Module 4 Unit A Flashcards
Thiazide Diuretics - concerns
HCTZ
Hypokalemia
Hyperglycemia
Hyperuricemia (uric acid=gout)
Hyponatremia
Use caution with sulfa drugs
Thiazide diuretics
Do not combine with lithium
thiazide (HCTZ) - can cause lithium toxicity
Do not prescribe to people with renal failure or hypokalemia
Thiazide
Calcium sparing effects make this a good drug for women with osteoporosis
HCTZ - they also stimulate osteoblast activity
How does the MOA of diuretic classes differ?
They block sodium and chloride reabsorption from kidneys
electrolyte abnormalities that can occur with diuretics
hyponatremia, hypochloremia, hypokalemia
How do loop diuretics work?
- Inhibit sodium-potassium-chloride pump of the kidneys
2. Inhibit the reabsorption of sodium and chloride in the loop of Henle and Proximal and distal tubules.
High risk for dehydration, hyponatremia, hypochloremia and hypotention
Loop diuretics (Lasix) greater than HCTZ
contraindicated in anuria
Loop diuretics
Black Box Warning for Lasix
Can lead to profound diuresis with water and electrolyte depletion
Work with a low GFR
loop diuretics
Black. Box Warning for ACE, ARB, ARNI
Can cause injury or death to developing fetus
Example of Aldosterone Receptor Antagonist or Potassium-sparing diuretic
Sprionolactone (Aldactone)
How does spironolactone work?
Blocks effects of aldosterone
block the reabsorption of sodium
Contraindicated in people with hyperkalemia (>5.5)
Aldactone (spironolactone)
ACE inhibitor indications
HTN, heart failure, diabetic neuropathy, MI
Prototype ACE inhibitor
Lisinopril
Concerns with ACE inhibitors
Hyperkalemia, angioedema, Late-stage CKD
Best choice for treatment of HTN in black patients
Calcium channel blockers or diuretics
what drugs are safe in pregnancy?
Calcium channel blockers (verapamil, nifedipine), labetalol, methyldopa
Use cautiously in diabetics - may potentiate hypoglycemia
Beta blockers
Beta 1 receptors located primarily where?
Heart and kidneys
Beta 2 receptors located primarily where?
lungs
How do Beta blockers work
- Block beta receptors which results in decreased cardiac output.
- Block effects of epinephrine causing heart to beat slower and with less force.
Best use for people with DM (can provide renal protection EARLY ON)
Angiotensin-2 receptor blockers (losartan/cozaar)
monitor closely for signs of worsening renal function - cause worsen renal function in patients with poor renal function.
Angiotensin-2 receptor blockers
Cardio–selective beta-1 blockers
safe in lung disease
Atenolol
Metoprolol
Non-selective beta blockers
Not safe in lung disease
Carvedilol
Propranolol
Two types of Calcium channel blockers
DHPs Nifedipine (Procardia) non-DHP (Cardizem, Verapamil)
Class of drugs used for Hypertension, angina, and cardiac dysrhythmias
Calcium channel blockers
Adverse effects of calcium channel blockers
flushing, dizziness, gingival hyperplasia, peripheral edema, reflex tachycardia
Can cause significant constipation in elderly
Non-DHPs:
Cardizem (Diltiazem)
Verapamil (Calan)
Cannot be combined with Beta-adrenerbic blockers
Non-DHPs (calcium channel blocker) - cardizem, verapamil
How do Aldosterone receptor antagonists work?
They block effect of aldosterone leading to blocking reabsorption of sodium.
Side effects of aldactone (spironolactone)
Bind to other steroid receptors leading to hormone issues - erectile dysfunction, post-menopausal bleeding, etc.
contraindication to Aldosterone receptor antagonists (spirinolactone/Aldactone)
Hyperkalemia
Side effects of CCB
Peripheral edema
flushing
headaches
dizziness
Risk factors for Angioedema
H/O previous angioedema >65 YO Aspirin or NSAID use female smoking seasonal allergies
populations at greatest risk for Angioedema
Women and African Americans
What drugs can cause angioedema
ACEI, ARBs, ARNIs, CCBs
