Prescription Drug Study Guide: Cardiovascular, Metabolic, and Pain Management

• Side Effects: Common issues include peripheral edema (swelling of the extremities), dizziness, and gingival hyperplasia (overgrowth of gum tissue).
• Dietary Interaction: Patients taking nifedipine or verapamil must avoid grapefruit juice, as it can interfere with drug metabolism.

Beta Blockers

Beta blockers (e.g., atenolol, metoprolol, propranolol, carvedilol) reduce heart rate and blood pressure by blocking beta-adrenergic receptors. They are vital for hypertension and heart failure management.

Critical Nursing Note: The Diabetic Patient Beta blockers can mask the symptoms of hypoglycemia (low blood sugar), such as tachycardia (rapid heart rate). Diabetic patients must be extra vigilant with blood glucose monitoring. Furthermore, these drugs should never be discontinued abruptly, as this can cause rebound hypertension.

Diuretic Therapy

Diuretics are "water pills" used to reduce edema and manage hypertension by increasing urine output.

• Thiazides: Patients should eat high-potassium foods to offset losses.
• Loop Diuretics: Furosemide carries a risk of ototoxicity (hearing damage) and increased sun sensitivity; patients should use sunscreen.
• Potassium-Sparing: Spironolactone can lead to dangerous hyperkalemia. Patients must be warned to avoid salt substitutes that contain potassium.

Metabolic Management: Diabetes and Lipids

Diabetes Medication

Diabetes management involves several distinct mechanisms to control blood glucose levels.

1. Biguanides: Metformin is a primary first-line therapy.
2. SGLT-2 Inhibitors: Drugs like canagliflozin and dapagliflozin work by promoting glucose excretion through the urine. Patients should be monitored for dehydration, genital fungal infections, and foot ulcers.
3. GLP-1 Analogs: Injectable or oral treatments like semaglutide (Ozempic) and dulaglutide (Trulicity) mimic incretin hormones.
4. Insulins: Ranges from rapid-acting (lispro) to long-acting (glargine).

Lipid-Lowering Agents

To manage hyperlipidemia and prevent cardiovascular disease, three main classes are used:

• Statins (HMG-CoA Reductase Inhibitors): (e.g., atorvastatin, simvastatin) These are the gold standard for lowering cholesterol. Warning: Patients must report unexplained muscle tenderness or weakness immediately, as this may indicate rhabdomyolysis (muscle breakdown). Avoid excessive grapefruit juice.
• Fibrates: (e.g., gemfibrozil, fenofibrate) Used for hyperlipidemia; monitor for jaundice and rhabdomyolysis.
• Cholesterol Absorption Inhibitors: Ezetimibe can be taken with or without food and is often used alongside statins.

Other Essential Medications

Smoking Cessation and Pain Management

• Smoking Cessation: Bupropion and varenicline are used to assist patients in quitting smoking.
• Analgesics (Opioids): For severe pain management, opioids such as hydrocodone, oxycodone, morphine, and fentanyl are used. These require careful monitoring due to the risk of respiratory depression and dependence.

Summary of Administration and Titration

Most chronic medications (like ACE inhibitors or CCBs) are titrated—meaning the dose is adjusted gradually based on the patient's response and tolerability. Patients should be instructed to:

1. Rise slowly from sitting or lying positions to prevent dizziness (orthostatic hypotension).
2. Maintain consistency in how they take their medication (e.g., with or without food).
3. Report specific symptoms like muscle pain (statins), swelling (CCBs), or decreased urination (ARBs) immediately.