Misc CV Agents Flashcards
Atorvastatin brand name
Lipitor
Atorvastatin indication/dosage
adjunct to diet to reduce elevated cholesterol levels: 10-80mg daily, given at any time of the day. Begin with 10mg daily with or without meals
Atorvastatin mechanism
selective, competitive inhibitor of HMG-CoA reductase. Decreases # of LDL receptors on cell surface
Reduces LDL, VLDL, and trigs, and increases HDL
Atorvastatin metabolism and elimination
metabolized by 3A4
excretion primarily in bile
>98% protein bound
Atorvastatin drug interactions
May increase digoxin level
coadmin with the following may increase plasma levels of atorvastatin: gemfibrozil, grapefruit, nicotinic acid, itraconazole, erythromycin, clarithromycin, azole antifungals, protease inhibitor combinations, and cyclosporine
Atorvastatin CI/precautions
CI: pregnancy and lactation, active liver disease, unplanned persistent elevations of LFT’s
caution: liver dysfunction, and who consume large amounts of alcohol
Atorvastatin monitoring
LFT q6w for first 3 months, then periodically
Atorvastatin discontinuation
LFT elevation >3x ULN
if do not decrease with discontinuation, biopsy should be considered
Atorvastatin pregnancy category
X
Atorvastatin ADRs
constipation, diarrhea, dyspepsia, flatulence
contact physician if myopathy or rhabdo occurs (muscle pain or tenderness)
Atorvastatin patient education
closely follow prescribed diet! cholesterol-lowering diet continued through therapy
avoid overexposure to sunlight
do not become pregnant during therapy
limit alcohol intake
Bumetanide brand name
Bumex
Bumetanide indication/dosage
treatment of edema associated with HF, cirrhosis of liver, and renal diseases
Oral: 0.5-2mg daily in 1-2 doses.
Parenteral: 0.5-1mg IM or IV over 1-2 minutes. second and third doses at intervals of 2-3h until desired diuresis occurs
Bumetanide max dose
10mg daily
Bumetanide mechanism
inhibits reabsorption of Na and Cl in ascending limb of LOOP OF HENLE
also has some action in proximal tubule, but NOT in distal tubule
Bumetanide onset of diuresis
30-60 minutes, lasts about 4 hours
IV speeds up onset to just minutes
Bumetanide drug interactions
cisplatin or aminoglycosides: increased auditory toxicity
electrolyte disturbances may predispose patient to digitalis-induced arrhythmias
Bumetanide CI/precautions
CI: patients with anuria and uncorrected hepatic coma or severe electrolyte depletion
caution: hypersensitivity to sulfonamides
excessive dosing may cause volume and electrolyte depletion
prevention of hypokalemia is important in patients with cirrhosis or ascites, diarrhea, K-losing nephropathy, and receiving digitalis therapy
Bumetanide pregnancy category
C
Bumetanide ADRs
DIZZINESS, MUSCLE CRAMPS, WEAKNESS, IMPAIRED HEARING, HYPOKALEMIA, hypotension, hyperuricemia, hypochloremia, hyponatremia, azotemia, and hyperglycemia
Bumetanide patient education
may take with food
should be given in AM or early in the day, due to diuresis
ortho hypo!! use care when standing
Chlorthalidone brand name
Hygroton
Chlorthalidone indication/dosage
adjunctive therapy in edema associated with HF, cirrhosis, CS and estrogen therapy, or renal dysfunction: 50mg daily, or 100mg QOD. Up to 200mg/day
HTN: 25mg daily initially, then 50-100mg/day
Chlorthalidone mechanism
inhibits Na and Cl reabsorption at cortical diluting segment of ascending limb of loop of Henle
Chlorthalidone drug interactions
may decrease SU hypoglycemia
electrolyte disturbances may cause DIGITALIS-induced arrhythmias
use with diazoxide may cause hyperglycemia
May increase lithium serum levels
Chlorthalidone CI/precautions
CI: anuria or hypersensitivity to sulfonamide-derrived drugs
Caution: dirrhosis, gout, impaired renal/hepatic function, diabetes, or taking CS or ACTH
Chlorthalidone pregnancy category
B
Chlorthalidone ADRs
MUSCLE CRAMPS, WEAKNESS, dry mouth, nausea, vomiting, anemia, dizziness, ortho hypo, anorexia, GI distress (diarrhea, constipation) hyperglycemia, photosensitivity, rash, transient blurred vision
Chlorthalidone patient education
take with food
Usually taken in early AM due to diuresis
avoid excessive sun exposure
