Mod A & B Patho-Pharm Drugs
Ø Volume affecting drugs
· Isotonic Fluids - 459-460
o Treatment:
§ Lost volume should be replaced with fluids that are isotonic to plasma. This can be accomplished by infusing isotonic
(0.9%) sodium chloride in sterile water, a solution in which both sodium and chloride are present at a concentration of
145mEq/L. Volume should be replenished slowly to avoid pulmonary edema. Pediatric dose 20mL/kg Infant
10mL/kg
· Albumin (volume expander) – 459-460
o Func. Class: Blood derivate- plasma
o Action: exerts colloidal oncotic pressure, which expands volume of circulating blood by pulling fluid from extravascular
to intravascular spaces, and maintains cardiac output.
o Therapeutic outcome: increased B/P, decrease edema, increased serum albumin levels, increased plasma protein.
o Uses: shock, hypoproteinemia, prevention of cerebral edema, cardiopulmonary bypass procedures, furosARDS,
Hemorrhage; also replacement in nephrotic syndrome.
o Adverse effects: Fever, Fluid overload, NV, Rash, Pulmonary edema
· Diuretics- Furosemide (Lasix) – 450-452
o Func. Class: Loop Diuretic
o Action: Act on the ascending loop of henle in the kidneys, inhibiting reabsorption of electrolytes sodium and chloride,
causing excretion of sodium, Ca,Mg,Cl,H20, and some K; decreases reabsorption of sodium and chloride and increases
excretion of potassium in the distal tubule of the kidney; responsible for slight antihypertensive effect and peripheral
vasodilation.
o Uses: Pulmonary edema; edema in CHF, hepatic disease, nephrotic syndrome, ascites, hypertension
o Unlabeled uses: Hypercalcemia in malignancy, HTN emergency, pulmonary edema or prevention of hemodynamic
effects associated with blood production transfusion, ascites.
o SE: HA, fatigue, Hypokalemia, nausea, dry mouth, Circulatory collapse, renal failure, thrombocytopenia, neutropenia,
anemia.
Torsemide (Demedex) - 452
Func Class: Loop diuretic, same as lasix
Action: Promote diuresis by inhibiting sodium and chloride reabsorption in the thick ascending limb of the
loop of henle.
Only Furosemide and Torsemide are approved for use with HTN
Hydrochlorothiazide (HCTZ) – 452-453
o
Functional Class: Diuretic, Antihypertensive
Action: Acts on the distal tubule in the kidney, increasing excretion of sodium, water, chloride, and potassium.
Therapeutic effect: Decreased B/P, decreased edema in lung tissues peripherally
Use: Edema, hypertension, diuresis, CHF; idiopathic lower extremity edema therapy
Adverse effect: Dizziness, fatigue, weakness, orthostatic hypotension, hypokalemia, N/V, anorexia, rash,
hyperglycemia, hyperuricemia, pancreatitis, hepatitis, agranulocytosis, thrombocytopenia, renal failure,
stevens-johnson syndrome, uremia. Monitor glucose in urine if patient is diabetic, orthostatic hypotension can
occur rapidly.
D’s way to remember: Pee EZ on HCTZ
Ø Vasodilators
· Sodium Nitroprusside (Nipride) – 497-498
o -Action: Nipride® (sodium nitroprusside) is a potent, rapid-acting, intravenous antihypertensive agent. The
antihypertensive action of Nipride® is probably due to the nitroso (NO) group. Its effect is almost immediate and usually
ends when the intravenous infusion is stopped. The brief duration of the drug’s action is due to its rapid biotransformation.
The hypotensive effect is augmented by ganglionic blocking agents. The hypotensive effects of Nipride® are caused by
peripheral vasodilation as a result of a direct action on the blood vessels, independent of autonomic innervation.
-Use: Nipride® (sodium nitroprusside injection) is indicated for the treatment of acute hypertension, refractory to standard
therapeutic measures.Nipride® (sodium nitroprusside injection) is also indicated for producing controlled hypotension
during anesthesia in order to reduce bleeding in surgical procedures, where surgeon and anesthesiologist deem it
appropriate. In each case, the benefit-risk ratio should be carefully considered on an individual basis.
, -Adverse Reactions: Nausea, diaphoresis, HA, palpitations, rapid reduction in BP.
-Storage: Nipride® should be stored at controlled room temperature (15-30 C).̊ It should be protected from light and
freezing. Once diluted in 5% Dextrose Injection, Nipride® tends to deteriorate in the presence of light. The diluted solution
should also be protected from light, using the supplied opaque sleeve, aluminium foil, or other opaque material. It is not
necessary to cover the infusion drip chamber or the tubing.
Nicardipine (Cardene) –490-491
o - Action:Nicardipine inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle without
changing serum calcium concentrations. The contractile processes of cardiac muscle and vascular smooth muscle are
dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. The effects of
nicardipine are more selective to vascular smooth muscle than cardiac muscle. Nicardipine produced relaxation of
coronary vascular smooth muscle at drug levels which cause little or no negative inotropic effect.
-Uses: angina, HR failure (Titrate slowly when using Cardene I.V. Premixed Injection, particularly in combination with a
beta-blocker, in patients with heart failure or significant left ventricular dysfunction because of possible negative inotropic
effects), Impaired Hepatic Function, Impaired Renal function.
-Adverse reaction: Severe hypotension, HA, tachycardia
-Contraindications:Advanced Aortic Stenosis Cardene I.V. Premixed Injection is contraindicated in patients with advanced
aortic stenosis because part of the effect of Cardene I.V. Premixed Injection is secondary to reduced afterload. Reduction
of diastolic pressure in these patients may worsen rather than improve myocardial oxygen balance.
· Milrinone (Primacor)- 523
o-Func. class.: Inotropic/vasodilator agent with phosphodiesterase activity.
- Action: Positive inotropic agent with vasodilator properties; increases contractility of cardiac muscle; reduces preload
and afterload by direct relaxation of vascular smooth muscle; increases myocardial contractility.
-Therapeutic outcome:Increased inotropic effect resulting in increased cardiac output.
- Uses: Short-term management of advanced CHF that has not responded to other medication.
- Adverse Effects: Dysrhythmias, Hepatotoxicity, Thrombocytopenia, hypotension, hypokalemia.
· Hydralazine (Apresoline) – 495-496
-Action: Although the precise mechanism of action of hydralazine is not fully understood, the major effects are on the
cardiovascular system. Hydralazine apparently lowers blood pressure by exerting a peripheral vasodilating effect through
a direct relaxation of vascular smooth muscle. Hydralazine, by altering cellular calcium metabolism, interferes with the
calcium movements within the vascular smooth muscle that are responsible for initiating or maintaining the contractile
state.
-Use: Severe essential hypertension.
-Contraindications: Hypersensitivity to hydralazine; coronary artery disease; mitral valvular rheumatic heart disease.
-Adverse reactions: HA, anorexia, nausea, vomiting, palpitations, tachycardia, angina pectoris, constipation, dyspnea,
numbness and tingling, dizziness, difficult urination, rash, flushing.
Ø Vasopressors
· Epinephrine – 148-50, 153-154
Functional Class: nonselective Adrenergic agonist, cardiac stimulant, vasopressor.
Action:B1 & B2 agonist causing increased levels of cyclic AMP to produce bronchodilation , cardiac and CNS Stimulation.
Lg dose causes vasoconstriction, small dose vasodilation.
Therapeutic Outcome:Vasoconstrictor, cardiac stimulator, bronchodilator, decrease aqueous humor.
Use:bronchospasm, anaphylaxis, cardiac arrest, shock, adjunct to anesthesia.
Adverse effect: tremors, anxiety, palpitations, tachycardia, dysrhythmia, anorexia, dyspnea, cerebral hemorrhage,
paradoxical bronchospasm. Site: extravasation
· Norepinephrine (Levophed) – 150
Functional class: Adrenergic
Action: Causes increased contractility and heart rate by acting on B receptors in heart. Also works on A receptors to
cause vasoconstriction to ^ BP, improve blood flow, and CO.
Therapeutic Outcome: Increased BP w/stabilization; adequate tissue perfusion.
Use: Acute hypotension, shock
Adverse Effect: HA, anxiety, palpitations, tachycardia, hypertension, ectopic beats, angina, N/V, cerebral hemorrhage,
gangrene Site: extravasation.
· Vasopressin (Pitressin) – 720-721
Functional Class: Pituitary hormone
