Term
| HMG-CoA Reductase Inhibitors/Statins |
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Definition
•Prototype drug: atorvastatin (Lipitor)
•Mechanism of action: inhibits HMG-CoA reductase; reduces synthesis of cholesterol
•Primary use: Reduces serum-lipid levels; first drugs of choice to reduce blood-lipid levels
•Adverse effects: headache, fatigue, muscle or joint pain, and heartburn, rhabdomyalysis (rare, but very serious; muscle damage)
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Term
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Definition
•Prototype drug: cholestyramine (Questran)
•Mechanism of action: bind with bile acids; prevent enterohepatic reabsorption of bile salts (cholesterol)
•Primary use: to lower serum-lipid levels; frequently used in combination with statins
•Adverse effects: GI tract, such as bloating and constipation
•Can bind other drugs, or alter clearance of other drugs increasing potential for drug interactions
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Term
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Definition
•Prototype drug: gemfibrozil (Lopid)
•Mechanism of action: increase clearance (removal from body) of VLDL particles & consequently decrease triglyceride levels
•Primary use: treating severe hypertriglyceridemia; drugs of choice for treating severe hypertriglyceridemia
•Adverse effects: GI distress, watch for bleeding with clients on anticoagulants
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Term
| Cholesterol Absorption Inhibitor |
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Definition
•Prototype drug: ezetimibe (Zetia)
•Mechanism of action: inhibits absorption of cholesterol
•Primary use: modest reduction in LDL
•Adverse effects: none
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Term
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Definition
•Prototype drug: niacin
•Mechanism of action: decreases VLDL levels (primary effect), & consequently LDL levels; also decreases triglycerides & increases HDL levels
•Primary use: to reduce triglycerides; increase HDL levels
•Adverse effects: flushing, hot flashes, nausea, excess gas, diarrhea; can increase fasting glucose levels
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Term
Angiotensin-converting enzyme (ACE) inhibitors
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Definition
–Prototype drug: enalapril (Vasotec)
–Mechanism of action: blocks conversion of angiotensin I into angiotensin II; decreases blood pressure
–Primary use: for hypertension
–Adverse effects: persistent cough and hypotension
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Term
Angiotensin-receptor blockers (ARBs)
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Definition
–Prototype drug: losartan potassium (Cozaar)
–Mechanism of action: blocks angiotensin receptors in arterial smooth muscle and adrenal glands
–Primary use: for hypertension
–Adverse effect: hypotension
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Term
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Definition
•Prototype drug: furosemide (Lasix)
•Mechanism of action: to increase urine flow, reducing blood volume and cardiac workload
•Primary use: to reduce edema and pulmonary congestion
•Adverse effects: dehydration, electrolyte imbalance, hypotension, ototoxicity
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Term
| Thiazide & Thiazide-like Diuretics |
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Definition
•Prototype drug: hydrochlorothiazide (HydroDiuril).
•Mechanism of action: to increase amount of urine produced and excreted
•Primary use: for mild to moderate hypertension
•Adverse effects: electrolyte imbalances, especially loss of potassium
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Term
| Potassium-sparing Diuretics |
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Definition
•Prototype drug: spironolactone (Aldactone).
•Mechanism of action: aldosterone antagonist; increases amount of urine produced and excreted
•Primary use: reduce mortality in heart failure (has only weak diuresis); also used to treat hyperaldosteronism
•Adverse effects: hyperkalemia
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Term
| Carbonic anhydrase inhibitor Diuretics |
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Definition
•Prototype drug: acetazolamide (Diamox).
•Mechanism of action: inhibits carbonic anhydrase
•Primary use: decrease intraoccular fluid pressure in glaucoma; not commonly used as diuretics
•Adverse effects: metabolic acidosis
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Term
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Definition
•Prototype drug: nifedipine (Procardia)
•Mechanism of action: selectively blocks calcium channels in myocardial and vascular smooth muscle; causes vasodilation & coronary vasodilation (lowers oxygen consumption by heart), increases cardiac output, decreases B/P
•Primary use: for hypertension and angina
•Adverse effects: include dizziness, headache, flushing
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Term
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Definition
•Prototype drug: hydralazine (Apresoline)
•Mechanism of action: to cause vasodilation by direct relaxation of arterial smooth muscle
•Primary use: for severe hypertension and hypertension crisis
•Adverse effects: reflex tachycardia, sodium and fluid retention
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Term
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Definition
•Prototype drug: lisinopril (Prinivil, Zestril)
•Mechanism of action: to enhance excretion of sodium and water; decrease afterload
•Primary use: drug of choice for heart failure; lower blood pressure and peripheral resistance in hypertension & in heart failure
•Adverse effects: first-dose hypotension, cough, hyperkalemia, renal failure
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Term
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Definition
•Prototype drug: carvedilol (Coreg)
•Mechanism of action: to slow heart rate and decreases blood pressure, reducing work of heart
•Primary use: to reduce symptoms of heart failure and slow progression of disease
•Adverse effects: fluid retention, worsening of heart failure, fatigue, hypotension, bradycardia, heart block
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Term
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Definition
•Prototype drug: isosorbide dinitrate (Isordil)
•Mechanism of action: to relax blood vessels; decrease afterload
•Primary use: to lower blood pressure in heart failure
•Used for clients who cannot take ACE inhibitors
•Adverse reactions: reflex tachycardia, orthostatic hypotension
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Term
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Definition
•Prototype drug: digoxin (Lanoxin)
•Mechanism of action: inhibits Na-K-ATPase, indirectly causing more calcium to be available inside myocardial cell, causing more forceful contraction
•Primary use: to increase contractility or strength of myocardial contraction in heart failure
•Adverse effects: neutropenia, dysrhythmias, digitalis toxicity
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Term
| Phosphodiesterase Inhibitors |
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Definition
•Prototype drug: milrinone (Primacor)
•Mechanism of action: to block enzyme phosphodiesterase in cardiac and smooth muscle; prolong life of cAMP, increase myocardial contractility
•Primary use: as short-term therapy for heart failure
•Adverse effects: hypokalemia, hypotension, ventricular dysrhythmias
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Term
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Definition
•Prototype drug: nitroglycerin (Nitrostat)
•Mechanism of action: potent vasodilator; directly relaxes vascular smooth muscle
•Primary use: for lowering myocardial oxygen demand; Tx of angina
•Adverse effects: hypotension, dizziness, blurred vision, dry mouth, headache
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Term
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Definition
•Prototype drug: atenolol (Tenormin)
•Mechanism of action: beta-adrenergic receptor antagonist; reduce the cardiac workload
•Primary use: for prophylaxis of chronic angina
•Adverse effects: hypotension, dizziness, fatigue during exercise
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Term
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Definition
•Prototype drug: diltiazem (Cardizem)
•Mechanism of action: reduce calcium influx into vascular smooth muscle, dilating vessels; reduce cardiac workload
•Primary use: for lowering blood pressure
•Adverse effects: hypotension, bradycardia, heart failure, constipation
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Term
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Definition
•Prototype drug: reteplase (Retavase)
•Mechanism of action: dissolve clots that obstruct coronary arteries
•Primary use: for restoring circulation to myocardium in clients with myocardial infarction
•Adverse effects: excessive bleeding
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Term
| Sodium-Ion-Channel Blockers (Class I) |
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Definition
•Prototype drug: procainamide (Pronestyl)
•Mechanism of action: to block sodium-ion channels, which slows rate of impulse conduction across heart
•Primary use: to correct atrial and ventricular dysrhythmias
•Adverse effects: creates new dysrhythmias or worsens existing ones
–Lupus effect, nausea, vomiting, abdominal pain,headache
–High doses can produce CNS effects
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Term
Beta-Adrenergic Blockers
(Class II) |
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Definition
•Prototype drug: propranolol (Inderal)
•Mechanism of action: to block beta receptors, which reduces automaticity and slows conduction velocity across myocardium
•Primary use: to treat atrial dysrhythmias associated with heart failure
•Adverse effects: bradycardia, hypotension with dizziness and fainting
–Bronchospasms, hypoglycemia, diminished libido
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Term
| Potassium-Ion-Channel Blockers (Class III) |
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Definition
•Prototype drug: amiodarone (Cordarone)
•Mechanism of action: to block potassium-ion channels in myocardial cells, which prolongs refractory period of heart
•Primary use: to treat resistant ventricular tachycardia, atrial dysrhythmias with heart failure
•Adverse effects: blurred vision, pneumonia-like syndrome, bradycardia, hypotension
–Can create new dysrhythmias or worsen existing ones
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Term
| Calcium-Ion-Channel Blockers (Class IV) |
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Definition
•Prototype drug: verapamil (Calan)
•Mechanism of action: to block calcium-ion channels, which reduces automaticity and slows myocardial (AV) conduction velocity
•Primary use: to treat supraventricular tachycardia
•Adverse effects: bradycardia, hypotension, headache
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Term
| Miscellaneous Antidysrhythmics |
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Definition
•Examples: digoxin (Lanoxin) and adenosine (Adenocard)
•Mechanism of action: to decrease automaticity of SA node and slow conduction through AV node but not act by blocking ion channels
•Primary use: for digoxin—certain types of atrial dysrhythmias; for adenosine—serious atrial tachycardia
•Adverse effects: creates new dysrhythmias or worsens existing ones
–Digoxin: nausea, vomiting, headache, visual disturbances
–Adenosine: facial flushing, dyspnea
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Term
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Definition
•Prototype drug: (ADP receptor blocker) clopidogrel (Plavix)
•Mechanism of action: to alter the plasma membrane of platelets so they cannot aggregate
•Primary use: to prevent thrombi formation after a stroke or myocardial infarction (MI)
•Adverse effects: abnormal bleeding
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Term
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Definition
•Prototype drug: alteplase (Activase)
•Mechanism of action: to convert plasminogen to plasmin, which digests fibrin and dissolves clot
•Primary uses:
–To dissolve existing clots–To treat acute myocardial infarction, deep vein thrombosis–To treat cerebrovascular accident, pulmonary embolism, arterial thrombosis–To clear IV catheters
•Adverse effects: abnormal bleeding; contraindicated in patients with bleeding disorder or who have had recent trauma or surgery
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Term
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Definition
•Prototype drug: aminocaproic acid (Amicar)
•Mechanism of action: to prevent fibrin from dissolving
•Primary use: To promote formation of clots by preventing and treating excessive bleeding from surgical sites
•Adverse effects: May cause hypercoagulation with concurrent use of estrogens and oral contraceptives
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Term
| Hematopoietic Growth Factor |
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Definition
•Prototype drug: erythropoietin, epoietin alpha (Epogen, Procrit)
•Mechanism of action: hormone secreted by kidneys, sends message to bone marrow to increase erythrocyte production
•Primary use: treatment of anemia
•Adverse effects: hypertension, seizures
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Term
| Colony-Stimulating Factor |
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Definition
•Prototype drug: filgrastim (Neupogen)
•Mechanism of action: to increase neutrophil production, enhance phagocytosis and cytotoxic functions; enhance immune function
•Primary use: chemotherapy, organ transplant, AIDS complications
•Adverse effects: bone pain, allergies, thrombocytopenia
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Term
Antianemic Agent—
Vitamin Supplement |
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Definition
•Prototype drug: cyanocobalamin (Crystamine, vitamin B12, others)
•Mechanism of action: to replete vitamin B12
•Primary use: treatment of vitamin B12 deficiency
•Adverse effects: diarrhea, hypokalemia, rash, anaphylaxis
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Term
Antianemic Agent—
Iron Supplement |
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Definition
•Prototype drug: ferrous sulfate (Feosol, others)
•Mechanism of action: to supplement iron
•Primary use: to treat iron deficiency
•Adverse effects:
–Nausea, heartburn, constipation, dark stools
–Cardiovascular collapse, aggravation of peptic ulcers or ulcerative colitis
–Hepatic necrosis, anaphylaxis (iron dextran)
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Term
Fluid-Replacement
Agent/Colloid |
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Definition
•Prototype drug: normal serum albumin (Albuminar, Albutein)
•Mechanism of action: to maintain plasma osmotic pressure and transport substances through blood
•Primary use: restoration of plasma volume and blood proteins
•Adverse effects: allergies and protein overload
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Term
Vasoconstrictors/
Sympathomimetics |
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Definition
•Prototype drug: norepinephrine (Levaterenol, Levophed)
•Mechanism of action: alpha-adrenergic agonist; act directly on alpha-adrenergic receptors to raise blood pressure; also has positive inotropic effects
•Primary use: to treat acute shock and cardiac arrest
•Adverse effects: tachycardia, bradycardia, and hypertension
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Term
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Definition
•Prototype drug: dopamine (Dopastat, Inotropin)
•Mechanism of action: is dose dependent;
–low doses = dopaminergic effect
•Renal vasodilation; reduction in glomerular filtration
–high doses = predominantly beta-adrenergic effect (dopamine is a precursor of norepinephrine)
•Primary use: to treat hypovolemic and cardiogenic shock
•Adverse effects: dysrhythmias, hypertension, gangrene
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Term
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Definition
•Prototype drug: epinephrine (Adrenalin)
•Mechanism of action: nonselective adrenergic agonist; vasoconstriction, increased cardiac output
•Primary use: to treat anaphylaxis, shock, cardiac arrest
•Adverse effects: hypertension and dysrhythmias
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Term
| Fluid-Replacement Agents—Colloids |
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Definition
•Prototype drug: dextran 40 (Gentran 40, Hyskon, 10% LMD, Rheomacrodex)
•Mechanism of action: to raise oncotic pressure of blood; expands plasma volume within minutes of administration
•Primary use: as fluid replacement with hypovolemic shock from hemorrhage, surgery, severe burns
•Adverse effects: hypersensitivity reactions, fluid overload, hypertension
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Term
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Definition
•Prototype drug: sodium chloride
•Mechanism of action: as electrolyte/sodium supplement
•Primary use: to treat hyponatremia when serum levels fall below 130 mEq/L
•Adverse effects: hypernatremia and pulmonary edema
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Term
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Definition
•Prototype drug: potassium chloride
•Mechanism of action: as electrolyte/potassium supplement
•Primary use: to prevent or treat hypokalemia
•Adverse effects: GI irritation, hyperkalemia; contraindicated in clients with chronic renal failure or those taking potassium-sparing diuretic
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Term
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Definition
•Prototype drug: sodium bicarbonate
•Mechanism of action: to raise pH of body fluids
•Primary use: to correct metabolic acidosis
•Adverse effects: metabolic alkalosis caused by receiving too much bicarbonate ion and hypokalemia
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Term
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Definition
•Prototype drug: ammonium chloride
•Mechanism of action: to decrease pH of body fluids
•Primary use: to reverse severe metabolic alkalosis
•Adverse effect: acidosis
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Term
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Definition
•Primary use as cancer chemotherapy agent
•Mechanism of action: Interfere with DNA synthesis
–Inhibit lymphocyte replication
•Examples: sirolimus (Rapamune) and azathioprine (Imuran)
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Term
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Definition
•Mechanism of action: Prevents the activation of calcineurin
–Calcineurin is activated by T cells & in turn activates IL-2 production
•cyclosporine (Sandimmune, Neoral) and tacrolimus (Prograf)
–Bind to calcineurin and disrupt T cells
•Used to treat of psoriasis
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Term
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Definition
•Created in other species to fight human T cells
•muromonab-CD3 (Orthoclone OKT3)
–Prevents rejection of kidney, heart, and liver transplants
–Depletes bone marrow of T cells prior to marrow transplant
•basiliximab (Simulect) and daclizumab (Zenapax)
–Prevent acute rejection of kidney transplants
•infliximab (Remicade)
–Suppresses inflammation in autoimmune disorders
•Suffix “ab” in generic name refers to antibody
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Term
| Immunostimulant—Interferon |
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Definition
•Prototype drug: interferon alpha-2a (Roferon-A)
•Mechanism of action: enhances or stimulates immune system to remove antigens; suppresses growth of cancer cells
•Primary use: to remove hairy-cell leukemia, chronic hepatitis C infection, or malignant melanoma
–Unlabeled uses: hepatitis B; AIDS-related Kaposi’s sarcoma
•Adverse effects: flu-like syndrome in 50% of clients (diminishes as therapy progresses)
–Headache, nausea, vomiting, diarrhea
–Anorexia, depression, suicidal ideation
–With prolonged therapy, immunosuppression, hepatotoxicity, neurotoxicity
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Term
Immunosuppressant—
Calineurin Inhibitor |
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Definition
•Prototype drug: cyclosporine (Neoral, Sandimmune)
•Mechanism of action: to inhibit helper T cells
•Primary use: for transplant recipients
•Adverse effects: 75% of clients experience reduction in urine flow
–Infections, tremor, hypertension, elevated hepatic enzymes
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Term
Immune Globulin
Preparations |
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Definition
•Provide passive immunity following exposure to hepatitis
•Administered when
–Client has already been exposed to virulent pathogen or is at very high risk of exposure
–There is not sufficient time to develop active immunity
•Clients who are immunosuppressed may receive these agents to prevent infections
–No memory cells are produced, and protective effects last only two to three weeks
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Term
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Definition
•Secreted by lymphocytes and macrophages that have been infected with a virus
•Slow spread of viral infections and enhance activity of leukocytes
•Two major classes
–Interferon alpha: used to treat leukemia, AIDS, and hepatitis B or C
–Interferon beta: used to treat multiple sclerosis, granulomatous disease, and severe osteoporosis
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Term
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Definition
•Used to treat metastatic renal carcinoma
•Stimulate platelet production in immunosuppressed clients
•Enhance capabilities of immune system
•Stimulate cytotoxic T cells
•Increase B-cell and plasma-cell production
•Promote inflammation
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Term
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Definition
•Inhibit immune response
•Used for clients receiving transplanted tissues or organs
•Used in short-term therapy for severe inflammation
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Term
Anti-inflammatory Drugs—
NSAIDs |
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Definition
•Prototype drug: ibuprofen (Advil, Motrin, others)
•Mechanism of action: to inhibit of prostaglandin synthesis
•Primary use: for musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, primary dysmenorrheal pain
•Adverse effects: nausea, heartburn, epigastric pain, dizziness
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Term
Anti-inflammatory Drugs—
Systemic Glucocorticoid |
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Definition
•Prototype drug: prednisone (Meticorten)
•Mechanism of action: being metabolized to an active form of glucocorticoid
•Primary use: to treat inflammation
•Adverse effects: long-term therapy may result in Cushing’s syndrome
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Term
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Definition
•Prototype drug: acetaminophen (Tylenol)
•Mechanism of action: to reduce fever by direct action at level of hypothalamus and dilation of peripheral blood vessels
–Enables sweating and dissipation of heat
•Primary use: to relieve pain and reduce fever; no anti-inflammatory actions
•Adverse effects: possible liver damage; causes less gastric irritation than aspirin; does not affect blood coagulation
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Term
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Definition
•Are anti-inflammatory drugs
•Prototype drug: prednisone (Meticorten, others)
•Mechanism of action: being metabolized to active form of glucocorticoids
•Primary use: to treat inflammation
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