Cardiovascular Flashcards
Patients with systolic
dysfunction, have lower than normal cardiac ejection fractions
(EF < 40%).
due to stroke volume reductions along with increases in end diastolic volumes.
Frank–Starling mechanism
increased fiber dilation heightens
the contractile force, which then increases the energy released
beta-adrenergic blockers interfere with the sympathetic nervous system. In what all ways?
norepinephrine induced (all the below list)-
peripheral vasoconstriction,
sodium excretion by the kidney,
cardiac hypertrophy
arrhythmia generation,
hypokalemia, or cell death (apoptosis) How cell death????????
through increased stress owing to norepinephrine stimulation.
blockers should not be taken without diuretics in patients with a current or recent history of fl uid
retention
to avoid its development and to maintain sodium balance.
Patients should be monitored for signs of fl uid retention & report any significant increases,
which might warrant increases in diuretic doses or reductions
in the dose of the beta-adrenergic blocker
fatigue, hypotension, bradycardia,
and heart block are reported side eff ects that
should be monitored to ensure appropriate attention
and management.
beta-Adrenergic blockers are generally used in conjunction with
diuretics, ACEIs, or ARBs
ACEIs contraindications include:
H/Ointolerance or adverse reactions
serum potassium >5.5 mEq/L
serum creatinine levels >3 mg/dL, symptomatic hypotension,
severe renal artery stenosis, pregnancy.
ACEIs: 1st method: They inhibit the ACE and this action significantly decreases total peripheral resistance(as Ang II is potent vasoconstrictor), which aids in reducing afterload.
2nd method: Inhibiting the production of angiotensin II interferes with stimulation of aldosterone release, thus indirectly reducing retention of sodium and water, which decreases venous return and preload.
ACEIs side effects to be monitored include
hypotension (patients should be well hydrated before initiation of ACEIs), dizziness,
reduced renal function (increased serum creatinine of 0.5 mg/dL or more requires reassessment),
cough
potassium retention (if potassium levels
are high without supplementation, discontinue the ACEI for several days and then try to restart at lower dose)
Angioedema is a life-threatening S.E
May elevate Li+ levels (monitor Li+ levels, adjust dose).
It is critical to wait______ hours between the administration of an ACE inhibitor and
valsartan/sacubitril (or switching back to an ACE inhibitor), to minimize the risk of
angioedema.
36
Patients who experience diuretic resistance or tolerance to their effects
might need intravenous administration, a combination of two DIURETIC agents with differing mechanisms or the addition of agents, such as dopamine or dobutamine VASODILATOR, which increase renal blood flow.
THIAZIDE
agents are relatively weak because they are able to increase the fractional excretion of sodium to only 5% to 10% of the filtered load. and lose their effectiveness with moderately impaired renal function (creatinine clearance <30 mL/min).
LOOP diuretics
ability to increase sodium excretion to 20% to 25% of the filtered load and to maintain their efficacy until renal function is severely impaired (creatinine clearance < 5 mL/min) plus have the added advantage of reducing venous return independent of diuresis.
SAR of statins
https://youtu.be/U_f7E5C7d1M
CYP3A4 inhibitor and so avoid with grape fruit juice
SAL
Simvastatin, Atorvastatin, Lovastatin
CYP2C9
Fluvastatin, Rosuvastatin
Statin with least drug interaction
Pravastatin
Statin that must be used With food or after food
Fluvastatin, Lovastatin. Lovastatin with food INCREASES the drug’s bioavailability by 50%
Statin that must be taken at bedtime
FLS- BEdtime
Fluvastatin, Lovastatin, Simvastatin
Statin that must be taken anytime of the day? WHy
Atorvastatin and Rosuvastatin. Longer half life
Side Effects of HMG CoA reductase inhibtor/Statins
mnemonic “HMG”
1) Hepatotoxicity( ↑Transaminases in 3-12 months)
2) Myopathy ( triad : Muscle weakness, Muscle pain, Dark urine-cola-colored urine)
Gastrointestinal
( Diarrhea (4.5%), abdominal cramps (3.3%), constipation (2.7%).
CNS: Q.) Headache (7.7%), insomnia, dizziness.
Skin: rash.
Statin that has low penetration into peripheral tissue and less side effects. WHy?
Pravastatin is the ring opened dihydroxy acid with 6-hydroxyl group is more hydrophobic than lovastatin
Antihyperlipidemic Drug of choice in pregnancy.
Resins (Bile acid sequestrant)
Antihyperlipidemic Drug avoid in patient with high triglycerides.
Resins
Gemfibrozil is contraindicated with statins
myopathies, or rhabdomyolysis
Another fibrate,Bezafibrate : Combined with statins to reduce triglyerides in patient with high triglycerines ( statin is good in decreasing LDL, but not good in decreasing, TG)
Lithiasis predispose gallstone formation. If tested discontinue the drug. Which is the antihyperlipidemic
Fibrates
Antihyperlipidemic Drug which inhibits tubular secretion of uric acid, causes gout or hyperuricemia.
Niacin
Niacin Side effect
skin flushing(Administration of ASA 325 mg prior) accompanied by uncomfortable feeling warm and pruritic, dry skin Hyperglycemia ( not used in Diabetes, Fibrate is drug of choice), hyperuricemia, GI distress like reactivation of peptic ulcer, flatulance, nausea and diarrhea:minimized by taking with food or immediately after food.
Fibrates mechanism of action
Activate or agonist peroxysome profilator activating receptors alpha (PPAR alpha)
Severe hepatic an renal dysfunction potentiate warfarin activity, in which antihyperlipidemic drug?
Fibrates
Which antihyperlipidemic drug have uricosuric effect?
Fibrates
More CO2 in blood
Metabolic acidosis: Acetazolamide ( ACIDzolamide
