Pharmacological Agents for Viral Infections and Cardiovascular Conditions, Exams of Nursing

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TTC NUR 161 Test 2 Exam Study Guide.

Nonselective Beta-Adrenergic Blocking Agent (Alfa Beta Blocker) (Propranolol) - Actions: Competitively blocks receptors in heart (= decreased HR contractility, excitability, membrane stabilization, decrease arrhyth., decrease heart workload, decrease O2 use) & in juxtaglomerular app. in nephron (no renin released = further decrease in BP. Indication: *HTN, angina, migraine headaches Re-infarction after MI's Prevention of stage fright Essential tremors Nucleoside inhibitors (Zidovudine) - Indication: Combination HIV tx Nucleoside inhibitors (Zidovudine) - Action: Competes w/naturally occurring nucleosides w/in cell that the virus needs to develop and build DNA chain = No production Can't build DNA chain! Nucleoside inhibitors (Zidovudine) - Caution: Hep/Renal dysfx Bone marrow suppression Contra: No breast feeding!! Nucleoside inhibitors

(Zidovudine) - Drug-Drug: Alcohol Some HIV meds Antibiotic/Anti-fungal (Increase their effects!) Nucleoside inhibitors (Zidovudine) - Adverse Effects: Hypersensitive rxn-fever* Hepatomegaly Bone marrow suppression Nucleoside inhibitors (Zidovudine) - Nursing C's: Safe if pregnant! Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Indications: HIV/AIDs w/ARC w/ decreased # of helpter T cells and increased opportunistic infections Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Action: Binds directly to HIV recerse transc. = Blocks RNA & DNA dependent DNA polymerase = virus can't form viral DNA & can't take over cell/reproduce Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Pharmaco: PO Contra: Preg/Lact Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Drug-Drug: Antiarrhy's

Calcium channel blockers Antituberculosis Warfarin Hormonal contracept. Clarithromycin St. Johns Wart Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Adverse Effects: Dry mouth, constipation/diarrhea, nausea, abd. pain, dyspnea, dizzy, blurred vision, FLu- like symp. ( muscle aches/pains, faligue, appetite loss, fever Protease Inhibitor (Fasamprenavir) - Actions: BLocks protease activity w/in HIV virus = remains immature & non-infective (unable to fuse w/and inject ifself into cells) Indication: Part of combo therapy for HIV inf. Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Caution: Hepatic dysfx saquinavir safe for lact Contra: No breast feeding!! Rash = Steven Johnson syndrome Use in children not est. Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Drug-Drug: Ritonavir Many other drugs Nonsedating antihistamines

Sedatives/Hypnotics Antiarrhythmics Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Adverse: Headache Mood changes Nausea diarrhea fatige Rash may = Steven Johnson Syndrome* Hump, thin arms/legs* Reverse Transcriptase Inhibitors-non nucleoside (Nevirapine, Abacavir, Viread) - Nursing C's: Pt's on diabetic drugs may require dose adjustments* Monitor renal/hep fx* Stop is rash occurs!* Reg med care, periodic blood tests* Fusion Inhibitor (Enfuvirtide) - Actions: Prevents the fusion of the virus within human cellular memb. = virus can't enter. (Can't Fuse!)* Indications: HIV inf...combo therapy Adults & children over 6yrs evidence of HIV rep. despite therapy Fusion Inhibitor (Enfuvirtide) - Pharmaco.: SubQ inj. Not excreted, recycled in the tissues**

Fusion Inhibitor (Enfuvirtide) - Caution: Lung disease Pregnancy Contra: No true contra* Breast feeding still not recommended Fusion Inhibitor (Enfuvirtide) - Drug-Drug: Pimozide, Rifampin, Triazolam, Midazolam, Oral contraceptives Fusion Inhibitor (Enfuvirtide) - Adverse: Periph. neuropathy* N/V GI upset* Rash Anorexia pneumonia Chills Insomnia Depression Myalgia Nursing C's Monitor Renal/Hep fx Agent for Sickle Cell Anemia (Hydroxyurea) - Action: Increase amount of fetal Hgb* produced in bone marrow & dilutes the formation of the abnormal Hgb = less clogging of small vessels/arteris = less painful crisis Agent for Sickle Cell Anemia (Hydroxyurea) - Indication:

Reduction in painful crisis & decrease need for blood transfusions in adults w/ sickle cell Leukemia, ovarian Ca., melanoma, & antineoplastic Agent for Sickle Cell Anemia (Hydroxyuera) - Pharmaco: PO Agent for Sickle Cell Anemia (Hydroxyurea) - Caution: Impaired renal/hep fx Preg/Lact Contra: Allergy Severe anemia Leucomenia (low WBC) Agent for Sickle Cell Anemia (Hydroxyuera) - Drug-Drug: Uricosuric agents Agent for Sickle Cell Anemia (Hydroxyurea) - Adverse Effects: GI effects!* Rash/erythema Bone marrow suppression** Headache, dizziness, fever/chills, disorientation, malaise Increase risk of cancer Nursing C's: Taken for several months before effective** Cytotoxic** Increase fluid intake* Agent for Iron Deficiency

(Ferrous Sulfate) - Action: Increase serum iron Indication: Tx of iron def. anemias Adjunct tx w/pt's receiving epoetin alpha Agent for Iron Deficiency (Ferrous Sulfate) - Pharmaco: Absorbd. in sm intestines Transported in blood bound transferrin Sm amounts lost daily in sweat, urine, sloughing of skin, mucosal cells, & intesinal cells PO or Inj. Agent for Iron Deficiency (Ferrous Sulfate) - Contra: Allergy Hemochomatosis (iron overload) Hemolytic anemia Normal iron balane Peptic ulcer, colitis, or regional enteritis Agent for Iron Deficiency (Ferrous Sulfate) - Drug-Drug: Antacids* Tetracycline Cimetidine Cipro Norfloxacin Ofloxacin Chloramphenicol Agent for Iron Deficiency (Ferrous Sulfate) - Adverse Effects:

Dark stools* Constipation* Staining of tissues* Nursing C's: Stain teeth = use straw* Inj = Ztrack to avoid staining skin* Can alter MRI image...report drugs* Don't take w/eggs, milk, coffee, or tea* Toxic if too much is taken Erythropoietins (Epoetin Alfa) - Actions: Treats anemia assoc. w/renal failure and AIDs, decreased need for blood transfusions in pts undergoing surgery. Acts like natural glycoprotein erythropoietin to stimulate RBC prod. in bone marrow* Indications: Tx of anemia assoc. w/renal failure and surgical pts Erythropoietins (Epoetin Alfa) - Pharm: IV or SubQ Must have adequate supply of RBC components Erythropoietins (Epoetin Alfa) - Caution: Adequate levels of epoetin Normal renal fx can cause rebound decrease in erythropoeitin Contra: Uncontrolled HTN Allergy to mammalian cell-derived Allergy to human albumin Lactation

Erythropoietins (Epoetin Alfa) - Drug-Drug: Don't mix anything into the solution** Erythropoietins (Epoetin Alfa) - Adverse Effects: Headache, fatigue, asthma, dizziness, seizures N/V, diarrhea HTN, edema, possible, chest pain Nursing C's: Give 3x/wk-calendar* Monitor lines for clotting* Hgb goal < or = to 12! Vitamin B 12 (Hydroxocobalamin) - Actions: Essential for nucleic acid & protein synth., used for growth, cell reprod., heamatopoeisis, nucleoprotein & myelin synth. Indications: Replacements Tx for megaloblastin anemia, pernicious anemia Maintenance of myelin nerve sheath Increase demand (preg, increase growth) Vitamin B 12 (Hydroxocobalamin) - Pharmaco: Given IM Q5- 10 days to build up levels then 1x/mo for life Vitamin B 12 (Hydroxocobalamin) - Caution: Children Preg/lact Anemias

Nasal ulcers w/spray Contra: Allergy Vitamin B 12 (Hydroxocobalamin) - Adverse Effects: Pruritis rash* Excessive Vit B levels (periph edema, HF)* Pain @ inj site* Nursing C's: Nasal form not approved for kids Can't be taken orally not absorbed in pernicious anemia (decrease instrinsic factor) Labs! Nutrition consult Folic Acid Dirivates (Folic Acid) - Actions: Maintenance of normal erythropoeisis Indications: Replacement Tx for megaloblastic anemia Rescue drug for cells exposed to chemo Folic Acid Dirivates (Folic Acid) - Pharmaco: IM, IV, PO, Sub Q Pernteral preferred Folic Acid Dirivates (Folic Acid) - Adverse:: Diarrhea Pain @ inj. site Nursing C's:

Nutrition consult Labs! Beta-Blockers (Metopolol) - Actions: Blocks receptors in the heart & kidneys, decrease SNS influence, decrease cardiac output & renin release* Indications: Tx stable angina pectoris &HTN* Prevents reinfarction after MI Tx stable CHF Beta-Blockers (Metopolol) - Caution: DM PVD Thyrotoxicosis ( hyperthyroid) Contra: Bradycardia Heart block Cardiogenic shock Asthma COPD Preg/Lact Beta-Blockers (Metopolol) - Drug-Drug: Cloridine* Adverse: Resp: bronchospasm, dyspnea, cough Nitrates (Nitroglycerin) - Action: Causes smooth muscle to relax & depress muscle tone (dilates blood vessels)* Indication: Prevention & Tx of angina attacks pectoris

Nitrates (Nitroglycerin) - Parmaco: IV, sublingual, translingual spray, transmucosal, oral, short release tab, ointment, transdermal Nitrates (Nitroglycerin) - Caution: Hep/Renal disease Hypotension Hypovolemia Conditions that limit cardiac output Contra: Anemia-severe Head trauma Cerebral hemorrhage Preg/lact Nitrates (Nitroglycerin) - Drug-Drug: Heparin* Ergot derivatives(severe headache tx)* Adverse: R/T vasodilation & decrease blood flow Decrease BP Flushing Pallor, increased perspiration Nursing C's: Can repeat 3x every 5min* Keep from heat & light Avoid alcohol, cigs, coffee, stress Don't swallow Calcium Channel Blockers (Diltiazem) - Action:

Inhibit movement of ca+ions across membranes of heart and arterial muscle cells..depresses impulse = slowed conduction, decrease contractility, dilation of arterioles = decrease BP & myocardial O2 consumption. Indications: Extended release preparation for HTN in adults.* Other preps. for angina Tx angina (prinzmental's angina)* Calcium Channel Blockers (Diltiazem) - Contra: allergy Heart block or sick sinus syndrome Renal/Hep dysfx Preg/Lact Calcium Channel Blockers (Diltiazem) - Drug-Drug: Cyclosporin Grapefruit juice Calcium Channel Blockers (Diltiazem) - Adverse Effects: Nausea Hypotension, bradycardia, heart block R/T effects of cardiac output Hep. injury Nursing C's: No grapefruit juice!** Potassium sparing diuretics (Spironolactone) - Actions: Causes loss of Na+ while retaining K+

Blocks action of aldosterone at distal tubule (decrease Na+ & H2O, No K+ loss) Indication: Adjunt w/thiazide or loop diuretics Pt who are at risk for hypokalemia Potassium sparing diuretics (Spironolactone) - Caution: Preg/Lact Contra: Hyperkalemia Renal disease Anuria Pt's on amloride (tx of CHF, increase BP, decrease K+), triamterene (tx for edema & increased BP) Potassium sparing diuretics (Spironolactone) - Drug-Drug: Salicylates Potassium sparing diuretics (Spironolactone) - Adverse: Hyperkalemia* ( lethargy, confusion, ataxia, arrhythmia, muscle crampl Associated w/androgen(hirsutism, gynecomasta, irregular menses) Nursing C's: Can be used in children>monitor labs! Avoid foods increase K+ Check skin tugor I&O's Take w/food/milk Avoid hot environments* Administer early in the day* Daily weights

Osmotic Diuretics (Mannitol) - Actions: Pulls water into renal tubule w/o sodium loss decrease H20, no changes in Na+ * Indications: ICP* Acute r/t shock Trauma Drug overdose Osmotic Diuretics (Mannitol - Pharmaco: Not secreted by renal tubules Resistant to metabolism* Osmotic Diuretics (Mannitol - Contra: Renal disease Anuria Pulmonary Congestion Intracranial bleeding, dehydration CHF Osmotic Diuretics (Mannitol - Adverse: R/T decrease in fluid levels N/V Light headedness Confusion/headache Hypotension Nursing C's: Administer slowly, early in the day*

Monitor I&O's, weight Give w/food Monitor electrolytes Loop Diuretics (Furosemide) - Actions: Blocks chloride pump in ascending loop of henle = readsorption of Na= & Cl- Decrease K+ decrease Ca+ Inditions: Acute CHF Acute pulmonary edema Edema r/t CHF or renal or liver disease HTN Loop Diuretics (Furosemide) - Pharmaco: Metabolized & excreted primarily through urine Loop Diuretics (Furosemide) - Caution: SLE Gout Diabetes mellitus Children-not est. Contra: Allergy Electrolyte depletion Anemia Severe renal failure Hepatic Coma Preg/Lact Loop Diuretics

(Furosemide) - Drug-Drug: Aminoglycosides or cisplatine Anticoags Indomethacin, ibuprofen, salicylates, NSAIDs Loop Diuretics (Furosemide) - Adverse: R/T imbalance of electrolytes fluid Hypokalemia=weakness* Hypocalcemia=tingling, palpitations, irritation* Alkalosis Ototxicity Nursing C's: Usual fluid intake, avoid excess salt Can be taken w/food Weights daily Increase thirst = sugar free hard candy See K+ sparing Increase K+ PO Carbonic Anhydrase Inhibitors (Acetazolamide) - Action: Blocks effects of carbonic anhydrase>slows movement of hydrogen ions= more Na+ & bicarbonate lost in urine Decrease Na+ & bicarb Indications: Adjunct to other diuretics Glaucoma* Epilepsy Mountain sickness Carbonic Anhydrase Inhibitors (Acetazolamide) - Pharmaco:

Rapidly absorbed Carbonic Anhydrase Inhibitors (Acetazolamide) - Caution: Lact Fluid/electrolyte imbalances Renal/hep disease Adrenocortical insufficiency Respiratory acidosis COPD Contra: Allergy Angle closure Glaucoma Carbonic Anhydrase Inhibitors (Acetazolamide) - Drug-Drug: Salicylates Lithium Carbonic Anhydrase Inhibitors (Acetazolamide) - Adverse: R/T disturbances in acid base imbalance & electrolyte balance Metabolic acidosis(N/V, fast breathing, lethargy) Hypokalemia Parasthesias of extremities, confusion, drowsiness Nursing C's: Increase K+ intake PO Thiazide (Hydrochlorothiazide) - Action: Block chloride pump Keep chloride & sodium in the tubule to be excreted in the urine = prevents reabsorption in vascular system

Decrease Cl- & Na+ Increase urine Indications: Tx for edema associated w/CHF, liver/renal disease Monotherapy or adjuncts tx HTN Thiazide (Hydrochlorothiazide) - Caution: Gout Systemic Lupus Diabetes Hyperparathyroidism Contra: Allergy to thiazides or sulfohamides Fluid/electrolyte imbalances Renal/liver disease Bipolar disorders* Preg/Lact Thiazide (Hydrochlorothiazide) - Drug-Drug: Cholestyramine or colestipol Digoxin Antidiabetic agents Lithium Thiazide (Hydrochlorothiazide) - Adverse: R/T interference w/normal regulatory mechanisms of nephron Hypokalemia Decreased Ca+ excretion* Altered blood glucose levels Urine is slightly alkalinized*=UTI Lithium

GI Upset Hypercalcemia Gout Nursing C's: Give early in the day Increase K+ PO Angiotensin-Converting Enzyme (ACE) inhibitor (Captopril) - Action: Acts in lungs to keep Ace from converting angiotensin I to angiotensin II = decreased BP, decreased aldosterone production, small increase in K+, decrease Na+, and fluid. Indication: Tx for HTN, CHF* Adjunct therapy for HF Tx for left ventricular dysfx after MI Diabetic neuropathy* Use in adults! Angiotensin-Converting Enzyme (ACE) inhibitor (Captopril) - Pharmaco: Oral (Enalapril can be used parentarally) Angiotensin-Converting Enzyme (ACE) inhibitor (Captopril) - Caution: HF Salt/Vol depleted pt's Contra: Preg/Lact Impaired renal fx Angiotensin-Converting Enzyme (ACE) inhibitor (Captopril) - Drug-Drug: Allopurinol

NSAIDs Angiotensin-Converting Enzyme (ACE) inhibitor (Captopril) - Adverse Effects: Reflex tachycardia, chest pain, angina, HF, arrhythmia, GI irritation, constipation Liver injury, renal insufficiency Proteinuria Rash, alopecia, dermatitis Photosensitivity Unrelenting cough* Nursing C's: Absorption decreases if taken w/food** Life style changes Alert HCP's of Meds* Monitor if pt's fluid volume may decrease Give enalapril parenterally only if it can't be given orally Angiotensin II-Receptor Blocker (Losartan) - Action: Selectively bind w/angiotensin II receptors in vascular smooth muscle & in adrenal cortex to block vasoconstriction & release of aldosterone = decreased BP Indication: Alone or combo therapy for HTN Slows diabetic neuropathy Angiotensin II-Receptor Blocker (Losartan) - Pharmaco: Oral Angiotensin II-Receptor Blocker (Losartan) - Caution: Hepatic/renal dysfx

Hypovolemia Contra: Pregnancy!** Lactation Allergy Angiotensin II-Receptor Blocker (Losartan) - Drug-Drug: Phenobarbital, indomethacin, rifamycin Ketoconazole, fluconazole, diltiazem* Angiotensin II-Receptor Blocker (Losartan) - Adverse: HA, dizziness, syncope, weakness, hypotension Diarrhea, abd. pain, dry mouth, tooth pain Cough, symptoms of upper resp infect. Rash, dry skin, alopecia Cancers!! Nursing C's: Lifestyle changes Give w/o regard to food Make sure pt isn't PREGNANT!!!! Vasodilator (Nitroprusside) - Action: Direct vasodilation! Acts on vascular smooth muscle to cause muscle relaxation = vasodilation & decreased BP Indication: Tx for hypertensive crisis* Maintain controlled HTN in surgery Vasodilator (Nitroprusside) - Pharmaco:

Nitroprusside-IV Hydralazine-PO, IV, IM Rapidly absorbed Vasodilator (Nitroprusside) - Caution: Peripheral vascular disease CAD HF Tachycardia Contra: Allergy Cerebral insuff. Preg/lact Vasodilator (Nitroprusside) - Drug-Drug: Each work differently Vasodilator (Nitroprusside) - Adverse: Cyanide toxicity* (vomiting, ataxia, unconsciousness, dilated pupils, shallow breathing, dist. heart sounds) Can lead to hypothyroidism skin rash, lesions GI upset BP changes>reflex tachy., anxiety, dizziness, HA, HF, chest pain, edema Nursing C's: Life style changes Monitor blood glucose & serum electrolytes Watch in situations where the pt may have a fluid drop Monitor BP & heart closely for admin. Nonselective Adrenergic Blocking Agent (Labetalol) - Actions:

Blocks effects of norepinephrine at alpha & beta blockers in SNS = Decreased BP, slowed HR, increased renal perfusion (w/decreased renin levels) Indications: *HTN...often used w/diuretics Pheochromocytoma Clonidine withdrawal Nonselective Adrenergic Blocking Agent (Labetalol) - Pharmaco: IV or oral Nonselective Adrenergic Blocking Agent (Labetalol) - Caution: Diabetics Thyroid diseases Herbal therapies!! Pt's w/bronchospasm Contra: Not est. in children Preg/lact bradycardia Heart blocks Asthma Shock HF Nonselective Adrenergic Blocking Agent (Labetalol) - Drug-Drug: Increased risk of hypotension w/liquid general anesthetics Diabetic agents Nonselective Adrenergic Blocking Agent (Labetalol) - Adverse:

Dizziness, parasthesias, insomnia, fatigue, vertigo N/V, flatulence, anorexia, diarrhea Heart arrhythmia, hypotension, HF, pulm. edema, CVA's Bronchospasm, cough, rhinitis, bronchial obst. Decreased exercise tolerance, rash, hypoglycemic Nursing C's: Must taper when stopping!** Monitor CV, pulm, CNS, electrolytes, renal/hep fx*(esp. caivedilol) Discuss w/HCP about withdrawing drug before surgery Nonselective Beta-Adrenergic Blocking Agent (Alfa Beta Blocker) (Propranolol) - Pharmaco: Oral..food increases bioavailability of propranolol Propranolol crosses blood-brain barrier Nonselective Beta-Adrenergic Blocking Agent (Alfa Beta Blocker) (Propranolol) - Caution: Diabetes & hypoglycemia Renal/hep dysfx Thyrotoxicosis Contra: Allergy Bradycardia Heart blocks Shock HF Bronchospasm, COPD, acute asthma Preg/lact Not studied in children Nonselective Beta-Adrenergic Blocking Agent (Alfa Beta Blocker) (Propranolol) - Drug-Drug: