cholesterol and hypertension Flashcards
what does a statin do?
decreases production of cholesterol in liver and increases receptors for LDL on liver cells
overall effect = lower LDL, lower triglycerides, higher HDL
most common adverse effect statin
myopathy (muscle injury) = muscle aches and weakness
rare but serious side effect of statins?
rhabdomyolysis
Muscle lysis with severe muscle pain
are statins safe in pregnancy?
No
What does nicotinic acid (Niacin) do?
inhibits hepatic secretion of triglycerides
overall effect of lowering LDL, triglycerides, and increasing blood HDL
what are the side effects of niacin?
• Intense facial flushing • Hepatotoxicity • Hyperglycemia • Skin rash • Increased uric acid levels *these limit use in patients
what do bile acid sequestrants do?
bind bile acids in the GI, blocking absorption, which increases demand for bile acid production in liver which requires LDL
bile acid sequestrants may decrease absorption of which type of drugs?
Thiazide diuretics, digoxin, warfarin, and certain antibiotics
(due to binding of + with - )
what do cholesterol absorption inhibitors do?
Inhibit transport protein responsible for absorbing dietary cholesterol
why are cholesterol absorption inhibitors used in combo with statins?
because they can produce compensatory increase in hepatic cholesterol synthesis
what do fibric acid derivatives (Fibrates) do?
increases synthesis of enzyme that breaks down lipoproteins by binding ppar-alpha
increases HDL, but no effect on LDL
adverse effects of Fibrates?
Increased risk for gallstones
Myopathy (if on statins - low dose, and carefully monitor for myopathy)
Hepatotoxicity
what is the site of action for loop diuretics?
ascending loop of Henle, sodium & chloride reapsorption
what is the site of action for thiazide diuretics?
Distal convoluted tubule, Block sodium & chloride reabsorption
what is the site of action for potassium sparing diuretics?
collecting duct, aldosterone receptors
why is there a risk for hypokalemia with loop and thiazide diuretics?
because the transporter that is blocked also blocks reabsorption of K+
why do potassium-sparing diuretics spare potassium?
because blocking of the aldosterone receptor increases potassium retention
what is necessary to avoid when on potassium-sparing drugs?
ACE inhibitors or renin inhibitors because they also conserve potassium
(RAAS pathway)
what is the main adverse effect of potassium-sparing diuretics?
hyperkalemia
what do beta blockers do?
they block beta 1 receptors (cardiac & juxtaglomerular cells)
Cardiac effect = lowered CO (blocked binding of catecholamines)
juxtaglomerular effect = decreased vascoconstriction d/t decreased renin release
what’s the difference between 1st and 2nd gen beta blockers?
1st gen is non-selective so also blocks beta 2 receptors in lungs which can cause bronchoconstriction (not approp for people with asthma/lung disease)
and inhibits breakdown of glycogen in muscles/liver (not approp for diabetics)
what do ACE inhibitors do?
inhibits the the enzyme that converts angiotensin I to II = vasodilation
decreases total blood volume = decreased CO
elevated levels of bradykinin = vasodilation
what are adverse effects of ACE inhibitors?
first dose hypertension - first few doses should be low
hyperkalemia - due to inhibition of RAAS pathway, avoid potassium supplements and potassium-sparing diuretics
what are the adverse effects of ACE inhibitors caused by bradykinin?
persistent cough
rare but fatal angioedema
drug interaction with NSAIDs - reduces effect of ACE inhibitor
what do angiotensin receptor blockers do?
block binding of angiotensin II to receptor on arterioles
= vasodilation
and decrease aldosterone release from adrenal cortex
- causing water and sodium excretion
what do direct renin inhibitors do?
bind renin blocking conversion of angiotensinogen to angiotensin I
which effects RAAS pathway, lowering BP similar to ACEI & ARBs
adverse effects of DRIs?
hyperkalemia (d/t RAAS pathway) - avoid potassium supplement/potassium-sparing diuretics
what do calcium channel blockers do?
decrease contraction blocking uptake of calcium into cells
what is the difference between dihydropyridine and non-dihydropyridine calcium channel blockers?
dihydropyridine = vasodilation, act only on arteries non-dihydropyridine = act on heart and arteries, so vasodilation AND decrease CO
adverse effects of calcium channel blockers?
Flushing Dizziness Headache Peripheral edema Reflex tachycardia (dihydro only) Rash (dihydro only) constipation (non-dyhydro) compromise cardiac function (non-dihydro)
what do centrally acting alpha 2 agonists do?
bind alpha 2 receptors in brain, decreasing sympathetic flow to heart & vessels (decrease CO and peripheral resistance)
adverse effects of centrally acting alpha 2 agonists
dizziness, drowsiness, dry mouth (3 Ds)
Rebound hypertension if withdrawn abruptly
