workman pharm classification- revised oct 2014 llanes slides

8/16/2019 Workman Pharm Classification- Revised Oct 2014 Llanes Slides

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Ch. 12: Drugs That Affect

Urine Output


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Diuretics

The primary therapeutic goal of a diuretic use isto reduce edema

TYPES:

Natriuretic Diuretics

Loop Diuretics

Potassium-Sparing Diuretics

Thiazide Diuretics

Osmotic Diuretics

Carbonic Anhydrase Diuretics


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DIURETICS: Loop

Diuretics Acts on the Loop of Henle- inhibiting Nareabsorption

Used to treat hypertension and CHF, renal

insufficiency

Side Effects: Dehydration, Hypokalemia/natremia

Nursing Indications: monitor VS, monitor output and

check potassium & sodium labs

Adverse reaction: ototoxic & hyperglycemia

Example: Furesomide (Lasix); Bumetanide (Bumex)


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DIURETICS: Potassium

SparingExample: Spironolactone (Aldactone)Useful as a antihypertensive

Side Effects: hyperkalemia, hyponatremia,postural hypotension,

Nursing indications: Check potassium labs,

Adverse reaction: cardiac arrhythmias,


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DIURETICS: THIAZIDEo

Treatment of hypertension

o Works at distal convoluted tubule

o Nursing Assessment: assess for allergy to

Sulfonamides; decrease electrolytes (


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DIURETICS: Osmotic

Prophylaxis against renal dysfunction, ReducesICP, decreases IOP, Promotes excretion of toxic

substances

Side Effects: headaches, edema, CHF, fluid andelectrolyte imbalance

Nursing Indications: check labs

Sample: Mannitol (Osmitrol)


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DIURETICS: Carbonic

Anhydrase

•

Proximal convoluted tubules

•

Treats Glaucoma•

Example:

• Acetazolamide (Diamox)

• Methazolamide (Neptazane)


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Overactive Bladder

Overactive bladder (OAB) incontrollablespasm of bladder muscle (detrusor )

causing urgency & incontinence

Urinary Antispasmodic: Sample-Oxybutynin (Ditropan)

Adverse reaction: anuria, dysuria, edema

Nursing consideration: assess BP & HR,baseline weight, risk for heatstroke


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Benign Prostatic Hyperplasia

Androgen (testosterone) promotes prostate cellgrowth & activity resulting in BPH

Nursing assessment: Lab test- prostate specific

antigen (>PSA), monitor for orthostatichypotension

Sample: Finasteride (Proscar)


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Critical Thinking

If your patient develop severe diuresis, what wouldyou do?

•

Check vital signs.•

Monitor urine output, via graduated cylinder

• Assess alert and orientation x4

• Assess capillary refill on extremities (digits), signs ofcyanosis at lip area

•

Determine adequate perfusion by looking at the meanarterial pressure (MAP) calculated as systolic plus

diastolic (x2) divided by 2.

• Hold the medication while you inform the MD of

assessment


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Ch. 13: Drugs for

Hypertension


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Pathophysiology

•

Arteriosclerosis- hardening of thearterial walls

• Atherosclerosis- plaques are

formed inside the wall of thearteries

• Cardiomegaly: enlargedheart

•

Types of hypertension:• Primary- no known

cause

• Secondary- caused byother disease & drugs

that affect blood pressure


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INTRODUCTION “HEART”


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Antihypertensive

• Nursing considerations:

• check BP & HR Q4-8 hrs

• Assess for Orthostatic hypotension:

•

Changes in 3 minutes- SBP 20BPM

• Take it as prescribed

• Health teaching: controls HTN not cure

•

Balance diet & exercise


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Antihypertensive

Antihypertensive: Used to prevent or controlhigh blood pressure.

There are sub classifications or families that

function as antihypertensive (p. 228):Diuretics

ACE Inhibitors

Angiotensin II receptor antagonists

Calcium channel blockersBeta blockers

Alpha-beta blockers

Central-acting adrenergic agents

Direct vasodilators


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Antihypertensives


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Critical Thinking

If your patient develophypotension, an expected

outcome when giving anti-

hypertensive medication, what

would you do?


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BETA-ADRENERGIC

BLOCKING AGENTS

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Beta blockers block the affectsof epinephrine (adrenaline) on

the heart

Classified as cardioselective and noncardioselective


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•

Medications ending in “- pine”

• Blocks calcium ions

• Sample:

•

Amlodipine (Norvasc)• Nifedipine (procardia)

• Nicardipine (Cardene)

Calcium Channel Blocking

Agents


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Calcium Channel Blockers

Side effect: hypotension, constitpation, nausea,headache, dizziness, light headedness, gingival

hyperplasia; gynecomastia

Adverse Effect: Stevens-Johnson syndrome(eryhthema multiforme); severe bradycardia


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Angiotensin II Receptor

AntagonistsBlocks effect of angiotensin II (vasocontriction, sodium, &

water retention). Inactivated by the liver & excreted from

the body by the kidney.

Side effects: hyperkalemia, hypotension, headache, dizziness

Adverse reaction: hepatotoxicity, angioedema (severe edema

that may cause breathing problems)

Nursing consideration: monitor electrolytes (K+), I & O,

ECG (increase T-waves= hyperkalemia).

Sample: “-tans” Losartan (Cozaar), Valsartan (Diovan)


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Alpha Blockers

Blocks receptors in arteries and smooth musclesresulting in relaxation of muscle, increase blood flow,

& lowering BP.

Interacts with phosphodiesterase type 5 inhibitors such

as sildenafil (Viagra)- used for erectile dysfunction-causing severe hypotension

Side effect: dizziness, drowsiness, headache, orthostatic

hypotension & runny nose

Adverse reaction: sycope, dyspnea, irregular heart

rhythm

Sample: “-zosin” Doxazosin (Cardura)


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Alpha-Beta Blockers

•

Combined effect of alpha & beta blockers: relaxblood vessels & slows HR

•

Side effect: weakness, hypotension, diarrhea,

hyperglycemia, & impotence

• Adverse reaction: cardiac dysrhythmias

• Nursing consideration: assess patient with

diabetes

• Sample: Carvedilol (Coreg)


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Central- Acting Adrenergic

•

Stimulate central nervous system receptors todecrease constriction of blood vessels, which leads to

dilation (widening) of arteries, and to lower blood

pressure.

•

Side effect: drowsiness, dry mouth, nasal congestion• Adverse reaction: myocarditis secondary to allergic

reaction to methyldopa (rare)

• Nursing consideration: mental monitoring, VS & weight

•

Sample:

• Methyldopa (Aldomet)- pregnancy category B

(safe) PO. Treatment for PIH

•

Clonidine (catapres)- topical route


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Vasodilators

Nursing consideration: Nitroglycerin

Wear gloves when applying (topical)

P. 257 Figure 14-6

Nitroglycerin tab: 3X every 5-10 mins onlyRotate & clean site

Remove old patch;

Have a “drug-free” time- lose effectiveness in

24 hrs; tablet is light sensitive (coloredbottled)


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Ch. 14: Drugs for Heart

Failure


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INTRODUCTION “HEART”

Preload versus afterload

Ejection fraction:normal 50%-70%


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Heart Failure

Left Sided Heart Failure

! C- coughing &

dyspnea

!

H- Hemoptysis

! O- Orthopnea

! P- Pulmonary

congestion

Right Sided Heart Failure

! H- Hematomegaly

! E-Edema

! A- Ascites

! D- Distended neck

veins

" Systolic left Heart Failure- heart contraction is weak" Diastolic left heart failure- ventricle not able to relax

C M h f


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Compensatory Mechanism for

Heart FailureSympathetic NervousSystem: release of

epinephrine &

norepinephrine

Renin-angiotensinsystem (RAS):

angiotensin II(increase afterload) &

aldosterone

(increase preload)


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Heart Failure

Nursing consideration:

Assess medical history including medication list

Monitor VS & HR & baseline weight

Assess for hypotension, dizziness, edema, weightgain, dyspnea,

Encourage a balance diet & exercise (


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Types of Drugs to treat HF

# ACE Inhibitors

#

Beta blockers

#

Vasodilators

# Cardiac Glycosides (Digoxin)

# Diuretics

#

Human B-Type Natriuretic peptides

# Positive Inotropes (Heart Pump Drugs)

# Potassium & Magnesium


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CARDIAC GLYCOSIDES

Cardiotonic: are used to stimulate(contract) andregulate (relaxes) the heart.

Effective for maintenance therapy for HF

Side effects- bradycardia, vision disturbance:yellow halos or light around objects

Adverse effect: cardiac dysrhythmias

Nursing consideration: Monitor HR/BP & ECG

Example: Digoxin (Lanoxin)


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Digoxin

Nursing Considerations:

must take heart rate for 60 seconds if the

heart rate falls below 60bpm hold the med

and call md

Check potassium labs

Check Digitalis labs

>2ng/ml is considered toxic


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Human BNP

•

Human B-Type Natriuretic Peptide- a hormoneproduced by the heart ventricle

• Action: increase water elimination & vasodilation

•

Route: IV• Sample: Nesiritide (Natrecor)

• Side effect: hypotension, polyuria, confusion,palpitations

•

Adverse reaction: apnea

• Nursing consideration: check IV patency, HR &

BP, check lab test (BNP), monitor urine output


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Positive Inotropes

• Heart pump drugs:: muscle contraction &relaxes blood vessels

• Effect is dose related: low dose- increase kidney

perfusion; high dose- causes vasoconstriction=>BP

• Route: IV

• Adverse reaction: ventricular dysrhythmias

• Nursing consideration: check IV patency, HR &

BP, check lab test (BNP), monitor urine output

• Sample: Dopamine (Intropin)


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Potassium & Magnesium

Supplements: Provide diet sources rich in K &Mg (p. 265 Figure 14-3 & 14-4)

Nursing consideration: monitor lab values (K

3.5-5.0 MEq/L) (Mg 1.2-2.1 MEq/L). Monitorhyperkalemia (increase muscle activity) &

hypermagnesemia (neuromuscular depression)

Monitor ECG, check IV patency, HR & BP, check

lab test (BNP), monitor urine output

Potassium- not given IV push


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Ch. 17 Drugs That Affect

Blood Clotting


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ANTICOAGULANTS

Anticoagulants: They increase the time it takesblood to coagulate.

Labs: PTT/PTT/INR

Example:

Heparin (heparin)

Warfarin (Coumadin)

Clopidogrel (Plavix)

Lovenox (Enoxaparin)- administered SQSide effects: rash and potential for hemorrhage.


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workman pharm classification- revised oct 2014 llanes slides

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