Pilocarpine

(Pilocar)

-Cholinergic Agonist

-used in glaucoma

-miosis

-driving, darkness, fall hazards

Bethanechol

(Urecholine)

-Cholinergic Agonist

-Urinary/GI tracts

-helps void

-Contraindicated in asthma

-Nicotinic Agonist

-helps stop smoking

-don't smoke when on it

MI

-cholinergic antagonist

-given in bradycardia, asystold, pre op (decrease secretions)

-blurred vision, urinary retention

-don't give with myasthenia gravis

-asthma sulfite allergy

-Anticholinergic

-CNS depression with sedative and tranq.

-motion sickness

Ipratropium 

(Atrovent)

- anticholinergic

-tx of asthma, COPD, rhinitis

-inhaled

Oxybutynin (Ditropan)

Tolterodine (Detrol)

-anticholinergic

-tx of overactive bladder and incontinence

Epinephrine

(Adrenalin)

- Nonselective Adrenergic Agonist

-anaphylaxix, cardiac arrest

-Contraindicated in glaucoma, labor, pregnancy

-Epipen

-Monitor vitals, give in large vein, monitor glucose

Ephedrine 

(Sudaphed)

-Nonselective Adrenergic Agonist

-OTC bronchodilators/decongestants

-methamphetamines

Norepinephrine

(Levophed)

-Nonselective Adrenergic Agonist

-NO beta-2

-STRONG alpha-1

-severe HTN

"Levophed or leave them dead"

Phenylephrine 

(Neo-synephrine)

-Alpha-1 Adrenergic Agonist

-nasal congestion, shock, hypotension

-OTC decongestant

-avoid MAOIs

Dopamine

(Intropin)

-Beta Adrenergic Agonist

-Dose dependant

-low=  inc. renal perfusion, inc. urine

-med= inc. hr, contrac., CO

-high= vc

-correct hypovolemia and acidosis  first

-large vein

-Regitine if extravasation

Dobutamine

(Dobutrex)

-Beta 1 adrenergic agonist

- ^ contractility

Isoproterenol

(Isuprel)

--Beta adrenergic agonist

Terbutaline

(Brethine)

-beta-2 adrenergic agonist

-asthma

-delays preterm labor

Fenoldopam

(Corlapam)

-Dopamine Agonists

-vasodilation

-severe HTN, renal impairment

Prazosin

(minipress)

-osin

-Alpha adrenergic antagonists

-vd

-HTN

-watch for O.H

-take first dose at bedtime

-avoid alcohol, driving

Phentolamine

(Regitine)

-alpha adrenergic antagonists

-use: raynaud's, prevents necrosis from extravasation

Propranolol 

(Inderal)

-lol

beta blockers

nonselective

bronchoconstriction

hypoglycemia

don't give in bradycardia

Metoprolol

(Lopressor, Toprol XL)

Selective beta blockers

check hr & bp

hold for SBP under 100 and HR 50-60

Carvedilol 

(coreg)

diet mod., weightloss, exercise

drug therapy= lifelong

must have follor up to see effectiveness

decrease volume

thiazide= first choice

decrease CO and flow

block renin release

uses of diuretics

give drug in AM

avoid ^ Na foods

measure I/O

weigh daily

for thiazide and loop diuretics: foods ^ in K- green leafy veggies

K-sparing diuretics: avoid high K foods

report 3lbs gain in a day

monitor Na, K, Mg, Ca leves

assess for hyponatremia (wt loss, weakness), hypokalemia (irreg pulse, arrhythmias), hyperkalemia (arrhythmias)

Hydrochlorothiazide

(Hydrodiuril)

Thiazides

-distal tubule

^ Na and K excretion

allergy to sulfa

many drug interactions

more affective in AA

Furosemide

(Lasix)

loop of henle

inhibits reabsorption of Na, H20 Cl

K, Mg, Ca are excreted

PO or IV

sulfa allergy

AE: ototoxicity- give slowly to avoid

Aminoglycoside antibiotic interaction

Spironolactone

(Aldactone)

Potassium sparing diuretics

blocks aldosterone in distal nephron

combo w/ thiazide or loop

MONITOR: hyperkalemia: ^T-waves, bradycardia, widened QRS 

avoid high K

Triamterene

(Dyrenium)

potassium-sparing diuretic

Na and H2O excretion in distal tubule

combo w/ loop or thiazide

MONITOR: hyperkalemia

Mannitol

(Osmitrol)

Osmotic Diuretics

^ osmotic pressure, pulls fluid into vascular space, prevents reabsorption of H2O, Na, Cl

USED: acute renal failure, cerebral edema

Assess hourly urine output: FOLEY

Amlodipine

(Norvasc)
Nifedipine

(Procardia)

dihydropyridines

calcium channel blocker- decreases smooth muscle contraction

EFFECTS: vd of peripheral, decreases contractility

does not usually affect HR, or AV

Captopril

(Capoten)

-pril

ACE

promotes Na and H2O excretion

decreases PVR

FOOD- decreases absorption

ACE inhibitiors

-pril

used: HTN

AE: chronic cough, hyperkalemia, renal failure, fetal injury

SERIOUS AE: angioedema

CONTRAINDICATED: pregnancy

Losartan

(Cozaar)

-sartan

Angiotensin II receptor blocker

HTN, HF, MI, CVA prevention

vasodilation

AE: angioedema, fetal harm, RF

Eplerenone (Inspra)

Spironoloactone (Aldactone)

Selective Aldosterone blocker

HTN, heart failure

MAJOR AE: Hyperkalemia

avoid K and salt substitutes

Labetalol

(Normodyne)

alpha (1) & beta blocker (1&2)

used: severe HTN

Clonidine

(Catapress)

Alpha-2 agonists

inhibits SNS, NE

decreases vc and bp

DO NOT: stop suddenly, causes rebound HTN

Hydralazine

(Apresoline)

direct acting vasodilator

reflex: ^hr & CO

increases renin

SERIOUS AE: symptoms of Lupus (SLE), arthralgia, dermatoses, fever, slenomegaly, glomerular nephritis

Minoxidill

(Loniten, Rogaine)

direct acting vasodilator

common effect: ^ hair growth

Nitroprusside

(Nipride)

treat HTN crisis

relaxes vascular smooth muscle

IV INFUSION: sensitive to light, must cover- faint brownish tint

CYANIDE toxicity: bright red venous blood, meta. acidosis, air hunger, confusion

Carvedilol

(Corgeg)

nonselevtive beta & alpha blocker

USED: chronic CHF

Cardiac Glycoside

(Digoxin- Lanoxin)

^ FOC, decreases AV & SA node conduction- dec. HR, increases CO and renal perfusion

USE: CHF, AFib

NORMAL DOSE: .125-.25 mg daily

REDUCED: elderly .125 daily, renal impairment .135 daily

ANTIDOTE: digoxin immune (Digiband)

monitor apical for 1 minute

HOLD for hr less than 60

DIG level: .5-2 ng/ml

Nesiritide

(Natrecor)

Natriuretic Peptides

Use: acute decompensated HF

Effect: decreases preload

Contraindications: SBP <90

Most common AE: hypotension

Monitor: heart rhythm, QT interval, BP, HR

Teach: IV site itches

Inamrinone

(Inocor)

Milrinone

(Primacor)

Phosphodiesterase inhibitors

^ FOC, decrease preload and aferload, increasing CO

tx of angina

relaxes vascular smooth muscle

Most common AE: h/a

1 tab/spray x 3...5 mins apart

Sublingual: avoid moisture

TD: remove patch 10-12 hours daily

prevents vasospasm (prinzmetal angina)

decreases afterload

lowers myocardial oxygen needs

Ranolazine

(Ranexa)

tx of chronic angina

AE: prolong QT interval

REDUCE: dose of digoxin

AVOID: grapefruit juice

Quinidine

(Quinaglute)

Lidocaine

(Xylocaine)

tx of ventricular arrhythmias

toxicity: seizures

Amiodarone

(Cordarone)

prolongs refractory, decreases HR and SA and AV node

SERIOUS AE: pulmonary toxicity

Verapamil

(Calan)

calcium channel blocker

decreases SA node, depresses contractility

WATCH FOR: bradycardia, hypotension, CHF

give slowly- IV push-5-10 mg/ 2 minutes

Adenosine

(Adenocard)

decreases automaticity

Can CAUSE: transient heart block

GIVEN: IV bolus then saline flush rapidly due to short half life

Sodium polystryrene sulfonate

(Kayexalate)

Potassium-removing resins

tx for hyperkalemia

Anticoagulant

prevents thrombus formation and extension of existing thrombus

IV bolus

Dosing= weight based

Monitor APTT (activated partial thromboplastin time- 1.5-2 x)

ANTIDOTE: protamine sulfate

CONTRA: allergy to beef/pork

DOUBLE CHECK DRUG CONCENTRATION

Enoxaparin

(Lovenox)

Warfarin

(Coumadin)

Vitamin K

(Aquamephyton)

Clopidegril

(Plavix)

Acetylsalicyclic acid 

(Aspirin)

MOST COMMON AE: bleeding

OVERDOSE: tinnitus

Tirofiban 

(Aggrastat)

Eptifibotide

(Integrillin)
Abcliximab 

(Reopro)

Alteplase

(Activase)
Retavase

(TNKase)