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Nursing
318 Exam
3 Study
Guide
TOPIC 8/
What are the MOA, indications, and adverse effects of drugs that affect cardiovascular and hematologic systems?
- Cardiac Glycosides o Digoxin ▪ Asses Apical pulse if administering ▪ Uses - Heart failure, atrial fibrillation ▪ MOA - Inhibits sodium-potassium ATPase, promoting increased force of cardiac contraction, cardiac output, and tissue perfusion - Decreases ventricular rate ▪ Therapeutic Level - For heart failure – 0.5 to 1 ng/mL o Too low ▪ Not therapeutic o Too High ▪ Digitalis Toxicity - anorexia, diarrhea, nausea and vomiting, bradycardia, premature ventricular contractions, cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, or yellow halos around objects), confusion, and delirium. ▪ Antidote - Digoxin-immune Fab o Binds to molecule to be excreted in urine o Combined with diuretics (causes Hypokalemia) and increases effect of drug - Side Effects : o CNS effects, GI distress o Blurred or yellow vision
- Adverse Effects : o Bradycardia
- Life Threatening Effects : o Cardiac dysrhythmias, thrombocytopenia ▪ CAMS
- Increased effects that can lead to toxicity
▪ Atenolol (Tenormin)
- Uses: o HTN, angina, and prophylaxis and treatment of acute myocardial infarction
- Mode of Action: o Selectively block beta 1-adrenergic receptor sites o Decreases sympathetic outflow to the periphery o Suppresses renin-angiotensin-aldosterone system o Side Effects: ▪ CNS effects, depression ▪ GI distress, cool extremities ▪ Erectile dysfunction (impotence) o Adverse Reactions: ▪ Bradycardia, hypotension, heart failure, dyspnea o Life threatening: ▪ Bronchospasm, dysrhythmias, thrombocytopenia o Calcium Channel Blockers ▪ Action
- Relax coronary artery spasm
- Reduce cardiac workload and oxygen demands ▪ **diltiazem (Cardizem)
- Uses o** Relaxes both coronary and peripheral blood vessels, bringing more oxygen to the myocardium and reducing cardiac workload. Used for atrial dysrhythmias and hypertension
- Mechanism of Action o Inhibits the transport of calcium ions to the myocardial cells
o If taken with digoxin or beta blockers – may cause partial or complete heart block, heart failure or dysrhythmias o If taken with digoxin – increases digoxin levels o If taken with beta blockers or other antihypertensives – can cause hypotension
- Side Effects o CNS effects, edema of ankles and feet, bradycardia, hypotension o Abrupt withdrawal may precipitate an acute angina episode
- Overdose: o Atropine can reverse bradycardia o Calcium chloride can reverse hypotension or heart block - CAMS o Decreased effectiveness of diltiazem ▪ St. John’s wort and ginseng o Increase the hypotensive effect ▪ Garlic and hawthorn - Drugs Used to Maintain or Restore Circulation o Anticoagulants ▪ Prevent the formation of clots that inhibit the circulation ▪ Prophylaxis ▪ Used in patients with venous and arterial disorders
- Deep vein thrombosis (DVT)
- Pulmonary embolism (PE)
- Coronary thrombosis
- Myocardial infarction
- Presence of artificial heart valves
- Cerebrovascular accidents (CVA)
- Mode of Action : o Depresses hepatic synthesis of vitamin K clotting factors
- Antidote – **Vitamin K
- Drug Interactions:** o Increased effect of warfarin if taken with: ▪ Aspirin, NSAIDs, sulfonamides, thyroid drugs, histamine blockers, oral hypoglycemic ▪ Diuretics, oral antibiotics, vitamin E o Decreased effect of warfarin if taken with: ▪ Barbiturates, laxatives, phenytoin, oral contraceptives ▪ Vitamin C and K
- Side Effects : o Headache, GI distress, alopecia o Fever, weakness, priapism
- Adverse Effects : o Purple-toe syndrome, bone fracture, hypotension o Chest pain, elevated hepatic enzymes
- Life Threatening : o Hemorrhage - CAMS o May increase bleeding if taken with warfarin: ▪ Feverfew, garlic, ginger, green tea, chamomile tea, gingko o May interfere with anticoagulation: ▪ Excessive doses of anise o May decrease the effects of warfarin: ▪ Ginseng, goldenseal, valerian o May decrease the effects of heparin: ▪ Goldenseal o May increase the action of anticoagulants: ▪ Hawthorn o Antiplatelets (antithrombotics) ▪ Prevent platelet aggregation ▪ Used to prevent thrombosis in the arteries by suppressing platelet aggregation
▪ Mainly for prophylactic use to:
- Prevent MI or stroke for clients with family history of these
- Prevention of repeat MI or stroke
- Prevention of stroke for clients having transient ischemic attacks (TIAs) - Clopidrogel (Plavix) o Uses : ▪ To prevent thrombosis associated with unstable angina, acute MI, stroke, TIAs o Mode of Action: ▪ Inhibits platelet aggregation and prevent ADP (adenosine diphosphate) from binding with the ADP platelet receptors o Side Effects : ▪ Abdominal pain, flulike symptoms, dizziness, confusion ▪ Headache, GI distress, bleeding, rash, pruritus ▪ Adverse Reactions: ▪ Hypotension, hypertension, bronchospasm ▪ Elevated hepatic enzymes, peptic ulcer o Life Threatening : ▪ Agranulocytosis, aplastic anemia, thrombocytopenia ▪ Stevens-Johnson syndrome o Drug Interactions: ▪ My increase bleeding when taken with:
- NSAIDs, anticoagulants, omeprazole, azole antifungals
- SSRIs, barbiturates ▪ Interferes with the metabolism of:
- Phenytoin, warfarin, NSAIDs, calcium channel blockers, morphine ▪ Food Interactions:
- Effects are decreased with grapefruit juice o Thrombolytics o CAMs : ▪ May increase bleeding if taken with:
- Ginger, garlic, gingko, feverfew, green tea ▪ Clot Busters ▪ Used to promote the fibrinolytic mechanism
- Converts plasminogen to plasmin destroys the fibrin in the blood clot
- PAD
o Inhibits HMG-CoA reductase, the enzyme necessary for hepatic production of cholestrol
- Use Caution o Asian population, older adults
- Side Effects : o CNS effects, flushing, myalgia, arthralgia, o GI distress, peripheral neuropathy, photosensitivity
- Adverse Reactions : o Rhabdomyolysis (rare), myopathy, hyperglycemia, o Elevated hepatic enzymes, renal failure o Hepatotoxicity, leukopenia, thrombocytopenia
- Drug Interactions : o Decreased effects of rosuvastatin if taken with: ▪ Antacids, phenytoin o May increase digoxin levels o Effect the efficacy of oral contraceptives o Increased drug effects of rosuvastatin if taken with: ▪ Macrolide antibiotics, antifungals **o Direct-Acting Vasodilator ▪ cilostazol (Pletal)
- Uses: o** To treat peripheral vascular disease and intermittent claudication - Mode of Action: o Acts directly to inhibit platelet aggregation and cause vasodilation, especially in the femoral vasculature - Cautions o Hepatic and renal disease, tobacco smokers o Pregnancy, older adults o Monitor VS (especially HR and BP) o Inform client that the therapeutic response may take 1. to 3 months o Advise client not to smoke because this can cause vasospasms o Encourage client to change position slowly due to orthostatic hypotension o Instruct client to take medication with meals to alleviate GI disturbances o Advise client to avoid alcohol with a vasodilator because it may cause a hypotensive reaction
- Diuretics o
- Drug Interactions : o Increased effects of drug with: ▪ Aspirin, clarithromycin, erythromycin, enoxaparin, warfarin
- Food Interactions : o Increased levels with grapefruit juice and green tea - CAMS o Increased bleeding time with gingko biloba o Decreased effects of drug with St. John’s wort
- Side Effects : o CNS effects, nasopharyngitis, GI distress o Melena, back and abdominal pain, peripheral edema, Increased susceptibility to infection, cough
- Adverse Reactions : o Tachycardia, palpitations, dysrhythmias o Elevated hepatic enzymes, blood disorders o Purposes of diuretics ▪ Reduce hypertension ▪ Decrease edema o Types of diuretics ▪ Thiazide and thiazide-like ▪ Loop or high-ceiling ▪ Osmotic ▪ Carbonic anhydrase inhibitor ▪ Potassium-sparing
- Life Threatening: o Severe hypokalemia, anemias, o Thrombocytopenia, renal failure, Stevens-Johnson syndrome
- Drug Interactions: o Increased digitalis toxicity if hypokalemia present o Increased renal toxicity with aspirin o Increased potassium loss with steroids o Decreased effects of antidiabtetic drugs o Decreased absorption of thiazide with NSAIDs
- CAM: o Aloe – can decrease serum potassium level o Gingko – may increase BP o Licorice – may increase potassium loss o Hawthorne – may potentiate hypotension o Loop (high-ceiling) Diuretics ▪ Action
- Act on ascending loop of Henle
- Inhibit chloride transport of sodium into the circulation
- Inhibit passive reabsorption of sodium
- Excrete sodium, water, potassium, calcium, magnesium - Can affect: o Blood glucose o Increase uric acid levels ▪ furosemide (Lasix)
- Uses: o To treat heart failure, renal dysfunction, hypertension o Nephrotic syndrome, acute pulmonary and peripheral edema
- Mode of Action: o Inhibition of sodium and water reabsorption from loop of Henle and distal renal tubules o Potassium, magnesium, and calcium may be excreted
- Contraindications: o Presence of severe electrolyte imbalance , hypovolemia, o Anuria, hepatic coma, o Hypersensitivity to sulfonamides
- Caution: o Heart failure, DM, hypotension, o Systemic lupus erythematosus, gout, o Patients with hearing impairment , nephrotoxicity
- Side effects o CNS effects, GI effects, hyperglycemia o Electrolyte imbalances o Blurred vision, photosensitivity o Orthostatic hypotension, hyperuricemia
- Adverse Reactions o Hypokalemia, hyponatremia, hypomagnesemia, o Orthostatic hypotension, hyperglycemia, gout o Hearing loss, elevated BUN, creatinine
- Life Threatening: o Renal failure, Stevens-Johnson syndrome
- Food Interactions: o Licorice may increase potassium loss
- CAM Interactions: o Hawthorne may potentiate hypotension o Ginseng may decrease the action of loop diuretics o Potassium Sparing Diuretics ▪ spironolactone
- Spironolactone acts differently than thiazide or loop diuretics because it does not deplete potassium , rather it hold on to it and can cause hyperkalemia. Therefore, it should not be combined with any other drugs or food that can increase the potassium level.
- Uses: o Peripheral and pulmonary edema, circulatory overload o Hypertension, heart failure, ascites, hypokalemia
- Mode of Action: o Acts on distal renal tubules to promote sodium and water excretion and potassium retention
- Drug Interactions: o Increased serum potassium with potassium supplements o Increased effects of anti-hypertensives and lithium **o Life threatening – hyperkalemia if given with an ACE inhibitor
- Side effects: o** CNS effects, GI effects o Muscle cramps
- Adverse Reactions: o None
- Life Threatening: o Severe hyperkalemia, thrombocytopenia, o Hepatotoxicity, Stevens-Johnson syndrome
o Increased hypotensive effects with other antihypertensives, nitrates, diuretics, alcohol o Decreased effects with NSAIDs o Angiotensin-Converting Enzyme (ACE) Inhibitors ▪ lisinopril (Prinvil)
- Uses o Hypertension
- Action: o Inhibits formation of angiotensin II o Blocks release of aldosterone
- Contraindications: o Hyperkalemia, pregnancy o DON’T TAKE with SPIRONOLACTONE (K+ sparing diuretic)
- Side Effects: o ACE cough (dry, hacking). o Cough, CNS effects, orthostatic hypotension
- Adverse Effects: o Angioedema
- Drug-Drug Interactions: o Decreased antihypertensive activity with NSAIDs o Hyperkalemia with potassium-sparing diuretics o Angiotensin II Receptor Blockers (ARBs) ▪ valsartan
- Use: o of hypertension and heart failure
- Mode of Action: o Potent vasodilator that inhibits binding of angiotensin II
- Caution: o Renal and hepatic impairments, hypotension, heart failure o Hypovolemia, hyperkalemia, o Pregnancy, breastfeeding
- Drug Interactions: o Anti-hypertensives, diuretics, MAOIs, and alcohol may increase hypotensive effects o ACE inhibitors and aspirin may increase hyperkalemia and renal dysfunction o Digoxin and NSAIDs may increase renal dysfunction
- Side effects: o CNS effects, cough (rare), headache o Palpitations, blurred vision, diarrhea,
o Abdominal and back pain, arthralgia, fatigue o Erectile dysfunction
- Adverse Reactions: o Orthostatic hypotension, hyperkalemia, o Rhabdomyolysis, elevated hepatic enzyme levels
- Life Threatening: o Renal dysfunction, neutropenia o CAMSs for HTN ▪ Hawthorn may increase the effects of beta blockers and angiotensin- converting enzyme (ACE) inhibitors. ▪ Licorice antagonizes the effects of antihypertensive drugs. ▪ Goldenseal may increase the effects of antihypertensive drugs. ▪ Parsley may potentiate hypotension when taken with an antihypertensive drug. TOPIC 10 What are the important things to know for anti-infective drugs? - Antibacterials o Bacteriocidal – killing fast o Bacteriostatic – killing slowly o Mechanism of Action ▪ Inhibition of bacterial cell wall synthesis ▪ Alteration of membrane permeability ▪ Inhibition of protein synthesis ▪ Inhibition of synthesis of bacterial RNA and DNA ▪ Interference with metabolism within the cell o Things that affect body defense
o Types of penicillins ▪ Basic penicillins ▪ Broad-spectrum penicillins ▪ Penicillinase-resistant penicillins ▪ Extended-spectrum penicillins o Amoxicillin ▪ Mode of Action:
- Inhibits the enzyme in cell-wall synthesis; has
- bactericidal effects ▪ Use
- Effective against: o Helicobacter pylori; Escherichia coli o Haemophilus; Enterococcus; Proteus; o Staphylococci; Streptococci
- Treats OM, tonsillitis, sinusitis, gastric/duodenal ulcers; and skin , respiratory and urinary tract infections ▪ Side Effects:
- GI distress, CNS effects, rash, stomatitis, tongue and tooth discoloration, edema, insomnia ▪ Adverse Effects:
- Superinfection (vaginitis) ▪ Life Threatening:
- Anaphylaxis - Cephalosporins o Beta-lactam structure o Action ▪ Inhibit bacterial cell-wall synthesis ▪ Bactericidal o Treat
▪ Respiratory, urinary, skin, bone, joint, and genital infections o Groups ▪ First, second, third, fourth, and fifth generation o ceftriaxone (Rocephin) 3 rd^ Generation ▪ Mode of Action:
- Inhibits bacterial cell-wall synthesis causing cells to lyse; bactericidal effect ▪ Uses:
- Effective against gram-positive and gram-negative bacteria o Staphylococci, Streptococci, E. coli, Klebsiella, o Proteus, Haemophilus influenza o Neisseria gonorrhoeae, Neisseria meningitides o Pseudomonas aeruginosa, Salmonella, Shigella, and Enterobacter species
- Has increased resistance to destruction by beta-lactamases
- OM, meningitis, appendicitis, gonorrhea
- Septicemia, surgical infection prophylaxis
- Skin, respiratory, bone/joint, gynecologic, and urinary tract infections ▪ Side effects:
- GI distress, rash
- Flushing, diaphoresis, fever
- CNS effects, edema
- Injection site reaction
- Stomatitis (Mouth Sores ▪ Adverse Effects:
- Superinfections, epistaxis, cholelithius
- Elevated hepatic enzyme levels
- Jaundice, hematuria ▪ Life Threatening:
- Seizures, anaphylaxis, neutropenia
- Renal failure, Stevens-Johnson syndrome ▪ Drug interactions
- Alcohol
- May cause disulfiram-like reaction
- Flushing, dizziness, headache, nausea, vomiting, and muscular cramps
- Uricosurics
- Decrease cephalosporin excretion - Macrolides o Action
