What is the prototype for statin medications (HMG- CoA Reductase Inhibitors)?
atorvastatin (Lipitor)
**all statin medications end in “statin”
atorvastin (Lipitor)
- mechanism of action
- adverse effects
- interactios
- major nursing assessments
- moa: inhibits HMG-CoA reductase and cholesterol synthesis in the liver; can decrease LDL’s up to 20-40% and can decrease trigly.
- adverse effects: liver function, rhabdomyolysis (breakdown of muscle fibers)->can cause renal failure, headache and fatigue
- interactions: grapefruit juice, Digoxin, Erythromycin
- major assessments: monitor protein levels, kidney & liver function, monitor for muscle pain and/or weakness (signs of rhabdomyolysis)
What is the prototype for bile acid-binding resins?
cholestyramine (Questran)
What is the first line of choice to reduce lipid levels?
Statin Medications
cholestyramine (Questran)
- mechanism of action
- adverse effects
- interactions
- moa: Increases excretion of cholesterol in the stool
- adverse effects: GI upset, decreased levels of Vitamin K (can increase the effects of anticoagulants)
- interactions: Digoxin and thiazide diuretics
- can produce a 20% decrease in LDL levels
- comes in powder form-needs to be diluted in h2o and pt need to drink a lot of h2o
- no medications can be taken 2 hours before or 4 hours after (a lot of interactions)
- usually used in conjunction with statin medications
Niacin
- moa
- adverse effects
- moa: decreases both VLDL and LDL levels
- adverse effects: hot flashes, flushing, hepatotoxicity (need to monitor liver function)
- given in low doses
- can predispose pt to Gout (can see an increase in uric acid)
- can cause blood sugar elevation (monitor blood glucose levels)
What is the prototype for Cholesterol Absorption Inhibitors?
Zetia
Zetia
- mechanism of action
- adverse effects
- moa: inhibits the absorption of cholesterol
- adverse effects: upper respiratory issues (cold, cough), myalgia **no serious side effects
*usually used in combo w/ statin
Nonpharmacolgic Management of HTN (8)
- limit alcohol intake
- restrict sodium intake
- reduce intake of saturated fat and cholesterol
- increase fresh fruits & veggies
- increase aerobic physical activity
- discontinue tobacco use
- reduce stress
- maintain optimum weight
What are the 3 different types of diuretics? (and their prototype)
- Loop Diuretics (Lasix & Bumex)
- Thiazide Diuretics (HCTZ)
- Potassium-Sparing Diuretics (Aldactone)
furosemide (Lasix) & bumetanide (Bumex)
- huge loss of what electrolyte?
- adverse effects
- huge potassium loss (hypokalemia): leg cramps, muscle weakness, shallow/labored breathing, dysrhythmias
- adverse effects: orthostatic HTN (due to huge fluid shift), ototoxicity (when pushed too fast)
HCTZ (Microzide)
-mechanism of action
- moa: depletes the body of potassium (not as sever as loop diuretic)
- Hyperkalemia can ^ Digoxin toxicity
spironolctone (Aldactone)
- patient teaching
- contraindication
- patient teaching: limit the use of salt substitutes and potassium rich foods
- contra: never use with pt’s w/ renal failure
What is the prototype for calcium channel blockers?
nifedipine (Procardia)
nifedipine (Procardia)
- use
- mechanism of action
- adverse effects
- interactions
- use: Treat HTN and angina
- moa: block calcium ion channel in arterial smooth muscle, causing vasodilation (causes BP to decrease, and can be significant)
- adverse effects: hyptension
- interactions: grapefuit juice
*Al calcium channel blocker medications end in “pine”
What is the prototype for ACE inhibitors?
lisinopril (Prinvil)
*All ACE inhibitors end in “pril”
lisinopril (Prinvil)
- mechanism of action
- adverse effects
-moa: block formation of angiotensin II causing vasodilation and block aldosterone secretion causing decreased fluid volume
adverse effects: cough, angioedema (swelling of airways), hyperkalemia
All Beta-adrenergic blockers end in -_____ and all Angiotensin II receptor blockers end in -________.
“lol”; “sartan”
*Angiotension II blockers are used for patients that can’t tolerate ACE inhibitors
Beta-adrenegic blockers
- mechanism of action
- adverse effects
- moa: decrease the heart rate and myocardial contractility
- adverse effects: bradycardia, fluid retention, fatigue
- have to be tapered down due to risk of rebound HTN
- not 1st choice of drug for treatment of HTN
What is the prototype for Alpha-adrenergic blockers?
doxazosin (Cardura)
doxazosin (Cardura)
-mechanism of action
- moa: inhibits sympasthetic actiavtes in the arterioles, causing vasodilation
- not 1st choice of drug for HTN; usually used in combo w/ another drug
What are the only two approved beta-blockers for treating heart failure?
- carvedilol (Coreg)
2. metoprolol (Toprol-XL)
digoxin (Lanoxin)
- mechanism of action
- therapeutic level
- adverse effects
- interactions
- S/S of toxicity
- moa: increases contractility and lowers heart rate
- therapeutic level: 0.8-2 ng/mL (anything ^1.8, hold & call dr)
- adverse effects: bradycardia (hold if HR <60), hyperkalemia (Digoxin levels inverse to potassium), renal issues (excreted through the kidneys)
- interactions: Diuretics, ACE inhibitors (can affect potassium levels), Ginseng (may increase toxicity)
- S/S: yellow-green halos, blurred vision, GI upset (N/V)
What medications are used for heart failure? (5)
- ACE Inhibitors (Prinivil)
- Diuretics
- Beta blockers
- Angiotensin II Receptor blockers
- Cardiac Glycoside (Digoxin)
