Exam 3 Review FC Flashcards
What is the first line recommendation for non-cancer pain?
NSAIDs
what are the three effects of NSAIDs?
analgesic, antipyretic, antiinflammatory
ibuprofen- class?
NSAID
naproxen- class?
NSAID
aspirin- class?
NSAID
toradol- class?
NSAID
mobic-class?
NSAID
two GI adverse effects of NSAIDs?
nausea, heartburn
non-GI side effects of NSAIDs? (2)
dizziness, mild headaches
hypertension taking NSAIDs?
no
history of ulcers taking NSAIDs?
no
history of Crohn’s taking NSAIDs?
no
GI bleeding taking NSAIDs?
no
liver disease- NSAIDs?
contraindicated
kidney disease- NSAIDs?
contraindicated
pregnancy- NSAIDs?
contraindicated
bleeding or platelet disorders- NSAIDs?
contraindicated
heart disease- NSAIDs?
contraindicated
three drug interactions with NSAIDs?
Warfarin, antihypertensives, digoxin (WAD)
antihypertensives, warfarin, digoxin- these are contraindicated with what class?
NSAID
N/V, diaphoresis, tinnitus, hypertenvilation (respiratory alkalosis)- these are symptoms of what?
salicylate toxicity
salicylates are WHAT-based?
aspirin
respiratory alkalosis- early or late signs of salicylate toxicity?
early
what is the physiologic manifestation of respiratory alkalosis?
hyperventilation
2005 black box warning for NSAIDs? (all prescription and OTC NSAIDs)
increased risk of CV events and serious GI bleeding
2015 black box warning for NSAIDs? (all nonaspirin NSAIDs)
emphasized increased risk of heart attack and stroke
a nonopioid, non-NSAID analgesic?
acetaminophen
when is acetaminophen used?
treatment of mild pain and fever
does acetaminophen have anti-inflammatory properties?
no
what are the three contraindications for acetaminophen?
alcohol abuse, liver/kidney disease, malnutrition
acetaminophen with ETOH abuse?
no
acetaminophen with liver disease?
no
acetaminophen with kidney disease?
no
acetaminophen with malnutrition?
no
acetaminophen toxicity causes what effects on the liver?
liver damage or failure
four signs of acetaminophen toxicity?
abdominal pain, N/V, dark urine, jaundice
abdominal pain, N/V, dark urine, jaundice- symptoms of what?
acetaminophen toxicity
how does acetaminophen toxicity manifest?
liver damage or failure
what is the definition of analgesia?
absence of pain
term? Absence of pain
analgesia
what is the effect/definition of an opioid analgesic?
analgesia (absence of pain) without resulting in loss of consciousness
what are the three categories of opioid analgesics?
full agonists, partial agonists, and antagonists
what is the prototype opioid agonist?
morphine
when do we use opioids?
serious/acute pain, post-surgery, chronic cancer pain
what type category of opioids activate the opioid receptor fully?
full agonists
what category of opioids interact with receptor to achieve a response?
full agonists
morphine- category of opioids?
full agonists
methadone- category of opioid?
full agonists
codeine- category of opioid?
full agonists
affinity plus efficacy- category of opioid?
full agonists
category of opioid? Activate opioid receptor to a lesser degree
partial agonists
category of opioid? Tramadol
partial agonists
category of opioid? Buprenorphine
partial agonists
category of opioid? Bind to opioid receptors without activating them
opioid antagonists
narcan- category of opioid?
opioid antagonists
naloxone- category of opioid?
opioid antagonists
category of opioid- affinity but no efficacy?
opioid antagonists
example of opioid antagonist?
naloxone
two examples of partial opioid agonists?
buprenorphine, tramadol
three examples of full opioid agonists?
morphine, codeine, methadone
hydromorphone- category of opioid?
full agonist
why doesn’t tramadol work as well as codeine?
affinity but low efficacy
hydrocodone- category of opioid?
full agonist
efficacy- think WHAT?
effectiveness
opioid antagonists bind to receptor but does not WHAT?
activate the receptor
when do we use opioid antagonists?
opioid overdose
opioid antagonists occupy the receptor so that full agonists cannot WHAT?
attach to the receptor
heroin- category of opioid?
full agonist
what are the three goals of therapy for gout?
1) management of pain associated with acute attacks 2) lower uric acid level 3) lifestyle management
example medication used for urate lowering therapy?
allopurinol
allopurinol- specific class?
xanthine oxidase inhibitor
example xanthine oxidase inhibitor?
allopurinol
what does allopurinol do?
inhibit the enzyme responsible for conversion of hypoxanthine and xanthine to uric acid
what is the first line medication for urate lowering therapy?
allopurinol
what medication? Inhibit the enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid?
allopurinol
liver-related adverse effect of allopurinol?
hepatotoxicity
gout flare at initiation of therapy- associated with what medication?
allopurinol
what FIVE labs should be monitored with allopurinol?
LFT, BUN, creatinine, uric acid level, CBC
drug interactions with allopurinol?
multiple
what gout medication can cause a skin rash?
allopurinol
how to manage gout flare with initiation of allopurinol therapy?
treat proactively
what is the gout flare when starting allopurinol associated with?
shrinking the crystals- makes them active
when does gout flare happen with allopurinol?
initiation of therapy
three types of meds used for gout flares?
colchicine, NSAIDs, glucocorticoids
what are the two goals of medication for acute gout flares?
reduce pain and severity of gout flare
low-dose or high-dose colchicine preferred for gout flare?
low-dose
is low-dose colchicine effective for a gout flare?
yes
where are corticosteroid hormones produced?
adrenal cortex
the adrenal cortex produces what?
corticosteroid hormones
when does disease result re: corticosteroids?
inadequate or excess secretion
when do we use short-term corticosteroids?
self-limiting, acute conditions
self-limiting, acute conditions- use what?
short-term corticosteroids
when do we use long-term corticosteroids?
life-threatening conditions or severe/disabling symptoms
local over WHAT steroid therapy should be used when possible?
local over systemic
can you abruptly stop corticosteroids?
no
effect of corticosteroids on bones?
osteoporosis
effect of corticosteroids on wound healing?
poor wound healing
effect of corticosteroids on sleep?
insomnia
effect of corticosteroids on skin?
thinning of skin
effect of corticosteroids on mood?
mood changes/depression
effect of corticosteroids on blood sugar?
hyperglycemia
effect of corticosteroids on vision?
cataracts
effect of corticosteroids on infection risk?
increased risk for infection
effects of corticosteroids on GI?
peptic ulcers; GI upset
why do we not abruptly withdraw corticosteroids?
HPA axis suppression
what is suppressed with longer-term corticosteroids?
HPA axis suppression
brand name for metformin?
glucophage
generic name for glucophase?
metformin
other than T2DM, when is metformin used?
metabolic-syndrome type disorders such as PCOS
route of metformin administration?
orally
metformin- monotherapy?
yes
metformin- used with other drugs?
yes
first line treatment for T2DM?
metformin
metformin- specific drug glass?
biguanides
example of biguanide medication?
metformin
adverse effects of metformin, are mostly what?
GI
how can patients avoid GI side effects of metformin?
take with food
four GI adverse effects of metformin?
nausea, diarrhea, abdominal cramping, and bloating
how should metformin dose be titrated?
slowly
why do we titrate metformin dose slowly?
to minimize GI adverse effects
what is the black box warning with metformin?
lactic acidosis
what three situations is lactic acidosis with metformin more likely? RED
renal impairment, dehydration, elderly
renal impairment, dehydration, and elderly- increased risk for WHAT with metformin? (RED)
lactic acidosis
renal impairment predisposes patients to what adverse effect of metformin?
lactic acidosis
dehydration predisposes patients to what adverse effect of metformin?
lactic acidosis
elderly- predisposes patients to what adverse effect of metformin?
lactic acidosis
prevalence of lactic acidosis with metformin?
rare
rare, serious adverse effect with metformin?
lactic acidosis
two examples of TZDs?
pioglitazone and rosiglitazone
pioglitazone- specific class?
thiazolidinediones
rosiglitazone- specific class?
thiazolidinediones
when are TZDs used?
type 2 diabetes mellitus
route of administration- TZDs?
orally
can TZDs be used alone?
yes
can TZDs be used with other drugs?
yes
effect of TZDs on insulin resistance?
decreased insulin resistance
what must be present for TZDs to decrease insulin resistance?
insulin
what do TZDs activate?
peroxisome proliferator-activated receptor gamma
what antidiabetic class acts on the peroxisome proliferator activated receptor gamma?
thiazolidinediones
what antidiabetic class regules gene transcription?
thiazolidinediones
gene transcription is regulated by TZDs so that WHAT are produced in the cell?
proteins
what do the proteins do with TZDs?
help insulin act in the cell
brand name for pioglitazone?
actos
generic name for actos?
pioglitazone
brand name- rosiglitazone?
avandia
generic name for avandia?
rosiglitazone
is a TZD an insulin secretagogue?
no
do TZDs cause the pancreas to produce more insulin?
no
why do TZDs cause weight gain and edema?
fluid retention and plasma volume expansion
what are the two symptoms of fluid retention and plasma volume expansion with TZDs?
weight gain and edema
what two things have decreased excretion with TZDs?
sodium and water
what is the effect of PPAR-gamma in the vasculature?
increased vascular permeability
what happens to vascular permeability with TZDs?
increased
why is vascular permeability increased with TZDs?
effects of PPAR-gamma on the vasculature
TZDs- lactation?
avoid
TZDs in pregnancy?
avoid unless benefits clearly outweigh risks
TZDs can cause anovulatory women to what?
ovulate
what antidiabetic class should have pregnancy prevention precautions?
TZDs
why can ovulation occur in anovulatory women with TZDs?
because of decreased insulin resistance
alpha glucosidase inhibitor- example?
acarbose
acarbose- specific class?
alpha glucosidase inhibitor
precose- generic name?
acarbose
acarbose- brand name?
precose
acarbose- monotherapy?
no
acarbose- route of administration?
orally
where do alpha glucosidase inhibitors act?
at the brush border of the small intestine
what is the main effect of alpha glucosidase inhibitors?
lower postprandial blood glucose
what do alpha glucosidase inhibitors compete with?
complex carbohydrates for digestion
what antidiabetic drug competes with complex carbohydrates for digestion?
alpha glucosidase inhibitor
what antidiabetic drug should not be used with intestinal adsorbents?
alpha glucosidase inhibitor
what are three examples of intestinal adsorbents?
kaolin, pectin, bismuth-subslicylate
when should alpha glucosidase inhibitors be taken?
with the first bite of the meal
alpha glucosidase inhibitors- pregnancy?
contraindicated
alpha glucosidase inhibitors- lactation?
contraindicated
alpha glucosidase inhibitors- renal impairment?
contraindicated
alpha glucosidase inhibitors- inflammatory bowel disease?
contraindicated
alpha glucosidase inhibitors- history of bleeding ulcers?
contraindicated
alpha glucosidase inhibitors- intestinal obstruction?
contraindicated
primary type of adverse effects of alpha glucosidase inhibitors?
GI symptoms (titrate slowly)
alpha glucosidase inhibitors- any serious GI stuff?
contraindicated
SGLT2 inhibitors- route of admin?
orally
what antidiabetic med causes osmotic fluid loss?
SGLT2 inhibitors
class? Inhibit the reabsorption of glucose in the kidney proximal tubule
SGLT2 inhibitors
can SGLT2 inhibitors be used as monotherapy?
yes
what is the ultimate result of SGLT2 inhibitors?
increased excretion of glucose in the urine
canagliflozin- specific class?
SGLT2 inhibitors
dapagliflozin- specific class?
SGLT2 inhibitors
empagliflozin- specific class?
SGLT2 inhibitors
genital infections- adverse effect of which antidiabetic class?
SGLT2 inhibitors
fungal genital infections- adverse effect of which antidiabetic class?
SGLT2 inhibitors
bacterial genital infections- adverse effect of which antidiabetic class?
SGLT2 inhibitors
UTI- adverse effect of which antidiabetic class?
SGLT2 inhibitors
hypovolemia- adverse effect of which antidiabetic class?
SGLT2 inhibitors
hypotension- adverse effect of which antidiabetic class?
SGLT2 inhibitors
osteoporosis- adverse effect of which antidiabetic class?
SGLT2 inhibitors
lower extremity infection/amputation- associated with which antidiabetic class?
SGLT2 inhibitors
Fournier’s gangrene- precaution with what antidiabetic class?
SGLT2 inhibitors
leg and foot amputations- precaution with what antidiabetic class?
SGLT2 inhibitors
ketoacidosis- precaution with what antidiabetic class?
SGLT2 inhibitors
fractures- adverse effect associated with what antidiabetic class?
SGLT2 inhibitors
sitagliptin- specific class?
DPP4 inhibitors/gliptins
DPP4 inhibitors- monotherapy?
yes
what class slows the breakdown of glucagon-like peptide 1?
DPP4 inhibitors/gliptins
sitagliptin- brand name?
januvia
DPP4 inhibitors- route of administration?
orally
are DPP4 inhibitors insulin secretagogues?
yes
do DPP4 inhibitors have a risk of hypoglycemia?
yes
metformin and TZDs and hypoglycemia?
least likely
antidiabetic class most likely to cause hypoglycemia?
sulfonylurea (not glucose-dependent)
DPP4 inhibitors- glucose dependent insulin secretion?
yes
sulfonylurea- glucose dependent insulin secretion?
no (hypoglycemia)
GLP1s- glucose dependent?
yes
effect of DPP4s on insulin synthesis?
increased
effect of DPP4s on beta cell mass?
increased- multiple mechanisms
effect of DPP4s on glucagon secretion?
suppression
effect of DPP4s on gastric emptying?
slowed
effect of DPP4s on appetite?
decreased (weight loss)
arthralgia- seen with which antidiabetic class?
DPP4 inhibitors/gliptins
pancreatitis- seen with which antidiabetic class?
DPP4 inhibitors/gliptins
skin rash- seen with which antidiabetic class?
DPP4 inhibitors/gliptins
renal impairment- DPP4 inhibitors?
caution
heart failure- DPP4 inhibitors?
caution
incretin mimetics?
GLP1 receptor agonists
exenatide- specific class?
GLP1 receptor agonists
dulaglutide- specific class?
GLP1 receptor agonists
semaglutide- specific class?
GLP1 receptor agonists
GLP1 agonists- monotherapy?
yes
GLP1 agonists with other medications?
yes
GLP1 agonists- MOA?
act as endogenous GLP1
effect of GLP1 on triglycerides?
reduction
effect of GLP1 on systolic blood pressure?
reduction
why is there weight loss with GLP1 agonists?
reduced appetite and reduced food intake
which GLP1 can be given orally?
semaglutide (rybelsus)
another name for GLP1 agonists?
incretin mimetics
what is the first oral GLP1 for T2DM only?
semaglutide (rybelsus)
most common adverse effects with GLP1 agonists?
GI- N/V
gallbladder dysfunction- adverse effect of which antidiabetic class?
GLP1 receptor agonists
thyroid dysfunction- adverse effect of which antidiabetic class?
GLP1 receptor agonists
pancreatitis or pancreatic duct metaplasia- which antidiabetic class?
GLP1 receptor agonists
adverse GLP1 agonist effect on kidneys?
kidney failure/injury
route of admin- GLP1 agonists?
subcutaneous injection
personal or family history of medullary thyroid carcinoma- contraindication for which antidiabetic class?
GLP1 receptor agonists
endocrine neoplasia- contraindication for what antidiabetic class?
GLP1 receptor agonists
moderate or greater renal disease- contraindication for what antidiabetic class?
GLP1 receptor agonists
history of GI disease is a contraindication GLP1 agonists
don’t give
mild renal disease- GLP1?
this is ok, but moderate or greater is a contraindication
what condition is treated with levothyroxine?
hypothyroidism
what medication acts like the body’s endogenous thyroid hormone?
levothyroxine
what three things does thyroid hormone regulate?
heart rate, respiratory rate, metabolic rate
heart rate, respiratory rate, metabolic rate- regulated by what?
thyroid hormone
five adverse effects of levothyroxine therapy?
diarrhea, weight loss, cardiac arrhythmias, menstrual irregularity, heat intolerance
what population is at risk of cardiac arrhythmias with thyroid hormone therapy?
elderly
adverse effects of thyroid hormone therapy mirror what condition?
hyperthyroidism
weight gain or loss with hyperthyroidism?
weight loss
what medication is used to treat hypothyroidism?
levothyroxine
too much levothyroxine in the elderly can cause what?
cardiac arrhythmias
when should levothyroxine be taken?
on an empty stomach at least 30 minutes before breakfast
levothyroxine relative to meals?
on an empty stomach at least 30 minutes before breakfast
what three labs should be monitored with levothyroxine?
TSH, T3, and free T4
levothyroxine should be taken when?
on an empty stomach at least 30 minutes before breakfast
definitive lab for monitoring levothyroxine?
TSH
graves disease causes what thyroid imbalance?
hyperthyroidism
toxic multi-nodular goiter- causes what thyroid imbalance?
hyperthyroidism
agranulocytosis- seen with what endocrine drug?
anti-thyroid drugs
aplastic anemia- seen with what endocrine drugs?
anti-thyroid drugs
what is the black box warning with propylthiouracil?
liver failure
hair loss- seen with what endocrine drugs?
anti-thyroid drugs
propylthiouracil- specific class?
anti-thyroid drugs
methimazole- specific class?
anti-thyroid drugs
how to anti-thyroid drugs work?
block synthesis of thyroid hormone by preventing iodination of tyrosine
how does propylthiouracil work?
block synthesis of thyroid hormone by preventing iodination of tyrosine
how does methimazole work?
block synthesis of thyroid hormone by preventing iodination of tyrosine
what class? Block synthesis of thyroid hormone by preventing iodination of tyrosine?
anti-thyroid drugs
another name for anti-thyroid class?
thionamides
another name for thionamide class?
anti-thyroid drugs
agranulocytosis and aplastic anemia- adverse effects of what class?
thionamides
what thionamide should be used in first trimester of pregnancy?
propylthiouracil
what thionamide should be used in second and third trimesters of pregnancy?
methimazole
what thionamide should be used in second trimester of pregnancy?
methimazole
what thionamide should be used in third trimester of pregnancy?
methimazole
patient education with thionamides?
report infections
what lab monitors for agranulocytosis with thionamides?
CBC
when should CBC be drawn with thionamides?
at initiation of therapy and if s/s infection d/t r/f agranulocytosis
hashimotos thyroiditis may be seen in what condition/state?
pregnancy
hashimotos thyroiditis is a potential indication for what class of drugs in pregnancy?
anti-thyroid drugs
propylthiouracil must be used in which trimester of pregnancy?
first trimester
what lab should be drawn with initiation of thionamide therapy?
CBC
what lab should be drawn if s/s of infection with thionamide therapy?
CBC
lisinopril- class?
angiotensin-converting enzyme inhibitor
enalapril- class?
angiotensin-converting enzyme inhibitor
two examples of ACE inhibitors?
lisinopril and enalapril
indications for ACE inhibitors?
HTN, diabetic proteinuric states, CAD with ischemia, post MI, heart failure
how do ACE inhibitors work?
block the conversion of AT I to AT II and less aldosterone produced
which CV drug results in less aldosterone being produced?
angiotensin-converting enzyme inhibitor
what causes vasodilation with ACE inhibitors?
increased bradykinin
effect of ACE inhibitors on bradykinin?
increased
increased bradykinin with ACE inhibitors leads to what physiologic effect?
vasodilation
what is the likely culprit for cough with ACE inhibitors?
increased bradykinin (vasodilation)
what is the likely culprit for angioedema with ACE inhibitors?
increased bradykinin (vasodilation)
cough and angioedema- associated with what CV drug class?
angiotensin-converting enzyme inhibitor
effect of ACE inhibitors on intravascular volume?
decreased
effect of ACE inhibitors on vasculature?
vasodilation
bradykinin causes what with ACE inhibitors?
cough and angioedema
losartan- class?
angiotensin II receptor blocker
valsartan- class?
angiotensin II receptor blocker
indications for ARBS?
HTN, diabetic proteinuric states, CAD with ischemia, post MI, heart failure
what two CV classes have the same indications?
ACE inhibitors and ARBs
two example drugs of ARBs?
valsartan and losartan
valsartan and losartan- class?
angiotensin II receptor blocker
how to ARBs work?
block binding of angiotensin II to receptor
what is the difference in the MOA/effects of ACE inhibitors and ARBs?
no bradykinin increase with ARBs so less risk of cough or angioedema
why do ARBs not affect bradykinin?
working down further in the pathway
if a patient has a dry cough on an ACEI- what should I do?
switch to an ARB
adverse blood pressure effect with ACEI and ARBs?
hypotension
does angioedema usually occur with an ARB?
no
tachyphylaxis- seen with what two CV med classes?
ACEI and ARBs
ACE inhibitors- pregnancy?
absolute contraindication
ARBs, pregnancy?
absolute contraindication
bilateral renal artery stenosis- ACE inhibitors?
absolute contraindication
bilateral renal artery stenosis- ARBs
absolute contraindication
angioedema hx- ACE inhibitors?
absolute contraindication
angioedema hx- ARBs?
absolute contraindication
effect of ACEIs on potassium?
risk for retention of potassium
effect of ARBs on potassium?
risk for retention of potassium
what three labs should be monitored with ACEIs?
BUN, creatinine, potassium
what three labs should be monitored with ARBs?
BUN, creatinine, potassium
bilateral renal artery stenosis is a contraindication for what classes of CV meds?
ACEI and ARBs
pregnancy is an absolutely contraindication for what classes of CV meds?
ACEI and ARBs
angioedema is an absolute contraindication for what classes of CV meds?
ACEI and ARBs
three absolute contraindications for ACEIs and ARBs?
pregnancy; bilateral renal artery stenosis; angioedema
ACEIs and ARBs are protective of what?
renally-protective
why should we monitor K+ with ACEIs?
retention of potassium
why should be monitor K+ with ARBs?
retention of potassium
when should we check renal function after starting ACE or ARB?
three-ish weeks
hyperkalemia is a sign of what with ACEI or ARBS?
kidneys not tolerating
two major categories of calcium channel blockers?
dihydropyridines and non-dihydropyridines
class? Bind to voltage gated L-type channels in the heart and blood vessels preventing calcium from entering the cells
calcium channel blockers
where do calcium channel blockers bind?
voltage gated L-type channels in the heart and blood vessels
calcium channel blockers prevent what from entering the cells?
calcium
why do CCBs cause vasodilation?
relaxation of smooth muscle
effect of CCBs on arterial beds?
dilates
effect of CCBs on afterload?
reduces
chronic and unstable angina is an indication for what CV drug class?
calcium channel blockers
vasospastic angina is an indication for what CV drug class?
calcium channel blockers
migraine prophylaxis is an indication for what CV drug class?
calcium channel blockers
what type of arrhythmias may be managed with CCBs?
some supraventricular arrhythmias
Raynaud’s syndrome is an indication for what CV drug class?
calcium channel blockers
CAD with ischemia- is an indication for what CV drug class?
calcium channel blockers
which category of CCBs are used in hypertension?
dihydropyridines
amlodipine- specific class?
dihydropyridine CCB
nifedipine- specific class?
dihydropyridine CCB
felodipine- specific class?
dihydropyridine CCB
three examples of dihydropyridine CCBs?
amlodipine, nifedipine, felodipine
when treating angina, what forms are preferred? Of Ccbs
long-acting forms of dihydropyridine CCBs
hypotension, dizziness, lower extremity edema, headache, reflex tachycardia- adverse effects of what specific class?
dihydropyridine CCB
lower extremity edema- associated with what CV drug class?
dihydropyridine CCB
reflex tachycardia- associated with what CV drug class?
dihydropyridine CCB
verapamil- specific class?
non-dihydropyridine CCB
diltiazem- specific class?
non-dihydropyridine CCB
what category of CCBs are used for supraventricular tachyarrhythmias?
non-dihydropyridine CCB
three adverse effects of non-dihydropyridine CCBs?
fatigue, dizziness, constipation
fatigue, dizziness, constipation- adverse effects of what CV class?
non-dihydropyridine CCB
inotropic effect of non-dihydropyridine CCBs?
negative inotropic effect
chronotropic effect of non-dihydropyridine CCBs?
negative chronotropic effect
can verapamil be used in HFrEF?
no
can diltiazem be used in HFrEF?
no
why should we NOT use non-dihydropyridines in HFrEF?
negative inotropic and negative chronotropic effects
two examples of non-dihydropyridines?
verapamil and diltiazem
effect of non-dihydropyridines on contractility?
decreased
effect of non-dihydropyridines on heart rate?
decreased
very common side effect with non-dihydropyridine CCBs?
constipation
CCBs in liver dysfunction?
caution
CCBs in pregnancy?
contraindicated
CCBs in lactation?
contraindicated
how to decide which CCB to use?
indication, actions, side effects, specific patient characteristics
HMG-CoA reductase inhibitors- broad class?
antilipidemics
cholesterol absorption inhibitors- broad class?
antilipidemics
fenofibrates- broad class?
antilipidemics
another name for statins?
HMG-CoA reductase inhibitors
another name for HMG- CoA reductase inhibitors?
statins
rosuvastatin- specific class?
HMG-CoA reductase inhibitors
atorvastatin- specific class?
HMG-CoA reductase inhibitors
two examples of HMG CoA reductase inhibitors?
rosuvastatin and atorvastatin
what are the two uses for statins?
LDL and hypertryglyceridemia
what is HMG CoA reductase?
an enzyme required in cholesterol synthesis in the liver
what is the enzyme required for cholesterol synthesis in the liver?
HMG CoA reductase
where does HMG CoA reductase work?
in the liver
what antilipidemic works to prevent atherosclerosis?
HMG CoA reductase inhibitors
what antilipidemic has pleotropic effects?
statins
what antilipidemic class has a decreased production of pro-inflammatory cytokines?
statins
what antilipidemic class results in increased activity of endothelial nitric oxide?
statins
effect of statins on pro-inflammatory cytokines?
decreased production
effect of statins on activity of endothelial nitric oxide?
increased activity
effect of statins on platelet activity?
reduced
effect of statins on synthesis of thromboxane A2?
reduced
what antilipidemic class has reduced platelet activity?
statins
what antilipidemic class has reduced synthesis of thromboxane A2?
statins
common general adverse effect of statins?
myopathies
four common GI adverse effects of statins?
nausea, constipation, indigestion, flatulence
what antilipidemic class is associated with flu-like symptoms?
statins
what antilipidemic class is associated with memory loss?
statins
memory loss with statins is WHAT?
reversible if drug stopped
myalgia is common with what antilipidemic class?
statins
myositis can be seen with what antilipidemic class?
statins
rhabdomyolysis can be seen with what antilipidemic class?
statins
effect of statins on liver?
liver dysfunction
what lab should be drawn to check for rhabdomyolysis?
creatinine kinase
why should we check creatinine kinase with statins?
make sure the patient does not have significant elevation (i.e. rhabdo, myositis)
headache with statins?
yes
type 2 DM and memory loss have been associated with antilipidemic class?
statins
statins- active liver disease?
contraindicated
statins- current ETOH abuse?
contraindicated
statins- history of liver disease?
contraindicated
statins- pregnancy?
contraindicated
statins- lactation?
contraindicated
ezetimibe- brand name?
zetia
zetia- generic name?
ezetimibe
what is ezetimibe used for?
reduction of LDL
ezetimibe- specific class?
cholesterol absorption inhibitor
ezetimibe- active liver disease?
contraindicated
in addition to statins, myalgia, myopathy, rhabdo can be seen with what drug?
ezetimibe
antilipidemic associated with acute liver injury?
ezetimibe
what two types of cholesterol does ezetimibe inhibit absorption of?
dietary and biliary sources
what two sources of cholesterol does ezetimibe act on?
dietary and biliary sources
what antilipidemic drug acts on dietary and biliary sources of cholesterol?
ezetimibe
where do cholesterol absorption inhibitors work?
brush border of the small intestine
what antilipidemic class works at the brush border of the small intestine?
cholesterol absorption inhibitor
ultimate action of ezetimibe?
decreased delivery of intestinal cholesterol to the liver
class? Decreased delivery of intestinal cholesterol to the liver
cholesterol absorption inhibitor
inhibits absorption of cholesterol (dietary and biliary sources) at the brush border of the small intestine- class?
cholesterol absorption inhibitor
example of cholesterol absorption inhibitor?
ezetimibe
most common adverse effects with cholesterol absorption inhibitor?
GI
most common adverse effects with ezetimibe?
GI
primary contraindication of ezetimibe?
active liver disease
gemfibrozil- specific class?
fibric acid derivative
fenofibrate- specific class?
fibric acid derivative
gemfibrozil- brand name?
lopid
fenofibrate- brand name?
tricor
lopid- generic name?
gemfibrozil
tricor- generic name?
fenofibrate
fibric acid derivatives reduce WHAT?
hypertriglyceridemia
what antilipidemic class has indirect elevation of HDLs?
fibric acid derivative
why do fibric acid derivatives cause indirect elevation of HDLs?
d/t lowering of triglyceride levels
lowering of tridlyceride levels indirectly lowers WHAT with fibric acid derivatives?
HDL levels
what class helps to avoid pancreatitis in hypertriglyceridemia?
fibric acid derivative
class? Act by causing an increase in lipolysis of triglycerides by using lipoprotein lipase
fibric acid derivative
class? Decreases VLDL synthesis by the liver
fibric acid derivative
liver synthesis of WHAT is affected by fibric acid derivatives?
VLDL
fibric acid derivatives help to avoid WHAT in hypertriglyceridemia?
pancreatitis
term? Inhibit coagulation cascade and fibrin formation
anticoagulants
what two things do anticoagulants inhibit?
coagulation cascade and fibrin formation
term? Inhibit clot formation by preventing platelet activation and aggregation
antiplatelets
how do antiplatelets inhibit clot formation?
by preventing platelet activation and aggregation
two types of antithrombotic drugs?
anticoagulants and antiplatelets
anticoagulants and antiplatelets are types of what?
antithrombotic drugs
what kind of drugs inhibit coagulation cascade?
anticoagulants
what kind of drugs inhibit fibrin formation?
anticoagulants
example- anticoagulant?
dabigatran
dabigatran- brand name?
pradaxa
pradaxa- generic name?
dabigatran
drug? Decreases risk of stroke and PE associated with non-valvular atrial fibrillation
dabigatran
when is dabigatran used to decrease risk of stroke and PE?
non-valvular atrial fibrillation
what type of a fib is dabigatran used in?
non-valvular atrial fibrillation
dabigatran reduces risk of what two things?
stroke and PE
when is dabigatran used to treat DVT and PE?
in patients who have been treated with a parenteral anticoagulant for 5-10 days
when is dabigatran used for DVT and PE prophylaxis?
patients after hip surgery
patients after hip surgery may receive what medication?
dabigatran
reversible competitive thrombin inhibitor- drug?
dabigatran
directly inhibits thrombin’s conversion of fibrinogen to fibrin- drug?
dabigatran
four GI adverse effects of dabigatran?
heartburn, diarrhea, nausea, belching
heartburn, diarrhea, nausea, belching- adverse effects of what drug?
dabigatran
is dabigatran reversible?
yes
idarucimab/praxbind- is the reversal agent for what?
dabigatran
what is the reversal agent for dabigatran?
idarucizumab/praxbind
IV monoclonal antibody that binds to dabigatran?
idarucizumab/praxbind
neutralizes anticoagulant effect for immediate surgical procedure or life-threatening bleed?
idarucizumab/praxbind
bleeding disorders- dabigatran?
contraindicated
history/active bleeding ulcers- dabigatran?
contraindicated
mechanical heart valve- dabigatran?
contraindicated
recent spinal epidural procedure- dabigatran?
contraindicated
kidney disease- dabigatran?
contraindicated
clopidogrel- drug type?
antiplatelets
brand name for clopidogrel?
plavix
generic name for plavix?
clopidogrel
drug? Reduces the risk of MI in patients with ACS, STEMI
clopidogrel
drug? Reduces risk of MI in stroke or established PAD?
clopidogrel
drug? Prodrug that selectively inhibits the binding of ADP to its platelet receptor
clopidogrel
drug? Affects the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex
clopidogrel
drug? Ultimately inhibits platelet aggregation
clopidogrel
can everyone take clopidogrel?
no- some people are unable to effectively metabolize it
bleeding, headache, taste disorders- adverse effects of what drug?
clopidogrel
clopidogrel- black box warning?
antiplatelet activity is dependent on conversion to an active metabolite by the CYP2C19 enzyme
why is genetic testing recommended with clopidogrel?
to make sure the patient is not a CYP2C19 poor metabolizer
clopidogrel- renal dysfunction?
contraindicated
clopidogrel- hepatic dysfunction?
contraindicated
clopidogrel- active bleeding?
contraindicated
sacubitril/valsartan- specific class?
ANRI
what do ANRIs inhibit?
RAAS system
another name for sacubitril/valsartan?
entresto
what two classes of drugs inhibit the SNS? (HF)
beta blockers (metoprolol) and alpha-beta blockers (Carvedilol)
eplerenone- class?
mineralocorticoid receptor antagonists
are loop diuretics first line therapy for HF?
yes
is ivabradine first line therapy for HF?
yes
is hydralazine plus a nitrate first line therapy for HF?
yes
amiodarone- specific class?
class III antiarrhythmic
drug? Used to treat a fib and ventricular arrhythmias
amiodarone
how does amiodarone work?
prolong cardiac myocyte repolarization through blockade of potassium channels
what channels does amiodarone block?
potassium channels
lung damage- associated with what CV drug?
amiodarone
thyroid dysfunction- associated with what CV drug?
amiodarone
other side effects of amiodarone?
N/V, fatigue
why should we check thyroid function on amiodarone?
can affect thyroid function
what labs should be checked on amiodarone?
thyroid labs
HFrEF reflects what type of dysfunction?
systolic
what is the normal EF?
55 to 70%
what is the EF of HFrEF?
<= 40%
systolic dysfunction where the heart is not able to meet the perfusion needs of the body’s tissues (term?)
HFrEF
what two things determine cardiac output?
HR and stroke volume
what does EF estimate?
stroke volume
what three things determine stroke volume?
contractility, preload, and afterload
when does contractility decrease?
anything that causes myocyte dysfunction or death
anything that causes myocyte dysfunction or death leads to what?
decreased contractility
preload increases with volume WHAT?
overload
preload increases with increased/decreased heart contractility?
decreased
what type of valve disease can increase afterload?
aortic
aortic valvular disease can do what to afterload?
increase
an elevated peripheral vascular resistance leads to increased what?
afterload
volume overload does what to preload?
increases
aortic stenosis does what to afterload?
increases
what three avenues of neurohormonal activation occur with HFrEF?
SNS activation, RAAS activation, natriuretic peptide release
what receptors activate the SN?
central baroreceptors
when do central baroreceptors activate the SNS?
due to decreased perfusion of the tissues in HF
decreased perfusion of tissues in heart failure result in activation of what?
central baroreceptors activate the SNS
SNS activation leads to more WHAT?
vasoconstriction
SNS simulation of what receptors lead to increased work of the heart?
beta 1 receptors
SNS activation does what to heart rate?
increases
SNS activation attempts to do what to contractility?
increased
activation of WHAT also leads to ADH production?
baroreceptors
ADH causes further increase in WHAT?
intravascular volume, vasoconstriction, and hyponatremia
increases in intravascular volume, vasoconstriction, and hyponatremia- caused by what hormone?
ADH
catecholamines are toxic to what?
myocardium
what hormones are toxic to the myocardium?
catecholamines
what happens to sodium with ADH?
hyponatremia
why is the RAAS system activated in HFrEF?
decreased cardiac output with decreased perfusion of the kidneys
decreased cardiac output with decreased perfusion of the kidneys leads to activation of what?
RAAS
why do preload and afterload increase with RAAS activation?
ATII and aldosterone production
vasoconstriction and extracellular volume increases with neurohormonal activation of what system?
RAAS
(term?) these peptides attempt to compensate for the pathophysiologic processes of HFrEF
natriuretic pepties
can natriuretic peptides overcome the pathophysiologic processes of HFrEF?
no
what does BNP do?
works to excrete more salt and water into the urine to offset the effects of aldosterone and ADH
what hormone works to excrete more salt and water into the urine to offset the effects of aldosterone and ADH?
brain natriuretic peptide
compensatory attempt for HFrEF is completed by what neurohormal systems?
natriuretic peptides
what process is mediated in part by the neurohormonal activation and multiple other factors such as inflammation
cardiac remodeling
angiotensin II and aldosterone are directly toxic to the WHAT?
myocardium
what two chemicals lead to cardiac remodeling, myocyte death, and fibrosis?
angiotensin II and aldosterone
what vascular effect does ATII cause?
vasoconstriction
angiotensin II and aldosterone do what to afterload?
increase
what do metabolic diseases like frank DM contribute to? (what process of HFrEF)
cardiac remodeling
what do inflammatory cytokines damage in cardiac remodeling?
myocytes
alterations of myocyte metabolism lead to what?
inability to produce the energy needed for contraction and more toxic metabolites are released
term? Patient must sit up to breathe
orthopnea
term? Patient suddenly wakes up and must sit up to breathe
paroxysmal nocturnal dyspnea
describe cough with HFrEF?
productive of frothy material
why is there edema and increase in weight with HFrEF?
volume overload
why is there decreased urine output in HFrEF?
decreased renal perfusion
what happens to urine output in HFrEF?
decreased
dyspnea and fatigue are seen in what disorder?
HFrEF
orthopnea definition?
patient must sit up to breathe
paroxysmal nocturnal dyspnea- definition?
patient suddenly wakes up and must sit up to breathe
cardiac cachexia is due to what?
inflammatory cytokines damage the myocytes and cause weight loss systemically
term? Inflammatory cytokines damage the myocytes and cause weight loss sytemically
cardiac cachexia
diabetes mellitus predisposes patients to what condition?
heart failure
heart failure can precipitate what condition?
diabetes mellitus
what condition causes DIRECT TOXICITY to the heart causing cardiomyopathy/HF?
diabetes mellitus
effect of DM on contractility?
decreased
effect of DM on cellular calcium efflux?
less efficacy
formation and deposition of WHAT in the myocardium with DM?
advanced glycation end products
advanced glycation end products cause what?
hypertrophy and fibrosis of the myocardium
effect of DM on ATP formation?
impaired
what is the alternative to ATP formation?
depend on fatty acid oxidation (much less efficient)
fatty acid oxidation is much less WHAT?
efficient
impaired ATP formation causes an increase in what?
oxygen demand
toxic lipid depositions can result from what?
impaired ATP formation (DM and HFrEF)
what is the SNS dysfunction seen with DM/HFrEF?
autonomic neuropathy
SNS dysfunction/autonomic neuropathy and inflammation of the heart lead to increased WHAT?
myocyte dysfunction
endothelial dysfunction pushes the patient to development of WHAT?
CAD
when may autonomic neuropathy occur?
DM
diabetes promotes what in the arteries?
atherosclerotic change
neurohormonal activation causes increased WHAT metabolism?
free fatty acid
what is postulated as a cause of increased insulin resistance in DM/HFrEF?
Neurohormonal activation causes increased free fatty acid metabolism
with direct therapy for HF, should also treat what?
any reversible cause/contributing factor
reverse myocardial ischemia- example of what?
any reversible cause/contributing factor
cardioversion for a-fib- example of what?
any reversible cause/contributing factor
reduction of WHAT is a goal of HFrEF therapy?
morbidity
decrease of WHAT is a goal of HFrEF therapy?
mortality
reduction of morbidity and decrease in mortality- goals of WHAT?
HFrEF
decrease in symptoms, improve quality of life/overall function, decrease in hospitalization- goals of what?
HFrEF
how to loop diuretics decrease preload?
by decreasing extracellular fluid by increased excretion of sodium and water through the kidneys
what class of medications? Decrease preload via decreasing extracellular fluid by increased excretion of sodium and water through the kidneys
loop diuretics
example of loop diuretic?
furosemide
furosemide class?
loop diuretics
effect of loop diuretics on afterload?
decrease
effect of loop diuretics on preload?
decrease
how do loop diuretics decrease afterload?
decreasing PVR
sodium, water, and WHAT are eliminated renally?
potassium
what three things are eliminated renally with loop diuretics?
sodium, water, and potassium
what electrolyte imbalance can occur with loop diuretics?
hypokalemia
MRAs do what with potassium?
hold onto it
MRA effect on afterload?
decrease
MRA effect on preload?
decrease
what three classes of drugs can be used to inhibit RAAS in HFrEF?
ARNI, ACE, OR ARBs
example ANRI drug?
sacubitril/valsartan
what is the preferred class of drug to inhibit RAAS in HFrEF?
ARNI
inhibiting the RAAS has what effect on preload?
decrease
why does RAAS inhibition lead to reduced preload?
less aldosterone
what does RAAS inhibition lead to reduced afterload?
less aldosterone and less ATII
what effect does RAAS inhibition have on afterload?
decrease
ACEIs and ARBs assist with preventing what?
cardiac remodeling processes that become maladaptive
what two drug classes assist with preventing cardiac remodeling processes that become maladaptive?
ACEIs and ARBs
less AT II production and actions with what drug class?
ACEIs
less AT II actions with what drug class?
ARBs
drug? A prodrug that acts to prevent the breakdown of natriuretic peptides by inhibiting neprilysin
sacubitril
what is the action of sacubitril?
a prodrug that acts to prevent the breakdown of natriuretic peptides by inhibiting neprilysin
what chemical does sacubitril inhibit?
neprilysin
sacubitril prevents the breakdown of what?
natriuretic peptides
ARNI enhance what two things?
natriuresis and vasodilation
natriuresis results in what effect on preload?
decreased
natriuresis results in what effect on afterload?
decreased
natriuresis results in what two things?
decreased preload and afterload
vasodilation has what effect on afterload?
decreased
RAAS inhibition results in decreased hypertrophy and fibrosis of the WHAT?
myocardium
inhibition of SNS is accomplished with what two drug classes?
beta blockers and alpha-beta blockers
example of beta blocker used in HFrEF?
metoprolol
example of alpha-beta blocker used in HFrEF?
carvedilol
metoprolol drug class?
beta blocker
carvedilol drug class?
alpha-beta blocker
what drug class? Decreased myocardial oxygen demand and decreased wall tension
beta/alpha-beta blockers
decreased myocyte apoptosis- what drug class?
beta/alpha-beta blockers
inhibition of downregulation of beta receptors- what drug class?
beta/alpha-beta blockers
beta/alpha-beta blockers have what effect on afterload?
decreased
decreased tachycardia- what class of HFrEF?
beta/alpha-beta blockers
improved diastolic filling times- what drug class HFrEF?
beta/alpha-beta blockers
prevention of dysrhythmias- what drug class HFrEF?
beta/alpha-beta blockers
rate control if a fib present- what drug class HFrEF?
beta/alpha-beta blockers
alpha-1 blockade with alpha-beta blockers causes what?
vasodilation
what drug class promotes osmotic diuresis?
SGLT2 inhibitors
what drug class promotes more glucose excreted in the urine?
SGLT2 inhibitors
natriuresis does what to preload?
decreased
osmotic diuresis does what to preload?
decreased
SGLT2 inhibitors cause what?
osmotic diuresis
how may SGLT2 inhibitors lower BP?
decreased afterload via vasodilation
metabolic modulation occurs with what drug class?
SGLT2 inhibitors?
lowered blood glucose is a result of WHAT with SGLT2 inhibitors?
metabolic modulation
possible improved efficiency of myocardial metabolism- what drug class?
SGLT2 inhibitors
what drug class- increased contractility and increased CO?
cardiac glycosides
what do cardiac glycosides do to contractility?
increased
what do cardiac glycosides do to cardiac output?
increased
what class of medications is not generally used in HFrEF?
calcium channel blockers
what category of CCBs should not be used in HFrEF?
non-dihydropyridines
two examples of non-dihydropyridines?
diltiazem and verapamil
why do we not use non-dihydropyridines in heart failure?
due to their negative inotropic effects
what two CCBs are neurtral re: inotropy?
almlodipine and felodipine
when might amlodipine and felodipine be used in HFrEF?
if additional control of HTN or angina is needed
why can amlodipine and felodipine be used in HFrEF?
neutral re: inotropy
are cardiac glycosides considered a first line therapy?
no
do cardiac glycosides affect mortality?
no
at what EF are cardiac glycosides used?
<40%
when are cardiac glycosides used in HFrEF?
EF<40% and are on other standard therapy
drug? Slows conduction through the sinoatrial node
ivrabradine
what does ivrabradine do?
slows conduction through the sinoatrial node
at what heart rate is ivabradine contraindicated?
pre-treatment heart rate <60 bmp
pre-treatment HR <60 bpm is a contraindication for what drug?
ivrabradine
what drug assists with keeping heart rate out of the 70-100 bpm range?
ivrabradine
elevation of what correlates with worse outcomes in HF?
heart rate
when is hydralazine + a nitrate used?
vasodilation for those intolerant to the ARNI, ACEIs, or ARBs
what effect does hydralazine + a nitrate have on afterload?
decrease afterload
what two effects does hydralazine + a nitrate have?
decrease afterload and open coronary arteries for those with myocardial ischemia
what does opening of coronary arteries improve?
improved oxygen delivery
where does ivrabradine slow conduction?
sinoatrial node
dietary considerations for HFrEF?
avoid all simple carbohydrates and sodium
maintain lean body weight, avoid all simple carbohydrates, regular strength training, aerobic exercise- nonpharm therapy for what?
HFrEF
what are two examples of myocardial toxins that should be avoided?
ETOH, cocaine
smoking cessation is important in what disease process?
HFrEF
unstable bronchospastic disorders like asthma, contraindication for what drug class?
beta blockers
what drug class? Gold standard to help reduce second cardiac event post-MI
beta blockers
why should beta blockers be used for patients with diabetes who have major blood glucose variation ranges?
they decrease insulin secretion and may mask many signs of hypoglycemia
what drug inhibits the enzyme that converts T4 to T3 and has iodine as a major component?
amiodarone
what drug has a major risk for patients with underlying predisposition to thyroid disease?
amiodarone
patients taking amiodarone are at risk for what two thyroid disorders?
thyrotoxicosis and hypothyroidism
what drug inhibits the enzyme that converts T4 to T3?
amiodarone
what enzyme does amiodarone inhibit?
the enzyme that converts T4 to T3
what side effect does hydralazine sometimes induce?
lupus-like syndrome
per the ADA, when might a less stringent A1C goal be used?
extensive comorbid conditions
what might be the A1c goal for a patient with extensive comorbid conditions?
<8%
when is nasally inhaled human insulin contrindicated?
patients who smoke or have a history of chronic lung disease
do biguanides affect gastric emptying?
no
are meglitinides insulin secretagogues?
yes
do meglitinides affect gastric emptying?
no
do sulfonylureas cause an increase in endogenous insulin secretion by the beta cells of the pancreas?
yes
do sulfonylureas delay gastric emptying?
no
what class should not be used if these conditions? Bowel disease, IBD, r/f bowel obstruction, colonic ulceration, chronic intestinal disease associated with marked digestive disorders; conditions that may deteriorate w/ increased gas in intestine
alpha-glucosidase inhibitors
class? Delaying the absorption of complex carbohydrates
alpha-glucosidase inhibitors
class? Inhibit the reabsorption of glucose in the kidney
SGLT2 inhibitors
term? Inhibiting glucose production in liver and muscle cells
glycogenolysis
drug? Enhancing fat storage and prevents mobilization of fat for energy
insulin
drug? Lowers blood glucose levels by stimulating glucose entry into the cell
insulin
migraine prophylaxis is an off-label indication for what class?
CCBs
what CCB is most commonly used for migraine prophylaxis?
verapamil
Raynaud’s is an off-label indication for what class?
Type 2 CCBs
which type of CCBs are used for Raynaud’s?
Type 2 CCBs
why are type 2 CCBs choice drug for Raynauds?
because of their peripheral vasodilating effects and some platelet inhibition
what is the drug of choice for Raynauds? (specific drug)
long-acting nifedipine
off-label use of what class? Mild esophageal spasm- transient improvement
CCBs
what drug can be used off label for mild esophageal spasm?
diltiazem
what drug can worsen GERD when treating mild esophageal spasm?
diltiazem
what type of CCBs are effective in treatment of stable and exertional angina?
type 1 and type 2
CCBs- peripheral vasodilation and negative inotropism- reduce what?
oxygen demand
CCBs- dilation of coronary arteries increases what?
oxygen supply
does decreasing the dose of an ACEI minimize the dry hacking cough?
no
switching to WHAT from an ACEI can help with dry cough?
ARB
what is a rare, life-threatening condition that can occur with metformin?
lactic acidosis
why can metformin cause lactic acidosis?
accumulation of lactic acid during treatment
what is the most common adverse reaction of metformin?
GI disturbance
what is the only oral agent approved for use in children by the FDA?
metformin
DPP-4 inhibitor in children?
no
meglitinides in children?
no
metformin in children?
no
can a basal insulin be used for hyperglycemia in children?
yes, but would not be an initial medication for T2DM
what two drug classes are most associated with erectile dysfunction?
beta blockers and thiazide diuretics
what is the beta blocker LEAST likely to cause ED and may even improve ED symptoms?
nebivolol
diffuse myalgias, muscle tenderness, weakness, and elevations in CK- consider what diagnosis?
myopathy
impaction is associated with what drug class?
bile-acid sequestrants
what drug class blocks synthesis of cholesterol in the liver by competitively inhibiting HMG-CoA reductase activity?
statins
what drug class induces an increase in high-affinity LDL receptors, resulting in increased catabolism of LDL and increase in liver’s extraction of LDL precursors
statins
drug class? Increase lipolysis of triglycerides via lipoprotein lipase
fibric acid derivatives
decrease in VLDL related to decreased secretion by the liver- class?
fibric acid derivatives
class? Exchange chloride ions for negatively charged bile acids
bile acid sequestrants
class? Promoting a 10-fold increase in bile acid excretion
bile acid sequestrants
class? Increased clearance results in enhanced conversion of cholesterol to bile acids by the liver
bile acid sequestrants
class? Increased uptake of LDL from plasma results from the upregulation of high-affinity LDL receptors on cell membranes, especially in the liver
bile acid sequestrants
what isoenzymes are involved in the metabolism of CCBs?
CYP3A4
why should grapefruit juice be avoided with CCBs?
drugs like CCBs that inhibit CYP3A4 isoenzymes may increase free drug levels
what drug class has the most potential for hypoglycemia?
sulfonylureas
DPP4 risk for hypoglycemia?
low risk
what is the purpose of antithyroid agents?
inhibit the synthesis of thyroid hormones
what happens to TSH in hyperthyroidism?
elevated TSH
what drug inhibits the peripheral conversion of thyroxine (T4) to T3?
propylthiouracil
canagliflozin- urine dipstick for glucose?
expected to show positive (intended consequence of the medication)
for patients with a history of gout or renal calculi, why is cautious use of diuretics suggested?
potential for hyperuricemia
high levels of WHAT may occur with all diuretics?
uric acid
what three diuretic classes are most likely to cause hyperuricemia?
thiazide, loop, spironolactone
what is the least likely diuretic to cause hyperuricemia?
indapamide/lozol
persistent, severe abdominal pain that may be accompanied by vomiting are hallmark symptoms of what?
pancreatitis
what two labs are used to monitor thyroid function in hypothyroidism?
TSH and free T4
