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Natalie Pharm > Cardio Meds-lecture > Flashcards

Cardio Meds-lecture Flashcards

1
Q

what is the basic pathophysiology of IHD/CHD

A

imbalance between cardiac oxygen needs and supply.

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2
Q

Acute therapy for chronic stable angina

A

Nitroglycerin

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3
Q

Are beta blockers used for long term or short term therapy for chronic stable angina

A

long term

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4
Q

Class of nitroglycerin

A

Vasodilator

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5
Q

Indications for nitroglycerine

A

angina

CHF

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6
Q

MoA for nitroglycerine and Isosorbide Dinitrate (Isordil)

A

dilates arteries and veins by acting on the smooth muscle

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7
Q

Contraindications for nitroglycerine and Isosorbide Dinitrate (Isordil)

A

Head trauma
severe dehydration

and obviously allergy

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8
Q

PDE-5 inhibitors are a known dx-dx for what?

A

Nitro and Isosorbide Dinitrate (Isordil)

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9
Q

There are many formulations for nitro. Name some

A 
Sub lingual spray
Sub lingua or buccal tab
topical 
IV
(glass bottle (?) vaporizes)
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10
Q

What do you use Isosorbide dinitrate (Isordil) for?

A

frequent stable angina, CHF

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11
Q

These meds dilate arteries and veins by relaxing the smooth muscle around them

A

Nitroglycerine and Isosorbide Dinitrate (Isordil)

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12
Q

Nitroglycering and Isosorbide Dinitrate (Isordil) are both vasodilators, which one is long acting and which is short acting?

A

Nitro-short

Isosorbide Dinitrate-long

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13
Q

Off-label use for Isosorbide Dinitrate (Isordil)

A

esophageal spastic disorders

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14
Q

How long should the nitrate-free interval be when using Isosorbide Dinitrate (Isordil)

A

8-12 hours

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15
Q

What are the 2 Dihydropyridine (DHP) Ca++ channel blockers?

A

Amlodipine (Norvasc)

Nifedipine (Adalat)

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16
Q

What kind of Ca++ blocker are Diltizem and Verapamil?

A

Nonhydropyridines (NDHP)

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17
Q

Can you use Dihydropyridine CCB to treat HTN?

A

Yes

Primary indication: Angina

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18
Q

How do the dihydropyridine CCBs work?

A

Cause vasodilation by blocking Ca++ channels in vascular smooth muscle. Any med ending in -dipine is a DHP and only affects peripheral vasculature. (But ppt says they also act on myocardium.)

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19
Q

Side effect seen in elderly with Nifedipine (Adalat) and Amlodipine (Norvasc)

A

Hypotension

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20
Q

What do patients need to avoid while on Ca++ channel blockers?

A

Grapefruit Juice

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21
Q

Contraindications for Nifedipine (Adalat) and Amlodipine (Norvasc). (DHP meds)

A

Just allergy

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22
Q

Side effects of Nifedipine (Adalat) and Amlodipine (Norvasc)

A

DHPs

Nausea
Palpitations
Peripheral Edema

Elderly-hypotension

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23
Q

What do we use PDE-5 inhibitors for? Give an example.

A

Erectile dysfxn. viagra (Sildenafil)

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24
Q

pregnancy category for most angina meds

A

C

Aspirin and Atenolol: D
Plavix: B

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25
Q

Of Amlodipine and Nifedipine, which is more likely to cause hypotension?

A

Nifedipine

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26
Q

What does it mean for a med to be in the class Non-dihydropyridine?

A

It blocks the Ca++ channels in the heart rather than the periphery.

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27
Q

Indications for NDHPs

A 
Diltiazam and Verapamil are used for:
Angina
HTN
PSVT
A fib
A flutter
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28
Q

MoA of NDHPs

A

Diltaziam and Verapamil dilate coronary arteries and decrease myocardial oxygen demands

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29
Q

What class is Diltiazem (Cardizem)?

A

Non-dihydropyridine Calcium Channel Blocker

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30
Q

Side effects of Diltiazem (Cardizem)?

A

Headache, edema, dyspepsia

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31
Q

Side effects of Verapamil (Calan)?

A

Headache, gingival hyperplasia, constipation, fatigue

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32
Q

Don’t give Diltiazem (Cardizem) or Verapamil (Calan) to people with…

A

Bradycardia, Sick Sinus Syndrome with no pacer.

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33
Q

Do you need to monitor LFT’s, BP, and chest pain with Verapamil (Calan)?

A

Yes, same goes for the other NDHP (Diltiazem-Cardizem)

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34
Q

Which calcium channel blockers can you combine with a beta blocker?

A

Amlodipine (Norvasc)

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35
Q

Which calcium channel blockers can you NOT combine with a betablocker? Why?

A

Diltiazem (Cardizem)
Verapamil (Calan)

Will decrease nodal conduction

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36
Q

Is CHF a contraindication for Diltiazem (Cardizem) and Verapamil (Calan)?

A

Yes

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37
Q

What impact does cirrhosis have on Diltiazem (Cardiezem)?

A

Increases the half life

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38
Q

Class of Propranolol (Inderal)

A

Non-selective Beta Blocker

Beta 1 and Beta 2

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39
Q

Class of Carvedilol (Coreg)

A 
Non-selective Beta Blocker
Mixed alpha (1) and beta (1 and 2) receptor inhibitaion
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40
Q

Uses for Propanolol (Inderal)

A

Angina, HTN, Tachy-arrhythmias, essential tremore, migrane prevention, anxiety

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41
Q

Uses for Carvedilol (Coreg)

A

Angina (off-label), HTN, stable HF, stable post-MI

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42
Q

What side effects do BOTH non-selective beta blockers cause?

A

Fatigue, sleep disturbance, depression

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43
Q

Side effects of Carvedilol (Coreg) that arne’t side effects of Propanolol (Inderal)

A

Bradycardia, rebound angina/hypertension, hypotension

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44
Q

Do beta blockers react with other drugs? Which ones?

A

A lot. Look it up.

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45
Q

What do we monitor on Beta blockers?

A

BP, chest pain, HR, LFT, eGFR

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46
Q

MoA of Propranolol (Inderal)

A

Blocks a1, b1, b2 and produces a reduction in myocardial oxygen demand

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47
Q

Hypersensitivity, bradycardia, and what else are contraindications for Carvedilol (Coreg)?

A

heart block, uncompensated HF, severe depression, bronchospasm, severe liver failure

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48
Q

Can you give Carvedilol (Coreg) to someone with asthma?

A

Probably not. It can cause bronchospasm

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49
Q

Can you give Beta Blockers (all kinds) to someone who has had an MI or has compensated HF?

A

Yes, but you need to titrate slowly

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50
Q

Can you drink alcohol while taking Propanolol (Inderal)?

A

no

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51
Q

What class is Metoprolol?

A

Selective beta blocker

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52
Q

Indications for Metoprolol and Atenolol (Tenormin)

A

Angina, HTN, hemodynamicaly stable MI

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53
Q

By how much do beta blockers reduce risk of second MI?

A

25%

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54
Q

How much of Atenolol (Tenormin) is excreted renally?

A

~50%

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55
Q

If you give someone high dose of Metoprolol (>100mg day), what happens?

A

Loses selectivity for B1.

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56
Q

Cardiac related contraindications for Atenolol (tenormin) and Metoprolol

A

bradycardia, rebound angina/hypertension, hypotension

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57
Q

Class of Ranolazine (Ranexa)

A

Na+ channel inhibitor. Anti-angina

This is a new drug

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58
Q

Uses for Ranolazine (Ranexa)

A

Chronic Angina

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59
Q

MoA of Ranolazine

A

Inhibits inward sodium channel in inschemic cardiac cells during repolarization. This reduces Na+/Ca++ exchange which relaxes cardiac muscle –>reduces oxygen consumption

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60
Q

Is Diltiazem a CYP34A inhibitor?

A

yes

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61
Q

Can you give Ranolazine and Diltiazem at the same time?

A

No, Ranolazine dx-dx with CYP34A inhibors (diltiazem, erythromycin, verapamil)

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62
Q

Can you give cyclosporine with Ranolazine (Ranexa)?

A

Nope. dx-dx with P-glycoprotein and Ranolazine (Ranexa)

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63
Q

What do you monitor with Ranolazine?

A

BP, HR, eGFR, LFTs

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64
Q

What happens to serum levels in people with renal dysfunction when they take Ranalzine?

A

They increase

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65
Q

If someone has renal cirrhosis, can you give them Ranalzine?

A

No. not even a little.

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66
Q

Can you take Ranolazine with food? with juice?

A

food yes, but NOT with grapefruit juice.

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67
Q

Can you crush the Ranolazine pills and mix them in with apple sauce?

A

nope

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68
Q

Should Ranolazine be used for acute angina?

A

no it should not

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69
Q

What impact does Ranolazine have on heart rhythm?

A

prolongs QT interval

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70
Q

MoA for aspirin

A

COX-1 inactivation. Stops thromboxane A2 formation. TXA2 is needed for platelet aggregation and vasoconstriction.

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71
Q

Will aspirin give me a tummy ache?

A

30% of the time is causes gastritis and dyspepsia.

Also monitor for melana

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72
Q

What is Samter’s triad?

A

Aspirin-induced respiratory disease. In aprox 25% of asthmatics with nasal polyps, aspirin will increase asthma and allergy symptoms (watery eyes, itching, bronchospasm).

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73
Q

Average dose of ASA?

A

81 mg

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74
Q

What is the difference between MoAs of Diltiazem and Verapamil

A

Diltiazem is a benzothiazapine and acts on both peripheral vasculature as well as coronary vasculature. Verapamil impacts only coronary arteries.

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75
Q

Who’s your FAST friend in heart failure???

A

Diuretics!!

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76
Q

What is heart failure? (In simple terms)

A

Heart can’t keep up with all the work it’s supposed to do. This creates a whole slew of systemic problems.

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77
Q

Primary goals of pharm therapy for heart failure

A
  1. improve cardiac fxn2. reduce clinal symptoms3. reduce hospitalizations4. reduce risk of death
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78
Q

What will a patient with heart failure complain of?

A

Fatigued, weak, exercise intolerant.

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79
Q

How often does someone with heart failure pee?

A

A lot. And at night.Polyuria, Nocturia

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80
Q

What will lower extremities look like in HF?

A

Dependent edema d/t inadequate perfusion of tissue

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81
Q

What will the neck look like in HF?

A

jvd

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82
Q

What will you see on exam if the patient has HF

A

Dyspnea, inadequte pumping, orthopnea (SOB when lying flat), Post-nasal drip

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83
Q

Do diuretics cure HF?

A

No, they can quickly help decrease acute fluid load

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84
Q

What should you watch for when using diuretics?

A

Electrolyte imbalance, general dehydration

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85
Q

Why do diuretics work well as initial therapy?

A

They can help clear fluid while long-term controlling agents are on-boarding.

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86
Q

What is the most common diuretic used?

A

Furosemide (Lasix)

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87
Q

Which diuretic has IV and oral dosing equilants?

A

Torsemide

88
Q

Which diuretics are sulfa meds?

A

Furosemide (Lasix)Torsemide (Demadex)

89
Q

Which diuretic is a non-sulfa med?

A

Ethacrynic Acid (Edecrin) not used much

90
Q

MoA for loop diuretics

A

Block reabsorption of Na+, K+ and Cl- in TAL (thick ascending loop) of henle and distal tubule. Water follows ions, so if the ions aren’t absorbed, everything gets peed out.

91
Q

Side effects of Loop Diuretics (Occurs in loop of Henley)

A

Electrolyte imbalance (esp hypokalemia-not enough K+)Orthostatic HypotensionDehydrationFurosemide has highest risk of these

92
Q

If you’re allergic to sulfa ABX, should you avoid sulfa diuretics?

A

No necessarily. No evidence that the allergies are related, but patients might be reluctant.

93
Q

What can you look for that might indicate decreased profusion resulting from dehydration?

A

hypotension, orthostatic hypotension

94
Q

How can you monitor the effectiveness of loop diuretics?

A

daily body weights

95
Q

What should you monitor with loop diuretics?

A

Electrolytes, BUN, Creatinine clearance

96
Q

Electrolyte imbalance and renal function changes are common when starting loop diuretics. When should we expect these to stabilize?

A

2-3 weeks, but continue to monitor even after that.

97
Q

Indications for Furosemide, Torsemide, and Ethacrynic Acid

A

Edema d/t CHF, Renal failure, Hepatic failure, HTN

98
Q

What effect do Loop Diuretics have on serum uric acid?

A

Furosemid, Torsemide and Ethacrynic acid can decrease then increase serum uric acid.

99
Q

Major difference between Torsemide and Furosemide?

A

Torsemide has longer half life. 10-20 mg of Torsemide has about the same diuretic impact as 40 mg of Furosemide.

100
Q

What happens when someone on Furosemide takes corticosteroids?

A

The steroids increase the impact of furosemide.

101
Q

what is the outpatient weight loss target with loop diuretics?

A

~2 lbs per day. Once at dry weight, titrate down.

102
Q

Can you use Nondihydropyridines for HF?

A

No, becasue of their cardiac impact

103
Q

Can you use dihydropyridines for HF?

A

Yes. It’s safe. Not the primary indication though. They have been shown to be safe in HF patients needing drug for angina or HTN.

104
Q

What do you want to monitor with Furosemide and Ethacryinic Acid?

A

Serum ElectrolytesBUNCrClBPHearing if high dose therapy

105
Q

What is anuria and which med is it a contraindication for?

A

Kidneys not making urine. Don’t use Torsemide with anuria.

106
Q

Side effects of Torsemide?

A

constipation. diarrhea. Really? Both??

107
Q

Remind me again what is unique about Ethacrynic Acid?

A

Non-sulfonamide

108
Q

Drug category/class of Spironolactone (aldactone) and Eplerenone (inspra)

A

Aldosterone Antagonistaka Potassium Sparing Diuretics

109
Q

MoA of Aldosterone Antagonists?

A

Spironolactone and Eplerenone: inhibit sodium reabsorption by disrupting aldosterone-dependent Na+/K+ pump. PEE MORE!Promote excretion of Na+, Cl-, and water. Retains K+. (Potassium sparing)

110
Q

Aldosterone Antagonists are relatively weak diuretics. Why do we use them?

A

Their anti-aldosterone activity reduces cardiac fibrosis.

111
Q

General GI/GU SEs of aldosterone antagonists

A

Hyponatremia, Diarrhea, amenorrhea, impotence, gynecomastia.

112
Q

General Neuro SE’s of aldosterone antagonists

A

Headache, Drowsiness

113
Q

Monitoring in Aldosterone Antagonists

A

BUN, Electrolytes, Potassium (especially with spironolactone)

114
Q

What do we specifically monitor with Spironalactone?

A

Potassium.But also: daily weights, BP, eGFR, gynecomastia

115
Q

What does poor renal fxn put people at risk for if taking Spironolactone & Eplerenone?

A

Aldosterone Antagonists can cause hyperkalemia

116
Q

Side effects specific to Spironolactone (Aldactone)

A

Ataxia, SJS, gynecomastia, amenorrhea, agranulocytosis (dec granulocytes, inc risk of infection), hepatotoxicity

117
Q

Contra indications of Spironolactone

A

Anuria, Acute renal insufficency, hyperkalemia, addison’s disease, low serum K+, low eGFR, K+supplements

118
Q

If a patient has an eGFR below ____, you can’t prescribe spironolactone.

A

30

119
Q

If a patient has a serum K level above _____, you can’t prescribe spironolactone.

A

> 5.5 mEq/L

120
Q

What drugs does Spironolactone interact with

A

Look it up. There are many.

121
Q

Can the elderly and patients with diabetes take Spironolactone?

A

Yes, but monitor renal fxn and serum K very closely!

122
Q

what is the outpatient weight loss target with loop diuretics?

A

~2 lbs per day. Once at dry weight, titrate down.

123
Q

Which drugs are the Loop diuretics?

A

Furosemide, Torsemide, Ethacrynic Acid

124
Q

Can you use Nondihydropyridines for HF?

A

No, becasue of their cardiac impact

125
Q

Can you use dihydropyridines for HF?

A

Yes. It’s safe. Not the primary indication though. They have been shown to be safe in HF patients needing drug for angina or HTN.

126
Q

What do you want to monitor with Furosemide and Ethacryinic Acid?

A

Serum ElectrolytesBUNCrClBPHearing if high dose therapy

127
Q

What is anuria and which med is it a contraindication for?

A

Kidneys not making urine. Don’t use Torsemide with anuria.

128
Q

Side effects of Torsemide?

A

constipation. diarrhea. Really? Both??

129
Q

Remind me again what is unique about Ethacrynic Acid?

A

Non-sulfonamide

130
Q

Drug category/class of Spironolactone (aldactone) and Eplerenone (inspra)

A

Aldosterone Antagonistaka Potassium Sparing Diuretics

131
Q

MoA of Aldosterone Antagonists?

A

Spironolactone and Eplerenone: inhibit sodium reabsorption by disrupting aldosterone-dependent Na+/K+ pump. PEE MORE!Promote excretion of Na+, Cl-, and water. Retains K+. (Potassium sparing)

132
Q

Aldosterone Antagonists are relatively weak diuretics. Why do we use them?

A

Their anti-aldosterone activity reduces cardiac fibrosis.

133
Q

General GI/GU SEs of aldosterone antagonists

A

Hyponatremia, Diarrhea, amenorrhea, impotence, gynecomastia.

134
Q

General Neuro SE’s of aldosterone antagonists

A

Headache, Drowsiness

135
Q

Monitoring in Aldosterone Antagonists

A

BUN, Electrolytes, Potassium (especially with spironolactone)

136
Q

What do we specifically monitor with Spironalactone?

A

Potassium.But also: daily weights, BP, eGFR, gynecomastia

137
Q

What does poor renal fxn put people at risk for if taking Spironolactone & Eplerenone?

A

Aldosterone Antagonists can cause hyperkalemia

138
Q

Side effects specific to Spironolactone (Aldactone)

A

Ataxia, SJS, gynecomastia, amenorrhea, agranulocytosis (dec granulocytes, inc risk of infection), hepatotoxicity

139
Q

Contra indications of Spironolactone

A

Anuria, Acute renal insufficency, hyperkalemia, addison’s disease, low serum K+, low eGFR, K+supplements

140
Q

If a patient has an eGFR below ____, you can’t prescribe spironolactone.

A
141
Q

If a patient has a serum K level above _____, you can’t prescribe spironolactone.

A

> 5.5 mEq/L

142
Q

What drugs does Spironolactone interact with

A

Look it up. There are many.

143
Q

Can the elderly and patients with diabetes take Spironolactone?

A

Yes, but monitor renal fxn and serum K very closely!

144
Q

What class is Eplerenone

A

Aldosterone Receptor Antagonist (Potassium Sparing Diuretic)

145
Q

If someone has excessive aldosterone excretion, you’re likely to see (many things and ) hypertension. What are 2 meds that will directly block the aldosterone receptor and lower blood pressure?

A

Spironolactone and Eplerenone

146
Q

Where will Spironolactone (Aldactone) block aldosterone receptors?

A

distal renal tubule and blood vessels

147
Q

Where will Eplerenone (inspra) block aldosterone receptors?

A

kindey, heart, blood vessels, brain

148
Q

Side effects of Eplerenone.

A

Hyperkalemia, hypertriglyceredemia, cough, diarrhea

149
Q

Is Eplerenone more or less likely than Spironolactone to cause gynecomastia?

A

less likely

150
Q

Where do beta blockers effect their impact?

A

Heart, kidneys. (beta 1)

151
Q

When using Beta Blockers in heart failure, what labs do we need in order to monitor patients?

A

None, but all patients should have baseline labs (BMP, CrCl, electrolytes, renal function). Also monitor HR

152
Q

What do beta blockers do?

A

Decrease HR
Decrease Stroke Volume
Decrease TPR (total peripheral resistance) by decreasing renin and angiontesin II

153
Q

What Beta Blocker is non-selective and will go to B1, B2, A1

A

Carvedilol (Coreg)

154
Q

When can you not prescribe Beta Blockers in HF? (6 answers)

A 
Asthma
Symptomatic HYPOtension
HR under 60
PAD with resting limb ischemia
Second or third degree AV block
Evidence of fluid retention
155
Q

Does metoprolol have the same dosing for angina and heart failure?

A

no, they are different.

156
Q

Decreasing (or blocking) norepinephrine binding rate will have what effect on BP?

A

lower’s BP

157
Q

Can carvedilol (coreg) cause you to lose weight?

A

Actually, weight GAIN is a side effect and you should monitor for it.

158
Q

Can you give Carvedilol (Coreg) to someone with COPD?

A

No, it is non-selective and will block B2 receptors causing bronchospasm

159
Q

What is Inotropy?

A

Force of contraction

160
Q

What do positive inotropes do?

A

Increase the force of ventricular contraction

161
Q

What do negative inotropes do?

A

Decrease the force of ventricular contraction

162
Q

What class is Digoxin?

A

Positive Inotropic Agent: Cardiac Glycocides

163
Q

What ion does digoxin increase intracelularly and how does it do this?

A

Na+ and Ca++. It inhibits Na-K-ATPase pump in myocardial cells.

164
Q

Will positive inotropic agents have an effect on HR?

A

They decrease HR by increasing vagal tone

165
Q

4 EKG changes seen with Digoxin

A 
Cardiac Glycocides can cause:
Prolong PR interval
ST seg depression
Inverted T wave
Short QT interval
166
Q

Initial does for Digoxin

A

0.125 mg to 0.25mg

167
Q

Should you give digoxin as a first line tx for HF?

A

No. it might induce arrhythmias (PVCs secondary to inc intracellular Ca++)

168
Q

Can we combine Digoxin with Beta Blockers?

A

don’t do it if possible

169
Q

Side effects of Digoxin

A 
Fatigue
Delirium
AV block
EKG changes
N/V/D
Visual disturbances
Toxic Psychosis
170
Q

Indications for digoxin

A

Mild-moderate HF

A-Fib rate control

171
Q

Symptoms of digitalis toxicity

A 
Confusion
Irregular pulse
Loss of appetite
N/V/D
Palpitations
Vision changes
172
Q

Can you give Digoxin to someone with V-Fib, thyroid disease, or recent MI?

A

No

173
Q

Class of Dobutamine

A

Positive Inotropic: Beta (adrenergic)-agonist

174
Q

Where else have we used Beta-Agonists?

A

Pulmonology!! Although Dobutamine mainly affects Beta 1

175
Q

Use for Dobutamine?

A

Short term management of cardiac decomposition

176
Q

MOI of Dobutamine

A

Stimulates B-1 receptros, which Increase HR

Increase contractility

177
Q

Side effects of Dobutamine

A

paradoxical hypotension.

Exacerbation of ventricular ectopy.

178
Q

Contra indications of Dobutamine?

A

Allergy to sulfites (may contain sodium bisulfate).
Recent use of MOA inhibitors.
IHSS

179
Q

Drug interactions

A

Sympathomemetics: stimulant compounds that mimic the effects of catecholamines (epi/norepi)

180
Q

Monitor these while on Dobutamine

A 
BP
HR
EKG
glucose
eGFR
urine output
181
Q

how do you administer Dobutamine

A

IV

182
Q

Class of Milrinone (Primacore)

A

Inotropic Agent-Phosphodiesterase Inhibitors (PDE-I)

PDE-3 inhibitor

183
Q

MoA for PDE-Is

A

Increase cAMP

184
Q

Will PCP prescribe Milrinone?

A

No, should only be used under close supervision of a cardiologist.
Contra in post-MI pts.

185
Q

We are studying 2 PDE inhibitors? What are they and which PDE do they each target?

A

Nitro PDE-5

Milrinone PDE-3

186
Q

What class is Nesiritide (Natrecor)

A

B-type Naturetic Peptide (BNP)

187
Q

When to use Nesiritide

A

Acute decomp HF with dyspnea at rest or with minimal activity

188
Q

What does Nesiritide do?

A

Decrease BP.

I don’t understand the complicated MoA, so we’ll stick with this

189
Q

Contra for Nesiritide (Natrecor)

A

Cardiogenic shock, hypotension (SBP

190
Q

Class of Aliskiren

A

Direct Renin Inhibitor

191
Q

What does Aliskiren do?

A

Causes vasodilation.

Keeps renin from converting angiotensinogen to agiotensin I so that there is less converstion of angiotensin I to angiotensin II.

192
Q

If someone is on Aliskiren and Furosemide, what are the interactions?

A

Aliskiren will decrease effect of Furosemide.

193
Q

What do NSAIDs do when taken with Aliskiren?

A

NSAIDs decrease effect of Aliskerin

194
Q

Class of Ivabradine (Corlandor)

A

SA node IF channel inhibitor

195
Q

When to use Ivabradine (Corlandor)

A

Heart Failure (EF

196
Q

MoA of Ivabradine

A

Inhibits funny current (If) in SA node. Prolongs diastolic depol which reduces HR.

197
Q

What are the 4 types of diuretics?

A

ThiazideThiazide-likeK+ sparingLoop Diuretics

198
Q

What type of med is the most commonly used for mild to moderate HTN?

A

diuretics

199
Q

How should you start dosing a diuretic?

A

Start with low potency, monitor for tolerance/response

200
Q

What are the 2 major dietary changes to recommend in HTN management?

A

Low Na+High K+

201
Q

What are the warning signs of K+ depletion?

A
  1. Weakness, fatigue (most common)2. Worsening diabetes control3. polyuria4. Arrhythmia5. Muscle cramps (severe)6. Psych changes
202
Q

Should patients be aware of any developing symptoms of hypokalemia when starting a diruretic?

A

Yes. Warn them.

203
Q

What electrolytes does HCTZ increase excretion of?

A

Na+Cl-

204
Q

How does HCTZ work?

A

inhibits Na-Cl pump in distal convoluted tubule. This increases Na, Cl excretion

205
Q

Side effects of HCTZ

A

Hypokalemia!!!anorexia, nausea, photosensitivity, QT prolongation, vertigo (rare)

206
Q

If someone has sulfa allergies, can they still take HCTZ?

A

no

207
Q

What could happen to blood sugar if someone on beta blocker and HCTZ?

A

hyperglycemia

208
Q

How much NaCl is absorbed in nephron BEFORE it gets to distal convoluted tubule?

A

~90%

209
Q

Chronic use of HCTZ can cause decrease excretion of what ion?

A

Ca++

210
Q

What is necessary GFR for HCTZ to be effective?

A

30-40 or higher

211
Q

Can HCTZ increase risk of gout?

A

yes, it increases serum uric acid

212
Q

What class is Chlorthalidone?

A

thiazide-like diuretic

213
Q

MoA of Chlorthalidone?

A

inhibits Na-Cl pump. increases excretion

214
Q

Are the side effects the same for Chlorthalidone and HCTZ?

A

yesHypokalemia, anorexia, nausea, photosensitivity, QT prolongation, vertigo (rare)

215
Q

What is the major difference between HCTZ and Chlorthalidone?

A

Chlorthalidone is approximately twice as potent.

Natalie Pharm (7 decks)

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