Pharm Mod 5-6

• Medication Suffixes


  • Beta-blockers: -OLOL
  • Diuretics: -IDE
  • ARBs: -ARTAN
  • ACE inhibitors: -PRIL
  • Calcium channel blockers: -IPINE*, -PINES
  • Sympatholytic medications: -INE
• Selective vs. non-selective beta-blockers

  Nonselective Beta-blockers: Nadolol, Timolol, Propranolol (high lipid solubility)

  Nonselective Beta-blockers with Alpha-1 antagonistic effects: Carteolol, Carvedilol, Labetolol

  Beta-1 selective: Atenolol, Bisoprolol, Esmolol, Metoprolol

  Beta-2 selective: None currently on the market
• Impact of beta-blockers, diuretics, antiarrhythmics, antihypertensives, and alpha-1 agonists on PT

  beta-blockers, diuretics: May decrease exercise tolerance initially (usually improves)

  Antiarrhythmics: Dizziness, visual disturbances, GI issues, anticholinergic effects

  Antihypertensives: Hypotension, reduced cardiovascular response to exercise

  Alpha 1 agonists: Treatment of hypotension and/or shock to increase systemic vascular resistance, nasal decongestant
• Primary drug types used to treat

  • Chest pain
  • Acute coronary syndromes
  • Heart failure
  • Arrhythmia
  • Hypertension
• Primary side effects of

  Beta-blockers: May cause or exacerbate heart failure, bradycardia, caution with other AV node slowing agents

  Alpha-agonist: Not listed

  Alpha-antagonist: Marked postural hypotension and syncope, reflex tachycardia
• Typical pharmacological and non-pharmacological management for

  • CHF
  • Stable angina
  • Post-MI

  
• Emergency procedures for suspected MI (symptoms) and medication administration

  1. Call 911

  2. Administer SL nitroglycerin if patient uses

  3. Administer 325 mg of chewable aspirin

  4. Administer O2 if O2 sat is <90%
• Most common side effects/adverse reactions seen in anti-hypertension medications

  • Acute kidney injury, hypotension, history of angioedema, bilateral renal artery stenosis

  African Americans: Peripheral edema, reflex tachycardia, orthostatic hypotension

  Thiazides: Increased risk of developing DM, pre-eclampsia/eclampsia, tonic-clonic seizures in pregnancy, orthostatic hypotension in older adults
• Effect of each type of anticoagulant agent

  • Vitamin K Antagonist: Warfarin

  Direct Thrombin Inhibitor: Dabigatran, Etexilate

  Factor Xa inhibitors: Rivaroxaban, Apixaban, Edoxaban

  Heparin and derivatives: UFH, LMWH, Fondaparinux

  Direct Thrombin Inhibitors: Bivalirudin, Argatroban
• Risks of heparin use including HIT

  Bleeding, thrombocytopenia, heparin-induced thrombocytopenia +/- thrombosis
• Primary medications, common side effects, and adverse outcomes associated with blood clotting disorders

  • Anticoagulants: Increased bleeding risk, bruising, GI upset, skin reactions. Adverse: Excessive bleeding, intracranial hemorrhage, HIT

  Antiplatelets: Increased bleeding risk, GI upset, allergic reactions. Adverse: Excessive bleeding, GI bleeding, allergic reactions

  Thrombolytics: Increased bleeding risk, intracranial hemorrhage, allergic reactions, low BP. Adverse: Excessive bleeding, reperfusion injury, allergic reactions
• Adverse outcomes of anticoagulants

  • Excessive bleeding, including gastrointestinal bleeding, intracranial hemorrhage (bleeding within the skull), and other major bleeding events
  • Rarely, heparin-induced thrombocytopenia (HIT), an immune-mediated reaction leading to low platelet counts and paradoxical clotting
• Types of antiplatelet agents


  • Aspirin
  • Clopidogrel
  • Ticagrelor
  • Prasugrel
  • Dipyridamole
• Common side effects of antiplatelet agents


  • Increased bleeding risk
  • Gastrointestinal upset
  • Allergic reactions
• Adverse outcomes of antiplatelet agents

  • Excessive bleeding, gastrointestinal bleeding
  • Rarely, severe allergic reactions or thrombotic events

  
• Types of thrombolytics (fibrinolytics)


  • Alteplase
  • Tenecteplase
  • Streptokinase
  • Urokinase
• Common side effects of thrombolytics


  • Increased bleeding risk, including intracranial hemorrhage
  • Allergic reactions
  • Low blood pressure
• Adverse outcomes of thrombolytics

  • Excessive bleeding, including life-threatening bleeding events
  • Reperfusion injury
  • Allergic reactions
• Primary drug types (and side effects) used in patients with abnormal cholesterol levels


  • Statins
  • Ezetimibe
  • PCSK9 Inhibitors
• Statin intensity levels


  • High intensity: Atorvastatin (Lipitor), Rosuvastatin (Crestor)
  • Moderate-Low Intensity: Simvastatin, Pravastatin, Lovastatin
• Statin side effects


  • Myopathy
  • Elevated liver enzymes
  • Teratogenic
• Ezetimibe


  Inhibits cholesterol absorption - well tolerated
• Common side effects of ezetimibe


  • Diarrhea
  • Upper respiratory infections
• PCSK9 Inhibitors


  • Alirocumab
  • Evolocumab
• Common side effects of PCSK9 Inhibitors


  • Injection-site reactions
  • Respiratory infections
• Resistance training and aerobic exercise—especially with increasing intensity—increase the risk of myalgias and skeletal muscle symptoms in individuals taking statins
• Arthralgia, myalgia, myopathy, and rhabdomyolysis are potential adverse effects of several lipid-lowering drug classes
• Statin-induced muscle symptoms often involve large, proximal, and symmetrical muscle groups, with lower extremity or calf muscles affected more often than upper extremities
• Antihistamines commonly used for allergies and cold symptoms


  • Loratadine (Claritin)
  • Cetirizine (Zyrtec)
  • Levocetirizine (Xyzal)
  • Fexofenadine (Allegra)
  • Diphenhydramine (Benadryl)
• Common side effects of antihistamines

  • Sedation (diphenhydramine and cetirizine)
  • Fatigue
  • Dizziness
  • Blurry vision
  • Poor coordination
• The "Three-Legged Stool" of Cystic Fibrosis treatment

  • Malabsorption and nutrition failure -> Pancreatic enzymes, high-calorie diets
  • Mucus obstruction -> Airway clearance
  • Recurrent/persistent infection -> Inhaled, oral, and IV antibiotics
  • Pulmonary decline -> Frequent and close monitoring
  • Mutations of CFTR -> CFTR modular therapy
• No mixing of medications in the inhaled therapeutic regimen for Cystic Fibrosis, 80 min 2-3x/day
• COPD inhalers


  • SABA
  • LABA
  • SAMA
  • LAMA
  • ICS
• Avoid combining SAMA and LAMA due to increased risk of side effects
• Combination COPD inhalers


  • LABA+LAMA
  • SABA+SAMA
  • LABA+ICS
  • LABA+LAMA+ICS
• Miscellaneous COPD medications


  • Macrolides
  • Systemic steroids
• Macrolides


  Use: Already taking LABA/LAMA OR LABA/LAMA/ICS and continue to have exacerbations

  Side effects: Bacterial resistance, Prolonged QTc interval (Increased risk of heart arrhythmias), GI disturbance, Impaired hearing tests
• Systemic steroids


  Use: Short-course for acute exacerbation

  Common side effects: Sick, Sad, Sex, Salt, Sugar
• Common misconceptions about nutritional and herbal supplements are that they must be safe because they are derived from natural sources, and that you can take as much as you want
• Risks associated with nutritional and herbal supplements include variability in purity and quality, potential for adverse effects and interactions, and lack of regulation by the FDA