Cardiac/renal Flashcards
Thiazide diuretics
HCTZ
*high dose therapy with HCTZ should be avoided due to increase risk of hypokalemia. Instead use combination of spironolactone + HCTZ
Loop diuretics
Furosemide, torsemide
Use caution with ________ if allergy to Bactrim (sulfa)
Loop diuretics (furosemide, torsemide)
Watch for hyperlipidemia in pt’s taking:
thiazide diuretics (HCTZ)
Potassium sparing diuretics
Spironolactone
often used in combination with HCTZ
Heart failure treatment
Stage a: ACEI!
Stage b: ACEI + BB
Cardiac glycosides
Digoxin
Digoxin ADR
toxicity in levels over 1mg/ml.
Increased risk of mortality in women
Antiarrhythmics
- Sodium channel blockers (flecainide, lidocaine),
- Beta blockers
- Potassium channel blocker (amiodarone)
- Calcium channel blockers(verapamil, cardizem)
Antiarrhthmic education
Educate patient on labs to monitor potassium, BUN/Cr, therapeutic drug levels. Baseline EKG.
DO NOT double dose.
Be aware of food-drug interactions.
HTN guidelines
- ACEI/ARB: first line for caucasians
- CCB: first line for African americans
Add thiazide diuretic if ineffective to control ^
When to initiate hypertensive therapy
If SBP greater than 20mmHg above goal.
Prescribe ACEI to which pts:
- White caucasians with primary HTN.
- DM pts for nephopathy
- Cardiac pts to reduce remodeling. tx angina after MI.
ACEI ADR
4x greater risk of angioedema in African Americans/asians
Hypotension, dry cough, loss of taste, blood dycrasias
CKD use:
ACEI until stage 3
Stroke prevention
Use ACEI + diuretic + ASA
What HTN med to use in pregnancy
NOT ACEI/ARB. Avoid.
Use BB.
Avoid BB in pt’s with
Severe or uncontrolled asthma
Do not take amiodarone with:
Grapefruit juice!
Dyslipidemia meds
- Statins (may cause rhabodo)
- Fibrates: Work for pts with VERY high TG levels (but not substantial decrease in LDL)
*monitor lipid levels! - Bile acid sequestrants:
Only class to use with liver failure. ADR related to intestine metabolism. Gas, constipation, bloating. Mix one packet with juice, never swallow dry. - Niacin: No longer approved by FDA for lipid management
- Zetia: Best used if combined with other dyslipidemic
Bile acid sequestriants are the only class of dyslipidemic used for:
- liver disease
- PREGNANCY.
Do not prescribe statins to pt’s with
PREGNANCY!
When to treat LDL
Do not necessarily have to treat if just high LDL. Treat if other risk factors for CV events.
Children/adolescents goal cholesterol is under 170.
Use primary prevention measures first: Diet/exercise.
Use ASCVD risk calculator to determine if statin necessary
Should you do regular liver lab levels with statins
No, not significant enough to do regular monitoring. Passive monitoring of symptoms is better approach.
