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1. Cardiac Glycosides:
Action: inhibit Na-K ATPase ---> increase cardiac contraction
LIZZY DIGGY
digoxin (Lanoxin)
digitoxin
2. Nitrates:
ANDY ANGINA
nitroglycerin (Nitro-Bid, Nitrostat, Transderm- Nitro)
isosorbide dinitrate (Isordil)
isosorbide mononitrate (Imdur)
Action
Relaxes vascular smooth muscle
venous return
arterial BP
left ventricular workload
myocardial oxygen consumption
3. Antiarrhythmic : Lidocaine
Action: Decrease cardiac excitability, delayed cardiac conduction
Indic: ventricular dysrhythmias (ie. PVCs, ventricular tachycardia & fibrillation)
SE:
• bradycardia/tachycardia
• hypotension, confusion & drowsiness
• dizziness, NV, seizures
• cardiac arrest
Liddy Lidocaine
lidocaine (Xylocaine)
4. ACE Inhibitors:
Action: supressess renin- angiotensin-aldosterones system (RAAS)
(blocks conversion of angiotensin 1---> angio .2)
Indic: HPN, adjunct in CHF, prevents kidney failurein DM
PRIL Sisters
captopril (Capoten)
enalapril
quinapril
Cough
ontraindicated in renal artery stenosis
Hypotension
yperkalemia
First- dose syncope
SVR PVR
Tx of MI
Relase of aldosterone
Occult diabetic nephropathy
LVD after MI
SVR =systemic vascular resistance
PVR = peripheral vascular resistance
LVD = left ventricular dilation
5. Angiotensin II Receptor Blockers (ARBS):
Action: blocks angio. II binding to receptor --> blocks VC & aldosterone release --> BP
Indic: HPN
SE: occasional – cough, URTI, dizziness, diarrhea
Overdose – hypotension
SARTAN Sisters
candesartan
telmisartan (Micardis))
valsartan (Diovan)
MINI’s SINS
prazosin (Minipress)
terazosin
doxazosin
SE:
Syncope, sexual dysfunction
Increased drowsiness, orthostatic hypotension, HR
Need to be recumbent for 3 -4 hours after initial dose
7. Beta- adrenergic Blockers:
Action: blocks beta 1 & 2 receptors
Indic: HPN, angina, MI
SE:
Bradycardia
Lipidemia , libido
brOronchospasm difficulty breathing
CHF, conduction abnormailities heart failure
Kinks peripheral vessels
Exhaustion, emotional depression fats in blood
Reduces recognition of hypoglycemia
Little or no
interest in sex
CATAPRES
clonidine(Catapres)
guanabenz
guanfacine
methyldopa (Aldomet)
10. Vasodilators:
Action: direct relaxation of bld vessels --> arteriole vasodilation --> decrease afterload
Indic: HPN
DILLY DILATOR
hydralazine (Apresoline), minoxidil
PRESSURE
Antihypertensive Drugs
1. ACE Inhibitors
2. Angiotensin II Receptor blockers (ARBS)
3. Alpha 1 Adrenergic Blockers
4. Beta Adrenergic Blockers
5. Calcium Channel Blockers
6. Central Alpha 2 Agonists
7. Vasodilators
8. Diuretics
DIURETICS
Diuretics:
1. Loop Diuretics
• furosemide (Lasix)
• bumetanide
• torsemide
• ethacrynic acid
2. Thiazides
• hydrochlorothiazide (HydroDiuril)
• chlorothiazide
• chlorthalidone
4. Osmotic diuretics
• mannitol (Osmitrol)
• urea
• glycerin
5. Carbonic anhydrase inhibitors
• acetazolamide (Diamox)
• methazolamide
I. Loop Diuretics:
Action: increase UO -->Inhibit Na, Cl & water reabsorption in the proximal portion of ascending
LOH.
Indications:
1. edema in CHF, liver or kidney dses
2. HPN
SE:
• hyponatremia, hypokalemia, hypocalcemia,hypochloremic alkalosis
• hyperglycemia, hyperuricemia
• hypotension, HA, dizziness, lightheadedness
• anorexia, nausea, diarrhea, dehydration
• muscle cramp, ototoxicity
• leucopenia & photosensitivity
Drug interactions:
• digitalis & lithium toxicity
• K with steroids & some penicillins, anticoagulant effect
• Avoid nephrotoxic & ototoxic drugs
Lou La BELL
furosemide (Lasix)
bumetanide
torsemide
ethacrynic acid
2. Thiazides:
Action: increase UO -->inhibit Na, Cl, & water reabsorption in the distal portion of the
ascending LOH.
Indic: same as Loop diuretics
SE:
• same electrolyte imbalance as loop diuretics except
o hypercalcemia
• same CNS & GI effects as Loop diuretics except no ototoxicity
Lou La
hydrochlorothiazide (Hydrodiuril)
chlorothiazide
chlorthalidone
3. Potassium-sparing Diuretics:
Action: promotes excretion of Na & water but retains K in the distal tubule
Indications:
1. same as Loop or thiazide
2. diuretic- induced hypokalemia
3. steroid- induced edema
4. hyperaldosteronism
SE:
• nausea, diarrhea, dry mouth
• dizziness, HA, photosensitivity
• peak T waves on ECG
Alan Aldactone
spirinolactone (Aldactone)
amiloride
triamterene
Low Na
Elevated T waves from K
Agranulocytosis with triamterene
K level must be monitored
4. Osmotic Diuretics:
Action: increase in osmotic pressure, preventing reabsorption of water --> increase UO
Platelet adhesion
to injured wall of bv &
platelet aggregation
thrombus
Prothrombin thrombin
Clot dissolution:
Plasminogen plasmin (fibrinolysin)
III. Thrombolytics:
1. altepase (tPA)
2. streptokinase
3. urokinase
CORA Coumadin
warfarin (Coumadin)
PT/INR
PT
therapeutic
range
1.5- 2.5 X control
INR = 2- 3
3- 4.5 = prosthetic valves
Avoid ASA
2. Heparin Sodium:
Action: combines with antithrombin III --> to stop thrombin activity.
LMWH --> blocks factor Xa & IIa
Indic:
1. thrombosis
2. reduces risk of MI, CVA
3. clots associated with atrial fibrillation & pulmonary embolism
Harry HEPARIN
heparin sodium (Heparin)
enoxaparin , dalteparin
--------------->
PTT
Therapeutic range
1.5 – 2.5 x control
Heparin Protamine
sulfate
------------------------------->
Annie ASPIRIN
Fever
Inflammation
III. THROMBOLYTICS:
Action: bind with plasminogen causing conversion to plasmin which dissolves clots.
Indic: dissolves existing clots in pxs with CAD, CVA, DVT, pulmonary embolism
SE: HA, nausea, rash, bleeding, fever, allergic rxn, hypotension, cardiac dysrhythmias
ADAM “ASE”
urokinase, streptokinase, altepase (tPA)
CBC, hgb, hct, - monitor
Indic: hypercholesterolemia
SE:
1. GI distress
2. HA, BOV with lovastatin
3. rare: liver dysfunction, myalgia, myositis
L.L. STATIN
atorvastatin (Lipitor)
simvastatin (Zocor)
lovastatin
PT monitoring
Increase GI distress – constipation
Decrease absorption of many meds
Indic: hyperlipidemia
SE:
1. same GI effects + cholelithiasis
2. HA, muscle pains
FIBRATES
gemfibrozil
clofibrate
Restrict alcohol
NIACIN
Note liver function tests – regular intervals
Itching & flushing – SE
Aspirin before Niacin may SE of VD
CI: liver dse, pregnancy
Instruct to take with food & at hs
No high cholesterol foods
DIABETES
Diet , weight loss, exercise
Identification – medic-alert bracelet
Avoid alcohol & other meds
Blood sugar, urine sugar, HbA1c
Educ. - antidiabetic agents
S/sxs of hyper/hypoglycemia
show to do self-monitoring
skin care
ANTIDIABETIC DRUGS:
I. Oral Hypoglycemic Agents (OHA)
A. Sulfonylureas
1. 1st generation: B. Nonsulfonylureas:
• chlorpropramide 1. Biguanides
• metformin (Glucophage)
• tolbutamide (Orinase)
• acetohexamide 2. Alpha-glucosidase inhibitor
• tolazamide • acarbose
2. 2nd generation: 3. Thiazolenidiones (Insulin sensitizer)
• glipizide • rosiglitazone (Avandia)
• glyburide
• glimepiride 4. Meglitinides:
• repaglinide (Prandin)
II. Insulin:
A. Rapid –acting insulin:
• Lispro (Humalog)
• Insulin aspart (Novolog)
B. Short-acting insulin:
• Regular (Humulin R, Novolin R)
C. Intermediate-Acting insulin:
• NPH (Humulin N, Novolin N)
• Lente (Humulin L, Novolin L)
D. Long-acting insulin:
• Ultralente (Humulin U)
• Insulin glargine (Lantus)
E. Premixed insulin:
• 70% NPH/ 30% regular (Humulin 70/30)
• 50% NPH/ 50% regular (HUmulin 50/50)
• 75% LIspro protamine/ 25%lispro
Alpha- glucosidase
Inhibitor works here
Sulfonylureas
& Meglitinides
work here
I. A. OHA - Sulfonylureas:
Action:
• stimulates insulin release from pancreas
• reduce glucose output by liver
• increase peripheral sensitivity to insulin
Indic: NIDDM -Type 2
SE: GI: NV, diarrhea
rash, pruritus, HA
hypoglycemia
2. 2nd generation:
• glipizide
• glyburide
• glimepiride
B. OHA- Nonsulfonylureas:
1. Metformin (Glucophage)
Action:
• decreases hepatic glucose production
• decreases intestinal glucose absorption
• increases peripheral insulin uptake
AVANDIA
II. Insulin:
Action:
• increase glucose transport across muscle & fat cell decrease blood glucose
• promote conversion of glucose to glycogen
SE:
1. local allergic reaction
2. insulin lipodystrophy
3. insulin resistance
4. Dawn Phenomenon
5. Somogyi phenomenon
6. Insulin waning
Hypoglycemic Reaction:
Irritability
Restlessness
Excessive hunger
B. Short-acting insulin:
• Regular (Humulin R, Novolin R) 30-60 min 2- 4 hr 6- 8
C. Intermediate-Acting insulin:
• NPH (Humulin N, Novolin N) 1-2 hrs 6-12hr 18- 24
• Lente (Humulin L, Novolin L) 1- 2.5 hrs 6-12 hr 18-24
D. Long-acting insulin:
• Ultralente (Humulin U) 6 hrs 18-24hr >36
• Insulin glargine (Lantus) 30- 60 min 24
E, Premixed insulin:
• 70% NPH/ 30% regular (Humulin 70/30) ½-1 hr 2-12 18-24
• 50% NPH/ 50% regular (Humulin 50/50) ½ hr 3- 5 24
• 75% LIspro protamine/ 25%lispro 10-15 min 1- 6 24
Mixing insulin
FOOD- DRUG interactions
Antacids
calcium carbonate (TUMS)
Bran & whole grain breads
Antibiotics
erythromycin, penicillin
citrus fruits, cola & any food
tetracycline
dairy products
Anticoagulants
Warfarin (Coumadin)
Vitamin K
MAO inhibitors
tyramine
acetaminophen
acyclovir
aminoglycosides
amphotericin B
ciprofloxaxin
cisplatin
methotrexate
NSAIDs
rifampin
sulfonamides
tetracyclines
vancomycin
Drugs that can cause HEPATOTOXICITY
ACE inhibitors
acetaminophen
alcohol
iron overdose
erythromycin
estrogens
fluconazole
isoniazid
itraconazole
NSAIDs
phenothiazines
phenytoin
rifampin
sulfamethoxazole & trimethoprin
aminoglycosides
bumetanide
cisplatin
erythromycin
ethacrynic acid
furosemide
hydroxychloroquine
NSAIDs
salicylates (chronic high dose)
vancomycin