Professional Documents
Culture Documents
REGULATORS OF BP SAMPLE
Baroreceptor -Hydrochlorothiazide (hydroDIURIL)
- aorta and carotid sinus
- pressure receptor CI and CAUTION
- vasomotor center in the medulla -Thiazide: renal insufficiency (creatinine clearance > 30
- hormones: antidiuretic (produced by the ml/min)
hypothalamus and is stored and release by the
posterior pituitary gland) , atrial natriuretic SYMPATHOLITICS (sympathetic Depressants)
peptide, brain natriueretic peptide 1. Beta- adrenergic blockers
2. Centrally acting alpha2- agonists
HYPERTENSION 3. Alpha- adrenergic blockers
-an increase in blood pressure such that the systolic 4. Adrenergic neuron blockers (peripherally acting
pressure is greater than 140 mmHg and the diastolic sympatholytics
pressure is greater than 90 mmHg 5. Alpha1 and Beta1 adrenergic blockers
SE SAMPLE
-decreased PR -Selective alpha1(ZOSIN)= prazosin, terazosin,
-markedly decreased BP doxazosin ------- reduce BP and used to treaty benign
-bronchospasm prostatic hypertension
-insomnia -Phentolamine, phenoxybenzamine and tolazolin----for
-depression hypertensive crisis and severe hypertension
-nightmares
-sexual dysfunction SE and AE
NSG INT. -ZOSIN: orthostatic hypotension, dizziness, faintness,
-Monitor VS especially BP light headedness, increased HR, nausea, drowsiness,
-Monitor laboratory results, especially BUN, serum nasal congestion, vasodilation, edema, wt gain
creatinine, AST and LDH -PHENTOLAMIN: hypotension, reflex tachycardia,nasal
-Instruct client to do not discontinue meds abruptly congestion, GI disturbances
because rebound hypertension may occur
-Inform client that herbs can interfere with beta blockers D-D
- prazosin + anti inflammatory = peripheral edema
2. CENTRALLY ACTING ALPHA2-AGONISTS - prazosin + mitroglycerin= faintness (syncope caused
USE by decrease BP)
MOA
-stimulate the alpha2 receptors NSG INT
-increase vagus activity -Monitor VS especially BP
-decrease CO -Check daily for fluid retention in the extremities
-decrease serum epinephrine, norepinephrine and -Encourage client to decrease salt intake
rennin release -instruct client to report edema if present
*which results to: decrease the sympathetic response 4.ADRENERGIC NEURON BLOCKERS
from the brainstem to the peripheral vessels -potent antihypertensive drugs
-last choice for treatment of chronic hypertension
SAMPLE:
-Methyldopa (Aldomet) = one of the 1st drugs widely MOA
used to control hypertension -block norepinephrine release from sympathetic nerve
-Clonidine- transdermal, 7 day duration of action endings causes decrease in norepinephrine which
-Guanfacine, guanabenz results to decrease BP
MOA MOA
-relaxes the smooth muscles of the vessels, mainly the -prevent release of aldosterone
arteries causing vasodilation -blocks angiotensin ii from the AT1 receptors
-promotes an increase blood flow to the brain and
kidneys *causes vasodilation and decrease peripherak
resistance
*BP decreases, Na and water are retained causing
peripheral edema CI
-pregnancy
SAMPLE
-hydralazine SAMPLE (SARTANS)
-menoxidil -Losartan (Cozaar)
-Nitroprusside and diazoxide (acute HPN) -Valsartan (Diovan)
-Irbesartan (Avapro)
SE -Olmesartan medoxomil (Benicar)
-hydralazine: tachycardia, palpitaitons, edema, nasal -Telmisartan (Micardis)
congestion, HA, dizziness, bleeding, lupus like
syndrome, tingling, numbness SE
-Nitroprusside and diazoxide: reflex tachycardia, -URI
palpitaions, agitation, nausea,and confusion, -HA
hyperglycemia -Dizziness
MOA SAMPLE
-Inhibits the formation of angiotensin II -aliskiren (Tekturna)
-blocks the release of aldosterone
CALCIUM CHANNEL BLOCKERS
SAMPLE -calcium agonists and calcium blockers
-Captopril (Capoten) -highly protein bound but have short half life
-Enalapril (Vasotec)= only ACE available on oral form
MOA
CI -block the binding of Ca to its receptor
-Pregnant women
-shoukd not be taken with K sparring diuretics such as *results: preventing muscle contraction, smooth muscle
relaxation, decrease peripheral smooth muscle tone S.E.:HA,weakness, drowsiness, vision changes, GI
upset, digitalis toxicity.
SAMPLE Digitalis toxicity
-dihydropyridine (amlodipine) – common s/sx: anorexia, diarrhea, bradycardia, PVC, N/V, cardiac
=largest group of calcium channel blockers dysrhythmias, blurred vision, visual illusions, HA,
= used to control HPN malaise, confusions, delirium.
= Nimodipine- prevent ischemic brain injury due Digoxin
to vasospasm -antidote for digitalis toxicity
-diphenylalkalamine (verampil) -digoxin immune tab(orine, digiland)
=used to treat chronic hypertension, angina pectoris Assessment:
and cardiac dysrhytmias -drug and herbal history
-benzodiazepines (diltiazem) -VS, PR
-ECG
SE/AE -renal function
-flush -serum electrolytes
-headache -s/sx of digitalis toxicity
-dizziness Intervention:
-ankle edema -monitor PR,don’t administer if PR below 60
-bradycardia -eat foods high in potassium
-AV block -drug compliance
-avoid OTC drugs
CI -weigh daily
-heart block
SIDE EFFECTS AND ADVERSE REACTIONS: • Used to prevent thrombosis in the arteries by
decrease in heart rate and blood pressure – suppressing platelet aggregation
both selective and non selective drugs • Mainly for prophylactic use in:
bronchospasm, behavioural or psychotic o Prevention of myocardial infarction or stroke
response and impotence – potential adverse for client w/ familial hx
reactions for non-selective beta-blockers o Prevention of repeat MI or stroke
NURSING INTERVENTION: o Prevention of a stroke for clients having transient
Vital signs need to be closely monitored in the ischemic attacks (TIAs)
early stages of beta blocker therapy xamples:
When discontinuing, dosage should be tapered • ASPIRIN
for 1-2 wks to prevent rebound effect like reflex o Long-term & low dose aspirin therapy
tachycardia or life-threatening cardiac Effective & inexpensive tx for
dysrhythmias suppressing platelet aggregation
Monitor PR o MOA: inhibits cyclooxygenase (enzyme
Inform patient it is a long term med
needed by platelet to synthesize
thromboxane A2 (TxA2)
• CALCIUM CHANNEL BLOCKERS o Indications:
- decrease the workload of the heart and
Prevention of thrombosis before or after
decrease oxygen demands
CVA or MI
- effective in treating variant angina pectoris
-treatment of stable and variant angina pectoris, Familial hx of MI or stroke
certain dysrhythmias and hypertension o Dose: 81, 162, or 325 md/day
-relax coronary artery spasm and relax Should be discontinued at least 7 days
peripheral arterioles decreasing cardiac oxygen before surgery
demand • CLOPIDOGREL (Plavix)
-decrease cardiac contractility, decrease o MOA:
afterload, decrease peripheral resistance and inhibits platelet aggregation
reduce the workload of the heart thus prevents ADP from binding w/ the ADP
decreasing the need for oxygen platelet recptor
-achieve their effect in controlling variant angina o May be prescribed singly or w/ aspirin
by relaxing coronary arteries and in controlling (more effective)
classic angina by decreasing oxygen demand o CI: peptic ulcer, active bleeding, intracranial
CALCIUM- activates myocardial contraction,
hemorrhage
increasing the workload of the heart and the
need for more oxygen
o SE: upper RTI, flulike symptoms, dizziness,
EXAMPLES: HA, fatigue, chest pain, diarrhea, may
Verapamil (Calan)- first calcium blocker cause HTN & bronchitis
- Bradycardia is a common Drug interaction: NSAIDs – may bleeding
problem
Nifedipine ( Procardia) – most potent of the calcium o Lab: prolongs bleeding time
blockers, promotes vasodilation of the coronary and o Herb: ginger, garlic, gingko, feverfew – may
peripheral vessels bleeding
-hypotension can result • GP IIb/IIIa inhibitors
Diltiazem (Cardizem) o MOA: blocks the binding of fibrinogen to the
SIDE EFFECTS AND ADVERSE REACTIONS glycoprotein IIb/IIIa receptor on the platelet
- Headache surface
- Hypotension ( more common with Nifedipine o Used primarily for acute coronary
and less common with Diltiazem) syndromes (unstable angina or non-Q-wave
MI) conversion of pro thrombin to thrombin and
o Prevents reocclusion of coronary arteries fibrinogen to fibrin.
flowing percutaneous transuminal coronary
angioplasty (PTCA) – given before & after Indications:
PTCA - prevents and treats venous vessel
o Example: abciximab (ReoPro) – drug of disorders such as DVT, pulmonary
choice for angioplasty embolism and emboli in arterial fibrillation,
• CILOSTAZOL (Pletal) diagnoses and treats disseminated
o Also a vasodilator that may be used for intravascular coagulation; preferred
intermittent claudication anticoagulant during pregnancy.
Nursing Considerations:
• Monitor BP Contraindications:
Bleeding tendencies
• Provide safety precautions
Thrombocytopenia
• Monitor INR regularly
Post operative clients
• Advise client not to smoke. Nicotine causes
vasoconstriction, which alters the effectiveness Side Effect:
of antiplatelet agents bleeding
• Monitoring for abnormal bleeding
Tests:
Anticoagulant PTT and aPTT
Pathophysiology
• Thrombus is the formation of a clot in an arterial Drug-Drug interactions:
or venous vessel. - any drugs that will cause bleeding
• Arterial clots are usually made up of WBC and -
RBC initiating the process, followed by fibrin Antidote:
formation and trapping of RBC in fibrin mesh. Protamine Sulfate (1mg of protamine for every
• Embolus – blood clot moving through the 1mg of LMWH)
bloodstream.
• Thromboxane A2 – product of prostaglandin and *Low-molecular-weight heparins (no need for PTT/aPTT
a potent stimulus for platelet aggregation. monitoring)
• Glycoprotein IIb/IIIa or GP IIb/IIIa – platelet - + ½ : 2-4 times longer than heparin
receptor protein that binds fibrinogen. - administered subQ once or twice per
day.
Anticoagulants - usually injected at abdomen.
- inhibits clot formation. - preferable when client is at home
- act prophylactically to prevent new clots because a family member can be taught how
from forming. to administer.
- Used in clients with arterial and venous
vessel disorder.
Examples:
Venous Problems Arterial Problems Dalteparin sodium (Fragmin)
Deep Vein Coronary Thrombosis Enoxaparin sodium (Lovenox)
Thrombosis (DVT) (myocardial infarction) Tinzaparin sodium (Innohep)
Pulmonary Presence of artificial
Embolism heart valves
Cerebrovascular Accident ORAL
(CVA)
Warfarin
MAO:
PARENTERAL (IV/SubQ) - antagonist of vit. K, which is necessary
for the synthesis of clotting factors VII, IX, X
Heparin and pro thrombin; as a result, it disrupts the
MOA: coagulation cascade.
- prevent new fibrin/clot formation by
enhancing inhibitory actions of antithrombinIndications:
III on several factors essential to normal - prevent venous thrombosis and
blood clotting, thereby blocking the thromboembolism associated with atrial
fibrillation and prosthetic heart valves; risk of promote the conversion of plasminogen to
recurrent transient ischemic attack, CVA and plasma.
MI.
3. Alteplase a.k.a Tissue Plasminogen Activator (TPA)
Contraindications:
bleeding MOA: promotes conversion of plasminogen to
vit. K deficiency plasmin and initiates fibrinolysis
pregnancy – category x Use: to dissolve clot following an acute MI,
breastfeeding – crosses into breast milk pulmonary embolism, acute ischemic stroke.
Side Effect: Contraindication: internal bleeding, bleeding
red-orange discoloration of urine disorders, recent CVA, surgery or trauma,
weakening of bones bacterial endocarditis, severe liver dysfunction,
(long-term use) severe uncontrolled hypertension
Tests: Side Effects: bleeding
PT and INR Adverse Reaction: Life-threatening:
intracerebral hemorrhage, stroke, atrial or
Antidote: ventricular dysrhythmias.
Vitamin K Drug-Drug Interaction: increase bleeding when
taken with oral anticoagulants, NSAIDs,
NSG RESPONSIBILITY cefotetan, plicamycin
check VS - PR, BP (bleeding)
control and prevent bleeding 4. Reteplase (Retavase)
if bleeding occurs, apply pressure for at least 5- Use: to treat coronary thrombosis by
10 minutes causing lysis of thrombi; inhibits fibrin
heparin: PTT and aPTT aspect of the thrombus
warfarin: PT and INR Pregnancy Category C
heparin: IV/subQ More effective than TPA with less risk of
warfarin: oral hemorrhage
instruct client to decrease intake of green, leafy 5. Tenecteplase (TNKase)
vegetables when taking warfarin. Use: to reduce mortality associated with
Check for bleeding, tarry stools AMI
Soft toothbrush to prevent gums from bleeding A “clot buster” that can be administered
Caution with use of electric razor in 5 seconds in one dose
Do not smoke – increases drug metabolism Pregnancy Category C
Use acetaminophen for pain instead of aspirin Dose is based on body weight
(bleeding)
Avoid coffee, tea, cola (caffeine), excessive Nursing Responsibilities:
alcohol. - Monitor VS
- Observe for s/sx of active bleeding from
Thrombolytics the mouth to the rectum.
Used since the early 1980s to promote the AMINOCAPROIC ACID – can be given as an
fibrinolytic mechanism (converting plasminogen intervention to stop bleeding.
to plasma, which destroys the fibrin in the blood - Check for active bleeding for 24hrs after
clot). thrombolytic therapy has been
Should be administered within 3 hours of a discontinued.
thrombolic stroke. - Observe for signs of allergic reaction to
streptokinase : itching, hives, flush,
Five commonly used thrombolytics are: fever, dyspnea, bronchospasm,
hypotension, and/or cardiovascular
1. Streptokinase (Streptase, Kibikinase) collapse.
Use: act systematically to promote the conversion - Avoid administering aspirin and
of plasminogen to plasma. NSAIDs. Acetaminophen can be
: dissolve blood clots caused by coronary substituted.
artery thrombi - Monitor ECG
Pregnancy Category C - Instruct the client to report any side
effects, such as lightheadedness,
2. Urokinase dizziness, palpitations, nausea,
Use: enzymes that act systematically to pruritus or urticaria.
►Table V-I (Autonomic nervous systems: sympathetic
NEURO: and parasympathetic ) p. 265
DRUG CLASS:
Anticholinergic,antimuscarinic, parasympatholytic, DRUG-DRUG INTERACTION
antispasmodic -decreased antipsychotic effectiveness of
haloperidol with anticholinergic drugs, increased
MODE OD ACTION anticholinergic side effects with amantadines, TCAs,
-competitively blocks the effects of acetylcholine at decreased antipsychotic effects and increased
receptors that mediate the effects of parasympathetic anticholinergic effects with phenothiazines.
postganglionic impulses; depresses salivary and
bronchial secretion; dilates the bronchi, inhibits vagal NURSING RESPONSIBILITIES
influences to the heart, relaxes the GI and GU tracts, • Assess for glaucoma, adhesions between iris
inhibits gastric secretions. and lens, stenosing peptic ulcer.
- Ensure adequate hydration; provide
INDICATIONS environmental control to prevent
• As a preoperative medication to decrease hyperpyrexia (temperature).
salivary secretions. - Have patient void before taking
• As an antispasmodic drug to treat peptic ulcers, medication if urinary retention is a
because it relaxes the smooth muscles of the problem.
GI tract and decrease peristalsis. - Advise patient to finish course of
• As an agent to increase heart rate when medicine.
bradycardia is present. • Take the medicine as prescribed.
• Teach patient to have proper diet.
CONTRAINDICATIONS • Tell patient to report rash, eye pain, difficulty
-contraindicated with glaucoma, adhesions between iris breathing, irregular heartbeats, loss of
and lens, stenosing peptic ulcer, toxic megacolon, coordination, abdominal distention, difficulty
cardiac arrhythmias, MI, COPD, impaired liver or kidney swallowing, sensitivity to light and, constipation.
functions. Use cautiously with elderly with Down
syndrome, brain damage, spasticity, HPN, Anxiolytic and Hypnotic agents
for the treatment of symptoms of anxiety.
An anxiolytic or anti-anxiety agent is a drug prescribed
AE (IV anesthetics): respi & cardio depression; ↑ risk for Spinal Anesthesia
bacterial infection (propofol) - a local anesthetic injected in the SUBARACHNOID
SPACE @ the 3rd or 4th LUMBAR SPACE
Topical Anesthetics - may result to HEADACHE possibly bec of a ↓ in CSF
-limited to mucous mem, broken/ unbroken skin pressure caused by a leak of fluid @ the needle
surfaces and burns insertion point
-solution, liquid spray, ointment, cream, gel, powder ** Encourage client to remain FLAT in bed ff surgery &
- ↓ sensitive nerve endings of the affected area to take ↑ fluids. (↓ likelihood of leaking spinal fluid)
Nursing Interventions:
Acetylcholinesterase inhibitors/ Assess for respirations (depth and rate) and
cholinesterase inhibitors muscle strength
Check for liver and kidney function
Make sure that Acetylcholinesterase inhibitors/ 3. light headedness
cholinesterase inhibitors are administered on 4. Headache
time bec. Late administration results to muscle 5. N/V
weakness 6. Diarrhea
Avoid taking muscle relaxants 7. GI upset
Administer drug with food to avoid GI
disturbances Nursing Interventions:
Check for availability and prepare atropine Avoid drugs such as histamine (H2)
sulfate(antidote) in case of overdosing blocker, indomethacin, beta-blockers
Multiple sclerosis Avoid CNS depressants(barbiturates,
-autoimmune disorder that attacks the myelin narcotics, alcohol) while taking muscle
sheath of the nerve fibers of the brain and relaxants
spinal cord which causes plaques (lesions) Discourage driving and operating
- symptoms include diplopia, weakness in machines
extremities and spasticity (for carisoprodol)
- Lab tests mau suggest MS • Monitor serum liver and
Increase immunoglobulin G in cerebrospinal enzyme levels. Report elevated levels
fluid of ALT,ALP,GGT
Increase IgG/albumin ratio • Tapered over 1wk. to
Multiple lesions observed through MRI avoid rebound spasms
• Usually taken for no
3 Phases longer than 3wks.
1. Acute Attack- characterized by fatigue, • Take with food to
motor weakness, optic neuritis decrease GI upset