Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
Math Proficiency Exam Practice Question Question # 19: Ordered: Cephalexin 5 mg p.o. t.i.d. Supply: Cephalexin 250 mg per 5 mL Give: _____t. Solution: 1.5 t 5 mL (Supply) 250 mg (Have) 5
375 mg (Desired) 7.5
1t 5 mL
1st we need to plug the numbers in where they belong for the dimensional analysis method. Supply x Desired + any conversions Have Figure out if there are any conversions to be made. Since this problem is asking for t, you will need to know how many mL are in 1 t since your supply is in mL. There are 5 mL in 1 t. 2nd circle (in this case I put in red) the unit of measure, etc. that you are looking for in the answer. The problem is asking for the # of t. This just helps to remind you of what you are solving for. 3rd you start canceling out the like units. 5 mL and 5 mL cancel completely out. mg and mg cancel out. 50 will divide into both 375 and 250, so we can reduce those to 7.5 and 5. 4th that leaves you with 7.5 x 1/5 = 7.5/5 = 1.5 t I have been using my book from last semester from UNA, so I am not able to give page numbers, etc. from our books for this semester. I am still waiting on my books to come in. They have been ordered, but it is taking forever to get them for some reason.
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
Antihypertensive Drugs
Adrenergic Drugs o Mechanism of Action Modify the SNS, vasodilation, reduces peripheral resistance and subsequently decreases blood pressure. o Medications in this Class clonidine-Catapres doxazosin-Cardura o Side Effects - bradycardia with reflex tachycardia, postural and post exercise hypotension, dry mouth, drowsiness, dizziness, depression, edema, constipation, and impotence are the most common. Others side effects include orthostatic hypotension, headache, sleep disturbances, palpitations, rebound hypertension, bronchoconstriction, and hypo/hyperglycemic episodes o Contraindications - drug allergy, acute heart failure, concurrent use of MAO inhibitors, severe mental depression, peptic ulcer, and severe liver or kidney disease, and asthma o Routes of Administration – P.O., T.D. Ace (Angiotensin-Converting Enzyme) Inhibitors o Mechanism of Action Inhibit angiotensin converting enzyme. This results in decreased B/P. B/P is reduced by decreasing systemic vascular resistance (SVR). Aids in heart failure patients due to prevention of sodium and water resorption. This leads to decreased preload and the work required by the heart. o Medications in this Class benazepril-Lotensin captopril-Capoten enalapril-Vasotec fosinopril-Monopril lisinopril-Prinivil, Zestril quinapril-Accupril Ramipril-Altace o Side Effects - Dry cough, rhinorrhea, and allergic-like symptoms are the most common side effects. Increased blood-potassium level (hyperkalemia), Fatigue, Dizziness, Headaches, Rapid heartbeat, Fainting, in rare cases — but more commonly in blacks and in smokers — ACE inhibitors can cause some areas of your tissues to swell (angioedema). If it occurs in the throat, that swelling can be life-threatening. o Contraindications - drug allergy, high potassium level, lactating women, children, and patients with unilateral renal stenosis
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) decrease the effectiveness of ACE inhibitors. o Routes of Administration – P.O., I.V. Angiotensin II Receptor Blockers – ARB’s o Mechanism of Action Help relax your blood vessels (dilate), which lowers your blood pressure and makes it easier for your heart to pump blood. o Medications in this Class losartan-Cozaar irbesartan-Avapro olmesartan-Benicar telmisartan-Micardis valsartan-Diovan o Side Effects – Headache, Dizziness, Lightheadedness, Nasal congestion, Back and leg pain, Diarrhea o Contraindications – pregnancy, allergy, lactating women o Routes of Administration – P.O., I.V. Vasodilators o Mechanism of Action Open (dilate) blood vessels. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and the walls from narrowing. As a result, blood flows more easily through your arteries, your heart doesn't have to pump as hard and your blood pressure is reduced. o Medications in this Class minoxidil-Loniten hydralazine-Apresoline diazoxide-Hyperstat nitroprusside-Nitropress o Side Effects - Chest pain, rapid heartbeat (tachycardia), heart palpitations, fluid retention (edema), nausea, vomiting, dizziness, flushing, headache, nasal congestion, excessive hair growth, contraindications, routes of administration. Some can increase your risk of developing lupus (connective tissue disease). o Contraindications - drug allergy, hypotension, cerebral edema, head injury, acute MI, coronary artery disease, may be contraindicated in cases of heart failure that is secondary to diastolic dysfunction. o Routes of Administration – P.O., I.V.
Antianginal Drugs
Nitrites and Nitrates o Mechanism of Action Dilates all blood vessels. Causes redistribution of blood and oxygen to previously ischemic myocardial tissue, and reduction of angina symptoms o Medications in this Class
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
amyl nitrite – rapid acting nitroglycerin – rapid and long acting isosorbide dinitrate – Isordil – rapid and long acting isosorbide mononitrate – Imdur – long acting o Side Effects - headache, postural hypotension, tachycardia, contact dermatitis with topical forms, tolerance o Contraindications - drug allergy, severe anemia, closed angle glaucoma, hypotension, severe head injury, certain medication interactions o Routes of Administration – P.O., S.L., T.D., I.V., Ointment, Spray Beta-Blockers (also known as beta-adrenergic blocking agents) o Mechanism of Action Reduce your blood pressure. Block the effects of the hormone epinephrine, also known as adrenaline. When taking these, the heart beats more slowly and with less force, thereby reducing blood pressure. Also help blood vessels open up to improve blood flow. o Medications in this Class carvedilol – Coreg metoprolol – Lopressor, Toprol XL atenolol - Tenormin o Side Effects – Fatigue, Cold hands, Headache, Upset stomach, Constipation, Diarrhea, Dizziness are the most common. Others include Dyspnea, Loss of Libido, Insomnia, and Depression. o Contraindications – systolic heart failure, serious conduction disturbances, DM, peripheral vascular disease. Generally aren't used in people with asthma because of concerns that the medication may trigger severe asthma attacks. In people who have diabetes, beta blockers may block signs of low blood sugar, such as rapid heartbeat. It's important to monitor your blood sugar on a regular basis. Beta blockers can also affect your cholesterol and triglyceride levels, causing a slight increase in triglycerides and a modest decrease in highdensity lipoprotein, the "good" cholesterol. These changes often are temporary. You shouldn't abruptly stop taking a beta blocker because doing so could increase your risk of a heart attack or other heart problems. o Routes of Administration – P.O., I.V. Calcium Channel Blockers (also called calcium antagonists) o Some calcium channel blockers are available in short-acting and long-acting forms. Short-acting medications work quickly, but their effects last only a few hours. Long-acting medications are slowly released to provide a longer lasting effect. o Mechanism of Action Prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. Relax and widen blood vessels by affecting the muscle cells in the arterial walls.
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
Some calcium channel blockers have the added benefit of slowing your heart rate, which can further reduce blood pressure, relieve chest pain (angina) and control an irregular heartbeat.
o Medications in this Class diltiazem – Cardizem amlodipine - Norvasc o Side Effects – Constipation, Headache, Rapid heartbeat (tachycardia), Dizziness, Rash, Fatigue, Flushing, Nausea, Swelling in the feet and lower legs o Contraindications – Calcium channel blockers interact with grapefruit products. Can reduce your ability to eliminate calcium channel blockers from your body, allowing the medication to build up in your body. This buildup could cause serious side effects. o Routes of Administration – P.O., I.V. Heart Failure Drugs
ACE Inhibitors o Ace Inhibitors are also used to treat heart failure (see other notes above). o Mechanism of Action Prevent angiotensin I from converting to angiotensin II Angiotensin II – potent vasoconstrictor; stimulates aldosterone secretion – stimulates Na+ and H2O resorption – increases B/P ACE inhibitors – prevent Na+ and H2O resorption by inhibiting aldosterone – diuresis-decreases blood volume and blood return to the heart – decreases preload and the workload of the heart. o Medications in this Class See Above + trandolapril – Mavik perindopril – Aceon, Coversyl Angiotensin II Receptor Blockers – ARB’s o ARB’s are also used to treat heart failure (see other notes above). o Mechanism of Action Potent vasodilators Decrease systemic vascular resistance (afterload) Angiotensin II receptor blockers help relax your blood vessels, which lowers your blood pressure and makes it easier for your heart to pump blood. By narrowing blood vessels, can increase your blood pressure and force your heart to work harder. Angiotensin II also starts the release of a hormone that increases the amount of sodium and water in your body, which can lead to increased blood pressure. Angiotensin II can also thicken and stiffen the walls of your blood vessels and heart.
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
That allows blood vessels to widen (dilate). o Medications in this Class See Above + candesartan – Atacand Beta-Blockers o Beta Blockers are also used to treat heart failure (see other notes above). o Also used as antianginal medications. (See other notes above). o Mechanism of Action Reduce sympathetic nervous system stimulation to the heart Decrease heart rate, delay AV node conductivity, reduce myocardial contractility, and decrease myocardial automaticity. Aldosterone Antagonists o Mechanism of Action Impede aldosterone to prevent retention of sodium and water. These are potassium-sparing diuretics, which also have additional properties that may help people with severe systolic heart failure live longer. o Medications in this Class spironolactone – Aldactone eplerenone - Inspra o Side Effects – N & V, Stomach Cramps, and Diarrhea are the most common. o Contraindications – allergy, pregnancy, lactating women Also in patients with anuria, acute renal insufficiency, significant impairment of renal excretory function, hyperkalemia, Addison’s disease and with concomitant use of eplerenone. o Routes of Administration – P.O. B-Type Natriuretic Peptide o Mechanism of Action Synthetic version of peptide released by ventricles Vasodilates both arteries and veins Currently used only in ICU setting to treat severe life-threatening heart failure. o Medications in this Class nesiritide - Natrecor o Side Effects - confusion, light-headedness, fainting, dysrhythmias, decreased urination, chest pain, fever, weakness, and fatigue o Contraindications - hypotension, drug allergy, cardiogenic shock o Routes of Administration – I.V. Phosphodiesterase Inhibitors o Mechanism of Action Inotropic drugs that inhibit the action of phosphodiesterase (enzyme); (+) inotrope. o Medications in this Class inamirinone – Amiodarone – Cordarone milrinone - Primacor
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
o Side Effects - dysrhythmia, hypotension, angina, hypokalemia, tremor, and thrombocytopenia o Contraindications - drug allergy, severe aortic or pulmonary valvular disease, and heart failure resulting from diastolic dysfunction o Routes of Administration – I.V. Cardiac Glycosides (Oldest Group) o Mechanism of Action Changes the electrical conduction properties of the heart and decreases the rate of electrical conduction and prolongs the refractory period in the conduction system (area between the atria and the ventricles). o Medications in this Class digoxin – Lanoxin – this is currently the only cardiac glycoside available. o Side Effects Toxicity and management of OD bradycardia, tachycardia, hypotension, headache, fatigue, confusion, convulsions, colored vision, halo vision, anorexia, N & V, diarrhea o Contraindications - allergy, 2nd or 3rd degree heart block, atrial fibrillation, ventricular tachycardia, heart failure resulting from diastolic dysfunction, and sub aortic stenosis o Routes of Administration – P.O., I.V.
Anti-Dysrhythmic Drugs
Vaughn-Williams Classification o System that is commonly used to classify anti-dysrhythmic drugs. o Based on the electrophysiological effect of particular drugs on the action potential.
Side Effects – hypersensitivity reaction, N & V, Diarrhea, dizziness, headache, blurred vision, new dysrhythmias, prolongation of QT interval Toxicity and management of OD Contraindications - allergy, 2nd or 3rd degree AV block, bundle branch block, cardiogenic shock, sick sinus syndrome Routes of Administration – P.O., I.M., I.V.
o Class 1 Divided into 1a, 1b, and 1c Mechanism of Action Membrane-stabilizing drugs Fast Sodium channel blockers Medications in this Class See 1a, 1b, and 1c below o Class 1a Mechanism of Action
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
Block sodium (fast) channels. Delay repolarization Increase action potential duration. Used for atrial fibrillation, premature atrial contractions, premature ventricular contractions, ventricular tachycardia, Wolff-Parkinson White Syndrome. Medications in this Class quinidine procainamide disopyramide o Class 1b Mechanism of Action Block sodium channels Accelerate repolarization Increase or decrease APD Used for ventricular dysrhythmias only o Premature ventricular contractions, ventricular tachycardia, ventricular fibrillation. Medications in this Class phenytoin lidocaine o Class 1c Mechanism of Action Block sodium channels (more pronounced effect) Little effect on atrial conduction Used for severe ventricular dysrhythmias May be used in atrial fibrillation/flutter, Wolff-Parkinson-White Syndrome, supraventricular tachycardia dysrhythmias. Medications in this Class flecainide propafenone o Class II: Beta-Blockers Mechanism of Action Reduce or block sympathetic nervous system stimulation. This in turn reduces transmission of impulses in the heart's conduction system Depress phase 4 depolarization General myocardial depressants for both supraventricular and ventricular dysrhythmias. Also used as antianginal and antihypertensive drugs. Medications in this Class atenolol esmolol metaprolol propranolol Page 8 of 15
Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
o Class III Mechanism of Action Increase APD Prolong repolarization in phase 3 Used for dysrhythmias that are difficult to treat. o Life threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter that is resistant to other drugs. o Sustained ventricular tachycardia Medications in this Class amiodarone sotalol ibutilide o Class IV Mechanism of Action Calcium channel blockers o Also used as antianginal medications. (See other notes above). o Inhibit slow-channel (calcium-dependent) pathways Depress phase 4 depolarization Reduce AV node conduction Used for paroxysmal supraventricular tachycardia; rate control for atrial fibrillation and flutter. Medications in this Class verapamil diltiazem Coagulation Modifier Drugs
Anticoagulants o Mechanism of Action decrease clotting, often used for strokes Work to prevent intravascular thrombosis by decreasing blood coagulability. Uses vary from preventing clot formation to preventing the extension of an established clot, or thrombosis. o Medications in this Class warfarin – Coumadin enoxaparin – Lovenox heparin fondaparinux – Arixtra argatroban -same trade name apixaban – Eliquis dabigatran – Pradaxa rivaroxaban - Xarelto o Side Effects Bleeding is the main complication, skin necrosis, and “purple toe” syndrome, thrombocytopenia, hematoma, bruising of skin. Page 9 of 15
Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
Toxicity and management of OD o Contraindications - allergy, thrombocytopenia, pregnancy, pt. with indwelling epidural catheter o Routes of Administration – P.O., I.V., S.C. Anti-platelets o Mechanism of Action keeps platelets from sticking together Prevent platelet adhesion at the site of blood vessel injury, which actually occurs before the clotting cascade. o Medications in this Class aspirin dipyridamole – Aggrenox clopidogrel – Plavix pentoxifylline – Trental cilostazol - Pletal o Side Effects - drowsiness, dizziness, confusion, flushing, N/V/D, GI bleeding, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia, bleeding, chest pain, edema, flulike symptoms, headache, epistaxis, rash, pruritus, bradycardia, hypotension o Contraindications - allergy, thrombocytopenia, active bleeding, leukemia, traumatic injury, GI ulcer, vitamin k deficiency, recent stroke o Routes of Administration – P.O., I.V. Thrombolytic Drugs o Mechanism of Action Activates the fibrinolysis system to breakdown the thrombus in a blood vessel quickly by activating the conversion of plasminogen to plasmin, which breaks down the clot. o Medications in this Class alteplase - Activase o Side Effects - internal, intracranial, and superficial bleeding, hypersensitivity reaction, anaphylactic reaction, N/V, hypotension, cardiac dysrhythmias o Contraindications - allergy to any ingredient in drug o Routes of Administration – I.V. Anti-fibrinolytic Drugs o Mechanism of Action inhibit the breakdown of fibrin, which prevents the destruction of the formed platelet o Medications in this Class aminocaproic acid – Amicar desmopressin - DDAVP o Side Effects - orthostatic hypotension, acute CVA thrombosis, and acute MI, dysrhythmias, headache, dizziness, fatigue, hallucinations, convulsions, N/V, cramps o Contraindications - allergy, disseminated intravascular coagulation o Routes of Administration – I.V.
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
Anti-lipemic Drugs
HMG-CoA Reductase Inhibitors o Mechanism of Action reduces plasma concentration of LDL cholesterol o Medications in this Class atorvastatin – Lipitor simvastatin - Zocor o Side Effects headache, dizziness, blurred vision, fatigue, insomnia, constipation, diarrhea, nausea, myalgia’s, skin rashes Toxicity and management of OD o Contraindications - allergy, pregnancy, liver disease, elevation of liver enzyme levels o Routes of Administration – P.O. Bile Acid Sequestrants o Mechanism of Action lower the plasma concentrations of LDL cholesterol and increase hepatic triglycerides and VLDL production o Medications in this Class choletyramine - Questran o Side Effects - constipation, heartburn, nausea, belching o Contraindications - biliary or bowel obstruction, phenylketonuria o Routes of Administration – P.O. Niacin-Nicotinic Acid o Mechanism of Action lowers lipid levels including triglyceride, total serum cholesterol, and LDL cholesterol o Medications in this Class Niacin o Side Effects - flushing, pruritus, GI discomfort o Contraindications - liver disease, hypertension, peptic ulcer disease, any type of hemorrhagic process o Routes of Administration – P.O. Fibric Acid Derivatives o Mechanism of Action decrease triglyceride levels and increase HDL cholesterol level o Medications in this Class gemfibrozil - Lopid o Side Effects - GI discomfort, diarrhea, nausea, blurred vision, increased risk for gallstones o Contraindications - severe liver or kidney disease, cirrhosis, gallbladder disease o Routes of Administration – P.O. Cholesterol Absorption Inhibitor o Mechanism of Action inhibits cholesterol absorption and reduces blood lipid profiles
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
o Medications in this Class ezetimibe - Zetia o Side Effects – GI Discomfort o Contraindications - acute liver disease or unexplained elevations in serum liver enzyme levels o Routes of Administration – P.O. Diuretic Drugs
Helps to rid your body of salt (sodium) and water. They work by making your kidneys put more sodium into your urine. The sodium, in turn, takes water with it from your blood. That decreases the amount of fluid flowing through your blood vessels, which reduces pressure on the walls of your arteries. o Overall Side Effects Include: Low sodium in your blood (hyponatremia) Dizziness Headaches Increased thirst Muscle cramps Increased blood sugar Increased cholesterol Rash Joint disorders (gout) Impotence Menstrual irregularities Breast enlargement in men (gynecomastia)
Carbonic Anhydrase Inhibitors o Mechanism of Action inhibit the activity of the enzyme, carbonic anhydrase, which is found in the kidneys, eyes, and other parts of the body o Medications in this Class acetazolamide – Diamox methazolamide - Neptazane o Side Effects - acidosis, hypokalemia, drowsiness, anorexia, paresthesia, hematuria, urticaria, photosensitivity, and melena o Contraindications - hyponatremia, hypokalemia, severe renal or hepatic dysfunction, adrenal gland insufficiency, cirrhosis o Routes of Administration – P.O. Loop Diuretics o Mechanism of Action blocks chloride and sodium reabsorption manage the edema associated with heart failure and hepatic or renal disease, control hypertension, and increase renal excretion of calcium o Medications in this Class
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
bumetanide – Bumex furosemide – Lasix torsemide - Demedex o Side Effects - hypokalemia, hyperglycemia, neutropenia, aplastic anemia o Contraindications - hepatic coma, severe electrolyte loss o Routes of Administration – P.O., I.M., I.V. Osmotic Diuretics o Mechanism of Action increases osmotic pressure in the glomerular filtrate, which in turn, pulls fluid into the renal tubules from the surrounding tissue o Medications in this Class mannitol - Osmitrol o Side Effects - convulsions, thrombophlebitis, pulmonary congestion o Contraindications - severe renal disease, pulmonary edema, intracranial bleeding o Routes of Administration – I.V. Potassium-Sparing Diuretics (also known as aldosterone-inhibiting diuretics) o Mechanism of Action Block the resorption of sodium and water that is induced by aldosterone secretion. interfere with sodium-potassium exchange o Medications in this Class amiloride – Midamor spironolactone – Aldactone triamterene - Dyrenium o Side Effects - urinary frequency, dizziness, headache, cramps, nausea, weakness and hyperkalemia o Contraindications - hyperkalemia, severe renal and hepatic failure, anuria o Routes of Administration – P.O. Thiazide and Thiazide-Like Diuretics o Mechanism of Action inhibits the reabsorption of sodium, potassium, and chloride, which results in osmotic water loss o Medications in this Class Thiazide Diuretics include: hydrochlorothiazide – Esidrix, HydroDIURIL chlorthiazide – Diuril trichlormethiazide – Metahydrin Thiazide – Like Diuretics include: metolazone – Mykorx, Zaroxolyn o Side Effects - electrolyte imbalances, metabolic imbalances o Contraindications - hepatic coma, renal failure, anuria o Routes of Administration – P.O.
Fluids and Electrolytes
Crystalloids
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
o Mechanism of Action Contain fluids and electrolytes that are normally found in the body and are given to replenish the body from loss of certain electrolytes. 1st choice of I.V. fluids Contain small molecules that flow easily across semipermeable membranes, allowing for transfer from the bloodstream into the cells and body tissues. This may increase fluid volume in both the interstitial and intravascular spaces. o Medications in this Class Normal saline (0.9% sodium chloride) Half normal saline (0.45% sodium chloride) Hypertonic saline (3% sodium chloride) Lactated Ringer's solution D5W Plasma – Lyte o Side Effects - peripheral or pulmonary edema o Contraindications - hypervolemia, severe electrolyte disturbances o Routes of Administration – I.V. Colloids o Mechanism of Action Contain large molecules that don't pass through semipermeable membranes. When infused, they remain in the intravascular compartment and expand intravascular volume by drawing fluid from extravascular spaces via their higher oncotic pressure. Colloids have a longer duration of action than crystalloids because the molecules remain within the intravascular space longer. The effects of colloids can last for several days if capillary wall linings are intact and working properly. o Medications in this Class Albumin 5% and 25% (from human donors) Dextran 40, 70, or 75 (a glucose solution) Hetastarch (synthetic, derived from cornstarch) o Side Effects – See Above o Contraindications - See Above o Routes of Administration - See Above Blood Products o Mechanism of Action improve tissue oxygenation and augment plasma volume o Side Effects - incompatibility with recipient’s immune system o Routes of Administration – I.V. Potassium o Content outside of cells ranges from 3.5 to 5 mEq/L o Obtained from foods o Excess excreted through the kidneys Impaired kidney function can lead to higher serum levels, possibly toxicity.
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Drugs Affecting the CV & Renal System and Math Proficiency Question Explanation
o Mechanism of Action Muscle contraction Transmission of nerve impulses Regulation of heartbeat Maintenance of acid-base balance Isotonicity Many other functions in the body. o Side Effects - hyperkalemia, N & V, Diarrhea o Contraindications - hyperkalemia, severe renal disease, acute dehydration, untreated Addison’s disease, severe hemolytic disease, severe burns, multiple trauma o Routes of Administration – P.O., I.V. Sodium o Normal concentration outside cells is 135 to 145 mEq/L o Maintained through dietary intake of sodium chloride (salt, fish, meats, foods flavored or preserved with salt). o Mechanism of Action Control of water distribution Fluid and electrolyte balance Osmotic pressure of body fluids Participation in acid-base balance o Side Effects - GI upset, N & V, cramps o Contraindications - hypernatremia o Routes of Administration – I.V.
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