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Functions:
  • positive Inotropic action
  • negative chronotropic action
  • negative dromotropic action
  • increas stroke volume
Cardiac Glycosides
Diuretics
Inhibits Na+ & H20 reabsorption in renal tubules
  • Decreased Na+ reabsorption =
  • Increased Na+ excretion through the kidneys =
  • Increased H20 excretion through the kidneys (H20 usually follows Na+)
Decreased reabsorption of other electrolytes is also common with use of diuretics (K+)
Main Uses:
  • Decrease edema
  • Decrease HTN (indirectly)
Potassium “wasting” vs. “sparing”
Antihypertensive
Beta Blockers
  • ↓ sympathetic nervous system response →
  • ↓ vascular resistance →
  • ↓ BP
ACE Inhibitors
  • Inhibits formation of angiotensin II (vasoconstrictor)  →
  • Blocks the release of aldosterone (promotes Na+ retention) →
  • Lose Na+ and H2O
Calcium Channel Blockers
  • ↓ calcium levels and thus ↓cardiac contractility
  • Promotes vasodialation
Anti-diabetic
Glucotrol (glipizide)
  • Type 2 diabetes mellitus
  • Stimulates functioning B cells in pancreas to release insulin
  • May improve insulin to bind with it’s receptors
  • Or may increase number of insulin receptors
  • Pt’s must have functioning B cells in order for this med to be effective
Insulin
  • Pancrease - Beta cells in islets of Langerhans - produce:
  • Insulin - needed for metabolism of carbs, fats, proteins (helps move glucose into cells) AND
  • Glucagon - stimulates conversion of glycogen to glucose in the liver
  • Normal adult blood sugar - 70 to 110 mg/dL
Rapid Acting Insulin
Novolog/Humalog/Lispro
  • Given right before a meal
  • Onset: 15-30 minutes
  • Peak: ½ to 1&1/2 hours
  • Duration: 3-4 hours
Short Acting Insulin
Regular/Humulin R/
Novolin R
  • Given ½ to 1 hour before a meal
  • Onset: 30minutes
  • Peak: 2&1/2 to 5 hours
  • Duration: up to 6 hours
Intermediate Acting Insulin
Humulin N/Novolin/Lente
  • Onset: 1&1/2 – 4hours
  • Peak: 6-12 hours
  • Duration: 12-18 hours
(Cloudy)
Long Acting Insulin
Lantus
  • Usually given once at bedtime
  • Onset: 1&1/2 hours
  • Peak: No peak  identified (sustained release)
  • Duration ~ 24 hours
  • Never mixed with another insulin
Blood Sugar Mnemonic
  • Hot & Dry = Sugar High
  • Cold & Clammy = need some candy (usually OJ and some type of carb)
Hypoglycemia
TIRED
Tachyardia
Irritability
Restless
Excessive Hunger
Diaphoresis/Depression
Thyroid Medications
Hypothyroidism may be primary (thyroid problem) or secondary (pituitary problem)
Synthroid is drug of choice for hypothyroidism
  • Increases T3 & T4
  • Also used to treat goiter
Digoxin Drug Name (Trade) Lanoxin
Classification  Action   Uses  Side Effects   Pharmacokinetics   WEGNSK  

Evaluation   Teach     Cardiac Glycoside  Inhibits Na-K ATPase, which makes more calcium available for contractile proteins, resulting in increased cardiac output.  Heart failure, A-Fib, arterial flutter  Headache, dysrhythmias, hypotension, AV block, blurred vision, yello-green halos, N/V, anorexia, abd. Pain, diarrhea  Half life: 1 ½ days, Exc. In urine, P.O.: onset ½ hr, peak 6-8 hr, duration 3-4 days.  IV: Onset 5-30 mins. , peak 1-5 hr, duration variable  Take Apical pulse before admin.: if less than 60 bpm in adult retake in 1 hr, if less than 60 bpm notify prescriber, note rate, rythym, character.  Monitor ECG continuously, I&O, wgt q day,blood studies, BUN, electrolytes. DO NOT BCC.  Therapeutic Response, decreased wgt., edema, pulse, resprs, crackles; increased urine output; serum digoxin level  Do not d/c abruptly, avoid OTC products, Notify prescriber if loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash depression, toxicity.  Teach toxic symptoms, maintain a Na restricted diet as ordered, Report SOB, dyspnea, wgt gain, edema, or persistent cough.
Drug Name (generic): Furosemide Drug Name (Trade): Lasix
 Classification  Action  
Uses  
Side Effects  



Pharmacokinetics   WEGNSK   Evaluation  
Teach    Loop Diuretic Inhibits reabsorption of Na and Chloride @ proximal/distal tube in loop of henle Pulmonary Edema, edema r/t CHF, hepatic disease, nephritic syndrome, ascites, hypertension Circulatory collapse, loss of hearing, hypokalemia, hypochloremia, alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, metabolic alkalosis, hyperglycemia, Nausea, polyuria, renal failure, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia, rash, pruritis, Steven’s Johnson Syndrome Half life ½ hr, P.O.: onset 1 hr, peak ½ hr, duration 6-8 hr. I.V. : onset 5 min, peak ½ hr, duration 2 hr. Mets in liver, Excr. In urine, feces. Monitor for s/s of metabolic alkalosis, hypokalemia, tachycardia, postural hypotension, leg cramps, weakness, confusion, hearing, rash, resprs, wgts, I&O’s, skin turgor, edema. Therapeutic response: improvement in edema of feet, legs cascral area (CHF), increase urine output, decreased B/P, decrease calcium levels (hypercalcemia) Discuss need for increase ofK in diet of supplement.  Change position slowly, adverse rxns, take w/ food or milk w/ GI symptoms, use sunscreen, take early in day, avoid OTC products
Drug name: Levothyroxine
Trade name: Synthroid
Classification   Action   Uses   Side Effects   Pharmacokinetics   WEGNSK   Teach     Thyroid hormone   Increases metabolic rate, controls protein synthesis, increases cardiac output, renal blood flow, 02, consumption, body temp, blood volume, growth development at cellular level  hypothyroidism, hyperthyroidism  
anxiety, insomnia,tremors, THYROID STORM, tachycardia, palpations, angina, dysrythmias, hypertension, cardiac arrest Half life: euthyroid 6-7 days, hypothyroid 9-10 days, hyperthyroid 3-4 days. PO onset 3-5 days, peak 6-8 weaks, duration 1-3weeks B/P, pulse periodically during treatment, weight daily in same clothing, using same scale, at same time of day, height, growth rate, T3 and T4, check for bleeding, bruising, increased nervousness, excitability, irritability Hair loss will occur, report any excitability, irritability, anxiety, which indicate overdose,  product may be discontinued after giving birth, thyroid panel evaluated after 1-2 months, product is not to be taken to reduce weight, OTC preparations with iodine, separate antacids, iron, calcium product by 4hrs, avoid iodine foods, idonized salt, high iodine seafood and bread, not a cure just controls symptoms.
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