Pharm- HTN, Respiratory, AnitCoag

• Seven main categories of drugs for treatment of HTN: Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, Aldosterone-receptor agonists, calcium channel blocker, beta blockers, central-alpha 2 agonists, alpha-adrenergic antagonists, and diuretics.
• Angiotensin-converting enzyme (ACE) inhibitors: angiotensin converting enzyme, which converts angiotensin I to angiotensin II and allows the blood vessels to remain dilated, thus keeping BP managed. Ace inhibitors also prevent the secretion of aldosterone, which prevents the body from holding on to water and sodium, thus lowering BP.
• ACE inhibitors: Diet modifications. Avoid potassium containing foods and potassium pills.
• ACE side effects: ACE Angioedema, Cough, Elevated K
• ACE inhibitors: (5) Pril . captopril, enalapril, fosinopril, lisinopril, ramipril.
• Alpha 2 Adrenergic Agonists: Alpha 2 adrenergic receptors are stimulated in the presynaptic phase. Blood vessels are opened. Vessles that were constricted are now Open. Lowering the BP.
• Clonidine: (Alpha 2 Adrenergic Agonists) 6 Ds- Decreased HR, Decreased BP, Dry mouth, Drowsiness, Dizziness, Depression of CNS.
• Alpha 2 Adrenergic Agonists Diet Modifications: Reduce salt intake.
• Alpha 2 Adrenergic Agonists: (3) clonidine, methyldopa, guanfacine. Uses HTN & HTN crisis, Alcohol & controlled drug withdrawal, Anxiety, ADHD.
• Beta- adrenergic blockers: lol. (6) acebutolol, metoprolol, propranolol, nadolol, atenolol, carvedilol. Used for HTN, Tachycardia, SVT, Stable angina, chronic & compensated HF, Dysrhythmias and Anxiety.
• Beta- adrenergic blockers: Action- blocks beta receptors, thereby blocking adrenaline and epinephrine. slows the heart and provides a more efficient beat. RN considerations: known to cause bronchospasms in patients with asthma. Remember BAN. Beta blockers, Aspirin, NSAIDS.
• Beta- adrenergic blockers: 6 Bs- Bradycardia and heart blocks, breathing problems, bad for heart failure patients, blood sugar masking, blood pressure lowered, blocks beta 1 and beta 2 receptors.
• Calcium Channel Blocker: Inhibits calcium ions from entering the cell of the heart and arteries. Inhibiting calcium causes the blood vessels to relax and heart stimulation to decrease which there for decreases the workload of the heard. Calcium increases the contraction of the heart and vascular smooth muscle. Used for HTN, stable angina and dysrhythmias.
• Calcium Channel Blocker: (5) Amlodipine, nicardipine, nifedipine, verapamil, diltiazem. Do NOT drink grapefruit juice. Reduce constipation with 4 Fs- Fruits, Fiber, Fluids, and Fill up the toilet.
• Calcium Channel Blocker: Known side effects- constipation, flushing, headache, peripheral edema.
• Heparin: prevents thrombin activation, which inhibits the conversion of fibrinogen to fibrin. Administered IV or SubQ. Onset is rapid and short-term therapy
• Anticoagulants (warfarin and Heparin): Bleeding precautions- Avoid NSAIDS, aspirin, antibiotics, alcohol. Avoid flossing and contact sports. Avoid straining of the bowels, use an electric razor, and wear medical alert bracelet.
• Heparin: monitor with aPTT. Normal pt 30-40 seconds. Pts on Heparin 47-70 seconds.
• Anticoagulants (warfarin and Heparin): Number are too High= patient will Die (high risk of bleeding). Number are low= clots will grow.
• Warfarin: interferes with the production of vitamin K. decreases clotting factors- II (prothrombin), VII, IX, and X. Oral medication. Warfarin- you have to Wait. Long-term therapy.
• Warfarin: pt/INR- warfarin pts 2-3 or 2.5-3.5
• Short-Acting Beta 2 Agonists: Quick relief of acute symptoms. Bronchospasms and asthma exacerbation. (4 meds) albuterol, epinephrine, levalbuterol, terbutaline.
• Short-Acting Beta 2 Agonists: Albuterol is for Acute Asthma Attacks. Shake before administration. Do not exceed 3 doses of 2-4 puffs every 20 minutes.
• Short-Acting Beta 2 Agonists and Long-Acting Beta 2 Agonists: Bronchodilators- Airway stretch or enlarge an opening. Side effects- Heart rate>100 (tachy), palpitations, tremors, cardia arrhythmia, Energy- insomnia/anxiety. Thrush (fungal infection of the mouth).
• Long-Acting Beta 2 Agonists: Uses for COPD, Chronic bronchitis, bronchospasms (preventative). Long-term management. (4 meds) salmeterol, arformoterol, budesonide/formoterol/glycopyrrolate, and oloaterol.
• Anticoagulants: Inhibits the action or formation of clotting factors. Prevents clot formation.
• Antiplatelet: Inhibits platelet aggregation. Prevent platelet plugs.
• Hemorheologic drugs: alter platelet function without preventing platelets from working.
• Thrombolytic drugs: Lyse (break down)existing clots.
• Anticoagulants: used for MI, CVA, unstable angina, A fib, indwelling devices and major orthopedic surgery.
• Anticoagulants Contraindications: drug allergy, any acute bleeding process or high risk for such an occurrence. Warfarin is strongly contraindicated in pregnancy. Low Molecular Weight Heparins are contraindicated in patients with an indwelling epidural catheter due to risk of epidural hematoma.
• Anticoagulants Adverse Effects: Bleeding, risk increases with increased dosages. May be localized or systemic. Heparin-induces thrombocytopenia (HIT). Nausea, vomiting, abdominal cramps, thrombocytopenia. Warfarin can cause skin necrosis and purple toes syndrome.
• Heparin toxic: IV protamine sulfate 1 mg can reverse the effects of 100 units of heparin.
• Warfarin toxicity: Vitamin K. May take 36-42 hours before the liver can resynthesize enough clotting factors to reverse the warfarin effects.
• Myocardial infarction (MI): embolus lodges in a coronary artery.
• Stroke: embolus obstructs a brain vessel
• Pulmonary emboli: embolus in the pulmonary circulation
• Deep vein thrombosis (DVT): embolus goes to a vein in the leg.
• Anticoagulants drug interactions: Enzyme inhibition of metabolism. Displacement of the drug from inactive protein-binding sites. Decrease in vitamin K absorption or synthesis by the bacterial flora of the large intestines. Alteration in the platelet count or activity. ALWAYS question an order if two anticoagulants are ordered. Expect bridge therapy.