Module four blueprint

On the study guide

Medication
Headings under meds or other sub headings
Lightening bolted info or important from book
Reagan said was important or emphasized

Chapter 38

● Effects of antihistamines and effects among different routes

○ H1 blockers or H1 antagonists, compete with histamine for receptor sites and
prevent a histamine response
○ Two types:
■ H1
● When the h1 receptors are stimulated, the extravascular smooth
muscles- including those lining the nasal cavity- are constricted.
■ H2
● With stimulation of the h2 receptor, an increase in gastric secre-
tions occurs, which is cause of peptic ulcer
○ Antihistamines decrease nasopharyngeal secretions by blocking h1 receptors
○ Most are rapidly absorbed in 15 minutes but are not potent enough for emer-
gency anaphylaxis
● First generation antihistamines: side effects and actions
○ Actions: blocks the effects of histamine by competing for and occupying h1 re-
ceptor sites
○ Typically have sedating effects, therefore you should not drive or operate heavy
machinery until response to medication is known
○ Side effects:
■ Drowsiness, dry mouth, and anticholinergic symptoms
○ Diphenhydramine
■ Use: to treat insomnia and allergic reactions including allergic rhinitis, the
common cold, cough, sneezing, pruritus, and urticaria and to prevent mo-
tion sickness
■ MOA: competes with histamine for binding at h1 receptor sites and antag-
onizes histamine effects (blocks histamine receptors)
■ Side effects
● Drowsiness, dizziness, headache, weakness, insomnia, fatigue,
urinary retention, blurred vision, dry mouth, dermatitis, rash,
paresthesia, abdominal pain, restlessness, confusion, diarrhea,
constipation
■ Adverse reactions:
● Seizures
● Life Threatening: thrombocytopenia
■ Contraindications:
 ● Breast feeding
● Cation: asthma, hepatic disease, COPD, neonate, prostatic hyper-
trophy, pregnancy, urinary retention, GI obstruction, increased in-
traocular pressure, older adults
■ Increased CNS depression with alcohol, opioids, hypnotics, and barbitu-
rates, avoid use with MAOIs
■ Nursing interventions
● Give oral form with food to decrease GI discomfort
● Administer the IM form in a large muscle
● Avoid subcutaneous injection
■ Patient teaching:
● Do not drive or operate machinery and performing other danger-
ous activities if drowsiness occurs or until stabilized on drug
● Advise patients to avoid alcohol and other CNS depressants
● Encourage patient to take as prescribed. Notify HCP if confusion
or hypotension occurs
● Teach patients on prophylaxis for motion sickness to take drug at
least 30 minutes before offending event, and also before meals
and at bedtime during event
● Inform breastfeeding mothers that small amounts of the drug can
pass into breast milk. Not recommended while breastfeeding.
● Children are more susceptible to side effects and adverse reac-
tions. Night mares, nervousness, and irritability are more likely to
occur in children.
● Older adults are more sensitive to the effects of antihistamines
and are more likely to develop confusion, difficult or painful urina-
tion, dizziness, drowsiness, feeling faint, and dryness of mouth,
nose, or throat
● Suggest sugarless candy or gum or ice chips, a saliva substitute
for temporary relief of dry mouth
● Second generation antihistamine: side effects and actions
○ Nonsedating antihistamines
○ These cause fewer anticholinergic effects
○ Examples: zyrtec, claritin
○ Cetirizines, fexofenadine, azelastine, desloratadine, loratadine have half lives be-
tween 3 and 30 hours and are administered by nasal spray
● Nasal vs. Systemic
○ Nasal (sympathomimetic amines):stimulate the alpha adrenergic receptors, pro-
ducing vascular constriction of the capillaries within the nasal mucosa
■ Frequent use of nasal decongestants can cause rebound congestion
○ Systemic decongestants (alpha-adrenergic agonists): available in liquid, capsule,
or tablet form and are used primarily for allergic rhinitis, including hay fever and
acute coryza (profuse nasal discharge)
 ■ Pseudoephedrine has been removed from OTC because of the reports
for causing stroke, HTN, renal failure, and cardiac dysrhythmias
○ Can make a patient feel restless or nervous
● Antitussives: three types
○ Act on the cough control center in the medulla to suppress the cough reflex
○ Nonopioid

Drug Route and Dosage Uses and Considerations

Benzonatate A: PO: 100-200 mg tid; max: 600 mg/d For cough. May cause drowsiness, dizzi-
ness, HA, dizziness, confusion, nausea,
constipation, and ocular irritation

○ Opioid

Drug Route and Dosage Uses and Considerations

Codeine Cough: A: PO: 10-20 mg q4-6h; max: For cough and pain. May cause drowsi-
120 mg/d ness, dizziness, euphoria, orthostatic hy-
potension, weakness, nausea, diarrhea,
constipation, dependence, tolerance, with-
drawal, and respiratory depression

Guaifenesin 100mg A: PO: 2 capsules q4h PRN; max: For cough and the common cold. May
codeine 9mg Codeine 120 mg/d and guaifenesin 2400 cause drowsiness, dizziness, headache,
(Mucinex) mg/d euphoria, hypotension, dependence, n/v,
constipation, abdominal pain, urinary re-
tention, and respiratory depression

Homatropine 1.5 mg A: PO: hydrocodone 5mg and homat- For cough. May cause drowsiness, dizzi-
and hydrocodone ropine 1.5 mg q4-6h PRN; max; hy- ness, euphoria, HA, blurred vision, dry
5mg drocodone 30 mg and homatropine 9 mouth, n/v, urinary retention, constipation,
mg/d and dependence

○ Combination preparations

Drug Route and Dosage Uses and Considerations

Guaifenesin and dex- Immediate release: For the common cold. May cause drowsi-
tromethorphan A: PO: guaifenesin 200-400 mg and dex- ness, dizziness, headache, confusion, irri-
tromethorphan 20 mg q4h PRN; Max: tability, nausea, and respiratory depres-
2400 mg guaifenesin and dextromethor- sion.
phan 120 mg/d

Extended Release:
 A: PO: 30-60 mg dextromethorphan, 200
mg guaifenesin q12h; max: 2 doses/d

● Expectorants: side effects and actions

○ Loosen bronchial secretions so they can be eliminated by coughing
○ Can be used with or without other pharmacologic agents
○ Patients should increase fluids to at least 8 glasses per day to help loosen mucus
○ Side effects: drowsiness, dizziness, nausea, vomiting, diarrhea
● Intranasal glucocorticoids
○ Are effective for treating allergic rhinitis because they have an antiinflammatory
action, thus decreasing the allergic rhinitis symptoms of rhinorrhea, sneezing,
and congestion
○ Dextromethorphan Hydrobromide
■ Drug class: antitussive
■ Therapeutic Use: for temporary relief of cough, especially a nonproduc-
tive cough due to sore throat, irritation, or the common cold
■ MOA: decreases excitability of cough center in the medulla
■ Side effects:
● Dizziness, drowsiness, confusion, fatigue, ataxia, n/v, restless-
ness
■ Adverse reactions:
● Psychosis, tachycardia, seizures
■ Life threatening:
● Respiratory depression and serotonin syndrome
■ Contraindications
● Hypersensitivity, MAOI therapy
● Caution: asthma, emphysema, hepatic disease, older adults, preg-
nancy, breastfeeding, tobacco smoking
● Table 38.1 Antihistamines for treatment of Allergic Rhinitis
○ First generation

Drug Route and Dosage Uses and Considerations

Brompheniramine tannate Extended release: For allergic rhinitis, rhinorrhea, and conjunct
Adult: PO 6-12 mg q12h; max 24 tis. May cause drowsiness, dizziness, restles
mg/d ness, euphoria, irritability, blurred vision, dry
mouth, constipation, urinary retention, palpit
tions, and tachycardia
Chlorpheniramine Immediate release: For allergic rhinitis and conjunctivitis. May ca
Adult: PO: 4mg q4-6h; max 24 drowsiness, dizziness, restlessness,
mg/d confusion,ataxia, weakness, blurred vision,
Extended Release: mouth, constipation, urinary retention, palpit
Adult: 8-12 mg bid; max 24 mg/d tions, and tachycardia

Clemastine fumarate A: PO 1 tab (1.34 mg) q12h; max: For common cold, allergic rhinitis, pruritus, a
2 tabs/d urticaria. May cause drowsiness, dizziness,
lessness, euphoria, HA, confusion, dry mout
constipation, palpitations, tachycardia, blurre
vision, and urinary retention.

Cyproheptadine A: initially 4 mg tid; maintenance: For allergic rhinitis; conjunctivitis, pruritus, an

4-20 mg/d in divided doses; max: urticaria. May cause drowsiness, dizziness,
32 mg/d mouth, constipation, excitability, euphoria,
blurred vision, restlessness, wheezing, hypo
sion, tachycardia, and urinary retention

Levocetirizine A: PO: 2.5-5 mg/d in the evening; For allergic rhinitis and chronic urticaria. May
maxL 5mg/d cause drowsiness, dizziness, blurred vision,
fever, hypotension, tachycardia, palpitations
tigue, nasal congestion, urinary retention

Chlorcyclizine A: PO: 25 mg q6-8h PRN; max: For allergic rhinitis and hay fever. May cause
75 mg/d blurred vision, dry mouth, weakness, dizzine
drowsiness, confusion, constipation, euphor
HA, restlessness, tachycardia, and urinary re
tention.

Azelastine and fluticasone A: nasal spray: 1 spray per nostril For allergic rhinitis. May cause drowsiness,
bid; max 2 sprays/nostril/d dizziness, blurred vision, HA, tachycardia, pa
tations, dysphonia, dysgeusia, rhinitis, nasal
tation, and epistaxis.

○ Second generation

Drug Route and dosage Uses and considerations

Azelastine Nasal Spray: For allergic rhinitis and pruritus. May cause
A: 1-2 sprays in each nostril q12h; drowsiness, headache, confusion, fatigue,
max: 4 sprays/nostril/d blurred vision, pharyngitis, ocular irritation, d
mouth, palpitations, tachycardia, and urinary
tention
 Cetirizine A: PO: 5-10 mg/d; max: 10 mg/d For allergic rhinitis and urticaria. May cause
Older A >77: PO: 5mg/d; max 5 drowsiness, dizziness, headache, insomnia
mg tigue, euphoria, ataxia, dry mouth, pharyngi
cough, epistaxis, hearing loss, blurred vision
urinary retention, diarrhea, and abdominal p

Fexofenadine A: PO: 60 mg q12h; max 120 For allergic rhinitis and chronic urticaria. Ma
mg/d cause dizziness, fever, fatigue, HA, restless
ness, cough, dyspepsia, vomiting, and diarr

Loratadine A: PO: 10 mg/d; max: 10 mg/d For allergic rhinitis, pruritus, and urticaria. M
cause drowsiness, confusion, HA, blurred v
sion, dry mouth, vomiting, constipation, urin
retention, palpitations, wheezing, and tachy
dia

Desloratadine A: PO: 5 mg/d; max: 5 mg/d For allergic rhinitis, chronic urticaria, and pru
tus. May cause drowsiness, dizziness, HA,
fever, infection, irritability, cough, restlessne
insomnia, dry mouth, tachycardia, palpitatio
n/v, and diarrhea

Chapter 39

● Epinephrine: class, action, effect, side effects

○ Alpha1, beta1, beta2 adrenergic
○ Mild bronchospasm:
■ A: inhalation: 1 inhale (0.125 mg), may repeat after 1 min if need, then
wait 4 h between doses; max: 0.25/dose, 1 mg/d
○ Use:
■ For acute bronchospasms, anaphylaxis, angioedema, nasal congestion,
asthma, and cardiac arrest.
○ Side effects:
■ restlessness, tremors, dizziness, diaphoresis, weakness, paresthesia, in-
fection, hypo/hyperglycemia, angina, palpitations, tachycardia, hyperten-
sion, and dysrhythmias
● Control of respiration/ respiratory drive
○ Oxygen, carbon dioxide, and hydrogen ion concentrations in the blood influence
respiration
○ Chemoreceptors are sensors that are stimulated by changes in these gasses
and ions
 ○ The central chemoreceptors, located in the medulla near the respiratory center
and CSF, respond to an increase in CO2 and a decrease in pH by increasing the
ventilation
○ If the co2 level remains elevated the stimulus to increase ventilation is lost
○ If oxygen therapy increases the oxygen level in the blood, the po2 may be too
high to stimulate the peripheral chemoreceptors, and ventilation will be de-
pressed
● MDI: patient teaching
○ If the beta2 agonist is given by MDI or dry powder inhaler (DPI), correct use of
the inhaler and dosage intervals need to be explained to the patient.
○ A spacer device may need to be used to improve drug delivery to the lungs
○ Excessive use of aerosol drug can lead to tolerance and loss of drug effective-
ness
○ Excessive use can also cause rebound bronchoconstriction
○ Make sure MDI is behind the teeth, take a deep breath in as you push down the
canister to administer medication, hold breath for 10 seconds
● COPD: what is it? Treatment?
○ Caused by airway obstruction with increased airway resistance of airflow to lung
tissues
○ Four major pulmonary disorders cause COPD:
■ Chronic bronchitis
■ Bronchiectasis
■ Emphysema
■ Asthma
○ Treatment: bronchodilators (primarily beta2-adrenergic agonists), methylxan-
thines, leukotriene agonists, glucocorticoids, cromolyn, and anticholinergics
● Class of medications
● Xanthine derivatives: use, side effects, precautions
○ The second major group of bronchodilators used to treat asthma
○ Include: aminophylline, theophylline, and caffeine
○ Stimulate the central nervous system and respiration, dilate coronary and pul-
monary vessels, and cause diuresis.
○ Because of their effect on respiration and pulmonary vessels, xanthines are used
to treat asthma
○ Tobacco smoking increases metabolism of theophylline drugs, thereby decreas-
ing the half-life
■ If you smoke you will get less effect and will need an increased dose
more often
○ Side effects:
■ Anorexia, n/v, diarrhea, gastric pain, hematemesis, dysrhythmias, tachy-
cardia, palpitations, and marked hypotension
○ Adverse CNS effects:
■ Headaches, irritability, restlessness, insomnia, dizziness, and seizures.
○ Can cause hyperglycemia, decreased clotting time, and rarely leukocytosis
 ○ Because of the diuretic effects patients should avoid tea, caffeine, coffee, cola,
and chocolate and should increase their fluid intake
○ Rapid IV administration can cause dizziness, flushing, hypotension, severe
bradycardia, and palpitations
■ Need to be administered slowly via IV pump
● Leukotriene receptor antagonist: use, side effects, precautions
○ A leukotriene is a chemical mediator that can cause inflammatory changes in the
lung
○ Cysteinyl leukotrienes: promote an increase in eosinophil migration, mucous pro-
duction, and airway wall edema that results in bronchoconstriction
○ Leukotriene modifiers: are effect in reduce the inflammatory sx of asthma trig-
gered by allergic and environmental stimuli
○ Nursing interventions:
■ Monitor respirations for rate, depth, rhythm, and type
■ Monitor lung sounds for rhonchi, wheezing, or rales
■ Observe lips and nails for cyanosis
■ Monitor drug therapy for effectiveness
■ Observe for side effects
■ Provide adequate hydration; fluids help loosen secretions
■ Monitor liver function tests; AST and ALT may be elevated with zafirlukast
and montelukast
■ Provide pulmonary therapy by chest clapping and postural drainage as
appropriate
○ Patient teaching:
■ Advise patients that if an allergic reaction occurs the drug should be d/c,
and a HCP should be notified
■ Monitor hepatic function
■ Do not take st johns wort without first checking with a HCP because this
product may decrease montelukast concentration
■ Warn patients that black or green tea and guarana taken with mon-
telukast and zafirlukast may cause increased stimulation
■ Encourage patients to stop smoking
■ Discuss ways to alleviate anxiety (relaxation techniques, music)
■ Advise patients who have frequent or severe asthmatic attacks to wear an
ID bracelet or med alert
■ Encourage patients contemplating pregnancy to seek medical advice first
■ Do not take aspirin or NSAIDs
■ Not to be used for acute reversal of asthma attacks
■ Continue use of inhaled prophylaxis and short-acting rescue medication
for exercise-induced bronchospasm
■ Encourage patients to inform HCP if short-acting inhaled bronchodilators
are needed more often than usual with montelukast
■ Tell patient to comply with medication regimen even during symptom free
periods
 ■ Chew chewable tablets thoroughly
■ Take in the evening for max effectiveness
○ Montelukast (Singulair)
■ Class: bronchodilator: Leukotriene receptor antagonist
■ Contraindications: hypersensitivity
● Caution: hepatic disease, depression, suicidal ideation, breast-
feeding, pregnancy, corticosteroid withdrawal, status asthmaticus,
acute bronchospams, alcohol abuse, and older adults
■ Uses: for treatment of allergic rhinitis and asthma, for exercise-induced
bronchospasm prophylaxis
■ MOA: binds with leukotriene receptors to inhibit smooth muscle contrac-
tion and bronchoconstriction
■ Side effects: HA, dizziness, drowsiness, cough, nasal congestion, fatigue,
infection, agitation, restlessness, insomnia, confusion, depression,
influenza, edema, palpitations, muscle cramps
■ Adverse reactions: bleeding seizures
● Life threatening: anaphylaxis, suicidal ideation, thrombocytopenia,
stevens johnson syndrome
■ Drug/lab/food interactions:
● Aspirin and NSAIDs block drug action
● Telithromycin, gemfibrozil, clopidogrel increase drug levels
● Lab: abnormal liver function tests (ALT, AST)
● Inhaled corticosteroids: use, side effects, precautions
○ Not helpful in treating severe asthma attacks
○ More effective at controlling symptoms that beta2 agonists , particularly in the re-
duction of bronchial hyperresponsiveness
○ Side effects:
■ Throat irritation, hoarseness, dry mouth, coughing
■ Candida albicans (oral infection)
● Brush teeth and rinse mouth after use
● Figure 39.2 Inhalants for Asthma Control

Categories Inhalant agents

Beta2 and some beta1 Metaproterenol sulfate
Beta2 Albuterol, salmeterol, terbutaline sulfate, for-
moterol, indacaterol, olodaterol, arformoterol
tartrate
Anticholinergics Ipratropium bromide, Aclidinium, Tiotropium,
Umeclidinium
Cromolyn Cromolyn
Glucocorticoids (corticosteroids) Beclomethasone, Budesonide, Flunisolide,
Fluticasone
 ● Figure 39.3 Theophylline Preparations

Drug Route and Dosage Uses and Considerations

Aminophylline- theophylline A: 18-59y For bronchospasm due to asthma o
IV: 0.4 mg/kg/h infusion; Max: 900 COPD. May cause restlessness,
mg/d headache, insomnia, GERD, dizzin
Older adults >60: n/v, diarrhea, hypokalemia, hyperca
IV: 0.2-0.3 mg/kg/h infusion cemia, palpitations, and tachycardia
Individual titration is based on serum
theophylline levels.
Therapeutic range: 5-15 mcg/L

● Table 39.1 Adrenergic Bronchodilators and anticholinergics (only included what she said
was important p. 477-478 for the rest

Drug Route and Dosage Uses and Considerations

Epinephrine Mild bronchospasm: For acute bronchospasms, anaphyl
A: Inhalation: 1 inhale (0.125 mg), may angioedema, nasal congestion, asth
repeat after 1 minute if needed, then and cardiac arrest. May cause restl
wait 4 h between doses. Max: 0.25/
ness, tremors, dizziness, diaphores
dose, 1 mg/d
weakness, paresthesia, infection, h
hyperglycemia, angina, palpitations
tachycardia, hypertension, and dysr
mias

Albuterol Acute bronchospasm To treat asthma and for prophylaxis

A: MDI: 2 puffs (90-180 mcg/inhal) q4- treatment of bronchospasm. May ca
6h; max: 12 puffs/d tremor, dizziness, drowsiness, restl
Bronchospasm prophylaxis
ness, agitation, anxiety, excitability,
A: PO: 2-4 mg q6-8h; max: 32 mg/d
Extended Release ataxia, headache, nasopharyngitis,
A: PO: 4-8 mg q12h; max: 32 mg/d somnia, weakness, dry mouth, n/v,
rhea, edema, urinary retention, mus
cramps, rhinitis, throat irritation, too
discoloration, and hyperhidrosis.
 Tiotropium COPD: A: oral inhalation: 2 inhal/d (2.5 For maintenance treatment of asthm
mcg/actuation) at the same time qd; and COPD. May cause insomnia, d
max: 2 inhal/d ness, depression, HA, sinusitis, na-
sopharyngitis, cough, dry mouth, vo
ing, abdominal pain, constipation, u
nary retention, arthralgia, myalgia, p
ripheral edema, blurred vision, oral
ceration, candidiasis, infection

Chapter 40

● Box 40.1Stages of heart failure

○
Stage Characteristics according to stage
A A high risk for heart failure bt without structural heart disease
or symptoms of heart failure
B Structural heart disease but without signs or symptoms of
heart failure
C Structural heart heart disease with prior or current symptoms
of heart failure
D Refractory heart failure requiring specialized interventions
○
○
● Combination therapy
● Non-pharmacologic interventions
○ Nondrug therapy is an integral part of the regimen for controlling HF.
○ It should be tailored to meet the needs of individual patient
○ The patient should limit salt intake to 2 g/day, approximately 1 teaspoon
○ Alcohol intake should either decreased to 1 drink per day or completely avoided
because excessive alcohol use can lead to cardiomyopathy
○ Fluid intake may be restricted
○ Smoking should be avoided because it deprives the heart of oxygen
○ Obesity can increase cardiovascular problems if it is associated with unhealthy
behaviors
○ Saturated fat intake should be decreased
○ Mild exercise, such as walking or biking is recommended
● Pertinent labs
○ Atrial natriuretic hormone or peptide (ANH)
 ■ 20-77 pg/mL positive value is greater than 100
■ Elevated ANH could indicate heart failure
■ ANH is secreted from the atria of the heart and acts as an antagonist to
renin and aldosterone. It is released during expansion of the atrium.
■ Produces vasodilation and increased glomerular filtration rate
■ Results of ANH secretion include a large volume of urine that decreases
blood volume and blood pressure
○ Brain natriuretic peptide (BNP)
■ Desired value is less than 100
■ Positive value is greater than 100
■ Primarily secreted from atrial cardiac cells and , when tested, aids in diag-
nosis of HF
■ A heart healthy diet is recommended
● Digitalis: use, side effects, toxicity
○ Use: to treat heart failure and atrial fibrillation
○ MOA: inhibits sodium-potassium ATPase, promoting increased force of cardiac
contraction, cardiac output, and tissue perfusion; decreased ventricular rate
○ Side effects
■ Anorexia, n/v, diarrhea, abdominal pain, headache, blurred or yellow vi-
sion, dizziness, weakness, confusion, visual impairment, anxiety
○ Adverse reactions
■ Bradycardia, hallucinations, bowel necrosis, palpitations
■ Life Threatening:
● Dysrhythmias, thrombocytopenia
○ Therapeutic range:
■ Dysrhythmias: 0.8-2.0
■ HF: 0.5-1.0
○ Toxicity
■ Signs and symptoms: anorexia, diarrhea, n/v, bradycardia (below 60
beats/min), premature ventricular contractions, cardiac dysrhythmias,
headaches, malaise, blurred vision, visual illusions (white, green, or yel-
low halos around objects), confusion, and delirium
■ Lidocaine should be used for short-term treatment
● Nitroglycerin: types, patient teaching, uses, side effects
○ Types:
■ Transdermal patch
● 1 patch qd, allow 10-12 h nitrate free removal
■ Translingual spray
● 1-2 sprays on or under the tongue at onset of attack, may repeat
q5min
■ Sublingual tab
● 1 tab of 0.3, 0.4, or 0.6 mg; repeat q5min x 3 as needed before
strenuous activities
■ PO
 ● 2.5-6.5 mg, 3-4 times/d
■ Topical ointment
● 15-30 mg (2.5-5 cm or 1-2 inches) q6-8h while awake, remove at
bedtime to provide 12-h nitrate free removal
○ Patient teaching
■ Administer SL nitro tablet if chest pain occurs. If pain has not subsided or
has worsened in 5 minutes, call 911.
■ Advise patients not to ingest alcohol while taking nitro to avoid hypoten-
sion, weakness, and faintness
■ Advise patients to notify HCP if chest pain is not completely alleviated.
Tolerance to nitro can occur.
■ Inform patients not to d/c beta blockers and calcium blockers without an
hcp’s approval. Withdrawal symptoms may be severe (reflex tachycardia
and pain).
○ Uses
■ To control angina. AMI, hypertensive emergency, pulmonary edema, and
heart failure
■ MOA: decreases myocardial demand for oxygen; decreases preload by
dilating veins, indirectly decreasing afterload
○ Side effects
■ HA, blurred vision, dizziness, syncope, weakness, diaphoresis, flushing,
n/v, dry mouth, paresthesia, peripheral edema, rash, pharyngitis, toler-
ance
● Table 40.5 Classes, actions, and indications of antidysrhythmic drugs

Classes Actions Indications

Class I
Sodium Channel Blockers

1A Slow conduction and prolong repolariza- Atrial and ventricular dysrhythmias,

tion paroxysmal atrial tachycardia (PAT
supraventricular dysrhythmias

1B Slow conduction and shorten repolariza- Acute ventricular dysrhythmias

tions
Lidocaine Dosage: Uses and considerations:
IV: LD: 1-1.5 mg/kg/LD, follow with 1-4 For ventricular dysrhythmias. May c
mg/min infusion erythema, pruritus, edema, injectio
reaction, petechiae, dizziness, n/v

1C Prolong conduction with little to no effect Life-threatening ventricular dysrhyt

on repolarization
Class II
Beta Blockers Reduce calcium entry Atrial flutter and fibrillation, tachydy
Decrease conduction velocity, automatic- mias, ventricular and supraventricu
ity, and recovery time (refractory period) dysrhythmias

Class III

Drugs that prolong repolar- Prolong repolarization during ventricular Life-threatening atrial and ventricul
ization dysrhythmias rhythmias resistant to other drugs
Prolong action potential duration
Adenosine Route: A: IV: initially 6 mg rapid bolus (1- Uses and considerations:
2s); follow with 12 mg rapid bolus twice if For PSVT and Wolff-Parkinson syn
needed, follow each dose with 20 mL drome. May cause HA, dizziness, f
saline flush; max: 12 mg/dose, 30 mg total ing, dyspnea, hypotension, nausea
paresthesia

Amiodarone hydrochloride Route and dosage: Uses and considerations:

PO: initially 800-1600 mg/d for 1-3 week, For life-threatening vtach and vfib.
then 600-800 mg/d for 1 month; then re- cause corneal deposits, anorexia, n
duce to the lowest effective dose (usually constipation, hypo/hyperthyroidism
400 mg/d) tion site reaction, bradycardia, hypo
IV: 150 mg over 10 min, then 1 mg/min in- sion, and photosensitivity
fusion for 6h; then 0.5 mg/min for 18h;
maintenance: 0.5 mg/min

Dofetilide Route and Dosage: Uses and considerations:

PO: dose is usually individually based on For atrial flutter and fibrillation. May
EKG and renal function tests; max: 1000 HA, dizziness, insomnia, chest pain
mcg/d fection, dyspnea, influenza, tachyca
nausea. Monitor renal function

Ibutilide Route and Dosage: Uses and Considerations:

A >60 kg: IV: 1 mg over 10 min; may re- For atrial flutter and fibrillation. May
peat with 1 mg in 10 min; max 2 mg over HA, palpitations, nausea, tachycard
20 minutes bradycardia, orthostatic hypotensio
A <60 kg: IV: 0.01 mg/kg given over 10 dysrhythmia exacerbation
minutes; may repeat after 10 min if no re-
sponse; max 2 mg in 20 min
Sotalol Route and Dosage: Uses and Considerations:
VTach For atrial flutter and fibrillation and
A: PO: initially 80 mg bid; maint; 160-320 May cause bradycardia, hyperhidro
mg/d; max: 640 mg/d musculoskeletal pain, diarrhea, che
A: IV: initially 75 mg q12h; maint: 150-300 pain, abdominal pain, fatigue, dizzi
mg/d; max 600 mg/d HA, palpitations, weakness, n/v, an
pnea

Class IV
 Calcium channel blockers Block calcium influx Supraventricular tachydysrhythmia
Slow conduction velocity vention of paroxysmal supraventric
Decrease myocardial contractility (nega- tachycardia (PSVTI)
tive inotropic)
Increase refraction in atrioventricular node

Verapamil hydrochloride Route and dosage: Uses and Considerations:

PSVT prophylaxis: Regular release: For angina, cardiac dysrhythmias, P
PO: 240-480 mg/d in 3-4 divided doses and hypertension. May cause perip
edema, constipation, dizziness,
fatigue,weakness, nausea, confusio
HA, blurred vision, ED, bradycardia
orthostatic hypotension

Diltiazem Route and Dosage Uses and Considerations:

PSVT: For angina, PSVT, atrial flutter or fi
A: IV: 0.25 mg/kg IV bolus over 2 minute, hypertension. May cause HA, perip
then after 15 min give 0.35 mg/kg bolus edema, dizziness, weakness, brady
over 2 min if needed, then 10 mg/h infu- dia, hypotension, fatigue, infection,
sion if needed; max: 24 h continuous infu- nea, pharyngitis, rhinitis, constipatio
sion at 15 mg/h and dyspepsia.
Others

Digoxin SEEE ABOVEEEE ITS UP THERE I

PROMISE

Chapter 41

● Different diuretics: types, side effects, uses precautions

○ Thiazide and thiazide like diuretics
■ Used primarily for patients with normal renal function
■ With renal disorder and creatinine clearance < 30 mL/min the effective-
ness is greatly decreased
■ Cause a loss of sodium, potassium, and magnesium
■ Promote calcium reabsorption
■ Use cautiously in adults with DM
■ Monitor electrolytes and glucose
■ Side effects:
● Electrolyte imbalances (hyperkalemia, hypercalcemia, and
hypomagnesemia), hyperglycemia, hyperuricemia, hyperlipidemia
● Dizziness, HA, n/v, constipation, and blood dyscrasias (rare)
■ Contraindications:
● Renal failure
 ● A marked decrease in urine output and elevated blood urea nitro-
gen
● Elevated serum creatinine
○ Loop diuretics
■ Act on the thick ascending loop of Henle to inhibit chloride transport of
sodium into circulation and inhibit passive reabsorption of sodium
■ Sodium and water are lost together with potassium, calcium, and magne-
sium
■ Affect blood glucose and increase uric acid level can
■ Can increase renal blood flow by 40%
■ Furosemide is commonly prescribed for patients whose creatinine clear-
ance is less than 30 mL/min and for those with end stage renal disease
■ Causes excretion of calcium
■ Side effects:
● Fluid and electrolyte imbalances
○ Hypokalemia, hyponatremia, hypocalcemia, hypomagne-
semia, hypochloremia
● Hyperchloremic alkalosis
● Thrombocytopenia, skin disturbances, and transient hearing loss
are rarely seen
■ Furosemide
● Uses: to treat HF, renal dysfunction, HTN, nephrotic syndrome,
and acute pulmonary and peripheral edema
● MOA: inhibit of sodium and water reabsorption from loop of Henle
and distal renal tubules; increases excretion of potassium, chlo-
ride, magnesium, ammonium, phosphate, and calcium
● Side effects:
○ Nausea, anorexia, diarrhea, dizziness, tinnitus, abdominal
cramps, constipation, rash, HA, weakness, blurred vision,
muscle cramps, photosensitivity, paresthesias, injection
site reaction
● Adverse reactions
○ Electrolyte imbalances, hypovolemia, metabolic alkalosis,
thromboembolism, orthostatic hypotension, DM, hyper-
glycemia, hyperuricemia, hypertriglyceridemia, hearing
loss, hypercholesterolemia, gout
● Life threatening reactions:
○ Aplastic anemia, hemolytic anemia, eosinophilia, leukope-
nia, thrombocytopenia, agranulocytosis, steven johnson
● Contraindications
○ Hypersensitivity to anuria
○ Use caution in
■ HF, electrolyte imbalance, DM, orthostatic hypoten-
sion, systemic lupus erythematosus, gout, hearing
 impairment, older adults, breastfeeding, hyper-
uricemia, renal/hepatic disease, thyroid disease
○ Osmotic diuretics
■ Increase the osmolality (concentration) and sodium reabsorption in the
proximal tubule and loop of Henle
■ Mannitol is most commonly prescribed
■ Side effects:
● Fluid and electrolyte imbalance
● Pulmonary edema from rapid shift of fluids
● n/v, tachycardia
■ Contraindications
● Extreme caution with heart disease and HF
● Immediately d/c i the patient develops HF or renal failure
○ Carbonic anhydrase inhibitors
■ Blocks the action of the enzyme carbonic anhydrase which is needed to
maintain the body’s acid-base balance
■ Used primarily to decrease IOP in patients with open-angle glaucoma
○ Potassium-sparing diuretics
■ Weaker than thiazides and loop diuretics
■ Used as mild diuretics or in combination with another diuretics and antihy-
pertensive medications
■ Do not take with potassium supplements
■ Side effects
● Main one is hyperkalemia
● Urine output should be at least 600 mL/day
● HA, dizziness, asthenia, GI disturbances, hyperuricemia, muscle
cramps, paresthesia
○ Thiazide and potassium sparing are most frequently prescribed for hypertension
and for edema associated with HF
○ Except for potassium sparing all diuretics are potassium wasting
● Spironolactone: use, effects, side effects
○ Uses: for edema, HTN, hypokalemia, and hyperaldosteronism
○ MOA: inhibit aldosterone effects on distal renal tubules to promote sodium and
water excretion and potassium retention
○ Side effects:
■ n/v, diarrhea, abdominal cramps, dizziness, drowsiness, HA, confusion,
weakness, muscle cramps, gout, paresthesia, dehydration, ataxia, ED
○ Adverse reactions
■ Hyperkalemia, hypomagnesemia, hyponatremia, hypocalcemia, hypov-
olemia, hyperglycemia, hyperuricemia, orthostatic hypotension, bradycar-
dia, metabolic acidosis/alkalosis
○ Life threatening reaction: Agranulocytosis, leukopenia, thrombocytopenia, renal/
hepatic failure, stevens-johnson
○ Contraindications
 ■Renal failure, hyperkalemia, adrenal insufficiency
■Caution with: Renal/hepatic dysfunction, DM, HF, acid-base imbalance,
acidosis/alkalosis, breastfeeding, pregnancy, older adults
● Drug interactions: interventions
● Labs to monitor
○ Electrolytes
○ Liver and kidney function
○ Uric acid levels
○ Glucose levels
● Electrolytes
● Table 41.3 Physiologic and lab changes associated with loop diuretics

Physiologic/laboratory changes Possible effects of loop diuretics

Physiologic changes

Hypotension Postural (orthostatic) hypotension can result because ECFV

deficit
Ototoxicity Hearing impairment, although rare, may occur. It is more com-
mon with use of ethacrynic acid. Diuretics in other categories a
not considered ototoxic.
CAUTION: avoid taking a loop diuretic with a drug that can be
ototoxic, such as aminoglycosides
Skin disturbances Pruritus, urticaria, exfoliative dermatitis, and purpura may occu
in some persons allergic to the drug or when taking a loop di-
uretic for a long period of time in high doses.

Photosensitivity When exposed to sunlight or a sunlamp for a prolonged time,

severe sunburn could result. Patients should use sunblock and
avoid long sun exposures.
Hypovolemia Excess extracellular fluid is lost through increased urine excre
tion
Laboratory changes

Hypokalemia, hypomagnesemia, hypona- These electrolytes are lost from the body from increased urine
tremia, hypocalcemia, hypochloremia excretion. Chloride, an anion, is attached to the cations potas-
sium and sodium, this chloride i lost along with potassium and
sodium
Hyperglycemia Increased glycogenolysis may contribute to elevated blood glu
cose level. Patients with diabetes should closely monitor blood
glucose level when taking a loop diuretic

Elevated BUN and creatinine These elevations may result from ECFV loss. Hemoconcentra
tion can cause elevated BUN and creatinine levels, which are
versible when fluid volume returns to normal levels
 Hyperuricemia Elevated uric acid levels are common in patients susceptible to
gout
Thrombocytopenia, leukopenia Decreases in platelet and white blood cell counts are rare, but
hey should be closely monitored
Elevated lipids Loop diuretics can decrease HDL and increase LDL. Patients
with elevated cholesterol levels should have their HDL and LD
levels checked. Regardless of the lipid effects, loop diuretics a
useful for patients with serous fluid retention caused by cardia
condition such as HF.

Chapter 42

● Non-pharmacologic interventions
○ Stress reduction techniques, exercise, salt restriction, decrease alcohol inges-
tion, and smoking cessation
● Classes of antihypertensives and their side effects
○ Diuretics
■ Electrolyte imbalances
○ Sympatholytics
○ Direct-acting arteriolar vasodilators
■ Tachycardia, palpitations, edema, nasal congestion, HA, dizziness, lupus-
like symptoms, and neurological symptoms
○ ACE inhibitors
■ Constant irritated cough
● Can be stopped by d/c medication
● Sometimes a need for a different medication is appropriate
■ n/v, diarrhea, HA, dizziness, fatigue, insomnia, serum potassium excess,
tachycardia
○ Angiotensin II-receptor blockers
○ Direct renin inhibitors
○ Calcium channel blockers
■ Flushing, HA, dizziness, ankle edema, bradycardia, and AV block
● Table 42.1 Antihypertensives: Beta blockers and central alpha 2 agonists
○ Clonidine hydrochloride
■ Route and dosage
● A: PO: initially 0.1 mg bid; maintenance: 2.4 mg/d
● A: transdermal patch: initially 1 patch (0.1 mg/24h) q7d
■ Uses and Considerations
● For HTN
● May cause fatigue, drowsiness, dizziness, confusion. HA, irritabil-
ity, nightmares, erythema, infection, anorexia, edema, anxiety, dry
 mouth, n/v, abdominal pain, constipation, bradycardia, orthostatic
hypotension
● Multiple therapeutic effects for certain medications
● Precautions, patient teaching, contraindications, special considerations
● Nursing interventions with adverse reactions

Chapter 43

● Heparin
○ Indications
■ To prevent thromboembolism associated with PE, MI, unstable angina,
prosthetic heart valves and PCI; and to treat DVT, DIC, and acute coro-
nary syndrome
○ Side effects
■ Itching, chills, headache, epistaxis, erythema, hematoma, hematemesis,
hematuria, alopecia, elevated hepatic enzymes, n/v, injection site reac-
tion, priapism
○ Adverse reactions
■ Bleeding, intracranial bleeding, ocular hemorrhage, anemia, bone frac-
tures, osteoporosis, hyperkalemia, Vitamin D deficiency, GI bleeding, hy-
perlipidemia, stroke
■ Life threatening: anaphylaxis, HIT, thrombocytopenia
○ Contraindications
■ HIT, hypersensitivity
■ Caution: peptic ulcer, hepatic/renal disease, hemophilia, DIC, diverticuli-
tis, head trauma, asthma, aneurysm, endocarditis, thrombocytopenia,
older adults, pregnancy, breast feeding
○ Patient teaching
■ Inform their dentist
■ Use a soft toothbrush
■ Shave with an electric razor
■ Monitor PT and INR
■ Carry a medical alert with them
■ Encourage patients not to smoke. Smoking increases metabolism
■ Check with provider before taking OTC medications
■ Inform that herbal medications interact with anticoagulants and may in-
crease bleeding
■ Control external hemorrhage from accidents or injuries by applying firm,
direct pressure for at least 5-10 minutes with a clean, dry, absorbent ma-
terial
■ Warn about frank or occult blood
■ Avoid large amounts of green leafy vegetables, legumes, soybean oil,
coffee, cola, tea, excessive alcohol, and certain herbs and nutritional sup-
plements
 ○ Labs
■ PT/INR
○ Antidotes
■ Protamine sulfate
○ Nursing intervention
■ Monitor vital signs and increased pulse rate followed by a decreased sys-
tolic pressure can indicate a fluid volume deficit resulting from external or
internal bleeding
■ Monitor INR or PT
● Normal levels: 2-3 except for patients with prosthetic heart valves,
then INR up to 3.5
■ Examine patient’s mouth, nose, urine, and skin for bleeding
■ Check stools for occult blood
● Warfarin
○ Indications
■ To prevent thrombosis associated with PE, MI, unstable angina, pros-
thetic heart valves, DVT, and PCI; to treat afib
■ MOA: inhibits hepatic synthesis of vitamin k clotting factors and anticoag-
ulant proteins
○ Side effects
■ HA, alopecia, fever, weakness, priapism, petechiae, ecchymosis
○ Adverse reactions
■ Purple-toe syndrome, bone fracture, hypotension, chest pain, hematuria,
ocular hemorrhage, intracranial/vaginal/GI bleeding
■ Life threatening: hemorrhage
○ Contraindications
■ Hematologic disorders, eclampsia, alcohol abuse, stroke, bleeding, head
trauma, aneurysm, psychosis
■ Caution: DM, leukemia, anemia, thyroid disease, hepatic and renal im-
pairment, peptic ulcer, afib, heart failure, cerebrovascular disease, bresat-
feeding
○ Patient teaching
■ Inform their dentist
■ Use a soft toothbrush
■ Shave with an electric razor
■ Monitor PT and INR
■ Carry a medical alert with them
■ Encourage patients not to smoke. Smoking increases metabolism
■ Check with provider before taking OTC medications
■ Inform that herbal medications interact with anticoagulants and may in-
crease bleeding
■ Control external hemorrhage from accidents or injuries by applying firm,
direct pressure for at least 5-10 minutes with a clean, dry, absorbent ma-
terial
 ■ Warn about frank or occult blood
■ Avoid large amounts of green leafy vegetables, legumes, soybean oil,
coffee, cola, tea, excessive alcohol, and certain herbs and nutritional sup-
plements
○ Labs
■ PT/INR
○ Antidotes
■ Vitamin K
○ Nursing intervention
● Monitor vital signs and increased pulse rate followed by a de-
creased systolic pressure can indicate a fluid volume deficit result-
ing from external or internal bleeding
● Monitor INR or PT
○ Normal levels: 2-3 except for patients with prosthetic heart
valves, then INR up to 3.5
● Examine patient’s mouth, nose, urine, and skin for bleeding
● Check stools for occult blood
● Clopidogrel
○ Indications
■ To prevent thromboembolism associated with unstable angina, AMI,
stroke, TIA
■ MOA: inhibits platelet aggregation and prevents ADP from binding with
the ADP platelet receptor
○ Side effects
■ Abdominal pain, dizziness, confusion, epistaxis, HA, hematoma,
dyspepsia, diarrhea, constipation, purpura, peripheral edema, rash,
pruritus
○ Adverse reactions
■ Hypotension, HTN, bronchospasm, bleeding, peptic ulcer, intracranial/ GI
bleeding
■ Life threatening: agranulocytosis, aplastic anemia, thrombocytopenia,
pancytopenia, hepatic failure, steven johnson
○ Contraindications
■ Intracranial hemorrhage, GI bleeding
■ Caution: hepatic/ renal disease, surgery, peptic ulcer, thrombotic throm-
bocytopenic purpura, trauma, older adults, pregnancy, breast feeding.
○ Labs
■ PT/ INR
■ Prolongs bleeding time
○ Antidotes
● Thrombolytics: contraindications, indications, assessment, interventions
○ Assessment
■ Assess baseline vital signs for comparison with future values
■ Check baseline CBC, PT, INR
 ■ Obtain a medical and drug history
○ Contraindications
■ Active bleeding, severe hypertension, anticoagulant therapy,
■ Recent history of traumatic injury, especially head injury
■ Interventions
● Monitor vital signs. Increased pulse rate followed by decreased
blood pressure usually indicates blood loss and impending shock.
Record vital signs and report changes
● Observe for signs of active bleeding from the mouth or rectum.
Hemorrhage is a serious complication of thrombolytic treatment.
● Aminocaproic acid can be given to stop bleeding
● Examine the patient for active bleeding for 24 hours after throm-
bolytic therapy has been d/c. This should be done every 15 min-
utes for the first horus, every 30 minutes until the 8th hour and
then hour
● Observe for signs of allergic reaction to thrombolytics such as itch-
ing, hives, flushing, fever, dyspnea, bronchospasm, hypotension,
and/or cardiovascular collapse
● Avoid aspirin or NSAIDs for pain or discomfort. Use ac-
etaminophen
● Monitor the EKG for presence of reperfusion dysrhythmias as the
blood clot is dissolving
● Avoid venipuncture and arterial sticks
■ Indications
● Blood clot in artery or vein
● Table 43.2 Comparison of Parenteral and Oral anticoagulants

Factors to Consider Heparin Warfarin (Coumadin)

Methods of Administration Subcutaneously Primarily orally
Intravenously
Drug actions Binds with antithrombin III, which in- Inhibits hepatic synthesis of vit
activates thrombin and clotting fac- K, which decrease prothrombin
tors, inhibiting fibrin formation clotting factors VII, IX, and X

Uses Treatment of venous thrombosis, PE, Treatment of DVT, PE, TIA; pro
thromboembolic complications (heart lactic for cardiac valves
surgery, DIC)

Contraindications/cautions Hemophilia, peptic ulcer, severe Hemophilia, peptic bleeding ulc

(stage 3 or 4) HTN, severe liver or re- blood dyscrasias, severe liver o
nal disease, dissecting aneurysm ney disease, AMI, alcoholism
 Lab tests PTT: 60-70 s PTT: 11-15 s
Anticoagulant therapeutic level: 1.5-2 Anticoagulant therapeutic level
x control in seconds 1.25-2.5 x control in seconds
aPTT: 20-35 s INR: 1.3-2
Anticoagulant: aPTT 30-85 s Anticoagulant: INR 2-3
Prosthetic heart valves: INR up
3.5
Side effects/ adverse reactions Bleeding, hemorrhage, hematoma, Bleeding, hemorrhage, GI blee
severe hypotension ecchymoses, hematuria

Antidote Protamine sulfate Phytonadione (vitamin K)

● Table 43.3
○ Aspirin
■ Thromboembolism prophylaxis
■ A: PO: 75-100 mg/d
■ TDM: salicylate toxicity is >300 mcg/mL
■ Uses and considerations
● For prevention and treatment of stroke; MI; TIA, prosthetic heart
valves, and thromboembolism prophylaxis.
● May cause abdominal pain, nausea, dyspepsia, gastritis, GI
bleeding, intracranial bleeding, epistaxis
○ Clopidogrel
■ See above

Chapter 44

● Labs to consider
○ Serum cholesterol
○ Serum triglycerides
○ If levels are high then a 12-14 hour lipid panel may be ordered
○ Table 44.1 Serum lipid values

Lipid Desirable (mg/ Low Risk (mg/dL) Moderate Risk High Risk (mg/
dL) (mg/dL) dL)
Cholesterol 150-200 200 200-240 >240
Triglycerides 40-150 Varies with age Varies with age >190
Lipoproteins

LDL <100 100-130 130-159 >160

HDL >60 50-60 35-50 <35
 ● Non-pharmacologic interventions
○ Total fat intake should be 30% or less of calorie intake
○ Cholesterol intake should be 300 mg/day or less
○ Read labels and containers to buy appropriate foods
○ Should choose lean meats such as chicken or fish
○ Exercise is important aspect to reduced cholesterol and increase HDL
■ Older adults can bike or walk
○ Smoking is another risk factor that should be eliminated
■ Smoking increases LDL and decreases HDL
● Statins: side effects, adverse reactions, indications, patient teaching
○ Side effects/adverse reactions
■ Constipation
● Increase fluids and eat high fiber foods
■ Peptic ulcer
● Early signs= nausea and abdominal discomfort
○ Patient teaching
■ Get an annual eye exam because cataracts can form
■ Monitor liver enzymes
■ Immediately report weakness or muscle aches as this could be rhabdo
○ Table 44.3 Antihyperlipidemics
Drug Dosage and Route Uses and considerations
Gemfibrozil A: PO: 600 mg bid 30 min before morn- For hyperlipoproteinemia and hypertrigly
ing and evening meals; max: 1200 mg eridemia. May cause drowsiness,
daily headache, weakness, nausea, diarrhea,
constipation, abdominal pain, cholelithia
sis, back pain, and elevated hepatic en-
zymes.
Fluvastatin Regular release For hypercholesterolemia. May cause
A: PO: initially 20-40 mg daily; mainte- headache, nausea, abdominal pain, dys
nance: 20-80 mg daily; max: 40 mg qd pepsia, diarrhea, hypertension, myalgia,
peripheral edema, influenza, arthralgia,
constipation, and elevated hepatic en-
zymes
Lovastatin Immediate release For hypercholesterolemia. May cause
A: PO: initially 10-20 mg qd with evening headache, sinusitis, infection, arthralgia,
meal; max 80 mg daily nausea, abdominal pain, diarrhea, const
Extended release pation, flatulence, influenza, weakness,
A: PO: 20-60 mg qd at bedtime; max: 60 back pain, and myalgia
mg qd
Pravastatin sodium A: PO: initially 40 mg daily; maintenance: For hypercholesterolemia. May cause
10-80 mg daily; max: 80 mg daily headache, dizziness, dyspepsia, flatu-
lence, n/v, diarrhea, fatigue, and muscu-
loskeletal pain
Rosuvastatin A: PO: 5-10 mg qd; maintenance 5-40 For hypercholesterolemia. May cause
mg/d; max: 40 mg qd dizziness, headache, nausea, constipa-
tion, diarrhea, abdominal pain, arthralgia
myalgia, and dyspepsia

Simvastatin A: PO: initially 10-20 mg mg qd at hs; For hypercholesterolemia. May cause

maintenance: 5-40 mg daily in the headache, edema, insomnia, nausea,
evening; max: 40 mg daily myalgia, abdominal pain, constipation,
atrial fibrillation, and infection

Pitavastatin A: PO: initially 2 mg qd; max 4 g daily For hypercholesterolemia, hyperlipopro-

with food teinemia, and hypertriglyceridemia. May
cause headache, myalgia, back pain, co
stipation, diarrhea, arthralgia, and abdom
inal pain
○
● Atorvastatin
○ Use: to decrease cholesterol levels and serum lipids, especially LDL and triglyc-
erides; for treatment of atherosclerosis, hypercholesterolemia, hyperlipoproteine-
mia, and hypertriglyceridemia
○ MOA: inhibits HMG-CoA reductase, the enzyme necessary for hepatic production
of cholesterol
○ Side effects
■ Dizziness, insomnia, memory impairment, flushing, nightmares, blurred
vision, weakness, myalgia, dyspepsia, nausea, diarrhea, flatulence, ab-
dominal pain, peripheral neuropathy
○ Adverse reactions
■ Rhabdomyolysis (rare), tendon rupture hyperglycemia, diabetes mellitus
■ Life threatening: hepatic/renal failure, stroke, leukopenia, hemolytic ane-
mia, thrombocytopenia
○ Contraindications
■ Hepatic disease/ encephalopathy, cholestasis, pregnancy, breastfeeding
■ Caution: alcohol use disorder, diabetes, seizures, renal impairment,
stroke, hypotension, hypothyroidism, electrolyte imbalance, rhabdomyoly-
sis, older adults

● Cilostazol: prototype drug chart

○ Uses: to treat peripheral vascular disease and claudication
○ MOA: acts directly to inhibit platelet aggregation and cause vasodilation, espe-
cially in femoral vasculature
○ Side effects
■ Dizziness, headache, nasopharyngitis, rhinitis, cough, dyspepsia, myal-
gia, flushing, nausea, vomiting, flatulence, diarrhea, melena, and abdomi-
nal pain, peripheral edema, infection, influenza, cholelithiasis
○ Adverse reactions
 ■ Tachycardia, palpitations, angina, HF, MI, hypo/hypertension, peptic ul-
cer, gout, diabetes mellitus, elevated hepatic enzymes
■ LIfe-threatening: thrombocytopenia, leukopenia, aplastic anemia, agranu-
locytosis, dysrhythmias, steven johnson syndrome
○ Contraindications
■ Heart failure, hypersensitivity, bleeding disorders
■ Caution: hepatic and renal disease, tobacco smoking, cardiovascular dis-
ease, dysrhythmias, pregnancy, breastfeeding, older adults