1. Bile Acid Sequestrants

Action: Bind bile acids in the intestines with cholesterol so that the molecules are too big to absorb and get eliminated through stool.

S/E: Nausea, vomiting, diarrhea, constipation, bloating

Nursing considerations:

• powdered-need to dilute
• affects absorption of other drugs (take 2hrs before or 4hrs after
• may need to tak vitamin supplements
• need to be cautious with patients with GI problems
• Adequate fluids and "bulk" in the diet can help with GI problems.

Action: unknown, but result is decreased production of triglycerides, lower VLDL, elevated HDL.  May cause slight increase in LDL

S/E: Rash, Gallstones, muscle pain or weakness

Nursing considerations:

• Given with meals to decrease GI symptoms
• Monitor closely with patients that are on blood thinners (can increase effect)
• Muscle pain and weakness can be increase when patients are taking statins as well.

Action: unknown but often used with other meds.  Causes lower VLDL, LDL, increased HDL and triglycerides.

S/E: GI problems, Gout, flushing, pruritis, Hyperglycemia, Hepatotoxicity.

Nursing considerations:

• 1500-1300mg dose for cholesterol vs 25mg as vitamin
• take with meal or after with cold water
• Most troublesome side effect is the pruritis and erythemia (can take Aspirin 30 min prior to help)

Action: inhibits the enzyme that is part of the process of cholesterol production.  Lowers LDL, triglycerides, increases HDL.

S/E: Indigestion, cramping, flatulence, constipation, myopathy (muscle pain,

weakness), liver dysfunction.

Nursing considerations:

• Taken at bedtime because that is when cholesterol is manuf. except for Lipitor and Crestor.
• Patients with known liver disease would either not be put on this drug or will be monitored carefully.

Action: Decreases absorption of cholesterol through the intestines.  Lowers LDL, triglycerides and increases HDL.

S/E:Joint pain, back pain, diarrhea, sinusitis, sometimes headaches, chest pain, dizziness if used with statins.

Nursing considerations:

• Do not take with bile acid sequestrants
• Caution in patients with liver/kidney problems
• Can be taken with other lipid medications. 

• Bile Acid Sequestrants
• Fibric Acid
• Nicotinic Acid
• Statins
• Zetia

• Diuretics
• Beta Adrenergic Blockers
• Calcium Channel Blockers
• Angiotensin Converting Enzyme (ACE) Inhibitors
• Angiotensin II receptor blockers (ARB)
• Aldosterone receptor blockers
• Central Alpha2 Agonists
• Arterial Vasodilators
• Alpha Adrenergic receptor agonists

Action: pulls water/sodium back into vascular space, increases urine production

S/E:  hyperglycemia, vasodilation, electolyte imbalances, gout, nausea, vomiting, diarrhea

Nursing Considerations:

• Will cause loss of potassium and magnesium
• Has effect on hypoglycemic agents
• Contraindication in patients with renal failure

Action: Inhibits sodium/water resorption

S/E: nause, increased urination, hypotension, ototoxic (if given IV push to fast).

Nursing Considerations:

• Take with food to decrease nausea
• Do not give at bedtime because of increased urination
• Will cause potassium loss-hypokalemic, will need to be on potassium supplement.
• Monitor I&O, and electrolyte levels.
• Monitor carefully at the start of therapy-patient will be more hypotensive at the beginning

Action: reduces sodium (water) resorption but spares potassium.  Weaker than other diuretics

S/E: By itself-kyperkalemia, photo sensitivety, rash, dizziness, GI problems.

Nursing Considerations:

• Watch electrolyte levels
• Monitor for symptoms of agranulocytosis (rash, fever, sore throat)
• Monitor vitals and I&O

Action: Selective (heart) Non-selective (heart & lungs) decreases L ventricle contraction, slows heart rate, decreases renin release.

S/E: Dyspnea, wheezing, hypotension, bronchospasm, rebound hypertension if stopped, insomnia, depression, nightmares, angina, fatigue, sexual dysfunction, exercise intolerance.

Nursing Considerations:

• Monitor HR and BP-check orders (may have an "...if less than 60 hold medication)
• Selective beta blockers can have respiratory effect at higher doses but unlikely.

Action: Limits the amount of calcium entering the cell (controls muscle contraction) can treat dysarrythmias. Dihydrophyredines- action on blood vessels. Nondihydropyridines- action on blood vessels and heart.

S/E: headache, dizziness, bradycardia, constipation, pedal edema, hypotension, reflex tachycardia

Nursing Considerations:

• Patient may need to be placed on stool softeners
• Vasodilation causes edema in lower extremities
• Monitor BP

Action: Blocks Angiotensin I from converting to Angiotensin II.  Inadvertly blocks Renin, vessels remain vasodilated, reduction in vascular resistance, increased sodium/water loss.

S/E: cough (persistant), headaches, dizzyness, hypotension (right at the start of treatment)

Nursing Considerations:

• Cough may be bad enough to stop therapy.
• Monitor BP
• Will need to ask for help getting up at the beginning of therapy.

Action: decreases peripheral vascular resistance.

S/E: Can cause angioedema(swelling face, throat), dizziness, diarrhea.

Nursing Considerations:

• This would be the drug that patients are moved to if side effects of ACE inhibitors don't work.

Action: prevents aldosterone from binding to receptors in the kidneys, reduces sodium and water retention.

S/E: headache, dizziness, hyperkalemia, nausea

Nursing Considerations:

• fairly new classification

Action: decreases sympathetic effect on vessels, decreases norepinephrine and epinephrine, decreases cardiac output.

S/E: drowsiness, dizziness, bradycardia, rebound hypertension, can develop edema from sodium/water retention.

Nursing Considerations:

• Not used much anymore.

Action: relaxes the smooth muscle of the arteries (dilates)

S/E: tachycardia, palpitations, headache nasal congestion, fluid retention, decreased kidney perfusion, edema.

Nursing Considerations

• Not used much, except for in emergencies
• Hyperstat and Nipride  have immediate actions with 2 minute half-life
• Light sensitive (bottle has to be wrapped in aluminum foil.
• Patient needs constant BP monitoring with arterial line.
• May cause apreapism (sustained, painful erection)

Action: Blocks sympathetic receptors, vasodilation

S/E: nausea, drowsiness, edema, nasal congestion, orthostatic hypotension.

Nursing Considerations:

• Not typically a first line drug-low effectiveness in reducing CV complications.
• Monitor vital signs and urine output.

Beta Adrenergic Agonists (Ultra short, short, intermediate, and long acting)

Anticholinergics

Methylxanthines

Immediate Onset 2-3 hr duration

Isuprel-metered dose or IV

Bronkosol-nebulizer

Rapid with longer duration 5-6 hrs

Might be given 4x daily

Alupent

Brethine

Maxair

Rapid onset with 8 hr duration

Proventil-inhalor

Xopenex-nebulizer (may be maintenance)

Tornalate

Fairly rapid onset (30min-1hr) wht 12hr duration

Serevent-not for acute exacerbation

Causes smooth muscle relaxation

selective-effect on lungs

non selective-lungs and heart

take before glucocorticoids or anti-inflammatory

need to monitor vitals, listen to breath sounds, limit caffeine, know what side effects to look for, inhale slowly and hold breath, wait 10 min between puffs, hold mouth open when taking meds or use spacer.

Blocks parasympathetic nervous system, leads to bronchodilation

S/E: rarely seen, dry mouth, GI problems, bitter taste

Used to treat chronic asthma, not acute

Monitor BP, P, and lung sounds

Spiriva is a capsule that you put in a "Handi-haler" device

Action: relaxation of smooth muscle, stimulates respiratory center

S/E: nausea, vomiting, diarrhea, restlessness, tachycardia, dizziness, irritability

Nursing Considerations:

• Not used much because of bronchodilators except for in an emergency.
• Aminophylline is given for status asthmaticus because of it's rapid effect.

Action: Blocks leukotrienes (end stage of inflammation) in airways.

S/E: headaches, cough, nasal congestion

Nursing Considerations:

• Not a good choice for rescue meds (not a bronchodilator)
• Used as maintenance drug
• Not used in patients with liver problems.

Anti-inflammitory

Need to use bronchodilators first

Patient may develop thrush from puffer medication, may have order for Nystatin

Solumedrol, methylprednisalone,

Decreases inflammation by inhibiting histamine

Maintenance-short half life-may have to take 4-6 times a day.

Intal-puffer, also inernasal

Tilade-puffer