B: 21-24 Flashcards by shir nov

Dyslipidemia drugs

Atorvastatin
Rosuvastatin
Simvastatin
Ezetimib
Fenofibrate
Colesevelam

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Statins MOA

HMG-CoA reductase inhibitors which is the rate limiting step of endogenous cholesterol synthesis

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Statins actions

Liver cholesterol ↓
LDL-R expression ↑
Plasma LDL ↓ (20-50% reduction)
VLDL synthesis by liver ↓
Plasma TG ↓

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Atorvastatin
Rosuvastatin
Simvastatin

Difference

Atorvastatin: Active as given
Rosuvastatin: Active as given
Simvastatin: Prodrug

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Atorvastatin
Rosuvastatin
Simvastatin

Metabolism

CYP450

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Atorvastatin
Rosuvastatin
Simvastatin

Indications

Atherosclerotic vascular disease
Acute coronary syndrome
Reduced risk of cardiovascular disease
Reduced mortality in ischemi heart dieseas

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Statins side effects

Hepatotoxicity
Myalgia
Rhabdonyolysis

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Statins contraindications

Teratogenic

Liver diseas caution

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Colesevelam MOA

Large non absorbable polymers that bind bile acidsand prevent their absorption which divers hepatic cholesterol to the synthesis of new bile

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Bile acid sequestrans drug

Colesevelam

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Colesevelam how to give and when?

Oral
With meals
Dont give togather with other drugs (wait btw. 4 h)

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Colesevelam indications

Primary hypercholesterolemia type IIA (LDL↑)

With Statins

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Colesevelam side effects

VLDL ↑
TG ↑
GI
Vit. ADEK malabsorption
Hyperglycemia
Gall stones

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Sterol absorption inhibitors

Ezetimibe

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Ezetimibe MOA

Block NPC1L1 in intestine
Reduce cholesterol absorption
Liver cholesterol ↓	
LDL-R expression ↑
Plams LDL ↓ (20% reduction)

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Carbonic Anhydrase inhibitors

Acetazolamide

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Acetazolamide indicaitons

Diuretic use if edema+metabolic alkalosis
Glaucoma
Mountain sickness
Innr ear disorder
Urinary alkalosis

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Acetazolamide side effects

Metabolic acidosis

Renal stones

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Loop diuretics MOA and names

Furosemide
Ethacrynic acid

Inhibition of Na/K/2Cl in the thick ascending limb

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Inhibition of Na/K/2Cl in the thick ascending limb will cause

Loss of NaCl
Loss of luminal positive potential (Mg,Ca reab.↓)
K and H wasting
Hypokalemic metabolic alkalosis
XOX-2 ↑ → GFR ↑

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Furosemide drug interactions

NSAID’s
Aminoglycosides
Lithium
Digoxin

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How are they different?

Furosemide is a Sulfa drug

Ethacrynic acid is not a Sulfa drug

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Furosemide indications

HF
Acute pulmonary edema
HTN
Hypercalcemic state
Acute renal failure management

Furosemide side effects

Sulfa drug
Hypovolemia
Hypokalemic metabolic alkalosis
Ototoxicity
Hypocalcemia
Hypomagnesemia
Hyperuriceria

Thiazides diuretics MOA

Inhibition of Na/Cl transporter in the distal conv. tubule

Hydrochlorothiazide drug properties

Sulfa drug Oral 6-12 h

Hydrochlorothiazide drug interactions

Digoxin | Avoid in DM

Hydrochlorothiazide indications

``` HTN CHF Nephrolithiasis Nephrogenic DI Osteoporosis ```

Hydrochlorothiazide side effects

``` Sulfa Hypokalemic metabolic alkalosis Hyponatremia Hypercalcemia Hyperuricemia Hyperglycemia Lithium levels ↑ ```

Thiazides diuretic drugs

Hydrochlorothiazide | Indapamide

Indapamide indications

HTN | Can be combined with ACEi

Mannitol MOA How to give? Duration of action

Osmotic diuresis IV Short

Mannitol indications

Intracranial HTN | Glaucoma

Mannitol side effects

Pulmonary edema HF exacerbation Na imbalance Acute hypovolemia

ENaC inhibitor

Amiloride

Amiloride MOA How to give? Duration?

ENaC inhibitor IV 24 h

Amiloride indications

Hypokalemia caused by other diuretics Nephrogenic DM Liddle's syndrome

Amiloride side effects

Hyperkalemia metabolic acidosis

ADH antagonist

Tolvaptam

Tolvaptam MOA Receptor preferance How to give? Duration?

ADH antagonist V2-R antagonist Oral 12-24 h

Tolvaptan indications

SIADH

Tolvaptan side effects

Polyuria Thirst Hypernatremia

Antihistamines | Types

1st gen: Diphenhydramine, Promethazine, Dimetindene | 2nd gen: Cetirizine, Fexofenadine

Antihistamines- 1st gen

Diphenhydramine Promethazine Dimetindene

Antihistamines- 2nd gen

Cetirizine | Fexofenadine

Antihistamines MOA

H1-R antagonists

``` Antihistamines- 1st gen How to give Duration Metabolism Molecule type ```

Oral, parenteral 4-12 h CYP450 Lipophilic

Diphenhydramine indications

``` IgE mediated allergies Sedative Antiemetic Sleep aid Anti motion sickness Pregnancy nausea Acute extrapyramidal symp. ```

Diphenhydramine side effects

Sedation Antimuscarinic a-R inhibatory effect Interact with alcohol- Sedation

Promethazine special features

Less anti motion sickness effect More sedative More autonomic effect

Dimetindene special features

Treatment of allergic reactions | Minimally cross BBB

Antihistamines- 2nd gen | What is special about them?

H1-R antag. at peripheral | No autonomic or anti motion sickness effect

Cetirizine Fexofenadine How to give Duration Metabolism Molecule type

Oral, parenteral 12-24 h CYP450 Less lipophilic

Cetirizine Fexofenadine Indications

IgE allergies

Cetirizine Fexofenadine Side effects

Sedation Arrhythmias in overdose When interact with alcohol- Sedation