glaucoma, htn, and coagulation drugs (final sg) Flashcards
(25 cards)
timolol maleate
➺ beta-adrenergic blocker indicated for control of elevated IOP (glaucoma)
moa: dec. aqueous humor formation by blocking the nerve endings that produce fluid
➺ interactions: do not use with clonidine, quinidine, verapamil (can result in AV block + bradycardia)
timolol maleate adverse effects
➺ betaxolol: ocular discomfort, blurred vision, keratitis, HF, heart block, bronchospasm
➺ carteolol: same as above, + ptosis, thyrotoxicosis
➺ levobunolol: can cause cardiac arrest, cerebral ischemia, Raynaud’s disease
pilocarpine
➺ cholinergic agonist indicated for acute-closed angle glaucoma and prevention of post-op IOP
moa: stimulates and contacts the sphincter muscle of the iris, constricting the pupil and improving the aqueous flow
➺ contra: dicyclomine (inc. IOP)
➺ interactions: dec. effect with pyridostigmine, doxepin, and hydroxyzine
pilocarpine adverse effects
➺ blurred vision
➺ tearing
➺ retinal detachment
➺ impaired dark adaptation
bimatoprost
➺ prostaglandin analogue that is the FIRST treatment for OPEN-ANGLE glaucoma
moa: dec. IOP by increasing aqueous outflow
➺ no significant drug interaction
bimatoprost adverse effects
➺ photophobia
➺ dry eyes
➺ cataracts
➺ macular edema
ace inhibitors
➺ *think -PRIL
➺ first-line drugs for HF and hypertension; prevents complications after MI and progression of diabetic nephropathy
moa: inhibits ACE that induces aldosterone secretion (inc. BP) and ultimately DEC. BP
➺ prevent sodium and water resorption
➺ decrease SVR + preload; essentially the work required of the heart
ace inhibitors adverse effects
➺ fatigue
➺ dizziness
➺ headache
➺ mood swings
➺ impaired taste
➺ hyperkalemia
➺ dry, nonproductive cough
➺ angioedema (RARE, FATAL)
➺ *first dose hypotension may occur
ace inhibitor complications
➺ cause renal impairement, identified with serum creatinine
➺ cause hyperkalemia, potassium serum levels must be monitored
arb
➺ *think -SARTAN
➺ angiotensin ii receptor blockers that do not produce dry cough that is common with ACE inhibitors
➺ indicated for treatment of HTN, not proven if it’s as effective as ACE inhibitors are for treating HF
moa: selectively block binding of angiotensin ii to type 1 angiotensin ii receptors in smooth muscle and adrenal gland tissues; they block vasoconstriction and secretion of aldosterone
arb adverse effects
➺ chest pain
➺ fatigue
➺ hypoglycemia
➺ diarrhea
➺ UTI
➺ anemia
➺ weakness
➺ hyperkalemia + cough (less likely to occur than with ACE inhibitors)
adrenergic drugs
➺ indicated for HTN primarily; glaucoma, BPH, management of HF (when used with cardiac glycosides + diuretics)
➺ contra: acute HF, MAOIs, peptic ulcers, liver / kidney dysfunction, asthma
➺ interactions: can cause additive CNS depression with alcohol, benzodiazepines, opioids
adrenergic drugs adverse effects
➺ orthostatic hypotension, first-dose syncope, bradycardia with reflex tachycardia, dry mouth, drowsiness / sedation, constipation, depression, edema, sexual dysfunction, headaches, sleep disturbances. nausea, rash, rebound hypertension with abrupt discontinuation
adrenergic neuron blockers (central + peripheral)
➺ CENTRAL: stimulate ALPHA2 adrenergic receptors in the brain that dec. sympathetic outflow from CNS, dec. norepinephrine production, and dec. renin activity (DEC. BP)
➺ PERIPHERAL: block ALPHA1 adrenergic receptor; when these are blocked, BP is dec.; indicated for BPH (inc. urinary flow rate, dilate arteries + veins, dec. outflow obstruction by preventing smooth muscle contractions)
clonidine
➺ alpha2 adrenergic receptor stimulator (agonist)
➺ not usually first line, used adjunctively for HTN when all other drugs have failed; also used for opioid withdrawal
➺ DO NOT STOP ABRUPTLY, will lead to rebound HTN
alpha1 blockers
➺ *think -OSIN
➺ doxazosin: commonly used alpha1 blocker; reduces peripheral vascular resistance and BP by dilating both arterial + venous blood vessels
carvedilol
➺ dual-action alpha1 and beta receptor blocker indicated for HTN, mild to moderate HP
➺ contra: allergy, cardiogenic shock, severe bradycardia / HF, bronchospastic conditions (asthma)
anticoagulants
➺ inhibits the action or formation of clotting factors, preventing clot formation
➺ have no direct effect on clots already formed
➺ used prophylactically
➺ indicated for MI, unstable angine, A-Fib, indwelling devices, major orthopedic surgery
anticoagulants adverse effects and contraindications
➺ allergy
➺ acute bleeding process or high risk for occurrence
➺ warfarin STRONGLY CONTRA in pregnancy
➺ LMWHs contra in patients with indwelling epidural catheter due to risk of epidural hematoma
➺ adverse effects: inc. bleeding, heparin-induced thrombocytopenia, NV, abdominal cramps, thrombocytopenia
➺ *warfarin can cause necrosis and “purple toes” syndrome
anticoagulant drug interactions
➺ enzyme inhibition of metabolism
➺ displacement of drug from inactive protein-binding sites
➺ dec. in vitamin K absorption / synthesis by bacterial flora of colon
➺ alteration in platelet count / activity
thrombolytics
➺ *think -KINASE (older) and -TEPLASE (current)
➺ lyse (break down) existing clots
moa: activate fibrinolytic system to break down clot in blood vessel quickly, activate plasminogen and convert it to plasmin (digests fibrin), reestablish blood flow to heart muscle via coronary arteries (prevent tissue destruction)
➺ indications: acute MI, arterial thrombolysis, DVT, occlusion of shunts / catheters, pulmonary embolus, acute ischemic stroke
thrombolytics adverse effects
➺ interal, intracranial, and superficial bleeding
➺ NV
➺ hypotension
➺ anaphylactoid reactions
➺ cardiac dysrhythmias
heparin
➺ anticoagulant
moa: inhibits clotting factors IIa (thrombin) and Xa
➺ there are unfractionated and low-molecular-weight heparins
➺ assessing aPTT (laboratory monitoring) labs frequently is necessary for unfractionated since they have a less predictable response
warfarin
➺ anticoagulant
moa: inhibits vitamin K synthesis, required for dependent clotting factors II, VII, IX, and X, by bacteria in the GI tract
➺ final effect is prevention of clot formation
➺ monitor PT/INR regularly
➺ antidote is vitamin K
