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Second Semester Pharmacology Orientation

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

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Second Semester Pharmacology Orientation

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  1. Second Semester Pharmacology Orientation Mrs. Adams Mrs. Angell Mrs. Bowler Mrs. Kovacic Ms. Stockwell

  2. 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…)

  3. Cardiac Medications • ACE Inhibitors • Angiotensin Receptor Blockers • Beta Adrenergic Blockers • Calcium Channel Blockers • Antiarrthymics • Vasodilators • Diuretics • Antiplatelet Aggregration • Anticoagulants

  4. 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)

  5. 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) =

  6. 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)

  7. 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) =

  8. 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).

  9. 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

  10. Calcium Channel Blockers • Slows passage of calcium between myocardial cells • Generic/trade name: diltiazem (cardizem), nifedipine (procardia), verapamil, felodipine (plendil), amlodipine (norvasc),

  11. 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

  12. 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)

  13. 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.

  14. 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)

  15. 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

  16. 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

  17. This drug will:Side effects: Increase urine output hypokalemia hyperkalemia w/ksparing 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

  18. 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.

  19. This drug will:Side effects: Preventclot 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

  20. 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

  21. This drug will:Side effects: Preventclot 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

  22. Respiratory Medications • Adrenergic Bronchodilators • Xanthine Bronchodilators • Glucortico-Steroids • Expectorants

  23. 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*****

  24. 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

  25. Xanthine Bronchodilators • Relaxes smooth muscles • Need to monitor for toxicity • May be inhaled, PO, IV or SQ • Theophylline (Theo-Dur; Aminophylline)

  26. 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***

  27. 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)

  28. 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***

  29. Expectorants • Loosen up respiratory secretions • Makes coughing effective re: secretion removal • DOES NOT STOP COUGHING • Most natural – water • Mucinex (humabid, guiafenesin, Robitussin)

  30. 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

  31. Insulins • Rapid Acting • Short Acting • Intermediate Acting • Long Acting See Chart

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