MOA:

Block sodium and chloride retention in Loop of Henle

Decrease preload and CVP

Rapid onset, lasts 2 hours

Kidney fxn diminished--loop diuretics may still be effective

MOA:

Loop Diuretics

MOA:

Pull fluid into renal tubule, reducing cerebral edema and increasing urine production

MOA:

Osmotic Diuretic

INDICATIONS:

Edema r/t HF, liver failure, renal disease, HTN

INDICATIONS:

Loop Diuretics

INDICATIONS:

Head trauma, early oliguric phase of renal failure

Decrease cerebral edema and ICP

INDICATIONS:

Osmotic Diuretic

SE:

Ototoxicity

SE:

Loop Diuretic

IMPLICATIONS:

-Sulfonamide allergy

-Electrolyte imbalance

-Hepatic Coma

Interaxns: corticosteroids and digoxin--> hypokalemia Increased serum uric acid, glucose, AST, ALT

TOXICITY: fluid & electrolyte replacement

IMPLICATIONS:

Loop Diuretics

MOA:

Vaughn Williams Classification

Class I

Class II beta blockers

Class III prolongs repolarization

Class IV calcium channel blocker

MOA:

Antidysrhythmics

INDICATIONS:

V Tach

V Dys

A Fib

A Flutter

INDICATIONS:

Antidysrhythmics

SE:

Antidysrhythmic hypersensitivity, n/v/d, headaches, blurred vision

Overdose: Mgmt consists of circulatory and ventilatory support; Symptomatic Treatment

SE:

Antidysrhythmic

IMPLICATIONS:

Contra: 2nd/3rd degree Heart Block, cardiogenic shock

Interaxns: Increases anticoagulant and Dilantin effects; can cause dyrhythmmmia when combined with other antidysrhythmics

Drink plenty of fluids unless contraindicated

Cardiac monitoring

IMPLICATIONS:

Antidysrhythmics

MOA:

Relax vascular smooth muscle

Decrease preload=decreased O2 consumption

Dilation of coronary arteries and collaterals

MOA:

Nitrates

INDICATIONS:

Angina treatment + Prophylaxis

CHF

Acute MI

Raynaud's

INDICATIONS:

Nitrates

SE:

Headaches (Most common)

BradyC

Postural hypotension

dizziness

weakness

confusion

Nightmares

SE:

Nitrates

IMPLICATIONS:

Contra: Pediatrics, Geriatrics (lower doses, risk of hypotension), pregnancy, cerebral hemorrhage, impaired hepatic fxn

Caution: Viagra

Don't touch pastes/put directly over heart

Always carry SL for emergencies

Medication vacation; Avoid changing brands

IMPLICATIONS:

Nitrates

MOA:

decrease myocardial contraxn

decrease automaticity of SA node

decrease conduction through AV node

decrease force of smooth muscle contraxn

MOA:

Calcium Channel Blocker

INDICATIONS:

angina (2nd line of choice; beta blockers 1st)

HTN (best for African Americans & geriatrics)

arrhythmias

INDICATIONS:

Calcium Channel Blockers

SE:

Overdose: monitor cardiac and respiratory fxn; lavage emetics; 2nd and 3rd degree heartblocks

hypotension

bradyC, asystole

SE:

Calcium Channel Blockers

IMPLICATIONS:

Contra: Hypersensitivity, Sick Sinus Syndrome, Heart Blocks, Lactation

IMPLICATIONS:

Calcium Channel Blocker

MOA:

Adrenergic: Block SNS stimulation (beta 1 cardioselective, beta 2 nonselective)

Compete with natural epi and norepi, blocking SNS stimulation of receptor sites

Decrease HR, conduction, and contractility

MOA:

Adrenergic Blockers

INDICATIONS:

Angina (1st choice)

Inhibit catecholamines

Post MI

dysrhythmias

HTN (Caucasians)

Migraine Head Ache

INDICATIONS:

Adrenergic Blockers

SE:

Extended actions

acute withrdawal w/c exacerbates angina and precipitates MI

MASK SIGNS OF HYPOGLYCEMIA

SE:

Adrenergic Blockers

Beta Blockers

IMPLICATIONS:

Contra: uncompensated HF, cardiogenic shock, Heart block, bradyC, pregnancy, severe pulmonary disease, Raynaud's

Taper Medication, monitor pulse

Diabetic pts (signs and symptoms of hypoglycemia)

Avoid OTC sympathomimetics

Causes impotence in male pts

IMPLICATION:

Adrenergic Blockers

Beta blockers

MOA:

Suppress RAAS

Reduce SVR, lowering BP

no change in HR

Increases renal perfusion

MOA:

ACE inhibitors

INDICATIONS:

HTN + thiazide diuretic

CHF

MI

Diabetic neuropathy

L Ventricular Dysfunction

INDICATIONS:

ACE Inhibitors

SE:

hypotension

palpitations

angina

orhtostatic hypotension

chronic cough (predominant SE)

SE:

ACE inhibitors

IMPLICATIONS:

Contra: Hx angioedema, 2nd and 3rd trimester of pregnancy, renal insufficiency, geriatrics

Identify name, type, and dose of drug for pt

DO NOT double dose

Identify common SE

Take with or without food

IMPLICATIONS:

ACE inhibitors

MOA:

increase muscle contractility

decrease conduction

inotropic, chronotropics, dromotropic effects

MOA:

Cardiac Glycosides

INDICATIONS:

HF

Supraventricular Dysrhythmias

Promote Diuresis

INDICATIONS:

Cardiac Glycosides

IMPLICATIONS:

Contra: 2nd/3rd degree heart block, V Tach, V Fib

DO NOT DOUBLE DOSE

DO NOT switch b/w trades and generics

DO NOT increase salt intake

KEEP OUT OF REACH of pets and children

wear ID bracelet

IMPLICATIONS:

Cardiac Glycosides

MOA:

Deplete norepi storage in neurotransmitter storage vesicles so that SNS is NOT stimulated

Result: decreased BP

MOA:

Adrenergic Agents

Central and Peripheral Acting Neuron Blocker

INDICATIONS:

HTN treatment

(seldom used because of frequent SE)

INDICATIONS:

Adrenergic Agent

Central and Peripheral Acting Neuron Blocker

SE:

Dry mouth, drowsiness, sedation, constipation

Headaches, sleep disturbances, nausea, rash, palpitations

Orthostatic hypotension

SE:

Adrenergic Agent

Central and Peripheral Acting Neuron Blocker

MOA:

Stimulate alpha-2 receptors in brain, decreasing sympathetic outflow from CNS in the brain

(decrease epi and norepi)

Result: decreased BP because of increased stimulus to alpha-2 receptors inhibits the further release of NE

END RESULT: VASODILATION

MOA:

Adrenergic Agent

Central Alpha-2 Agonists

INDICATIONS:

Tx of HTN, usually after other agents have failed due to side effects

Tx Dysmenorrhea, menopausal flushing, glaucoma

Clonidine: mgmt of w/drawal symptoms in opioid or nicotine dependent persons

INDICATIONS:

Adrenergic Agents

Central Alpha-2 Agonists

IMPLICATIONS:

HTN drug of choice for PREGNANCY

IMPLICATIONS:

Adrenergic Agents

Central Alpha-2 Agonists

MOA:

Block alpha-1 so SNS is not stimulated

RESULT: decreased BP

MOA:

Adrenergic Agent

Peripheral Alpha-1 antagonist

INDICATIONS:

Tx HTN

Relief of Sx, of BPH

Mgmt of severe HF + caridiac glycosides and diuretics

INDICATIONS:

Adrenergic Agents

Peripheral Alpha-1 Antagonists

MOA:

Act in periphery of heart and blood vessels

Decrease HR (beta-1 blockade)

Cause vasodilation (Alpha-1 blockade)

MOA:

Adrenergic Agent

Dual Alpha 1 and Beta Blocker

MOA:

Act in periphery of heart to decrease HR

MOA:

Adrenergic Agent

Beta Blocker

MOA:

Block ACE, thus preventing formation of angiotensin II

Prevent breakdown of bradykinin

Result: Decreased systemic vascular resistance (afterload); vasodilation, DECREASED BP

MOA:

ACE Inhibitor

INDICATIONS:

HTN

HF

Slow down L. Vent Hypertrophy post MI

Renal protection in diabetic pts

INDICATIONS:

ACE Inhibitors

SE:

Fatigue, headache, impaired taste, dizziness, mood changes, hyperkalemia

Dry, nonproductive cough which reverses when therapy is discontinued

SE:

ACE Inhibitors

IMPLICATIONS:

First-dose hypotension may occur

Pt K+>5.0 mEq NOT suitable for use, can potentiate

LITHIUM TOXICITY

IMPLICATIONS:

ACE Inhibitors

MOA:

Allow angiotensin I to convert to angiotensin II, but BLOCKS receptors that rcv angiotensin II

Blocks vasoconstriction and release of aldosterone

MOA:

ARB's

INDICATIONS:

HTN, Adjunct in HF

May be used alone or with other agent as diuretics

Primarily used in pts who cannot tolerate ACE inhibitos

INDICATIONS:

ARBs

SE:

URI

Headaches

Dizziness, Insomnia, Diarrhea, Dyspnea, heartburn, nasal congestion, back pain, fatigue

Hyperkalemia less likely to occur

SE:

ARBs

IMPLICATIONS:

Well tolerated because does not cause cough like ACE inhibitors

IMPLICATIONS:

ARBs

MOA:

Causes sm muscle relaxation by blocking calcium binding

Decreased peripheral smooth muscle tone and decreased systemic vascular resistance

RESULT: Decreased BP

MOA:

Calcium Channel Blocker

INDICATIONS:

Angina

HTN

Dyrhythmias

Migraine Headaches

Raynaud's

INDICATIONS:

Calcium Channel Blockers

SE:

hypotension, palpitations, tachC, constipation, nausea, rash flushing, peripheral edema, dermatitis

SE:

Calcium Channel Blockers

MOA:

Directly relaxes arteriolar smooth muscle

Result: decreased systemic vascular response, decreased afterload, peripheral vasodilation

MOA:

Vasodilator

INDICATIONS:

HTN

Emergency HTN: Sodium nitroprusside Diazoxide

INDICATIONS:

Vasodilators

SE:

Hydralazine: Dizziness, Headaches, tachC, n/v, diarrhea, anemia, dyspnea, edema, nasal congestion

Sodium Nitroprusside: bradyC, hypotension,

CYANIDE TOXICITY

SE:

Vasodilators