Term
| ADRENERGIC RESPONSES TO STIMULATION |
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Definition
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Term
| Cardiovascular: Blood Vessels |
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Definition
receptor: alpha one
response: constriction
receptor: beta two
response: dilation |
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Term
| Cardiovascular: Cardiac Muscle |
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Definition
receptor: beta one
response: increased contractility |
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Term
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Definition
receptor: beta one
response: increased heart rate |
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Term
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Definition
receptor: beta one
response: increased heart rate |
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Term
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Definition
receptor: beta one
response: decrease insulin release |
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Term
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Definition
receptor: beta two
response: glycogenolysis |
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Term
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Definition
receptor: beta two
response: increased renin secretion |
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Term
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Definition
receptor: beta two
response: decreased motility |
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Term
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Definition
receptor: alpha one
response: constriction |
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Term
| Genitourinary: Bladder Sphincter |
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Definition
receptor: alpha one
response: constriction |
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Term
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Definition
receptor: alpha one
response: ejaculation |
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Term
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Definition
receptor: alpha one
response: contraction
receptor: beta two
response: relaxation |
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Term
| Respiratory: Bronchial Muscles |
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Definition
receptor: beta two
response: dilation |
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Term
| Ocular: Pupillary Muscles of Iris |
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Definition
receptor: alpha one
response: mydriasis |
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Term
| Adrenergic Catecholamines |
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Definition
substances that can produce a sympathomimetic response
endogenous: epinephrine, norepinephrine, dopamine
synthetic: isoprotenerol, dobutamine, phenylephrine
hint: mostly end in "ine" |
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Term
| Category: Adrenergic Agonist Agent |
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Definition
classification: alpha/beta adrenergic
prototype: epinephrine
route: IV
onset of action: <2 min
peak: rapid
half-life: <5 min
duration: 5-30 min
route: subcut
onset of action: 5-10 min
peak: 20 min
half-life: variable
duration: unknown
NOTE: EPINEPHRINE ACTIVATES ALL ADRENERGIC RECEPTORS |
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Term
| Adrenergic Agonist Agent Indications (epinephrine) |
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Definition
increase BP
restore cardiac function in an arrest
delay absorption of local anesthetic
overcome AV block
bronchial dilation in asthma
Tx of choice in anaphylactic shock |
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Term
| Adrenergic Agonist Agent Side Effects |
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Definition
hypertensive crisis
dysrhythmias
angina pectoris
necrosis following extravasation
hyperglycemia |
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Term
| Beta Adrenergic Agonist Response |
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Definition
bronchial, GI, and uterine smooth muscle relaxation
glycogenolysis
cardiac stimulation |
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Term
| Alpha-Adrenergic Side Effects |
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Definition
CNS: headache, restlessness, excitement, insomnia, euphoria
CV: palpitations (dysrhythmias), tachycardia, vasoconstriction, hypertension
other: anorexia, dry mouth, nausea, vomiting, taste changes (rarely occurs) |
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Term
| Beta-Adrenergic Side Effects |
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Definition
CNS: mild tremors, headache, nervousness, dizziness
CV: increased heart rate, palpitations (dysrhythmias), fluctuating blood pressure
other: sweating, nausea, vomiting, muscle cramps |
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Term
|
Definition
an additional adrenergic receptor
stimulated by dopamine
causes dilation of renal, mesenteric, coronary, and cerebral blood vessels, resulting in increased blood flow |
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Term
| Category: Vasoactive Sympathomimetics |
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Definition
category: pressors, inotropes
prototypes: dobutamine, dopamine, epinephrine, isoproterenol, norepinephrine
route: IV
onset of action: 2-5 min
peak: rapid
half-life: <2 min
duration: 10 min
also fall under the category of inotropic drugs with vasopressors |
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Term
| Vasoactive Sympathomimetics Indications (dopamine) |
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Definition
shock
heart failure
acute renal failure |
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Term
| Vasoactive Sympathomimetics Mechanism of Action (dopamine) |
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Definition
dose dependent receptor specificity
low doses act on dopaminergic receptors only
high doses act on both dopaminergic and beta 1 receptors
very high doses activate alpha 1 receptors as well |
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Term
| Vasoactive Sympathomimetics Side Effects |
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Definition
CV: tachycardia, dysrhythmias, angina
respiratory: dyspnea
integumentary: extravasation |
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Term
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Definition
B1 affects the heart
B2 affects the lungs |
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Term
| Beta Blocker Mode of Action |
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Definition
beta receptors are on the surface of cells, innervated by the SNS, and mediate certain physiologic responses to adrenaline
beta receptor blockers block the activity of a beta receptor, decrease heart rate and force of contractions, and lower high blood pressure |
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Term
| Category: Antihypertensives |
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Definition
classification: alpha antagonists
prototypes: phentolamine (Regitine), doxazosin (Cardura), terazosin (Hytrin), prazosin (Minipress), ergotamine tartrate (Ergostat), phenoxybenzamine HCI (Dibenzyline), tolazoline (Priscoline)
hint: mostly end in amine or zosin |
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Term
| Alpha Blocker Indications |
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Definition
treat vascular headaches (migraines)
control post-partum bleeding
treat hypertension
treat BPH |
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Term
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Definition
antiangina
cardioprotective
class II antidysrhythmic
antihypertensive
treatment of migraine headaches
glaucoma (topical use) |
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Term
| Alpha Blocker Mechanism of Action |
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Definition
interrupt SNS stimulation
results in vasodilation, reduced BP, miosis, reduced smooth muscle tone |
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Term
| Beta Blocker Mechanism of Action (cardioselective B1) |
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Definition
reduces SNS stimulation of the heart
decreases heart rate
prolongs SA node recovery
slows conduction rate through the AV node
decreases myocardial contractility, thus decreasing myocardial oxygen demand |
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Term
| Beta Blocker Mechanism of Action (nonspecific B1 and B2) |
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Definition
effects on heart: same as cardioselective
effects on bronchioles: constriction, resulting in narrowing of airways and shortness of breath
effects on blood vessels: mild vasoconstriction |
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Term
| Alpha Blocker Pharmacokinetics (phentolamine) |
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Definition
route: subcut
onset of action: immediate
peak: 2 min
half-life: unknown
duration: 15-30 min |
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Term
| Category: Antihypertensives |
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Definition
classification: beta blockers
non-cardio selective prototypes: carvedilol (Coreg), labetolol (Trandate), propanolol (Inderal), sotalol (Betapace)
cardioselective prototypes: atenolol (Tenormin), metoprolol (Lopressor), esmolol (Brevibloc)
hint: end in olol |
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Term
| Beta Blocker Phamacokinetics (carvedilol) |
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Definition
route: po
onset of action: 20-120 min
peak: 1-4 hours
half-life: 6-8 hours
duration: 8-24 hours |
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Term
| Beta Blocker Phamacokinetics (labetalol) |
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Definition
route: IV
onset of action: 2-5 min
peak: 5-15 min
half-life: 2.5-8 hours
duration: 2-4 hours
route: po
onset of action: 20-120 min
peak: 1-4 hours
half-life: 2.5-8 hours
duration: 8-24 hours |
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Term
| Beta Blocker Pharmacokinetics (propanolol) |
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Definition
route: IV
onset of action: 2 min
peak: 1-4 hours
half-life: 3-5 hours
duration: 3-6 hours
route: po
onset of action: 1-2 hours
peak: 1- 4 hours
half-life: 3-5 hours
duration: 6-12 hours |
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Term
| Beta Blocker Pharmacokinetics (sotalol) |
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Definition
route: po
onset of action: 1-2 hours
peak: 2.5-4 hours
half-life: 12 hours
duration: 8-16 hours |
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Term
| Beta Blocker Pharmacokinetics (atenolol) |
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Definition
route: IV
onset of action: immediate
peak: <5 min
half-life: 6-7 hours
duration: <12 hours
route: po
peak:2-4 hours
half-life: 6-7 hours
duration: 24 hours |
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Term
| Beta Blocker Pharmacokinetics (metaprolol) |
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Definition
route: IV
onset of action: 1 min
peak: 20 min
half-life: 3-8 hours
duration: 5-8 hours
route: po
onset of action: 1 hour
peak: 2-4 hours
half-life: 3-8 hours
duration: 10-20 hours |
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Term
| Beta Blocker Pharmacokinetics (esmolol) |
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Definition
route: IV
onset of action: immediate
peak: 6 min
half-life: 9 min
duration: 15-20 min |
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Term
| Alpha Blocker Side Effects |
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Definition
CV: palpitations, orthostatic hypotension, tachycardia, edema, dysrhytmias, chest pain
CNS: dizziness, headache, drowsiness, anxiety, depression, vertigo, weakness, numbness, fatigue
GI: nausea, vomiting, diarrhea, constipation, abdominal pain
other: incontinence, nosebleed, tinnitus, dry mouth, pharyngitis, rhinitis |
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Term
| Beta Blocker Side Effects |
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Definition
blood: agranulocytosis, thrombocytopenia
CV: AV block, bradycardia, heart failure, peripheral vascular insufficiency
CNS: dizziness, mental depression, lethargy, hallucinations
GI: nausea, dry mouth, vomiting, diarrhea, cramps, ischemic colitis
other: impotence, rash, alopecia, bronchospasm |
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Term
| Alpha/Beta Blocker Toxicity |
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Definition
acute overdose of po meds:
empty patients stomach immediately
induce emesis with syrup of ipecac
gastric lavage
acute overdose of IV meds:
treat symptoms (decreased BP/seizures) |
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Term
| Adrenergic Blocking Agents Nursing Implications |
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Definition
assess for allergies and history of COPD, hypotension, cardiac dysrhythmias, bradycardia, HF, or other cardiovascular problems (any preexisting condition that might be exacerbated by the use of these agents might be a contraindication to their use)
remember that alpha blockers may precipitate hypotension
remember that beta blockers may precipitate bradycardia, hypotension, heart block, HF, and bronchoconstriction
avoid OTC medications because of possible interactions (antacids, antimuscarinics/anticholinergics, diuretics and cardiovascular drugs, neuromuscular blocking agents, oral hypoglycemic agents)
monitor for side effects such as hypotension, tachycardia (alpha blockers), bradycardia, heart block, HF, increased airway resistance, fatigue, lethargy, depression, insomnia, vivid nightmares
monitor for therapeutic effects such as decreased chest pain in patients with angina, return to normal BP and pulse, other specific effects depending on the use |
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Term
| Beta Blocking Agents Nursing Implications |
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Definition
rebound hypertension of chest pain may occur if this medication is discontinued abruptly
patients should notify their physician if they become ill and unable to take medication
inform patients that they may notice a decrease in their tolerance for exercise; dizziness and fainting may occur with increased activity (notify physician if this occurs)
patients should report weight gain of more than two in a week, edema of the feet and ankles, shortness of breath, excessive fatigue or weakness, syncope or dizziness to their physician |
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Term
| Category: Antihypertensive |
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Definition
classification: angiotensin converting enzyme inhibitor
prototypes: captopril (Capoten), lisinopril (Zestril), enalapril (Vasotec), quinapril (Acupril)
route: PO
onset of action: varies with drug
peak: varies with drug
half-life: varies with drug
duration: varies with drug |
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Term
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Definition
hypertension
HF (either alone or in combination with diuretics or other agents)
slows progression of left ventricular hypertrophy after an MI
renal protective effects in patients with diabetes
drugs of choice in hypertensive patients with HF |
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Term
| Category: Antihypertensives |
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Definition
classification: angiotensin II receptor blocking agents
prototypes: iosartan (Cozaar, Hyzaar), valsartan (Diovan)
route: po
onset of action: varies with drug
peak: varies with drug
half-life: varies with drug
duration: varies with drug
hint: sartan |
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Term
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Definition
hypertension
adjunctive agents for the treatment of HF
may be used alone or with other agents such as diuretics
used primarily in patients who cannot tolerate ACEI |
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Term
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Definition
allow angiotensin I to be converted to angiotensin II, but block the receptors that receive angiotensin II
block vasoconstriction and release of aldosterone |
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Term
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Definition
upper respiratory infections
headache
may cause occasional dizziness, inability to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue
hyperkalemia much less likely to occur |
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Term
| Category: Antihypertensive |
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Definition
classification: calcium channel blocker
prototypes: verapamil (Calan), nifedipine (Procardia), dilatizem (Cardizem)
route: po
onset of action: varies with drug
peak: varies with drug
half-life: varies with drug
duration: varies with drug |
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Term
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Definition
| blocks calcium access to cells causing decreased decreased contractility, decreased conductivity of the heart, and decreased demand for oxygen |
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Term
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Definition
decreased blood pressure
bradycardia
may precipitate AV block
headache
abdominal discomfort (nausea, vomiting)
peripheral edema |
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Term
| CCB Side Effects by System |
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Definition
CV: hypotension, palpitations, bradycardia
GI: constipation, nausea
other: rash, flushing, peripheral edema, dermatitis |
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Term
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Definition
angina
hypertension
dysrhytmias
migraine headaches
raynaud's disease |
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Term
|
Definition
blood levels should be monitored to ensure they are therapeutic
oral CCBs should be taken before meals and as ordered
patients should be encouraged to limit caffeine intake
extended release formulas should never be crushed or chewed |
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Term
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Definition
classification: HMG-CoA reductase inhibitors
prototypes: atrovastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor)
route: po
onset of action: 0.5 hours
peak: 1-2 hours
half-life: 7-14 hours
duration of action: unknown
hint: all end in astatin |
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Term
| HMG-CoA Inhibitor Reductase Indications |
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Definition
hypercholesterolemia
primary and secondary prevention of CV events
post-MI therapy
diabetes |
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Term
| HMG-CoA Reductase Inhibitor Mechanism of Action |
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Definition
inhibition of HMG-CoA reductase = lower cholesterol biosynthesis
increased number of LDL receptors on hepatocytes = remove more LDL from blood
decreased production of aliprotein B-100 = decreased production of VLDLs |
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Term
| HMG-CoA Reductase Inhibitor Side Effects |
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Definition
CNS: headache
skin: rash
GI: dyspepsia, cramps, flatulence, constipation, abdominal pain |
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Term
| HMG-CoA Reductase Inhibitor Adverse Effects |
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Definition
hepatotoxicity: liver function tests every six months while on treatment
myopathy: rhabdomyolisis (mostly with rosuvastatin)
peripheral neuropathy: linkage to muscle weakness and tingling in hands and feet (reversible with stopping treatment)
link to parkinson's disease: being studied, no direct linkage proven yet |
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Term
| HMG-CoA Reductase Inhibitor Drug Interactions |
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Definition
most other lipid-lowering drugs (except bile acid sequestrants)
drugs that inhibit CYP3A4 (macrolid antibiotics, azole antifungal drugs, HIV protease inhibitors, amiodarone, cyclosporine, grapefruit juice) increase levels of statins
pregnancy category x
dosing should be once daily in the evening (endogenous cholesterol synthesis increases during the night) |
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Term
|
Definition
classification: nicotinic acid (vitamin B3)
prototypes: nicotinic acid (Niacin), nia-bid, niaspan, slo-niacin
route: po
onset of action: rapid
peak: 30-60 min
half-life: 45 min
duration: unknown
hint: look for nia |
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Term
| Nicotinic Acid Indications |
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Definition
hyperlipidemia
hypertriglyceridemia |
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Term
| Nicotinic Acid Mechanism of Action |
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Definition
inhibit lipolysis in adipose tissue
increase activity of lipoprotein lipase
decrease esterification of triglycerides (conversion of triglycerides in liver to storage form)
lower LDLs and higher HDLs by lower metabolism of cholesterol and triglycerides |
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Term
| Nicotinic Acid Adverse Effects |
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Definition
skin: flushing, itching (intense flushing initially can be pretreated with aspirin; also decreased with SR version of niacin)
GI: abdominal discomfort
hepatotxicity: most likely with slo-niacin/less likely with niaspan
hyperglycemia: occurs most commonly in patients with DM
gouty arthritis: competes for renal excretion with uric acid leading to increased levels of uric acid
can raise blood levels of homocysteine
may increase risk for CHD |
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Term
|
Definition
classification: bile acid sequestrants
prototypes: cholestyramine (Questram), colestipol (Colestid), colesevelam (Welchol) (newer drug tablet form only, used before Questram and Colestid, used if intolerant to statins)
route: po
onset of action: unknown
peak: unknown
half-life: unknown
duration: unknown
hint: look for cole |
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Term
| Bile Acid Sequestrants Indications |
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Definition
hyperlipidemia
hyperglycemia in patients with DM |
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Term
| Bile Acid Sequestrants Mechanism of Action |
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Definition
bind bile preventing resorption of bile acids from small intestine to lower LDLs (bile acids necessary for the absorption of cholesterol in the small intestine)
increase LDL receptors on hepatocytes |
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Term
| Bile Acid Sequestrants Side Effects |
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Definition
| GI: heartburn, nausea, belching, bloating, constipation |
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Term
| Bile Acid Sequestrants Adverse Effects |
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Definition
| bleeding, headaches, tinnitus, burnt odor to urine |
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Term
|
Definition
classification: cholesterol absorption inhibitor
prototype: ezetimibe (Zetia)
route: po
onset of action: unknown
peak: 4-12 hours
half-life: 22 hours
duration: unknown |
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Term
| Cholesterol Absorption Inhibitor Indications |
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Definition
| hyperglycemia: approved for monotherapy and combined use with statins (slightly increases risk for liver damage) |
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Term
| Cholesterol Absorption Inhibitor Mechanism of Action |
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Definition
| selectively inhibits absorption of cholesterol and other sterols from the small intestine, resulting in lower total cholesterol, LDL, alipoprotein B, and triglycerides |
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Term
| Ezetimibe (Zetia) Adverse Effects |
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Definition
myopathy
rhabdomyolysis
hepatitis
pancreatitis
thrombocytopenia |
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Term
| Ezetimibe (Zetia) Drug Interactions |
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Definition
statins
fibrates
bile-acid sequestrants
cyclosporine |
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Term
|
Definition
classification: fibric acid derivates (fibrates)
prototypes: gemfibrozil (Lopid), fenofibrate (Tricor), fenofibric acid (TriLipix)
route: po
onset of action: several days
peak: 1-2 hours
half-life: 1.3-1.5 hours
duration: unknown
hint: look for fibr |
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Term
| Fibric Acid Derivative Indications |
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Definition
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Term
| Fibric Acid Derivative Mechanism of Action |
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Definition
activate lipoprotein lipase which is responsible for breakdown of cholesterol
also suppress release of fatty acids from adipose tissue
inhibit triglyceride production in liver
increase secretion of cholesterol into bile for excretion |
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Term
| Fibric Acid Derivative Acverse Effects |
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Definition
| rash, GI disturbances, gallstones, myopathy, liver injury (hepatotoxic) |
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Term
| Fibric Acid Derivative Interactions |
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Definition
displaces warfarin from plasma albumin
measure INR frequently |
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Term
|
Definition
classification: nitrates
prototypes: nitroglycerin (Nitro-bid, Nitrol), isosorbide dinitrate (Isordil, Sorbitrate, Dilatrate SR), isosorbide mononitrate (Imdur, Monokate, ISMO)
hint: look for bide and nitrate |
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Term
| Nitrates Pharmacokinetics (nitroglycerin) |
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Definition
route: sublingual
onset of action: 2-3 min
peak: unknown
half-life: 1-4 min
duration: 0.5-1 hour |
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Term
| Available Forms of Nitrates |
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Definition
sublingual
buccal
chewable tablets
oral capsules/tablets
IV solutions
ointments
transdermal patches
translingual sprays |
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Term
|
Definition
treat stable, unstable, and vasospastic angina
prevent angina attacks |
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Term
| Nitrate Mechanism of Action |
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Definition
dilate all blood vessels:
dilation of coronaries --> redistribution of oxygenated blood flow to ischemic areas
dilation of veins --> reduction in venous return --> decreased left ventricular end diastolic pressure --> decreased preload
dose dependent arterial vasodilator effect |
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Term
|
Definition
CNS: headache (usually diminishes over time)
CV: tachycardia, postural hypotension
blood: methemoglobin
skin: rash
other: tolerance may develop |
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Term
| Nitrate Drug Interactions |
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Definition
hypotensive drugs
phosphodiesterase type 5 inhibitors
beta blockers, verapamil, and diltiazem |
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Term
|
Definition
belongs to the first new class of antianginal agents approved in more than 25 years
benefits modest and greater in men that women
does not reduce heart rate, blood pressure, or vascular resistance
can prolong QT; multiple drug interactions
not a first line drug therapy (combine with first-line agents for inadequate response to other first-line medications) |
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Term
|
Definition
classification: phosphodiesterase inhibitors (PDI)
prototypes: inamrinone (Inodilator), milrinone (Primacor)
route: IV
onset of action:5-15 minutes
peak: immediately
half-life: 2-3 hours
duration: 8-10 hours |
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Term
|
Definition
| short term management of heart failure |
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Term
|
Definition
inhibit action of phosphodiesterase = increase in intracellular cAMP specifically in the cardiac muscle --> positive inotropic affect and vasodilation
increased Ca+ available for cardiac contraction = greater force of contraction
may increase heart rate = positive chronotropic response |
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