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Drug Effects
Antilipemics
72
Nursing
Undergraduate 2
06/18/2012

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Term
Hyperlipidemia
Definition
major cause of atherosclerosis
Term
Atherosclerosis
Definition
most cause of MI, CVA, and PVD
Low HDL and high LDL are risks for atherosclerosis and CAD
Term
Antilipemics
Definition
Diet, exercise and other lifestyle changes attempted first
Term
What are some other lifestyle changes that should be made in order to help decrease hyperlipidemia?
Definition
Decrease alcohol intake
Decrease lean food
Quit smoking
Term
Bile Acid-binding resins
Definition
Actions:
Binds with bile acids in intestine to decrease cholesterol (CHOL)

Uses:
Antilipemic
Treats pruritus due to biliary stasis
Treats diarrhea caused by excess bile acids


Side effects:
Constipation
Decreases absorption of fat soluble vitamins and many other oral meds

Example:
Questran (cholestyramine) – should be given 1 hour and 4 hours after meds, to prevent from binding with other meds, don’t mix with carbonated beverages.

This drug is not hepatotoxic.
Term
Niacin (nicotinic acid):
Definition
a water-soluble B3 vitamin

High doses decreases CHOL
Term
Side effects of Niacin
Definition
Facial flushing
Itching
Hypotension
Hepatotoxic


It is believed that facial flushing and itching is the effect of the release of niacin.
Term
Which antilipemic agents would cause hepatotoxicity?
Definition
Niacin, statins, fibric acids
Term
HMA-CoA Reductase Inhibitors (statins)
Definition
Most potent antilipemic agents available
Term
Example of statins
Definition
Zocor (simvastatin)
Lipitor (atorvastatin)
Term
statin Side effects:
Definition
Myopathy (rhabdomyolosis) – breakdown of muscles, cause renal failure, pt complains of muscle ache, muscle soreness, and muscle weakness

Which chol meds will cause rhabdomyolosis? Statins, fibric acids

Hepatotoxicity

Best time to take this is at bedtime. Cholesterol is mostly produced by the liver at night.
Grapefruit juice increases the level of cholesterol increasing side effects
Term
Which chol meds will cause rhabdomyolosis?
Definition
Statins, fibric acids
Term
Myopathy (rhabdomyolosis)
Definition
breakdown of muscles, cause renal failure, pt complains of muscle ache, muscle soreness, and muscle weakness
Term
HMA-CoA Reductase Inhibitors (statins)
Definition
Best time to take this is at bedtime. Cholesterol is mostly produced by the liver at night.
Grapefruit juice increases the level of cholesterol increasing side effects
Term
Fibric Acids
Definition
Most effective agents in lowering triglycerides
Term
Fibric Acids Example
Definition
Lopid (gemfibrozil)
Term
Fibric Acids Side effects:
Definition
Myopathy (rhabdomyolosis)
Hepatotoxicity
Term
Omega-3 fatty acids
Definition
Fish oils
Can be combined with statins
Does not cause myopathy (rhabdomyolosis)
Term
Miscellaneous Antilipemic
Zetia (ezetimibe)
Definition
Blocks absorption of chol by intestine
Can be used along with statins
Cal elevate liver enzymes when used with statins
Vytorin is a combination of Zocar and Zetia, monitor liver function tests,
Term
Hypertension
Definition
Condition characterized by increase in systolic B/P, diastolic or both
Term
Goals in treating hypertension in patient with co-existent diseases:
Definition
Renal disease and DM
Maintain B/P less than 130/80
CHF
Maintain B/P 120/80
Term
Patient teaching for Hypertension
Definition
Take meds as prescribed (even when B/P normal)
Don’t take extra doses or skip doses
Some antihypertensive agents can cause impotence
If one antihypertensive is not effective, then other antihypertensive agents can be added (step
approach)
Encourage monitoring B/P at home, check it at different time of the day
Some antihypertensive meds cause drowsiness for first few weeks
Elderly people are more susceptible to orthostatic hypotension
Term
Beta Adrenergic Blocking Agents
Definition
Blocks cardiac response to sns stimulation
Decrease heart rate
Decrease B/P
Decrease force of myocardial ctx
Term
Beta Adrenergic Blocking Agents Examples
Definition
Tenormin (atenolol)
Lopressor (metoprolol)
Inderal (propranolol
Term
Beta Adrenergic Blocking Agents note
Definition
Monitor blood pressure and pulse, because this drug could potentially decrease it.
Term
Ace Inhibitors (angiotensin converting enzyme inhibitors)
Definition
Action:
Prevents the conversion of angiotensin I to angiotensin 2
Decrease b/p
Decreases secretion of aldosterone.
Decrease sodium and water retention
Term
Ace Inhibitors (angiotensin converting enzyme inhibitors) Examples:
Definition
Vasotec (enalapril)
Zestril (lisinopril)
Term
Ace Inhibitors (angiotensin converting enzyme inhibitors) note
Definition
B/P should be assessed before ACE inhibitors
Monitor potassium, aldosterone causes the potassium to elevate.
Salt substitute be avoided because they substitute it with potassium.
Term
Angiotensin II receptor Antagonists (ARBs)
Definition
Action:
Decreases effects of angiotensin ii by preventing angiotensin ii from binding to receptor sites
Decrease B/P
Decrease Na+ retention
Term
Angiotensin II receptor Antagonists (ARBs)Examples:
Definition
Cozaar (losartan)
Atatcand (candesartan)
Avapro (irbesartan)
Term
Aldosterone Receptor Antagonist
Definition
Action:
Prevents Na+ and H2O retention by blocking receptor stimulation by aldosterone
Example:
Inspra (eplerenone)
Term
Direct Renin Inhibitor
Definition
Action:
Blocks renin
Prevents angiotensin ii from activating its receptors which decreases catecholamine release
Decreases aldosterone secretion
Decreases Na+ reabsorption

Example:
Tekturna (aliskiren)
Term
Calcium channel blockers
Definition
Action:
Inhibits the movement of Ca++ across cell membrane
Causes vasodilation
Decreases B/P
Some decrease heart rate and weaken force of myocardial contraction
Example:
Procadia (nifedipine)
Norvasc (amlopidine)
Calan (verapamil)
Cardizem (diltiazem)
Cardizem XL

Check B/P before administering B/P meds.
Term
Alpha 1 Adrenergic Blocking Agents
Definition
Actions:
Blocks alpha 1 adrenergic receptor site
Vasodilation of arterioles
Decrease B/P
Example:
Cardura (doxazosin)

Give this at bedtime to decrease chances of orthostatic hypotension.
This helps with BPH.
Term
Centrally acting alpha 2 agonist
Definition
Action:
Stimulates alpha 2 receptors
Prevents the release of norepinephrine and that lower B/P
Decreases effects of SNS
Decreases B/P
Decreases heart rate


Example:
Catapres, Catapres TTS (clonidine), TTS is a patch, patch can be worn for 7 days, it comes with overlay to prevent it from coming off. Check the pulse when giving clonidine. Pt complains that this causes sedation.
Term
Peripherally acting antiadrenergic
Definition
Action:
Uses up stores of norepinephrine and prevents its release
Example:
Reserpine
Term
Direct vasodilator
Definition
Action:
Acts directly on smooth muscles of blood vessels
Causes vasodilation

Examples:
Apresoline (hydralazine)
Loniten (minoxidel) – used for baldness
Nipride (nitroprusside sodium) – emergency drug when B/P is dangerously low, given in continuous drip, then you titrate according to the pt’s condition. Very sensitive to light. Monitor B/P very frequently and very closely.
Term
Heart failure
Definition
when the heart is unable to meet the demand of the body. Decreased cardiac output.
Term
Heart failure
Definition
a cluster of S/S that arise when the ventricles (left, right, or both) lose the ability to pump enough blood to meet the body’s circulatory needs.
Term
The body compensates for inadequate output by:
Definition
SNS releasing epinephrine and norepinephrine
Increases the heart rate, causes tachycardia, therefore increasing cardiac output
Causes tachycardia
Increased contractility
Peripheral vasoconstriction – makes the heart work harder
Increased afterload forces a further decrease in CO
Afterload is the amount of blood that the ventricles are pumping out
Decreased renal perfusion

Renin-angiotensin-aldosterone system
Stimulates renal distal tubules to retain sodium and water retention
Increases workload on heart
Increased production of vasopressin
Kidneys increases sodium reabsorption to expand circulating blood volume
Increased pressure within capillaries
Results in edema
Term
Three therapies used for treatment of heart failure
Definition
Vasodilator
Inotropic
Diuretic
Term
Vasodilator
Definition
– decrease the strain on left ventricle by reducing SVR systemic vascular resistance (afterload)
Term
Inotropic
Definition
– increase the force of myocardial contraction, boosts cardiac output by stimulating the heart to increase force of contractions
Term
Diuretic
Definition
helps in decreasing of sodium and water, enhances sodium and water excretion which decreases of workload of heart
Term
Digitalis Glycosides

Lanoxin (digoxin)
Definition
Treats systolic failure not responding to diuretics and ACE inhibitors
Two primary actions on the heart:
Positive inotropic action – increases the force of contraction
Negative chronotropic action – slows the heart rate
Typical dose:
0.125-0.25 mg/day
Term
Digitalization (loading doses)
Definition
Larger dose for an initial period of 24 hours
Reaches therapeutic dose faster
Older adults frequently experience digoxin toxicity
Monitored closely for digoxin toxicity
Nausea and vomiting, bradycardia, cardiac arrhythmia, visual disturbances.

Low potassium levels will increase chances of digoxin toxicity
Term
Nursing implications for digitalis glycosides
Definition
Check apical pulse for one minute, hold it if its lower than 60.
Monitor potassium levels
Monitor digoxin levels
Term
Phosphodiesterase Inhibitors
Definition
Inotropic agent increases force of myocardial contractions
Short-term management of heart failure in patients responsive to digoxin, diuretics, or vasodilator therapy

Example:
Inorcor (inamrinone)
Term
Angiotensin-Converting Enzymes Inhibitors (ACE inhibitors)
Definition
Inhibits the enzyme that converts angiotensin I to angiotensin ii
Decreases B/P
Decreases secretion of aldosterone
Decreases Na+ and H2O retention
Examples:
Vasotec (enalapril)
Zestril (lisinopril)
Term
Beta adrenergic blocking agents
Definition
Given with other drugs such as ACE inhibitors to decrease HF symptoms
Examples:
Coreg (carvedilol)
Toprol XL, Lopressor (metoprolol)
Term
Vasodilators
Definition
Relaxes blood vessels and lowers B/P
Examples:
Apresoline (hydralazine)
Isordil (isosorbide dinitrate)
Bidil (hydralazine and isosorbide dinitrate)
Term
Natriuretic Peptides (only given IV)
Human B type natriuretic peptide
Definition
Hormone secreted by ventricles in response to fluid and pressure overload
Reduces preload and afterload
Preload is the amount of venous blood that is returning to the heart
Increases diuresis and sodium excretion
Suppresses renin-angiotensin-aldosterone system
Decreases secretion of norepinephrine
BNP lab, if its greater than 100, then its heart failure
Example:
Natrecor (nesiritide)
Used in patients with severe heart failure who have dyspnea at rest or with minimal activity.
Term
Dysrhythmias
Definition
caused by firing of abnormal pacemaker cells, and /or the blockage of normal electrical pathways.
Term
Drugs used to treat dysrhythmias
Goal of treatment:
Definition
Restore normal sinus rhythm (NSR)
Restore normal cardiac function
Prevent recurrence of life-threatening dysrhythmias
Term
Antidysrhythmic agents classified according to effects on electrical conduction system
Definition
Monitor heart rate, rhythm, and B/P
All have the potential to decrease heart rate and B/P
Cardiac monitor if given IV
Term
Beta Adrenergic Blocking Agents
Definition
Used to treat certain types of tachycardia
Some suppress irritable ventricles
Example:
Inderal (propranolol)
Lopressor (metoprolol)
Term
Pronestyl (procainamide)
Definition
Treats atrial and ventricular arrhythmias
Side effects:
Hypotension
Lupus-like syndrome
Term
Xylocaine (lidocaine)
Definition
Treat ventricular arrhythmias
Side effects:
Hypotension
Seizures
Term
Cardarone (amiodarone)
Definition
Used in management of life threatening arrhythmias
Side effects:
Adverse reaction very common
Can cause other arrhythmias
Term
Adenocard (adenosine)
Definition
Used to convert PSVT (paroxysmal supraventricular tachycardia) to normal sinus rhythm (NSR)
Side effects:
Causes a few seconds of asystole
Term
Calcium channel blockers
Definition
Used to decrease heart rate in certain types of arrhythmias. Monitor heart rate and B/P.
Calan (verapamil)
Cardizem (diltiazem)
Term
Nitrates
Definition
Increases myocardial oxygen supply
Coronary vasodilator
Decrease oxygen demands on heart
Causes peripheral vascular smooth muscle relaxation
Reduces venous blood return to the heart
Administration forms:
Sublingual tablets
Can be given in anticipation of angina
Treat acute angina attacks
Sustained-release capsules, tablets, ointment, transmucosal tablets, and transdermal patches
Used to prevent angina attacks
Translingual spray
Intravenous
Term
Sublingual NTG:
Definition
Usual dose: 0.4 mg (gr 1/150)
Have pt sit or lie down – prevents orthostatic hypotension
3 NTG can be given 5 minutes at a time
Only good for 6 months
Take out the cotton upon initial opening of the bottle, cotton might absorb NTG
Cant be kept in any luggage compartment
Term
Topical ointment NTG:
Definition
Prevents angina attacks
Decrease peripheral resistance in CHF
Dose prescribed in inches using special paper
Application:
Do not apply on hairy areas (clip hair if necessary)
Avoid contact with nurses’ skin
Rotate sites
Term
Transdermal NTG patch:
Definition
Prevents angina attacks
Releases NTG for up to 24 hours
Patch is usually worn for 12-14 hours and removed for 10-12 hours at night to prevent
a tolerance to NTG.
Refer to text for application technique
Term
Intravenous NTG:
Definition
Used in ER and critical care areas
Used to treat angina pain, CHF
Must use special IV tubing
Always administer using volumetric pump
Closely monitor B/P
Term
NTG examples
Definition
Nitrostat, Nitrobid (nitroglycerine)
Isordil (isosorbide dinitrate)
Imdur (isosorbide mononitrate)
Term
NTG side effects
Definition
Hypotension
Prolonged headache
Tolerance with prolonged use
Term
NTG drug interactions
Definition
ETOH
Calcium ion antagonists, beta-adrenergic blocking-agents (lower blood pressure)
Viagra (sildenafil): CONTRAINDICATED!
Fatal drop in blood pressure possible

Monitor:
B/P and pulse, decreases B/P but increases pulse. We worry really about the B/P.
Term
Beta-Adrenergic Blocking Agents
Definition
Action:
Blocks SNS (beta adrenergic receptors in the heart)
Reduces myocardial oxygen demand

Uses:
Prevents frequency and severity of angina attacks
Tx hypertension
Antirhythmics because it decrease heart rate
Decreases the mortality rate with MI and prevent MI reoccurrence
Antirrhythmics decreases heart rate

Side effects:
Decreased B/P
Bradycardia
CHF
Drowsiness
Masks s/s of hypoglycemia in diabetic receiving antidiabetic meds

Monitor:
Heart rate
B/P
Term
Calcium channel blockers
Definition
Action:
Inhibits flow of calcium ion cross cell membrane
Dilates peripheral vessels
Improves coronary blood flow
Reduces myocardial oxygen demand
Uses:
Prevents angina attacks
Tx hypertension
Antiarrhythmic (decreases HR especially with atrial fibrillation)

Side effects:
Decrease B/P
Bradycardia
CHF
Peripheral edema

Monitor:
B/P and pulse
Term
ACE Inhibitors
Definition
Action:
Inhibits the conversion of angiotensin I to angiotensin II
Decreases aldosterone
Uses:
Hypertension
CHF
Secondary prevention of MI
Side effects:
Lowers B/P
Hypotension
Chronic cough
Monitor:
B/P
Example:
Altace (ramipril)
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