Create an educational item that describes/displays the dangers associated with the chosen drugs.
Lisinopril (Prinivil, Zestril)
Therapeutic Class: Drug for heart failure and HTN Pharmacologic Class: ACE inhibitor actions and Uses Because of its value in the treatment of both HF and HTN, lisinopril has become one of the most frequently prescribed drugs. Lisinopril acts by inhibiting ACE and decreasing aldosterone secretion. Blood pressure is decreased and cardiac output is increased. As with other ACE inhibitors, 2 to 3 weeks of therapy may be required to reach maximum effectiveness, and several months of therapy may be needed for cardiac function to return to normal. An additional indica-tion for lisinopril is to improve survival in patients when given within 24 hours of an acute MI. Fixed-dose combinations of lisinopril and hydrochlorothiazide (a diuretic) are marketed for HTN as Prinzide and Zestoretic. Treatment of migraines is an off-label indication for lisinopril. administration alerts • Assess blood pressure just prior to administering lisino-pril to be certain that effects are lasting for 24 hours and to determine whether the patient’s blood pressure is within the acceptable range. • Safety and efficacy have been established for the use of this medication in children age 6 and older. • Geriatric patients may have higher blood levels related to renal failure. • Pregnancy category C (first trimester) or D (second and third trimesters). Discontinue use as soon as pregnancy is suspected. onset 1 h PHarMaCokinetiCs Peak 6–8 h Duration 24 h adverse effects Lisinopril is well tolerated by most patients. The most common adverse effects are cough, headache, dizziness, orthostatic hypotension, and rash. Hyperkalemia may occur during therapy; thus, electrolyte levels are usually monitored periodically. Other effects include taste disturbances, chest pain, nausea, vomiting, and diarrhea. Though rare, angi-oedema is a serious adverse effect. Black Box Warning: Fetal injury and death may occur when ACE inhibitors are taken during pregnancy. When pregnancy is detected, they should be discontinued as soon as possible. Contraindications: Lisinopril is contraindicated in patients with hyperkalemia and in those who have previously experienced angioedema caused by ACE inhibitor therapy. It should not be used during pregnancy. interactions Drug–Drug: Indomethacin and other NSAIDs may interact with lisinopril, causing decreased antihypertensive activity. Because of the additive hypotensive action of lisinopril and diuretics, combined therapy with these or other antihyper-tensive drugs should be carefully monitored. When lisinopril is taken concurrently with potassium-sparing diuretics, hyperkalemia may result. Aliskirin (Tekturna), a renin inhibitor, should not be used concurrently with lisinopril due to an increased risk of hypotension and renal impairment. Lisinopril may increase lithium levels and cause lithium toxicity. lab tests: May cause positive antinuclear antibody (ANA) titer and increase values of the following: blood urea nitrogen (BUN), serum bilirubin, serum alkaline phosphatase, aspar-tate aminotransferase (AST), and alanine aminotransferase (ALT). Herbal/Food: Excessive intake of foods rich in potassium and potassium-based salt substitutes should be avoided because of the possibility of hyperkalemia. treatment of overdose: Overdose causes hypotension, which may be treated with the administration of normal saline or a vasopressor.
Norepinephrine (Levophed)
Pharmacologic Class: Nonselective adrenergic agonist: vasopressor Actions and uses Norepinephrine is a sympathomimetic that acts directly on alpha-adrenergic receptors in vascular smooth muscle to immediately raise blood pressure. To a lesser degree, it also stimulates beta1-receptors in the heart, thus producing a positive inotropic response that may increase cardiac output. Its primary indications are acute shock and cardiac arrest. Norepinephrine is the vasopressor of choice for septic shock because research has demonstrated that it significantly decreases mortality. It is given by the IV route and has a du-ration of only 1 to 2 minutes after the infusion is terminated. Administration Alerts • Start an infusion only after ensuring the patency of the IV. Monitor the flow rate continuously. • If extravasation occurs, administer phentolamine to the area of infiltration as soon as possible. • Do not abruptly discontinue infusion. • Pregnancy category D. onset Immediate PhArmACokineTiCS Peak 1–2 min Duration 1–2 min Adverse effects Norepinephrine is a powerful vasoconstrictor; thus, continuous monitoring of the patient’s blood pressure is required to prevent the development of hypertension. When first administered, reflex bradycardia is sometimes expe-rienced. It also has the ability to produce various types of dysrhythmias, although less so than other vasopressors. If extravasation occurs, the drug may cause serious skin and soft tissue injury. Blurred vision and photophobia are signs of overdose. Black Box Warning: Following extravasation, the affected area should be infiltrated immediately with 5 mg to 10 mg of phentolamine, an adrenergic blocker. Contraindications: Norepinephrine should not be admin-istered to patients who are experiencing hypotension due to blood volume deficits because vasoconstriction already ex-ists in such patients. Norepinephrine may cause additional, severe peripheral and visceral vasoconstriction with de-creased urine output. Norepinephrine is not usually given to patients with mesenteric or peripheral vascular thrombosis, because there is an increased risk of increasing ischemia and worsening the infarction. interactions Drug–Drug: Alpha and beta blockers may antagonize the drug’s vasopressor effects. Conversely, ergot alkaloids and tricyclic antidepressants may potentiate vasopressor effects. Digoxin, halothane, and cyclopropane may increase the risk of dysrhythmias. Lab Tests: Unknown. herbal/Food: Unknown. Treatment of overdose: Discontinuing the infusion usu-ally results in a rapid reversal of adverse effects such as hypertension.