I GOT LIKE HELLA DRUGS

barrel to the roof of my mouth

100

We always check BP before? (drug classes)

ACE, ARB, ARNI, BB

200

preload reducers? (2)

• Diuretics
• Nitrates

300

give me info abt streptomycin 

Class

• Aminoglycoside

Major Side Effect

• Ototoxicity
• Nephrotoxicity

Nursing implications

Baseline hearing test

• Monitor kidney function
• Assess for tinnitus

400

DIGOXIN

give mechanism, why we use in HF, special characteristics, and nursing implications

Mechanism

• Positive inotrope → ↑ contractility
• Negative chronotrope → ↓ heart rate
• Slows AV conduction

Why used in HF?

• Improves symptoms
• Helps with atrial fibrillation rate control

Narrow Therapeutic Window

• Therapeutic level: 0.5–2.0 ng/mL
• Toxic > 2.0 ng/mL

Digoxin Toxicity Signs

• N/V
• Anorexia
• Bradycardia
• Visual changes (yellow/green halos)
• Confusion
• Arrhythmias

Nursing Implications

• Check apical pulse for 1 full minute
• 
  
  • Hold if HR < 60
• 
  
• Monitor potassium
• 
  
  • Hypokalemia ↑ toxicity risk
• 
  
• Monitor digoxin levels
• Antidote: Digoxin immune Fab (Digibind)

500

ACTIVE tb treatment drugs?

Initial Phase (First 2 Months)

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

Continuation Phase (Next 4 Months)

• Rifampin
• Isoniazid

Total treatment = 6 months minimum

PT EDUCATION that this treatment takes time!!!

idk im tired

100

Sotalol 

give why we use for dysrhythmias, side effects, special characteristics, and nursing implications

Special Notes

• Beta blocker + potassium channel blocker
• Can prolong QT interval

Risk

• Torsades de pointes (polymorphic vent tachycardia, LIFE THREATENING)

Nursing implications

• Must be started with continuous EKG monitoring
• Monitor QT interval
• Monitor potassium and magnesium

200

Always check HR before? (drug name and a drug class)

Digoxin and beta blockers

300

LOOP DIUERETICS 

give mechanism, why we use in HF, special characteristics, and nursing implications

Decrease Preload

Loop Diuretics (Most Common)

• Furosemide (Lasix)
• Bumetanide

Mechanism

• Powerful diuresis
• ↓ fluid overload
• ↓ pulmonary congestion

Side Effects

• Hypokalemia
• Dehydration
• Hypotension
• Ototoxicity (high doses)

Nursing implications

• Daily weights (most accurate fluid indicator)
• Strict I&O
• Monitor potassium
• Monitor BP
• Assess lung sounds

400

Most dangerous effect for RIPE drugs?

Isoniazid: Hepatotoxicity + neuropathy

Rifampin: Hepatotoxicity + thrombocytopenia

Ethambutol: Optic neuritis

500

Slow heart rate? (2)

• Beta blockers
• Digoxin

12:27am

100

Improve contractility? (1)

• Digoxin

200

ARNI (Neprilysin Inhibitor + ARB) 

give mechanism, why we use in HF, special characteristics, and nursing implications

Example: Entresto (Sacubitril/Valsartan)

Mechanism

• Enhances natriuretic peptides
• Causes vasodilation
• Promotes sodium/water excretion

Important

• Do NOT give with ACE inhibitor
• Must wait 36 hours after stopping ACE before starting

Nursing implications

• Monitor BP
• Monitor potassium
• Monitor renal function

300

Flecainide

give why we use for dysrhythmias, side effects, special characteristics, and nursing implications

Mechanism

• Slows conduction

Side Effects

• Dizziness
• Visual disturbances
• Arrhythmias
• Liver toxicity

Nursing implications

• EKG monitoring
• Monitor for new arrhythmias
• Monitor liver function

400

Monitor K+ with? (looking for 3 drug classes)

ACE/ARB (increase K+)

Loop diuretics (increase K+)

Digoxin (we all know why, can cause toxicity if potassium too low, short therapeutic window, yada yada yada)

500

Non-DHP Calcium Channel Blockers

give mechanism, why we use for dysrhythmias, special characteristics, and nursing implications

(Diltiazem, Verapamil)

Mechanism

• Slow AV conduction
• Decrease HR
• Decrease contractility

Side Effects

• Hypotension
• Bradycardia
• Constipation
• Edema

Nursing implications

• Check HR & BP
• Hold if HR < 60
• Avoid in heart failure (can worsen)

im in your walls

100

Amiodarone

give why we use for dysrhythmias, side effects, special characteristics, and nursing implications

this drug EATSSSS

Mechanism

• Blocks potassium channels
• Prolongs repolarization

Major Side Effects 

• Pulmonary toxicity (most dangerous)
• Thyroid dysfunction (hyper or hypo)
• Liver toxicity
• Corneal deposits
• Blue-gray skin discoloration
• Photosensitivity
• Bradycardia

Nursing Monitoring

• Baseline CXR
• Pulmonary function tests
• Thyroid labs
• Liver enzymes
• EKG monitoring

200

RAAS INHIBITORS

give mechanism, why we use in HF, special characteristics, and nursing implications

ACE Inhibitors (-pril)

Examples: Lisinopril, Captopril

ARBs (-sartan)

Examples: Losartan, Valsartan

Mechanism

• Block RAAS
• ↓ afterload
• ↓ preload
• ↓ aldosterone
• ↑ cardiac output

Side Effects

• Hyperkalemia
• Hypotension
• ACE: Dry cough
• ACE: Angioedema

Nursing Implications

• Monitor potassium
• Monitor BP
• Assess for facial/lip swelling
• Check renal function (BUN/Creatinine)

300

alr now expand on the RIPE drugs

i wanna see mechanism, side effects, special characteristics, and nursing implications

Isoniazid

Mechanism

• Inhibits mycolic acid synthesis
• Bactericidal

Major Side Effects

• Hepatotoxicity
• Peripheral neuropathy
• Elevated liver enzymes

Key Exam Point

➡️ Always give Vitamin B6 (Pyridoxine) to prevent neuropathy

Nursing Implications

• Monitor AST/ALT
• Assess for numbness/tingling
• Avoid alcohol
• Report jaundice, fatigue, dark urine

Rifampin

Mechanism

• Inhibits RNA synthesis
• Bactericidal

Major Side Effects

• Hepatotoxicity
• Thrombocytopenia
• Orange/red body fluids (normal!)

Nursing Implications

• Monitor LFTs
• Educate: urine, sweat, tears turn orange
• May stain contact lenses
• Reduces effectiveness of birth control

Pyrazinamide

Mechanism

• Disrupts bacterial cell membrane metabolism

Side Effects

• Hepatotoxicity
• Hyperuricemia (↑ uric acid)
• Gout flare

Nursing implications

• Monitor liver enzymes
• Monitor uric acid levels
• Assess joint pain

Ethambutol

Mechanism

• Inhibits cell wall synthesis

Major Side Effect

• Optic neuritis

Symptoms

• Blurred vision
• Red-green color blindness

Nursing implications

• Baseline visual acuity exam
• Monthly vision testing
• Stop drug if vision changes occur

400

Afterload reducers? (4)

• ACE inhibitors
• ARBs
• ARNI
• Hydralazine

500

BETA BLOCKERS

give mechanism, why we use in HF, special characteristics, and nursing implications

Examples:

• Atenolol
• Labetalol
• (HF preferred: Metoprolol succinate, Carvedilol)

Mechanism

• Slow HR
• ↓ myocardial oxygen demand
• Mild vasodilation

Important

• NOT started during acute decompensated HF
• Used once patient stable

Side Effects

• Bradycardia
• Hypotension
• Fatigue
• Worsening HF if started incorrectly

Nursing implications

• Check HR and BP before giving
• Hold if HR < 60
• Monitor for worsening SOB or edema

Ą̸̹̼̣̬̣̺̱̪̫̃̀́́͊̂̆͝͠ͅn̸̡̢̛̗̭̮̮̫͖̼̲̳̊̂̓͗̔̒̍̉̎̓̆̍̂͠ ̶̻͔̱̜̺̗̠̭̦͍͈͂͐̑͑̅͊͐̕ȅ̴͉̼̓̇́̋́̈́͛͝͝͝ŷ̸̨̩͕̮̹̥̫̖̙͍̻̘̟̣̞e̸͍͖͆̏̆̓̽͋̕͠l̶͙̮̬͖̞̮̯̦̹̽͐̈̉̔͆̈́ͅę̸̼͓͍̭͔̙̫̇͒͒̃̄̍̓͜͝s̶͇͈̎̋̍̋̆̒̍s̴̨̧̪̥͎̙̠̹͛͊́̉̅̅́̀̕̚͝͝ ̴̜̯̿̒͐̋͋̚͝͠a̶͇̩̰͙͂̊́͐̐͆͌̍̈́̚͝͝b̶̯̣̠̀͗ỡ̷̘͎͙̳͇͚̝̫̥͓͈̲͇̙͑̂͒̃̍̆̿̿͘͝m̶̔

100

Labs to monitor for RIPE drugs? why?

• Liver panel (AST, ALT)
• Renal panel
• Platelets (rifampin)
• Uric acid (PZA)

Other Monitoring

• Visual acuity (Ethambutol)
• Audiometry (Streptomycin)

200

Biggest SE with streptomycin?

ototoxicity 

300

VASODILATORS

give mechanism, why we use in HF, special characteristics, and nursing implications

Examples:

• Hydralazine
• Nitrates

Mechanism

• ↓ afterload
• Improve cardiac output

Used When

• Cannot tolerate ACE/ARB
• Often used in African American patients

Nursing implications

• Monitor BP
• Headache common with nitrates
• Assess for hypotension

400

Biggest SE with sotalol and amiodarone?

Sotalol: QT prolongation

Amiodarone: Pulmonary toxicity

500

SGLT2 Inhibitors 

give mechanism, why we use in HF, special characteristics, and nursing implications

Examples:

• Farxiga (dapagliflozin)
• Invokana (canagliflozin)

Originally diabetes meds — now HF therapy

Mechanism

• Osmotic diuresis
• ↓ preload
• Improves HF outcomes even without diabetes

Side Effects

• Dehydration
• UTIs
• Hypotension

Nursing implications

• Monitor hydration
• Monitor kidney function
• Educate about genital infections