Pharmacology Exam 4 Study Guide

Introduction

Welcome! This guide covers key topics from Module 11 (Blood Coagulation, Diuretics, Renal Function) and Module 12 (Antihypertensives, Antiarrhythmics, Antianginals, Lipid-Lowering Agents). Each step gives you the main points about how these drugs work, why they’re used, and important safety tips.

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1. Blood Coagulation Medications

These drugs help prevent or treat blood clots (like DVT, PE, stroke), but they can increase bleeding risk.

Anticoagulants

  • Heparin/LMWH (Enoxaparin): Quick onset, monitor aPTT (for IV heparin), watch for HIT.
  • Warfarin: Long-term use, monitor INR, keep Vitamin K intake consistent.
  • DOACs (e.g., Rivaroxaban): Fixed dosing, minimal labs, reversal agents available.

Antiplatelets

  • Aspirin: Blocks platelet aggregation; used for heart attack/stroke prevention.
  • Clopidogrel: Often used with stents or combined with aspirin.

Thrombolytics (tPA)

“Clot busters” dissolve existing clots; used for acute MI, stroke, or large PE in a strict time window. High bleeding risk!

2. Diuretics & Renal Function

Diuretics help remove extra fluid by blocking sodium and water reabsorption in the kidneys. They’re used for high blood pressure, edema, and sometimes to protect kidney function.

Loop Diuretics

  • Furosemide (Lasix): Powerful, watch for low potassium, low BP, possible hearing issues if given IV too fast.

Thiazide Diuretics

  • Hydrochlorothiazide (HCTZ): Common for mild hypertension, can lower potassium and raise blood sugar.

Potassium-Sparing Diuretics

  • Spironolactone: Blocks aldosterone; can cause high potassium and hormonal side effects (e.g., gynecomastia).

Osmotic Diuretics

  • Mannitol: Draws fluid into the urine; used for high intracranial or intraocular pressure.

3. Antihypertensives & RAAS

High blood pressure is managed by reducing heart workload, relaxing blood vessels, or lowering fluid volume. RAAS inhibitors (ACE inhibitors or ARBs) are a mainstay.

ACE Inhibitors / ARBs

  • Lisinopril (ACE): Lowers Ang II production; can cause cough, high K⁺, angioedema.
  • Losartan (ARB): Blocks Ang II receptors; avoids cough but watch for hyperkalemia.

Beta Blockers (e.g., Metoprolol)

  • Slow heart rate and reduce contractility → lower BP and heart workload.
  • Check heart rate; can mask low blood sugar signs in diabetics.

Calcium Channel Blockers

  • Amlodipine: Vasodilates, watch for edema.
  • Diltiazem/Verapamil: Also slow heart rate; avoid grapefruit juice.

Other classes: Alpha-1 blockers (like Prazosin), Central alpha-2 agonists (Clonidine), direct vasodilators (Hydralazine).

4. Cardiac Glycosides

Digoxin

  • Increases heart's pumping force but lowers heart rate.
  • Narrow therapeutic range (~0.5–2.0 ng/mL); risk of toxicity.
  • Toxic signs: GI upset, vision changes (halos), arrhythmias.
  • Hold if HR <60 bpm; check potassium levels.

5. Antiarrhythmic Drugs

These help correct or control abnormal heart rhythms. They can also cause new rhythm problems if not used carefully.

Class I (Na⁺ Channel Blockers)

  • IA (Procainamide): Slows conduction, can prolong QT interval.
  • IB (Lidocaine IV): Shortens repolarization, used for ventricular arrhythmias.
  • IC (Flecainide): Strong block; avoid in structural heart disease.

Class II (Beta Blockers)

  • Slow SA/AV node conduction, helpful in AF/flutter or post-MI arrhythmias.

Class III (K⁺ Channel Blockers)

  • Amiodarone: Works in many arrhythmias; can damage lungs, liver, thyroid, eyes.

Class IV (Ca²⁺ Channel Blockers)

  • Diltiazem, Verapamil: Slow AV node; used for rate control in AF.

Others

  • Adenosine: Resets SVT by causing brief asystole.
  • Atropine: Speeds up bradycardia by blocking vagal stimulation.
  • Digoxin: (Also see Cardiac Glycosides) can help control ventricular rate.

6. Antianginal Medications

Nitrates (Nitroglycerin)

  • Dilate veins and some arteries → lower heart’s oxygen demand.
  • Sublingual for quick relief, also patches/pills for prevention.
  • Side effects: Headache, low BP, reflex tachy. Avoid ED meds (e.g. sildenafil).

Beta Blockers & CCBs for Angina

  • Decrease heart workload (HR, contractility, afterload).
  • Help prevent chest pain episodes and lower oxygen demand.

7. Lipid-Lowering Agents

These reduce LDL (“bad”) cholesterol, lower triglycerides, and sometimes raise HDL.

Statins (e.g., Atorvastatin)

  • Block cholesterol production in liver → big LDL drop.
  • Check for muscle pain (myopathy), watch liver function, avoid grapefruit.

Bile Acid Sequestrants

  • Cholestyramine: Binds bile in gut; can cause GI discomfort, constipation.

Niacin (Vitamin B3)

  • Raises HDL; flushing is common (take aspirin ~30 min before).

Fibrates

  • Gemfibrozil: Mainly lowers triglycerides; watch for gallstones, myopathy.

Ezetimibe

  • Blocks dietary cholesterol absorption; often used with a statin.

References

  1. Open RN Nursing Pharmacology – Blood Coagulation Modifiers
  2. Open RN Nursing Pharmacology – Diuretics
  3. Open RN Nursing Pharmacology – Antihypertensives
  4. Open RN Nursing Pharmacology – Cardiac Glycosides
  5. Open RN Nursing Pharmacology – Antiarrhythmics
  6. Open RN Nursing Pharmacology – Antianginals
  7. Open RN Nursing Pharmacology – Antilipemics

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