Pharmacotherapies Flashcards
Thiazide diuretics
Name, mechanism, side effects and considerations
Antihypertensive drug
Hydrochlorothiazide
Mechanism: decreased resorption of Na and K, causes osmotic diuresis and increase Na, K and H+ excretion
Side effects: hypokalemia, hyperglycemia, anorexia, malaise, muscle weakness
Considerations: provide K-rich foods, provide K supplements (which can irritate mucosal linings and increased risk of ulceration, N/V/D)
Loop diuretics
Name, mechanism, side effects and considerations
Antihypertensive
Furosemide
Mechanism: decreased resorption of Na and K, causes osmotic diuresis and increase Na, K and H+ excretion
Side effects: hypokalemia, hyperglycemia, anorexia, N/V, constipation
Considerations: provide K-rich foods, provide K supplements (which can irritate mucosal linings and increased risk of ulceration, N/V/D)
K sparing diuretics
Name, mechanism, side effects and considerations
Antihypertensive
Spironolactone, triamterene, amiloride
Mechanism: aldosterone inhibition - ↓ Na reabsorption and ↓ K excretion
Considerations: avoid excess K, supplements and Na substitutes, avoid excess H2O, avoid natural liquorice and take with food
ACE inhibitors
Name, mechanism, side effects, considerations
Antihypertensive drug
Ramipril (-pril)
Mechanism: inhibition of ACE enzyme which converts AngI —> AngII active form
- decreases vasoconstriction, vasopressin and aldosterone release
Side effects: hypotension (elders, main), dry cough (main), worsened renal function, hyperkalemia, worse in AA
Considerations: avoid salt substitutes and natural liquorice
ARBs name, mechanisms, side effects, and considerations
Antihypertensive drugs
Angiotensin II receptor blockers
Valsartan and losartan
Mechanism: blocks AngII receptor to decrease activity causing vasodilation, ↓ vasopressin and ↓ aldosterone
Side effects: hyperkalemia, nausea, dizziness
Considerations: avoid salt substitutes, avoid natural liquorice, Losartan caution w/ grapefruit
Used when ACEi not tolerated
Calcium channel blockers name, mechanisms, side effects, considerations and contraindications
Antihypertensive drug
Amlodipine (-dipine)
Mechanism: affects Ca movement through Ca channels –> blood vessel relaxation esp large ones
Side effects: edema, nausea, heartburn
Considerations: avoid natural liquorice, limit caffeine and alcohol, avoid grapefruit w/ felodipine
Contraindicated for heart failure
Beta blockers name, mechanisms, side effects, and considerations
Antihypertensive drugs
Propanolol, atenolol and metoprolol (-olol)
Mechanism: blocks adrenergic β-receptors (B1) in heart to decrease rate and CO
Side effects: INSOMNIA, DIZZINESS, FATIGUE, N/V, constipation/diarrhea, bloating, masked hypoglycemia (T2D caution), bradycardia, hallucinations
Considerations: avoid natural liquorice, not recommended as initial therapy in those over 60
Major considerations with antihypertensive drugs
Liver, kidney as locations of metabolism/excretion
Drug-nutrient interactions: grapefruit and avoid liquorice (glycyrrhinic acid) for all antihypertensives
Polypharmacy
Nutritional status, physiological status
Patients with diabetes, coronary artery disease and heart failure are treated with which antihypertensives generally?
Diabetes: ACEi and ARBs (with complications) or CCB or diuretics if no complications
Coronary artery disease: ACEi and ARBs, and β-blockers or CCB for stable angina
Heart failure: ACEi or ARB + β-blockers
Bile acid sequestrants use, names, mechanisms and predicted effects
Medication for hyperlipidemia
Begin with chole or cole
Mechanism:
1) Promotes sterol excretion by binding in GI and reduce absorption
2) Increased LDL-R
Effect:
1) 15-30% decrease in LDL and cholesterol
2) transient VLDL increase in first month, decreased absorption of fat-soluble vitamins/Fe/Ca/Zn/Mg
Side effects: significant constipation
Contraindications: existing hemorrhoids, peptic ulcers, hiatus hernia, drug use, extensive travel, hypertriglyceridemia
Statins use, names, mechanisms and predicted effects
Hyperlipidemia medication, 1° and 2°
HMG-coA reductase inhibitor
Ends in -statins
Mechanisms:
1) blocks cholesterol synthesis to decrease pool
2) Increased LDL receptor transcription to decrease circulating cholesterol
Effect decrease LDL-C (18-55%) + TG, increase in HDL-C (5-15%)
Fibrates use, names, mechanisms and predicted effects and side effects
Hypertriglyceridemia medication
Fibrates: gemfibrozil and fenofibrate
Mechanism: decrease VLDL synthesis and enhance LPL action
Effect: decrease TG 20-50% and LDL 5-25%, increase HDL
Side effects: GI reaction, muscle toxicity, taste changes
Contrindications: hepatic/renal dysfunction, gallbladder disease, combo w/ Simvastatin
Cholesterol absorption inhibitor use, names, mechanisms and predicted effects and side effects
Hyperlipidemia medication, first line add-on to statins at max dose
ezetimibe
Mechanism: inhibits cholesterol GI absorption
Effect: Decrease LDL-C (18%)
Side effects: abdominal pain, diarrhea, rash, fatigue, muscle weakness/pain
Contraindications: liver disease/failure
PCSK9 inhibitors use, names, mechanisms and predicted effects and side effects
Hyperlipidemia medication
Proprotein convertase subtilisin/kexin type 9
Medication for hyperlipidemia and add-on to statins in low-risk individuals
End in -ocumab
Mechanism: Inhibits PCSK9 enzyme which promotes LDL-R degradation, thus preventing LDL-R catabolism = more LDL recycling
Recommended for familial hypercholesterolemia, ASCVD, and high LDL-C despite max statin
Effect: decreased LDL 50-60%
Side effects: myalgia (muscle aches, don’t supplement to resolve) and myopathy, increased liver enzymes and low risk diabetes, bruising around injection site and diarrhea
Contraindicated for grapefruit juice (esp Simvastatin)
Icosapent ethyl use, names, mechanisms and predicted effects and side effects
Hypertriglyceridemia
Ethyl ester of EPA (omega-3) 4g BID
For very high triglycerides in moderate risk patients
Mechanism:
1) Decrease VLDL-TG secretion/synthesis
2) Increase VLDL-TG clearance by increased LPL activity
Effect: Reduced CVD events in statin-treated patients with CVD or diabetes or CVD risk factor
Side effects: muscle/joint pain, edema, constipation, bleeding if on anticoagulants
Nicotinic acid use and recommendation, mechanism, effect, side effect and contraindications
Hypertriglyceridemia medication, NOT recommended as statin add-on
Nicotinic acid
Mechanism: decrease VLDL synthesis and increase LPL activity
Effect: decrease TG 20-50% and LDL 5-25%, increase HDL
Side effects: low % who tolerate, GI distress, flushing (nicotinic acid), itching, hepatotoxicity and arrhythmias
Contraindications: active peptic ulcer, hepatic disease or gout, hyperuricemia
Prednisone nutritional considerations and concerns of long term use
Nutritional recommendations
Anti-inflammatory drug
Ex. used in emphysema patient
Steroid induced hyperglycemia/diabetes
Weight gain, increased appetite
Puffiness, swelling, edema, water retention and hypertension
Hyperlipidemia
Long term: muscle wasting, negative nitrogen balance, ↓ bone mineral density/fractures and Ca wasting
Nutritional recommendations:
- low salt, high Ca/Vit D, high protein, diabetic diet and heart healthy diet
