MODULE 17
Antihypertensive Medications
◦ Key Classes & Suffixes:
◦ ACE Inhibitors: -pril (e.g., lisinopril, enalapril)
◦ ARBs: -sartan (e.g., losartan, candesartan, valsartan)
◦ Beta Blockers: -olol (e.g., metoprolol, atenolol)
◦ Calcium Channel Blockers: -dipine (e.g., amlodipine, nifedipine)
◦ Digitalis Cardiac Glycosides: -oxin (e.g., digoxin)
◦ Diuretics:
◦ Loop: -ide (e.g., furosemide)
◦ Thiazide: -thiazide (e.g., hydrochlorothiazide)
◦ Potassium-Sparing: -actone (e.g., spironolactone)
◦ Common Side Effects of Antihypertensives:
◦ Orthostatic Hypotension: Prevent by changing positions slowly.
◦ Rebound Hypertension: Avoid abruptly stopping medications; taper them.
Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)
◦ Suffix: -pril
◦ Examples: captopril, enalapril, lisinopril, ramipril
◦ Therapeutic Uses: Hypertension, heart failure, myocardial infarction
◦ Mechanism of Action: Inhibits ACE, preventing the conversion of angiotensin I to angiotensin II,
causing vasodilation. Also prevents aldosterone secretion.
◦ Side Effects: Orthostatic hypotension, dizziness, angioedema, dry cough, elevated potassium.
◦ Nursing Considerations: Monitor renal function (BUN: 7-20 mg/dL, Creatinine: 0.6-1.2 mg/dL).
◦ Patient Education: Avoid potassium-containing foods & salt substitutes, report facial or mouth
swelling, do not stop medication abruptly.
◦ Contraindication: Pregnancy (teratogenic)
• Angiotensin II Receptor Blockers (ARBs)
◦ Suffix: -sartan
◦ Examples: losartan, olmesartan, valsartan, azilsartan, candesartan
◦ Similar to ACE inhibitors in uses, side effects, nursing considerations, and patient education.
◦ Main Differences: ARBs have fewer side effects than ACE inhibitors.
• Alpha-2 Adrenergic Agonists
◦ Examples: clonidine, methyldopa, guanfacine
◦ Therapeutic Uses: Hypertension, hypertensive crisis, alcohol & controlled substance withdrawal,
anxiety, ADHD
◦ Mechanism of Action: Stimulates alpha-2 adrenergic receptors in the presynaptic phase, leading to
vasodilation.
◦ Side Effects: Decreased heart rate, decreased blood pressure, dry mouth, drowsiness, dizziness,
depression.
◦ Patient Education: Reduce salt intake, suck on hard candy/sip liquids for dry mouth, do not stop
medication abruptly.
• Beta-Adrenergic Blockers (Beta Blockers)
◦ Suffix: -olol
◦ Examples: acebutolol, metoprolol, propranolol, nadolol, atenolol, carvedilol
◦ Therapeutic Uses: Hypertension, tachycardia, stable angina, chronic heart failure, dysrhythmias,
anxiety
◦ Mechanism of Action: Blocks beta receptors, slowing the heart and providing a more efficient beat.
◦ Side Effects: Bradycardia, breathing problems (bronchospasm), blood sugar masking, hypotension.
◦ Nursing Considerations: Avoid in asthma patients (non-selective beta-blockers).
◦ Patient Education: Do not stop medication abruptly, change positions slowly.
• Calcium Channel Blockers
◦ Suffix: -dipine
◦ Examples: amlodipine, nicardipine, verapamil, nifedipine, diltiazem
◦ Therapeutic Uses: Hypertension, stable angina, dysrhythmias
◦ Mechanism of Action: Inhibits calcium ions from entering heart and artery cells, causing vasodilation
and decreased heart stimulation.
◦ Side Effects: Orthostatic hypotension, dizziness, constipation, flushing, headache, peripheral edema.
◦ Patient Education: Avoid grapefruit juice, do not stop medication abruptly, elevate legs to reduce
edema, increase fiber and fluids.
• Nitrates
◦ Examples: nitroglycerin, isosorbide mononitrate
◦ Therapeutic Uses: Treatment or prevention of angina, acute coronary syndrome
◦ Mechanism of Action: Vasodilators that enlarge blood vessels.
◦ Side Effects: Headache, hypotension, hot/flushed face.
◦ Routes of Administration: IV, sublingual, buccal, topical, oral spray, transdermal patch.
◦ Patient Education: Remove prior patches, rotate sites, do not swallow or chew sublingual tablets,
store in original container.
Contraindications: Phosphodiesterase inhibitors (e.g., sildenafil), hypotension, increased intracranial
pressure.
MODULE 18
Angina Pathophysiology
Explanation of what angina is (chest pain due to reduced blood flow to the heart muscle).
• Nitroglycerin Mechanism of Action: How nitroglycerin works to relieve angina (vasodilation, increasing blood
flow, reducing workload on the heart).
• Nitroglycerin Administration: Different routes (sublingual, transdermal, IV), proper techniques, and patient
education.
• Nitroglycerin Side Effects: Common side effects (headache, hypotension, flushing) and nursing interventions.
• Nursing Considerations: Monitoring blood pressure, pain relief, patient education on storage and use of
nitroglycerin.
Key Points
• Nitroglycerin is a vasodilator used to treat angina.
• Sublingual nitroglycerin is for acute angina attacks (fast-acting).
• Transdermal nitroglycerin is for long-term prevention of angina.
• Monitor blood pressure before and after nitroglycerin administration.
• Headache is a common side effect; patient can take acetaminophen.
• Patient education is crucial for proper use and storage.
MODULE 19
Statins (Antihyperlipidemics)
• Mechanism of Action: Statins inhibit the enzyme HMG-CoA reductase in the liver.
• Result: This inhibition leads to decreased cholesterol synthesis in the liver.
• HMG-CoA Reductase: This enzyme is crucial in the cholesterol production pathway in the liver. By blocking it,
statins effectively reduce the amount of cholesterol the body produces.
• Antihyperlipidemic Action: By lowering cholesterol synthesis, statins are used to treat hyperlipidemia (high
cholesterol) and reduce the risk of cardiovascular diseases.
• Nursing Pharmacology Focus: This video is tailored for nursing students, suggesting it will likely cover
essential nursing considerations related to statins, such as:
◦ Common Statins: Examples of commonly prescribed statins (e.g., atorvastatin, simvastatin).
◦ Side Effects: Potential side effects (e.g., muscle pain/rhabdomyolysis, liver issues) and monitoring.
◦ Patient Education: Instructions for patients taking statins (e.g., importance of lifestyle changes, reporting
muscle pain).
◦ Administration: Considerations for administering statins.
• Osmosis Style: Osmosis videos are known for their clear, visual explanations, often using animations to
illustrate complex concepts. This likely means the video will provide a visual representation of how statins
interact with the HMG-CoA reductase enzyme.
Key Points
• Statins lower cholesterol by inhibiting HMG-CoA reductase in the liver.
• They are a key treatment for hyperlipidemia and cardiovascular disease prevention.
• Nurses need to be aware of potential side effects like muscle pain and liver issues.
• Patient education on lifestyle modifications and medication adherence is crucial.
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Platelet Function: Explanation of the role of platelets in blood clotting.
• Antiplatelet Mechanism of Action: How antiplatelet drugs work to prevent platelet aggregation (clumping).
• Common Antiplatelet Drugs: Examples of commonly used antiplatelet medications (e.g., aspirin, clopidogrel
(Plavix)).
• Indications for Antiplatelet Use: Conditions where antiplatelets are prescribed (e.g., prevention of heart
attack, stroke, after stent placement).
• Side Effects: Potential side effects of antiplatelet drugs (e.g., bleeding) and nursing interventions.
• Nursing Considerations: Monitoring for bleeding, patient education on signs and symptoms of bleeding, and
medication adherence.
Heparin and Warfarin (Anticoagulant Medications)
Mechanism of Action:
◦ Heparin: How it works to prevent clot formation (likely focusing on its action on thrombin and other clotting
factors).
◦ Warfarin: How it interferes with Vitamin K-dependent clotting factors.
• Administration:
◦ Heparin: IV and subcutaneous administration.
◦ Warfarin: Oral administration.
• Onset and Duration:
◦ Heparin: Rapid onset, short duration.
◦ Warfarin: Slower onset, longer duration.
• Monitoring:
◦ Heparin: aPTT (activated Partial Thromboplastin Time).
◦ Warfarin: PT/INR (Prothrombin Time/International Normalized Ratio).
• Therapeutic Uses: Conditions for which each drug is used (e.g., DVT, pulmonary embolism, atrial fibrillation).
• Antidotes:
◦ Heparin: Protamine sulfate.
◦ Warfarin: Vitamin K.
• Side Effects: Primarily bleeding risk for both.
• Nursing Considerations:
◦ Monitoring for signs of bleeding.
◦ Patient education (dietary restrictions with warfarin – Vitamin K consistency, signs of bleeding).
◦ Administration techniques.
Thrombolytics (also known as Fibrinolytics)
Mechanism of Action: How thrombolytics work to dissolve existing blood clots (likely focusing on their action
on plasminogen and plasmin).
• Common Thrombolytic Drugs: Examples of commonly used thrombolytics (e.g., alteplase (tPA),
tenecteplase, reteplase).
• Indications for Thrombolytic Use: Conditions where thrombolytics are prescribed (e.g., acute ischemic
stroke, acute myocardial infarction (heart attack), pulmonary embolism). Crucially, these are for situations
where a clot is ALREADY PRESENT and needs to be dissolved.
MODULE 20
Antianemic Agents & Iron Supplements
Folic Acid (Vitamin B9):
◦ Function: Essential for cell growth and division, particularly in the production of red blood
cells.
◦ Mechanism of Action: Involved in DNA synthesis and red blood cell maturation.
◦ Indications: Treatment of folic acid deficiency anemia, prevention of neural tube defects
during pregnancy.
◦ Nursing Considerations: Assess for signs of deficiency, educate patients on dietary
sources of folate.
• Cyanocobalamin (Vitamin B12):
◦ Function: Required for red blood cell formation, neurological function, and DNA synthesis.
◦ Mechanism of Action: Acts as a cofactor for several important enzymatic reactions.
◦ Indications: Treatment of vitamin B12 deficiency anemia (pernicious anemia), often due to
impaired absorption.
◦ Nursing Considerations: Administer via IM injection or intranasal route (if absorption is
impaired), monitor for neurological symptoms.
• Iron Supplements (Ferrous Sulfate, Iron Dextran):
◦ Function: Iron is a component of hemoglobin, which carries oxygen in red blood cells.
◦ Mechanism of Action: Replenishes iron stores in the body, allowing for increased
hemoglobin production.
◦ Indications: Treatment of iron deficiency anemia.
◦ Nursing Considerations:
◦ Ferrous Sulfate (Oral): Administer on an empty stomach (if tolerated) to increase
absorption. Vitamin C can enhance absorption. Common side effects include GI upset,
constipation, and dark stools. Educate patients on these side effects.
◦ Iron Dextran (IM/IV): Used when oral iron is not tolerated or is ineffective. Higher risk of
allergic reaction (anaphylaxis), so administer a test dose first. Use the Z-track method for IM
injections to prevent staining.
• Key Nursing Considerations (General for all Antianemic Agents):
◦ Assess for underlying cause of anemia (e.g., dietary deficiency, malabsorption, blood loss).
◦ Monitor hemoglobin and hematocrit levels to assess treatment effectiveness.
◦ Educate patients on proper administration techniques, potential side effects, and dietary
sources of essential nutrients.
Diuretics
Loop Diuretics (Furosemide):
◦ Action: Strongest, acts in loop of Henle.
◦ Key Side Effect: Hypokalemia (low potassium).
◦ Teaching: Take in AM, monitor weight, watch for cramps.
• Thiazide Diuretics (Hydrochlorothiazide):
◦ Action: Acts in distal tubule.
◦ Key Side Effect: Hypokalemia (low potassium), increased blood glucose.
◦ Teaching: Like loops, plus sunscreen.
• Potassium-Sparing (Spironolactone):
◦ Action: Blocks aldosterone, retains potassium.
◦ Key Side Effect: Hyperkalemia (high potassium).
◦ Teaching: Avoid extra potassium.
• Osmotic (Mannitol):
◦ Action: Draws water into tubules.
◦ Key Side Effect: Fluid overload, pulmonary edema.
◦ Nursing: Use filter needle, watch for lung issues.
MODULE 21
Respiratory Drugs
◦ Bronchodilators: Beta-agonists (albuterol), anticholinergics (ipratropium).
◦ Anti-inflammatories: Corticosteroids (fluticasone), leukotriene modifiers (montelukast).
◦ Memorization: Use acronyms, chunk by mechanism, visual imagery, compare/contrast
tables.
• Discussion:
◦ Beta-agonists are for rescue (acute bronchospasm), while corticosteroids are for
prevention (long-term inflammation control). Mnemonics and visual aids can greatly
improve memorization. Think "B2 agonists BUTe open" the airways.
Module 22
GI Pharmacology — Anti-Ulcer / Acid Control
◦ H2 Blockers (famotidine): Block histamine, reduce acid.
◦ PPIs (omeprazole): Block proton pump, strongest acid suppression.
◦ Antacids: Neutralize acid, fast relief.
◦ Mucosal Protectants (sucralfate): Coat ulcers.
◦ Prostaglandin Analogs (misoprostol): Protect lining.
◦ Nursing: Take H2 blockers/PPIs before meals. Antacids between meals. Space sucralfate
from other drugs. Misoprostol contraindicated in pregnancy.
• Discussion:
◦ PPIs are the most potent acid suppressants but have long-term risks. Antacids are for
immediate relief. Mucosal protectants physically coat ulcers. Misoprostol has important
safety considerations.
Laxatives — GI Pharmacology
• Short Notes:
◦ Stool Softeners (docusate): Soften stool.
◦ Bulk Formers (psyllium): Increase stool bulk.
◦ Stimulant (bisacodyl): Stimulate peristalsis.
◦ Osmotic (magnesium hydroxide): Draw water into bowel.
◦ Nursing: Ensure fluid intake, monitor electrolytes.
• Discussion:
◦ Overuse of laxatives can lead to dependence and electrolyte imbalances. Bulk formers
require adequate fluid intake to prevent obstruction.
MODULE 23
VASOPRESSOR DRUGS
◦ Epinephrine: ↑ HR, ↑ contractility, vasoconstriction. Uses: Cardiac arrest, anaphylaxis.
Mnemonic: "Epi = Energy"
◦ Norepinephrine: Strong vasoconstriction. Uses: Septic shock.
◦ Vasopressin: Vasoconstriction, no HR effect. Uses: Septic shock (adjunct).
◦ Dobutamine: ↑ Contractility, ↑ CO. Uses: Heart failure. "Do boost the heart"
◦ Dopamine: Dose-dependent effects.
◦ Nursing: Monitor BP, HR, ECG, urine output. Central line preferred.
• Discussion:
◦ Vasopressors are powerful drugs that can quickly increase blood pressure, but they also
have significant risks (tissue necrosis, arrhythmias). Careful monitoring is essential.
Knowing the receptors each drug acts on helps predict its effects.