Furosemide (Lasix)

Therapeutic Class: Drug for heart Failure and HTN

Pharmacologic Class: Diuretic (loop type)

Actions: loop diuretic, inhibits absorption of Na+ and Cl-, used for ^ B/P, edema in CHF, monitor K+ and Digoxin levels (K+ is low, Dig gets High) promotes excretion of K+.

Admin. Alerts: Check patient's serum K levels before admin the drug. If K levels are below normal, notify the health care provider before admin. Due to proglonged half-life in premature infance and neonate, the drug must be used with caution. Geriatric patients may require lower doses. Pregnancy category C

Adverse Effects: Potential electrolyte imbalanes, hypokalemia. Bc furosemide so effective, fluid loss must be carefully monitored for dehadration and hypotension. Hypovolemia may cause orthostatic hypotension and syncope.

Contraindication: hypersensitivity to furosemide or sulfonamids, anuria, hepatic coma, and severe fluid or electrolyte depletion.

Interactions: hypokalemia may cause dysrhythmias in patients taking cardia glycosides, combination therapy with digoxin must be monitored. concurrent use w/ corticosteroids, amphotericin B, or other potassium-depleting drugs can cause hypokalemia. When given with lithium, elimination of lithium is decreased causing higher risk of toxicity. Furosemide may diminish the hypoglycemic effects of sulfonylureas and insulin.

Lab Tests: increased values of blood glucose, BUN, serum amylase, cholestrol, triglycerides and serum electrolytes

Overdose: result in hypotension and severe fluid and electrolyte loss. Treatment: replacement fluids and electrolytes and possible administration of vasopressor.

Pharmacokinetics: onset: 30-60 mins, PO; 5 min IV. Peak: 60-70 min PO;20-60 min IV. Half life: 30-60 min. Duration 6-8 h PO; 2 h IV

Diltiazem

(Cardizem, Cartia XT, Dilacor XR, Taztia XT, Tiazac)

Therapuetic Class: Antiangianal drug

Pharmacologic Class: Calcium channel blocker

Action: inhibits the transport of calcium into myocardial cells. Ability to relax both coronary and peripheral blood vessels, bringing more oxygen to the myocaridum and reducing cardiac workload. Useful in treatment of atrial dysrhthmias and hypertension, stable and vasospastic angina. When given as sustained-release capsules, it is administered once daily.

Admin Alerts: During IV admin the patient must be continuously monitored and cardioversion equitment must be available. Extended-release tablets and capsules should not be crushed or split. Pregnancy category C.

Adverse Effects: generally not serious related to vasodilation: headache, dizziness, and edema of ankles and feet. Abrupt withdrawal my precipitate and actue anginal episode.

Contraindications: patients with AV heart block, sick sinus syndrome, severe hypotension, or bleeding aneurysm, or those undergoing intracrainal surgery. Caution in patients with renal hepatic impairments.

Interactions: Concurrent use with other cardiovascular drugs particularly digoxin or beta-adrenergic blockers may cause partial or complete heart block, heart failure, or dysrhthmias. Diltaizaem may increase digoxin or quinidine levels when taken concurrently. Additive hypotension may occur if used with ehanol, beta blockers, or antihypertensives.

Lab tests: unknown

Herbal/Food: st. john's wort and ginseng may decrease effectiveness. Garlic, hawthorn, and goldenseal may increase antihypertensive effect.

Overdose: Atropine or isopoterenol may be used to reverse bradycardia. Hypotension may be reveresed by vasopressors such as dopamine or dobutamine. Calcium chloride can be admin slow IV push to revere hypotension or heart bloack induced by CCBs.

Pharmacokinetics: Onset: 30-60 min (2-3 h sustained release). Peak: 2-3 h (6-11 h sustained release). Half-life 3.5-9 h. Duration: 6-8 h (12 h sustained release)

Warfarin

(coumadin)

Therapeutic Class: Anitcoagulant (oral)

Pharmacologic Class: Vitamin K antagoinst

Actions: anticoagulant – depresses hepatic synthesis of Vit K-dependant clotting factors II, VII, IX & X. Must monitor PT/INR values, used in A-Fib patients, no pregnant patients.

Admin Alerts: If life-threatening bleeding occurs during therapy, the anticoagulant effects can be reduced by IM or subcutaneious administratino of its antagonist vitamin K1. Pregnancy catergory X.

Adverse Effects: Most serious is abnormal bleeding. On discontinuation the anticoagulant activity may persist for up to 10 days.

Contraindications: pateitns with recent trauma, active internal bleeding, bleeding disorders, intracranial hemmorrhage, servere hypertension, bacterial endocarditis, or severe hepatic or renal impairment should not take.

Interactions: extensive protein binding is responsible for numerous drug-drug interactions increased effect of Warfarin with alcohol, NSAIDs, diuretics, SSRIs, and other anitdepressants, steriods, antibiotics, and vaccines, and vitamins ( vit K). Patient should not take other prescription or OTC drugs unless approved by health care provider.

Lab Tests: unknown

Herbal/food: green tea, ginkgo, feverfew, garlic, cranberry, chamomile, and ginger may increase risk of bleeding.

Overdose: oral parenteral admin of vitamin K1. When admin IV K1 can reverse the anticoagulant effects of warfain in 6 h.

Pahrmacokinetics: (PO): Onset: 2-7 days. Peak: 0.5-3 days. Duration: 3-5 days.

Oxycodone Hydrochloride

(Oxycontin, Percodan, Percoset)

Opioid agonists with moderate effectiveness

Actions: opiate pain reliever, causes sedation, constipation, resp depression, (hepatotoxic when combined with acetaminophen)

Pharmacokinestics: PO: 5-10 mg qid prn

Adverse Effects: sedation, nausea, constipation, dizziness, heaptotoxicity, repiratory depression, ciruculatory colapse, coma.

Docusate

(Colace)

Action: Laxative

Stool softener/surfactant

Adverse Effects: abdominal cramping, diarrhea, no serious adverse efffects

Pharmacokinetics: PO; 50-500mg/day

Acetaminophen

(Tyenol, others)

Therapeutic Class: Antipyretic and analgesic

Pharmacologic Class: Centrally acting COX inhibitor

Actions: analgesic, antipyretic, no antiinflammatory properties, little antiplatelet properties. Very hepatotoxic, no alcohol.

Admin Alerts: liquid forms are available in varying concentrations. Use the appropriate strength product in children to avoid toxicity. Never admin to pateints consume alcohol reg. due to hepatotoxicity. Advise patients that acetaminophen is found in many OTC and extreme care must be taken to not dublicate doses by taking several concurrently. Pregnancy category B.

Adverse Effects: less gastic irritation that aspirin does not affect blood coagulation. Not reccommended for malnourished which acute toxicity can result leading to renal failure which can be fatal. Signs of acute toxicity are: nausea, vomiting, chills, abdominal discomfort, and fatal hepatic necrosis. Risk for liver damage with Acetaminophen. Liver failure in number of patients. Significantly greater with alcohol consumption.

Contraindications: hypersensitivity to acetaminophen or phenacetin and chronic alcoholism

Interactions: inhibits warfarin metabolism, causing anticoagulant to accumulate to toxic levels. High dose or long term acetaminophen use my result in elevated warfarin levels and bleeding. Ingestion of drug with alcohol or other heaptotoxic drugs such as phenytoin or barbiturates is not recommended bc of possible liver failure from hepatic necrosis.

Lab Test: increase hepatic test functions values: serum bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). May increase urinary 5-hydroxyindole acetic acid (5-HIAA) and serum uric acid.

Hebal/food: avoid taking herbs that have potential for liver toxicity, including comfrey, coltsfoot, and chaparral.

Overdose: Oral  or IV admin of N-acetylcysteine (Acetadote) stat after overdose. Drug protects liver from toxic membranes of acetaminophen.

Pharmacokinetics: Onset: 30-60min, Peak 0.5-2 h, Half-Life: 1-3 h, Duration 1-3 h

Metoprolol

(Lopressor, Toprol XL)

Therapeutic Class: Drug for heart failure and HTN

Pharmacologic Class: Beta-adrenergic blocker

Actions: Selective beta1-adrenergic blocker available in tablet, sustained release tablet, and IV forms. At higher doses may also affect beta2 receptors in bronchial smooth muscle. Reduces sympathetic stimulation of the heart, thus decreasing cardiac workload. Slow progression of HF and significantly reduce long-term consequences of the disease. Usually combine with other HF drugs such as ACE inhbitors. approved for angina, HTN, anf for reducing cardiac complications following an MI.

Admin Alerts: IV administration monitor ECG, BP, and pulse. Assess pulse and BP before oral admin. Hold if pule is below 60 beats per min or if patient is hyptensive. Advise pateint not to crush or chew tablet. Safety in children under 6years has not been established. Doses should be reduced for elderly patients bc they are at risk for dizziness and falls. Pregnancy category C.

Adverse Effects: few adverse effects on other autonomic targets and thus preferred. Adverse effects generally minor and relate to its autonomic activity, such as slowing HR and hypotension. Patients with HF should be monitored. Frequent adverse effects are: abnormal sexual function, drowsiness, fatigue, and insomina.

Contradications: patients with asthma, cardiogenic shock, sinus bradycardia, heart block greater than first degree, and overt cardiac failure.

Interactions: concurrent use with digoxin may result in bradycardia. oral contrceptives may cause increased metoprolol effects. use with alcohol or antihypertensives may cause hyptension. metorolol may enhance hypoglycemic effects of insulin and oral hypoglycemic agents.

Lab Test: increase values for uric acid, lipids, potassium, bilirubin, alkaline phosphatase, creatinine, and antinuclear antibody.

Herbal/Food: unknown

Overdose: Atropine or isoproterenol can be used to reverse bradycardia. Hypotension may be reversed by a vasopressor such as parenteral dopamine or dobutamine.

Pharmacokinetics: Onset: 10-15 min sustained release unknown. Peak: 1.5-4 h; 6-12 h sustained release. Half-life: 3-4 h. Duration: 6h (24 h sustained release).

Ferrous Sulfate

(Feosol, others)

Therapeutic Class: Agent for anemia

Pharmacologic Class: Iron Supplement

Actions: iron supplement containting 20-30% elemental iron. Other forms include ferrous fumarate which contains 33% elemental iron and ferrous gluconate with contains 12% elemental iron. In generral pateints respond to ferrous sulfate rapidly. Positive therapeutic response may occur in 48 hours therapy may continue for several months to replensih the storage of depots for iron. Lab evaluation of hemoglobin (Hgb) and hematocrit (Hct) are conducted regularly as excess is toxic

Admin Alerts: admin IV careful to prevent infiltration as iron is highly irritating to tissues. Use Z-track method (deep muscle) when giving IM. Do not crush tablet or empty contents of capsule when admin. Do not give tablets or capsules within 1 hour of bedtime. Pregnancy category A.

Adverse Effects: most frequent of ferrous sulfate is GI upset. Taking drug with food help GI but can decrease absorption by 50%-70%. Antacids should not be taken with ferrous sulfate bc reduce absorption of the mineral. admin 1 h before or 2 h after meal. may darken stools, but is harmless side effect. Constipation is common therefore increase in dietary fiber may be indicated. Excessive doses of iron are very toxic.

Contraindicaitons: Iron salts drugs should not be used in hemolytic anemia without documentation of iron deficiency bc iron will not correct this condition and my build to toxic levels. should not be admin to pateints with hemochromatosis, peptic ulcer, regional enteritis, or ulcerative colitis.

Interactions: absorption reduced with antacids, proton-pump inhibitors, or calcium supplements. Iron decreases absorption or tetracyclines, fluoroquinolones, and etidronate. Preven possible side effects take iron supplements 1-2 hours before or after other medications.

Lab Tests: ferrous sulfate may decrease calcium level and increase serum bilirubin.

Herbal/food: food, especially dairy products will inhibit absorption of ferrous sulfate. foods high in vit C, orange juice and strawberris can increase absorption of iron.

Overdose: Deferoxamine (Desferal) is antidot for acute iron intoxication. binds iron which is subsequently removed by the kidneys turning the urine a reddish brown color.

Pharmacokinetics: because it is a natural substance it is difficult to obtain pharmacokenetic values.