Midterm Study Guide Flashcards FOR Advanced Pharmacology Nursing 6521<\/p>\n\n\n\n
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 the study of the movement of drugs within the body pharmacokinetics the study of the effects of drugs and their mechanism of action pharmacodynamics describes what the body does to the drug through absorption, distribution, metabolism, and excretion pharmacokinetics describes what the drug does to the body pharmacodynamics What is the impact of Cirrhosis on drug levels and dosing? Because medications with a low extraction ratio (e.g., warfarin, phenytoin, carbamazepine, and lorazepam) rely heavily on the metabolic capacity of the liver for intrinsic clearance through CYP 450 enzymes, these medications will be impacted more significantly.Nearly 30% of patients with cirrhosis suffer adverse drug reactions or hepatoxicity if these risk factors are not considered or monitored closely. So Close monitoring of liver functions and doses may need to be reduced due to risk of hepatoxicity. What is the impact of protein binding on drug levels and dosing? Decreased plasma protein binding leads to an increase in free plasma fraction causing an increase in volume of distribution and a shorter elimination half life. The increase in the apparent volume of distribution and the shorter elimination half life cause a decrease in total plasma concentration. what is the impact of drug interactions on drug levels and dosing? \u2026 What is the impact of half-life on drug levels and dosing? For drugs with short half-life the dosing interval must be correspondingly short. If a drug has a long half-life a long time can separate doses without loss of benefit. The actual amount of drug lost in one half life depends on how much drug is present the tire drug in the body, the larger the amount of drug lost in one half-life What is the efficacy of a drug? Efficacy is the maximum response achievable from a drug. Effectiveness refers to the ability of the drug to produce a beneficial effect. What is Drug tolerance?
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 a state of decreased sensitivity to a drug that develops as a result of exposure to it What is addiction? the fact or condition of being addicted to a particular substance, thing, or activity. what is Dependence? physiological or psychological need for a substance what is Withdrawal? the discomfort and distress that follow discontinuing the use of an addictive drug what is First pass effect? After oral administration, many drugs are absorbed intact from the small intestine and transported first via the portal system to the liver, where they undergo extensive metabolism, therefore usually decreasing the bioavailability of certain oral medications. What is Idiosyncratic response? Idiosyncratic reactions are unpredictable and not explained by the pharmacologic properties of the drug. Medication Reconciliation process of creating an accurate list of all medications a patient is taking, including drug name, dosage, frequency, and route, and comparing the list to the physician’s admission, transfer, or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital what is Polypharmacy? regular use of at least five medications, is common in older adults and younger at-risk populations and increases the risk of adverse medical outcomes. Which drug classes produce withdrawal if stopped abruptly? Central nervous system depressants, such as alcohol, benzodiazepines, barbiturates, and opioids. Central nervous system stimulants, including cocaine, amphetamines, and methamphetamine. When is withdrawal life threatening? acohol, barbiturates, and benzodiazepines Which drugs\/meds have EPS symptoms? anti-psychotics Understand the appropriate use of herbal therapies
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 \u2026 Understand components of cultural competence cultural competence has four components a) an awarement of ones own cultural worldview, b) attitude towards cultural differences, c) knowledge of different cultural practices and worldview and 4)cross-cultural skills How can adverse drug events be minimized? Providers need to find ways to streamline the medical regimen, such as periodically reviewing all medications in relation to the Beers criteria and avoiding new prescriptions to counteract adverse drug reactions. The incorporation of computerized alerts and a multidisciplinary approach can reduce adverse drug events. Why do drugs require clinical study and FDA approval? to ensure that all drugs are safe and effective and is stricter than other countries government agencies and is harder to get drugs approved here than in Europe Know common teaspoon, tablespoon, and milliliter conversions 1\/2 tsp=2.5 ml 1 teaspoon = 5 ml 2 teaspoons= 10 ml 1\/2 tablespoon= 7.5 ml 1 tablespoon=15 ml 3 teaspoons=1 tablespoon 1 Liter= 1000 ml 1 fluid ounce=30 ml What are the special prescribing restrictions for these various classes? (DEA schedule 1-5) \u2026 What is the purpose of the MedWatch Program? allows health care professionals and consumers to report serious problems that they believe may be associated with the medical products they prescribe, dispense or use Medwatch receives reports from the public and when appropriate, publishes safety alerts for FDA-regulated products Symptoms and treatment of drug intoxication from cocaine, opioids, marijuana \u2026 Appropriate use of reversal agents for digoxin?
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 \u2026 Appropriate use of reversal agents for opioids? \u2026 Understand the implications of changing renal function on creatinine and drug dosing? \u2026 when selecting drugs and determining doses for patients it is essential to consider what individual patient factors that might impact pharmacokinetic and pharmacodynamic processes? genetics, gender, ethnicity, age, behavior (diet, nutrition, smoking, alcohol, illicit drug abuse) and or a pathophysiological change due to disease to counter effects of severe bleeding from Warfarin patients can be given? (ie: traumas, excessive bleeding) Vitamin K Warfarin MOA:prevents clots by lowering levels of vitamin K USE: prescribed for DVT & PE, and A-fib many foods modify effects of warfarin common side effects? S\/E: bleeding, bruising how pts. metabolize varies greatly and PT\/INR levels need to be monitored closely and doses adjusted accordingly contraindications: INTERACTS WITH EVERYTHING-aspirin, Tylenol, antacids, antibiotics, anti-fungals Do not give BACTRIM to pt. on warfarin (unless closely monitoring) stop 5 days before having surgery INR needs to stay 2-3 -anyone with a bleeding issue or recent surgery should not be given warfarin Dabigatrin (Pradaxa) MOA:a direct reversible inhibitor of thrombin, by preventing conversion of fibrinogen to fibrin USE:non-vitamin K oral anti-coagulant can be given in a fixed dose without need for monitoring prescribed for DVT & PE, knee or hip replacement, sometimes a-fib Adverse effects: Bleeding and GI disturbances-abdominal pain, bloating, nausea and vomiting, GERD, esophagitis or gastritis like symptoms Contraindication: Combined use with a P-glycoprotein inhibitor (ketoconazole, amiodarone, verapamil,
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 quinidine, can cause BLEEDING from excessive Dabigatrin levels, hence pts taking these meds should be MONITORED CLOSELY Rivaroxaban (Xarelto) MOA: binds directly with the active center of factor Xa and thereby inhibits the production of thrombin. Use: used in patients who have had a heart attack, Prevention of DVT and PE after total hip or knee replacement surgery, prevention of stroke in patient with A-fib, prevention of recurrent DVT & PE, treatment of DVT and PE adverse effects:Bleeding, spinal or epidural hematoma drug interactions: Precautions: DO NOT USE IN RENAL OR HEPATIC IMPAIRMENT, UNSAFE IN PREGNANCY Non vitamin K oral anti-coagulants (NOACS) 2 Approved anti-dotes Idarucizumab, and andexanet alfa Diphenoxylate HCl with atropine sulfate (Lomotil) MOA:Anti-diarrheal, decreases intestinal motility\/ peristalsis; Use: Tx: ulcerative colitis, SE: abd distension, dry mouth, monitor for dehydration Risk for TOXIC MEGACOLON (tachycardia, hypotension, increased temp, abd cramping, decrease or cessation of diarrhea)Anti-diarrheal; decreases intestinal motility\/peristalsis contraindication: Bismuth subsalicylate (Pepto-Bismol) MOA-Coats the lining of the GI tract and soothes irritation stimulating local reflexes to cause excessive GI activity and diarrhea Use- adverse effects: contraindications Loperamide (Imodium) MOA-agonist at mu opioid receptors; slows peristalsis to treat diarrhea, slows gut motility use:diarrhea poor CNS penetration (low addictive potential) adverse effects: dizziness, constipation, GI upset contraindicated: diarrhea with blood or fever fiber laxatives (bulk forming)
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 MOA:absorbs water, softening feces and increasing their mass and bulk. swelling of fecal mass produces peristalsis. USE: constipation, and diverticulitis, and IBS, can also provide symptomatic relief of diarrhea Meds: mehylcellulose, psyllium, polycarbophil adverse effects: esophageal obstruction can occur if they are swallowed in the absence of sufficient fluid, intestinal obstruction or impaction contraindicated: should be avoided if there is a narrowing of the intestinal lumen Osmotic laxatives- laxative salts (MOM) sodium phosphate and magnesium hydroxide MOA:loosens by pulling water into the colon and increasing water in the feces USE: constiption, high doses can empty bowel for prep of diagnostic and surgical procedures, and to purge the bowel of INGESTED POISONS and evacuate dead parasites after anthelmintic therapy Adverse effects-dehydration (increase fluid intake) drug interactions & contraindications: in pts. with RENAL DISEASE, FLUID RETENTION FROM SALTS MAY EXACERBATE HEART FAILURE, HYPERTENSION AND EDEMA & is CONTRAINDICATED in these patients. Can cause KIDNEY FAILURE in those with KIDNEY DISEASE and those taking drug that ALTER RENAL FUNCTION ie: diuretic, ACEI’s , and ARB’s. Sodium phosphate should be avoided in this group Stimulant laxatives MOA:Stimulates peristaltic activity by direct action on the intestinal mucosa or nerve plexus (affecting the smooth muscle). Act on the colon to produce a semifluid stool within 6-12 hours use: TX of opioid induced constipation, and tx. of constipation resulting from slow intestinal transit S\/E: Contraindication: long term use should be discouraged Alosetron (Lotronex) MOA: USE: S\/E: Contraindication: Omeprazole (Prilosec)(GI) MOA: USE: S\/E: Contraindication: Ranitidine (Zantac) (GI) MOA: USE:
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 S\/E: Contraindications Mesalamine MOA: 5-ASA to reduce inflam in IBD, reduced production of prostaglandins decreases inflammation in the colon and symptoms of ulcerative colitis use: Used in mild -> moderate IBD, ulcerative colitis S\/E’s:H\/A, flatulance, hair loss, itching, N\/V, HA, joint\/muscle pain contraindications: combining mesalamine with NSAIDS may cause reduced function of kidneys. mesalamine may increase the blood thinning effect of warfarin(Coumadin) . Mesalamine should only be used in pregnancy if the benefit of use justifies the unknown risks. dextromethorphan (cold, cough, sinus therapies) MOA: USE: S\/E: Contraindications: Loratadine (Claritin) MOA: USe: adverse effects: contraindications: Fexofenadine (Allegra) MOA_Binds to H1 receptors blocking histamine thus preventing adverse effects of histamine stimulation (allergies) -Designed to NOT cross BBB causing only Peripheral effects use: rhinitis, allergies, colds S\/E-Drowsiness Headache dizziness diarrhea vomiting pain cough hives rash itching difficulty breathing
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 hoarseness swelling contraindications:Hypersensitivity to fexofenadine Zofran MOA MOA: blocks type 3 serotonin receptors (5-HT3 receptors) located in chemoreceptor trigger zone( CTZ) and on afferent vagal neurons in the upper GI tract Use: anti-nausea Side effects: headache, diarrhea, dizziness, prolongation of QTC interval and tornadoes de pointes, a potentially life threatening dysrhythmia. contraindications: should not be given to pts. with long QT syndrome and should be used in caution in its with electrolyte abnormalities, heart failure or bradydysrhythmias and in those taking Schedule 1 Drugs substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote Schedule 2 Drugs drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin schedule 3 Drugs drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone Schedule 4 drugs defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol Schedule 5 drugs
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin Naltrexone a pure opioid antagonist that by blockade of dopamine release secondary to blockade of opioid receptors decreases cravings for alcohol and blocks alcohol’s re-inforcing (pleasure) effects Use: treats Alcohol Use Disorder S\/E: nausea, headache, anxiety and sedation adverse effects: can precipitate withdrawal in opioid dependent patients Acamprosate MOA: possible restoration of balance between inhibitory (GABA) and excitatory (glutamate) neurotransmitters Use: approved for maintaining abstinence in patients with alcohol dependance after detoxification. Benefits derive from reducing unpleasant feelings (tension, dysphoria, anxiety) brought on by abstinence S\/E: diarrhea contraindications: 333 mg delayed release tablets (666 mg po 3 times daily-TAKE WITH MEALS) Disulfiram (Antabuse) MOA: disruption of alcohol metabolism through irreversible inhibition of aldehyde dehydrogenase Use:helps individuals with alcohol use disorder avoid drinking by causing unpleasant effects if alcohol is ingested. S\/E: ACETALDEHYDE SYNDROME nausea, copious amounts vomiting, flushing, palpitations, headache, sweating, thirst, chest pain, weakness, blurred vision, hypotension, blood pressure can decline to shock levels Contraindications: contraindicated in patients suspected of being incapable of abstinence from alcohol, for patients with myocardial disease, coronary occlusion, or psychosis and for patients who have recently received alcohol, metronidazole, or alcohol containing cough syrups. -warn pt. to avoid all forms of alcohol including alcohol in vinegar, sauces, cough syrup, and acohol applied to the skin in aftershave lotions and colognes.- -the first dose of disulfiram should not be administered until at least 12 hours after the last alcoholic drink was consumed. When stopping Disulfiram the effects can last up to 2 weeks after the last dose was given BLACK BOX WARNING: Disulfiram should never be administered to a patient experiencing acohol intoxication because this may cause a potentially fatal reaction
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 Lasix (Furosemide) MOA: acts in the thick segment of the ascending limb of the Loop of Henle to block reabsorption of sodium and chloride. By blocking solute reabsorption it prevents passive reabsorption of water Use: Pulmonary Edema assoc. with Congestive Heart Failure, demands of hepatic, cardiac or renal origin that have been unresponsive to less efficacious diuretics, HTN that cannot be controlled with other diuretics. Especially useful in patients with Renal Impairment since the drug can promote diuresis even when renal blood flow and GFR are low. S\/E: hyponatremia, hypochloremia, and dehydration, rarely (ototoxicity)-specifically a risk for ototoxicity if furosemide is given with amino glycoside anti-biotics (gentamycin). Drug interactions: in the presence of low potassium the risk for serious digoxin-induced toxicity (ventricular dysrhythmias) is greatly increased Avoid taking Digoxin while on Loop Diuretics Loop Diuretics baseline data weight, vital signs, electrolytes Loop Diuretics high risk patients use with caution in patients with vascular disease, renal impairment, Diabetes Mellitus or a hx. of gout and in patients who are pregnant or taking digoxin, lithium, ototoxic drugs, NSAIDS, or anti-hypertensive drugs Loop Diuretics evaluating therapeutic effects monitor blood pressure and pulse rate also, pts. should weigh themselves daily and evaluate for decreased edema. Have patients monitor for signs or symptoms of hypokalemia Loop diuretics minimizing adverse effects Initiate therapy with low doses, adjust doses carefully, monitor weight loss daily, and use an intermittent dosing schedule. Hydrochlorothiazide (Microzide)-MOA MOA: promotes urine production by blocking the re-absorbtion of sodium and chloride in the early segment of the distal convoluted tubule. Retention of sodium and chloride in the nephron causes water to be retained as well, thereby producing an increased flow of urine. Hydrochlorothiazide-USE The primary indication for hydrochlorothiazide is hypertension, which thiazides are often drugs of first choice. Thiazides are preferred drugs for mobilizing edema associated with mild to moderate heart failure
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 Hydrochlorothiazide- adverse effects initiated therapy with low doses, adjust doses carefully, monitor weight losss daily, and use an intermittent dosing schedule Thiazide Diuretics Therapeutic goal: TX HTN and EDEMA Baseline Data: Weight, vital signs, electrolytes Identifying high risk patients: use with caution in patients with cardiovascular disease, renal impairment, Diabetes Mellitus, or a hx. of gout and in pts. taking digoxin, lithium or anti-hypertensive drugs Eval. Therapeutic effects: monitor BP & P, have pts. weigh themselves daily, and evaluate for decreased edema. Have pts. monitor for signs and symptoms of HYPOKALEMIA adverse effects: initiate therapy with low doses, adjust doses carefully, monitor weight loss daily, and use an intermittent dosing schedule Spironolactone (Aldactone) MOA blocks the actions of aldosterone in the distal nephron. B\/C aldosterone acts to promote sodium uptake in exchange for potassium secretion, inhibition of aldosterone has the opposite effect: RETENTION OF POTASSIUM AND INCREASED EXCRETION OF SODIUM Spironolactone (Aldactone) USE Used primarily for HTN and EDEMA. most commonly used in combination with a thiazide or loop diuretic-to counter potassium wasting effects of more powerful diuretics Used to TX SEVERE HEART FAILURE-reduces mortality and hospital admissions. Benefits derive from the protective effects fo aldosterone blockade in the heart and blood vessels Spironolactone (Aldactone)-adverse effects Hyperkalemia, and endocrine effects such as gynecomastia, menstrual irregularities, impotence, hirtuism, and deepening of the voice Spironolactone (Aldactone)-drug interactions Because of the risk for HYPERKALEMIA , caution must be employed when spironolactone is combined with potassium supplements, salt substitutes, (which contain potassium chloride_ or another potassium sparing diuretic.. Also 3 Groups of drugs: ACEI, ARB, and DIRECT RENIN INHIBITORS- can elevate potassium levels (by suppressing aldosterone secretion) and hence should be combined with spironolactone only when necessary Spironolactone- Aldactone BLACK BOX WARNING has been shown to be tumorigenic in rats, avoid unnecessary use
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 Triamterene (Dyrenium)-MOA disrupts sodium-potassium exchange in the distal nephron, but is a DIRECT INHIBITOR of the exchange mechanism itself. Causes DECREASE IN SODIUM REABSORPTION AND A REDUCTION IN POLTASSIUM SECRETION. THEREFORE SODIUM EXCRETION IS INCREASED AND POTASSIUM IN CONSERVED. TRIAMATERINE WORKS WITHIN HOURS COMPARED WITH DAYS FOR SPIRONOLACTONE. Triamterene (Dyrenium)-USE Can be used alone or in combination with other diuretics to TX HTN and EDEMA. When used alone Triamterene produces mild diuresis, when used combined with other diuretics (furosemide, hydrochlorothiazed) triamterene augments diuresis and helps counteract the potassium wasting effects of the more powerful diuretic. Triamterene (Dyrenium)-adverse effects HYPERKALEMIA, nausea, vomiting, leg cramps and dizziness. Rarely blood dycrasias Potassium Sparing Diuretics Goal: Counterbalance potassium losing effects of thiazide and loop diuretics baseline data: weight, vital signs, electrolytes high risk patients: potassium sparing diuretics are contraindicated in patients with hyperkalemia, and should be used with caution in patients taking potassium supplements or another potassium sparing diuretic. Use with caution in patients taking ACEI, ARB or DIRECT RENIN INHIBITOR. therapeutic effects: potassium levels should be monitored on a regular basis. The object is to maintain serum potassium levels between 3.5 and 5 m\/Eq\/L. minimizing adverse effects: Pts. should be instructed to restrict their intake of potassium rich foods. ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEI)-MOA 1)reducing levels of angiotensin II ,ACE inhibitors can dilate blood vessels (primarily arterioles and to a lesser extent veins) reduce blood volume (through effects on the kidneys), and more importantly prevent or reverse pathologic changes in the heart and blood vessels mediated by angio-tension II and aldosterone. ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEI)-USE -MILD-MODERATE HYPERTENSION (ACEI) reduce the risk for cardiovascular mortality caused by hypertension. -HEART FAILURE -by lowering arteriolar tone, these drugs improve regional drug flow and by reducing cardiac after load, they increase cardiac output -MYOCARDIAL INFARCTION: -DIABETIC AND NON DIABETIC NEPHROPATHY -PREVENTION OF MYOCARDIAL INFARTION, STROKE, DEATH IN PATIENTS AT HIGH CARDIOVASCULAR
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 RISK -DIABETIC RETINOPATHY ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEI)- ADVERSE EFFECTS First does hypotension, cough, hyperkalemia, renal failure-ACEI can cause severe renal insufficiency in patients with bilateral renal artery stenosis, Angioedema, Neutropenia ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEI)-Drug Interactions Diuretics-diuretics may intensify first dose hypotension-diuretics should be withdrawn 2-3 days before giving an ACE inhibitor Anti-hypertensive Agents Drugs that Raise Potassium Levels Lithium-ACEI can cause lithium to accumulate to toxic levels. Frequent lithium monitoring required Nonsteroidal anti-inflammatory drugs ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEI)- BLACK BOX WARNING- Fetal Injury Use of angiotensin-converting enzyme (ACE) inhibitors during the second and third trimesters of pregnancy can injure the developing fetus. Specific effects include hypotension, hyperkalemia, skull hypoplasia, anuria, renal failure (reversible and irreversible) and death. Women who become pregnant while using ACE inhibitors should discontinue treatment as soon as possible. Infants who have been exposed to ACEI during the second or third trimester should be closely monitored for hypotension, oliguria, and hyperkalemia angiotensin-converting enzyme inhibitors-Summary of Key Prescribing Considerations Therapeutic Goal: Reduce blood pressure in patients with hypertension improve hemodynamics in patients with heart failure, slow progressive of established diabetic nephropathy, reduce mortality, and treat heart failure after myocardial infarction. Baseline data: determine blood pressure and renal function monitoring: consider checking creatinine 2-4 weeks after starting. Have patients track blood pressure values identify high risk patients: angiotensin-converting enzyme inhibitors are contra-indicated during the second and third trimesters of pregnancy and in pts. with bilateral renal after stenosois. evaluating therapeutic effects: monitor for reduced blood pressure. In patients with diabetic nephropathy, monitor proteinuria, and glomerular filtration
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 minimizing adverse effects: instruct patients to consult the prescriber if experiencing cough or facial swelling. Use caution in combinations with drugs that elevate potassium levels. Angiotensin II Receptor Blockers MOA Angiotensin 2 receptor blockers, block the ACTIONS of Angiotensin II and decrease the influence of angiotensin II. Angiotensin 2 receptor blockers pose a much lower risk for cough or hyperkalemia Angiotensin II Receptor Blockers-USE Hypertension Heart Failure- Valsartan (Diovan) and Candesarten (Atacand) are approved for heart failure. mainly used for people who cannot tolerate ACE inhibitors because of a cough Diabetic Neuropathy- 2 ARBS Irbesartan (Avapro) and Losartan (Coozar) are approved for managing nephropathy in hypertensive patients with type 2 diabetes. Myocardial Infarction- Valsartan (Diovan) is approved for reducing cardiovascular mortality in post-MI patients with heart failure or LF dysfunction. Stroke Prevention- Losartan (Coozar) is approved for reducing the risk for stroke in patients with HTN and LV hypertrophy. Prevention of MI, Stroke, Death in pts with high cardiovascular risk- One ARB Telmisartan (Micardis)-is approved for reducing the risk for MI, stroke, and death from cardiovascular causes in patients older than 55 but only if they are INTOLERANT of ACE-inhibitors Diabetic Retinopathy- ARB losartan (Cozaar) in patients with type 1 diabetes without established retinopathy Angiotensin II Receptor Blockers-(ARBS) Adverse Effects most ARBs are well tolerated, they can cause ANGIOEDEMA like ACE inhibitors but the incidence is much LOWER with ARBs. RENAL FAILURE- ARBs can use renal failure in patients with bilateral renal artery stenosis or stenosis in the the artery to a singe remaining kidney. Angiotensin II Receptor Blockers- (ARBs) Drug interactions when an ARB is added to an antihypertensive regimen, dosages of the other drugs may require reduction Aliskiren (Tekturna) (direct renin inhibitor)-MOA Aliskiren binds tightly with renin and thereby inhibits then cleavage of angiotensinogen into angiotensin I. Aliskiren can reduce the influence of the entire RAAS. Aliskiren (Tekturna) (direct renin inhibitor)- USE Approved only for Hypertension– Do not eat with high fat meal it lowers availability of drug
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 Aliskiren (Tekturna) (direct renin inhibitor)- Adverse effects generally well tolerated. At high doses some patients experience DIARRHEA and other GI effects. AVOID USE DURING PREGNANCY -at usual doses,LOW risk of agioedema, cough or hyperkalemia Aliskiren (Tekturna) (direct renin inhibitor) BLACK BOX WARNING THE DRUG IS LIKELY TO POSE A RISK FOR MAJOR CONGENITAL MALFORMATIONS AND FETAL DEATH. ALISKIREN IS CONTRAINDICATED DURING THE SECOND AND THIRD TRIMESTERS AND SHOULD BE DISCONTINUED AS SOON AS POSSIBLE WHEN PREGNANCY OCCURS Eplerenone (Inspra) (Aldosterone antagonists)-MOA produces selective blockade of aldosterone receptors having little or no effect on receptors for other steroid hormones (glucocorticoids,progesterone, androgens.) Causes retention of potassium and increased excretion of sodium and water., which reduces blood volume and blood pressure Eplerenone (Inspra) (Aldosterone antagonists)- USE Hypertension, Heart Failure Eplerenone (Inspra) (Aldosterone antagonists)- adverse effects the greatest concern is HYPERKALEMIA- b\/c of this risk combined use with potassium supplements, salt substitutes, or potassium sparing diuretics (spironolactone, triamterene) in CONTRAINDICATED Eplerenone (Inspra) (Aldosterone antagonists)- DRUG INTERACTIONS INHIBITORS of CYP3A4 can increase levels of Eplerenone, thereby posing a risk for toxicity. Weak Inhibitors (Erythromycin, Saquinavir, verapamil, fluconazole) can DOUBLE Eplerenone s levels. Strong inhibitors (ketoconazole, itraconazole) can increase levels fivefold. Eplerenone should not be combined with a strong inhibitor Should not be combined with potassium supplements, salt substitutes or potassium sparing diuretics. Caution is advised when combined with Lithium as lithium levels may increase. Frequent Lithium level monitoring required. Spironolactone (Aldactone) BLACK BOX WARNING Use of spironolactone is tumorigenic in chronic toxicity studies in rats Spironolactone (Aldactone) MOA blocks receptors for Aldosterone but also binds with receptors for other steroid hormones (glucocorticoids, progesterone, androgens).
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 Spironolactone (Aldactone)-USE Hypertension and Heart Failure Spironolactone (Aldactone)- Adverse Effects main-hyperkalemia binding with other steroids causes gynecomastia, menstrual irregularities, impotence, hirtuism, and deepening of the voice. Calcium Channel Blockers drugs that prevent calcium ions from entering cells. These agents have the greatest effects on the heart and blood vessels. They are used to treat hypertension, angina pectoris, and cardiac dysrhythmias. There is controversy about there safety in patients with hypertension and diabetes Verapamil Nondihydropyridine: agent that affects the heart and blood vessels Nifedipine Dihydropyridine: Agent that acts mainly on blood vessels Verapamil (Calan)-MOA blocks calcium channels in the blood vessels and the heart, overall effect is vasodilation accompanied by reduced arterial pressure and increase coronary perfusion, suppress impulse conduction through AV node Verapamil (Calan)-USE Angina Pectoris, Essential hypertension-2nd line agent used after thiazide diuretics, cardiac dysrhythmias- used IV to slow ventricular rate in pts with a-fib and paroxysmal supra ventricular tachycardia Verapamil (Calan)- Adverse effects most common complaint is constipation, esp. older adults cardiac effects, can cause partial or complete AV block Must be used with caution in pts with CARDIAC FAILURE and not used at all in pts with SICK SINUS SYNDROME OR SECOND AND THIRD DEGREE AV BLOCK Verapamil (Calan)-Drug and food interactions Digoxin- pts on Digoxin and verapamil have an increased risk for AV block. verapamil increases plasma levels of digoxin by 60%, risk of DIGOXIN TOXICITY
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 If B blocker and Verapamil are used together there is an increases risk for excessive cardiosuppression. B-Blockers and IV VERAPAMIL should be administered several hours apart! Grapefruit juice can inhibit intestinal and hepatic metabolism of certain drugs New Evidence reveals that Felodipine and Nifedipine carry the highest risk Diltiazem (Cardizem)-MOA blocks calcium channels in the heart and blood vessels. Lowers Blood pressure through arteriolar dilation extensively metabolized in first pass through the liver-only bioavailability of 50% Diltiazem (Cardizem)-USE Angina Pectoris, Essential Hypertension, Cardiac Dysrhythmias (atrial flutter, atrial fibrillation, and paryoxysmal supra ventricular tachycardia Diltiazem (Cardizem)- Adverse Effects dizziness, flushing, headache, edema of ankles and feet. can exacerbate cardiac dysfunction in patients with bradycardia, sick sinus syndrome, heart failure or 2nd and 3rd degree heart block, can cause chronic eczematous rash in older adults Diltiazem (Cardizem)- drug and food interactions diltiazem can exacerbate digoxin induced suppression of AV conduction and can intensify the cardiosuppressant effects of Beta blockers. Giving Diltiazem concurrently with digoxin or a B-blocker should be monitored closely for cardiac status Verapamil and Diltiazem Therapeutic Goal: Verapamil and Diltizem are indicated for hypertension, angina and cardiac dysrhythmias Baseline Data: Determine Blood Pressure and pulse rate and obtain laboratory evaluations of liver and kidney function. Monitoring: No routine blood monitoring required Identifying high risk patients: These drugs are contraindicated in patients with hypotension, sick sinus syndrome and 2nd and 3rd degree AV block Evaluating Therapeutic effects: monitor blood pressure periodically. For ANGINA pt. should keep ongoing records of time and intensity of anginal attacks. minimizing adverse effects: Initiate Therapy with low doses, adjust dose carefully, monitor weight loss daily, and use an intermittent dosing schedule. Dihyrdropyridines end in PINE, produce significant blockade of calcium channels in blood vessels but not the heart.
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 Nifedipine (Procardia)-calcium channel blocker-MOA blocks calcium channels in the vascular smooth muscle and promotes vasodilation. But not much in heart. Effects; lowers blood pressure, increases heart rate, increases contractile force (primarily with Immediate release versus slow release) Nifedipine (Procardia)-calcium channel blocker- USE Angina (vasospastic angina) and Hypertension (use SR only) Nifedipine (Procardia)-calcium channel blocker-Adverse Effects Reflex Tachycardia (with Immediate Release)- can increase cardiac demand and increase angina pain. To prevent reflex tachycardia Nifedipine can be combined with a Beta Blocker (metoprolol) IR Nifedipine in high doses need to be used with caution (can increase risk MI-Immediate release) (Only use beta blocker with Nifedipine as using one with Verapamil or diltiazem can excerbate cardiac effects.) Dihydropyridines-Summary of key prescribing considerations Amlodipine, Nifedipine and Nicardipine are approved for Essential hypertension and Angina. Isradipine, Felodipine, Nisoldipine are approved for HTN only. Baseline data:determine BP and Pulse rate and obtain lab evaluations of liver and kidney function Identifying high risk patients: use with caution in patients with hypotension, sick sinus syndrome, heart failure or 2nd or 3rd degree AV block Evaluating therapeutic effects: monitor blood pressure periodically, Patients should keep an ongoing record of anginas attacks including time and frequency Minimizing adverse effects; reflex tachycardia can be suppressed with a Beta Blocker. Peripharel edema can be reduced with a diuretic Vasodilators- MOA they act directly on the smooth muscles in arterioles and veins to reduce vessel relaxation. Vasodilators-Use Essential Hypertension, Hypertensive Crisis, Angina Pectoris, Heart Failure, and Myocardial Infarction Vasodilators- Adverse Effects Postural Hypotension Vasodilator- Pt. Education Vasodilators place patients at increased risk for falls. Pts receiving vasodilators should be informed about symptoms of hypotension (lightheadedness, dizziness) and be advised to sit or lie down if these
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 occur. Failure to follow this advice my result in failing. Pts should also be taught they can minimize hypotension by avoiding abrupt transitions from a supine or seated position to an upright position, Hydralazine (Vasodilator)-MOA causes selective dilation of arterioles , acts direcly on vascular smooth muscle -in slow acetylators to avoid accumulation of hydralazine dosage should be reduced Hydralazine (Vasodilator)-USE Essential Hypertension and Heart Failure Hydralazine (Vasodilator)-Adverse Effects Reflex tachycardia, increased blood volume, Systemic Lupus like syndrome Hydralazine (Vasodilator)- Drug interactions If Hydralazine is used with other anti-hypertensive agents care is needed to avoid excessive hypotension Minoxidil-MOA produces more intense vasodilation of arterioles (which can increase cardiac demand and exacerbate Angina Pectoris Minoxidil- USE SEVERE HYPERTENSION- reseved for patients who have not responded to safer drugs. Minoxidil-Adverse Effects Reflex tachycardia, sodium and water retention (so serious requires use of loop diuretic (furosemide) alone or used in combination with a thiazide diuretic to prevent cardiac decompensation, hypertrichosis (excessive growth of hair) Minoxidi-BLACK BOX WARNING Minoxidil can cause pericardial effusion, occasionally progressing to tamponade and may exacerbate Angina Pectoris Diuretics- for Hypertension Hydrochlorithizide & Spironolactone B-adrenergic Blocker for Hypertension Metoprolol Inhibitors of Renin-Angiotensin-Aldosterone System tx, HTN
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 Captopril-ACE inhibitor Losartan-Angiotensin II receptor blocker Aliskiren-direct renin inhibitor Eplerenone-aldosterone antagonist Calcium Channel Blockers to TX HYPERTENSION Verapamil Nifedipine Drug classes recommended for initial therapy of HTN- with COMORBID condition HEART FAILURE Diuretic, B-Blocker, Ace Inhibitor, ARB, Aldosterone angtagonist Drug classes recommended for initial therapy of HTN-with COMORBID condition Post Myocardial Infarction Beta Blocker, ACE inhibitor, Aldosterone antagonist Drug classes recommended for initial therapy of HTN-with COMORBID condition-High Coronary Artery Disease RISK Diuretic, Beta Blocker, ACE inhibitor, Calcium channel blocker Drug classes recommended for initial therapy of HTN-with COMORBID condition-DIABETES Diuretic, beta blocker, ACE inhibitor, ARB, Calcium Channel Blocker Drug classes recommended for initial therapy of HTN-with COMORBID condition- Chronic Kidney Disease ACE inhibitor, ARB Drug classes recommended for initial therapy of HTN-with COMORBID condition- PREVENTION OF STROKE Diuretic and ACE inhibitor Heart Failure Treated routinely with 3 types of drugs 1)Diuretics, 2)Agents that inhibit Renin Angiotensin Aldosterone System, 3)Beta Blockers thiazide Diuretics hydrochlorothiazide (use in heart failure) produce moderate diuresis. For long term therapy of HF when edema is not too great. Adverse effect: hypokalemia, which increases risk for digoxin induced dysrhythmias. Loop Diuretics- furosemide (use in heart failure)
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 can produce profound diuresis. Can promote fluid losss even when GFR is low. Loop diuretics are preferred to Thiazide diuretics when cardiac output is greatly reduced. DRUG OF CHOICE FOR SEVERE HEART FAILURE Adverse effects- cause hypokalemia, which increases the risk for digoxin toxicity Potassium Sparing Diuretics- Spironolactone and Triamterene)-(Use in Heart Failure) promote only scant diuresis. In pts with HF these drugs are used to counteract potassium loss caused by thiazide and loop diuretics, thereby lowering the risk for digoxin induced dysrhythmias B\/C ACE inhibitors and Angiotensin II receptor blockers also carry a risk for hyperkalemia, caution is needed if these drugs are combined with a potassium sparing diuretic. Accordingly when a ACEI or ARB is initiated in treatment of heart failure the potassium sparing diuretic should be DISCONTINUED DRUGS FOR HEART FAILURE-Inhibitors of Renin-Angiotensin-Aldosterone System Captopril (angiotensin-converting enzyme inhibitor)(ACEI) Losartan (Angiotensin II receptor Blocker (ARB) Eplerenone (aldosterone Antagonist) DRUGS FOR HEART FAILURE- Diuretics Hydrocholorthiazide Furosemide DRUGS FOR HEART FAILURE-Inotropic Agent Digoxin (a cardiac) glycoside Captopril, Enalapril-ACEI can improve functional status and prolong life–MOA block the production of angiotensin II decrease the release of aldosterone and suppress the degradation of kinins. Thus improving hemodynamics and favorably altering cardiac remodeling. Captopril, Enalapril-ACEI-Adverse Effects Hypotension, hyperkalemia, intractable cough, and angioedema. Can cause renal failure in pts with bilateral renal artery stenosis B\/C of their ability to elevate potassium levels , ACEI’s should be used in caution in pts. taking potassium supplements, or a potassium sparing diuretic (spironolactone or triamterene) Angiotensin Converting Enzyme Inhibitors BLACK BOX WARNING USE OF ACEI’S during PREGNANCY-especially the second and third trimester can cause fetal injury. Accordingy if pregnancy occurs these drugs should be discontinued Angiotensin II receptor blockers (ARB’s)-Heart Failure
MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 ARB’s should be reserved for HEART FAILURE pts. who CANNOT TOLERATE ACEI’S USUALLY OWING TO INTRACTABLE COUGH (as they do not increase levels of kinins and favor cardiac remodeling, ACEI are preferred) Angiotensin Receptor Neprilysin Inhibitor- Sacubitril\/ Valsartan (Entresto)-newly approved class of drug-MOA increases natriuretic peptides while suppressing the negative effects of the Renin-Angiotensin-Aldosterone System (RAAS)- Entresto is approved for patients with stage II to IV Heart Failure to be used in place of ACEI or ARB Adverse Effects- cause angioedema, hyperkalemia and hypotension. Contraindication- Should BE AVOIDED IN PREGNANCY may cause fetal harm<\/p>\n","protected":false},"excerpt":{"rendered":"
Midterm Study Guide Flashcards FOR Advanced Pharmacology Nursing 6521 MIDTERM STUDY GUIDE FLASHCARDS FOR ADVANCED PHARMACOLOGY NURSING 6521 the study of the movement of drugs within the body pharmacokinetics the study of the effects of drugs and their mechanism of action pharmacodynamics describes what the body does to the drug through absorption, distribution, metabolism, and […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-132619","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/132619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=132619"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/132619\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=132619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=132619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=132619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}