monitor:
That the benefit of this drug is:   Airway patency
Opens airway by reducing swelling   Blood sugar
                                    S/S of Infection
                                    Oral mucosa
                                    I’s & O’s
                                    Weight

                                    ***Rinse mouth after inhaled use***
                                    ***Do not stop abruptly***
             Expectorants
• Loosen up respiratory secretions
• Makes coughing effective re: secretion
  removal
• DOES NOT STOP COUGHING
• Most natural – water
• Mucinex (humabid, guiafenesin,
  Robitussin)
This drug will:                           Side effects:
Loosen up respiratory secretions          Drowsiness
                                          Headache




I teach my patient                        I will closely monitor:
That the benefit of this drug is:         Fluid intake (encourage)
Makes it easier to cough up respiratory   Expectorations
  secretions                              Have suction available
                  Insulins
•   Rapid Acting
•   Short Acting
•   Intermediate Acting
•   Long Acting



                   See Chart
Type of Insulin
                    Onset           Peak           Duration           Role in Blood Sugar Management
& Brand Names
Rapid-Acting
Humalog or        15-30                                       Rapid-acting insulin covers insulin needs for meals
                            30-90 min             3-5 hours
lispro            min.                                        eaten at the same time as the injection. This type of
Novolog or        10-20                                       insulin is used with longer-acting insulin.
                            40-50 min.            3-5 hours
aspart            min.
Apidra or         20-30                           1-2½
                            30-90 min.
glulisine         min.                            hours
Short-Acting
Regular (R)                                                   Short-acting insulin covers insulin needs for meals
                  30 min.
humulin or                2-5 hours               5-8 hours   eaten within 30-60 minutes
                  -1 hour
novolin
Velosulin (for
                   30 min.-
use in the insulin          2-3 hours             2-3 hours
                   1 hour
pump)
Intermediate-Acting
                  1-2                             18-24       Intermediate-acting insulin covers insulin needs for
NPH (N)                     4-12 hours
                  hours                           hours       about half the day or overnight. This type of
                                                              insulin is often combined with rapid- or short-
                  1-2½                            18-24
Lente (L)                   3-10 hours                        acting insulin.
                  hours                           hours
Long-Acting
                  30 min.-                        20-36       Long-acting insulin covers insulin needs for about
Ultralente (U)             10-20 hours
                  3 hours                         hours       one full day. This type of insulin is often
                                                              combined, when needed, with rapid- or short-
                            No peak time;
                  1-1½                           20-24        acting insulin.
Lantus                      insulin is delivered
                  hour                           hours
                            at a steady level
Levemir or        1-2                             Up to 24
                            6-8 hours
detemir           hours                           hours
Pre-Mixed*
                                                  14-24       These products are generally taken twice a day
Humulin 70/30     30 min. 2-4 hours
                                                  hours       before mealtime.
                                                  Up to 24
Novolin 70/30     30 min. 2-12 hours
                                                  hours
                  10-20                           Up to 24
Novolog 70/30               1-4 hours
                  min.                            hours
                                                  18-24
Humulin 50/50     30 min. 2-5 hours
                                                  hours
Humalog mix                                       16-20
                  15 min. 30 min.-2½ hours
75/25                                             hours
*Premixed insulins are a combination of specific proportions of intermediate-acting and short-acting insulin in
one bottle or insulin pen (the numbers following the brand name indicate the percentage of each type of insulin).
                                         (Chart recovered from WebMD.com)

				
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posted:9/11/2012
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