Quiz-AntiHTN and hyperlipidemia Flashcards
hydrochlorothiazide
Thiazide. Works on distal tubule. Increase Na and H20 excretion. First line drug for HTN.
Loop diuretics
inhibit reabsorption of Na and chloride in ascending loop.
Furosemide
Loop diuretics. Stops reabsorption of Na and Cli in ascending loop of henle
Eplerenone
K sparing diuretics. Stops aldosterone action in collecting duct. Helps pt. survive CHF. Doesn’t cause gyneomastia so preferred.
Beta 1 blockers
First line drug therapy for HTN with concomitant disease (MI) Beta 1 blockers mainly affect the heart.
Metaprolol
Beta 1 blocker. Used for HTN with concomitant dz (MI).
Beta 1 blockers SE
Decreased BP, Fatigue, sexual disfunction, bradycardia, insomnia.
ACE inhibitor
Used when diuretics or beta blockers are contradictor of ineffective (HF, renal dz). They decrease angiotenonsin II and increase bradykinin levels (cause persistent cough).
Drug names pril
Ace inhibitor SE
Dry cough, hyperkalemia, hypotension, skin rash, fever.
Angiotensin II-Receptor blocker
Alternative to AceI. Produse arteriorlar and venous dilation and block aldosterone secretion. Do not increase bradykinin levels so have reduced drug cough and angioedema.
Angiotensin II-receptor blocker drugs
All end in sartan!
Renin inhibitor
Acts earlier in the renin-angiotensin-aldosterone system. Used with other antihypertensives. A fixed dose combination with valsartan (Angiotensin II receptor blocker) or HCTZ (thiazide)
Aliskiren
Renin inhibitor. used with Valsartan or HCTZ.
Calcium channel blockers
Good for elderly and african americans. Have dipine suffix!!
Verpamil
CCB. Treats angina, tachyarrhythmias, and to prevent migraine and cluster HA
Nifedipine
CCB. First generation. Treats cardiovascular disease
CCB SE
Flushing, dizziness, fatigue, constipation, HA, hypotension
Alpha 1 blockers
Blocking alpha 1 relaxes the vessels. However alpha 1 tends to be used more often in the treatment of benign prosthetic hypertension. End in suffix odin. Can have first dose hypotension (rapidly decrease BP so the pt faints. Takes only at night) i.e. doxazosin and prazosin.
Alpha 2 agonist
Diminishes the central adrenergic outflow. Serves as a negative feedback mech. to slow down the heart and decrease BP. i.e. clonidine
Labetalol
Block alpha 1, beta1 and beta 2 blocker. Given as an IV in a hypertensive 911.
Minoxidil
Vasodilation. Often used with a BB and diuretic to treat severe malignant hypertension. Can use with ESRD.
Sodium nitroprusside
Used for a HTN emergency. Given as an IV.
Nitrates
Reduce peripheral resistance and pressure by dilation of vessels
What drugs should you use on young, white pt?
Start with an Acei or Beta blocker (AB)
What drugs should you use on older and black pt?
Start with an Calcium-channel blocker or diuretics (CD)
Which causes fetotoxicity
ACEi, ARBs, and aliskiren
Long term complications of HTN?
Cerebrovascular accidents, congestive HF, myocardial infarction, and renal damage.
Coronary Heart disease
Cause of death in about half of all deaths in the US. Correlated with high levels of ldl and low levels of hdl. Other risk factors are smoking, hypertensives, obesity, and diabetes. Can also be due to genetics.
Cholesterol
Found in cell membranes, vitamin D, and hormones
Triglyceride
Used to store FA.
Lipoproteins
Phospholipida and proteins that carry triacyglycerides and cholesterol in the body.
Chylomicrons
A type of lipoprotein. Carry cholesterol and triaacylglcerides (lipids) absorbed in intestines. Can be turned into different densities.
VLDL
Has smaller protein content. Transported to tissue and delivers triacyglycerides and becomes iDL and then LDL
LDL
Has small protein content. BAD
HDL
Has a high amount of protein. Can remove remnant lipoproteins and deliver them back to the liver to be re-used. This is the good cholesterol.
Step 1: Serum triglycerides
Normal 500
Step 2 of treatment
Figure out what patient risk is for CHD, carotid a. disease, peripheral arterial disease, or abdominal aortic aneurysm based on their numbers
Step 3
Look at major risk fators. smoking, hypertension, family history of CHD, age (greater then 45 men and 55 for women)
Type I inherited lipodemia.
Famililal hyperchylomicronemia. Have high chlyomicrons in blood even with normal dietary fast intake resulting in elevated TG levels. Deficiency of lipoprotein lipase or normal apolioprotein CII (rare). Not associated with increased risk of CHD. Low fat diet. no drug therapy will work.
Type IIA
Familial hypercholesterolemia. Increased LDL with normal VLDL levels due to block in LDL degradation. Have an increased cholesterol levels but normal TG levels. Caused by defect in the synthesis or processing of LDL receptors. Ischemic heart dz is accelerated.
Type IV
Familial Hypertriglyceridemia. VLDL levels are increased, where LDL levels are normal or decreased resulting in normal to elevated cholesterol, and greatly elevated TG levels. Cause is overproduction and or decreased removal of VLDL in serum. This is a relatively common dz. Has accelerated ischemic HD. Frequently patients are obese, diabetic, and hyperuricemic.
Treatment goals
Reduce ldl levels. CHD is positively associated with high cholesterol and with elevated LDL cholesterol in the blood.
Treatment options for hypercholosterolemia
Diet, exercise, weight reduction, drug therapy if ldl levels high then 60
Clinical signs of high cholesterol in the eye
Xanthalasthma-fat deposits in the lid
arcus-gray deposits along the limbal area.
HMG CoA reductase inhibitors
Inhibits the first committed step of cholesterol synthesis. Improves coronary endothelial function. Inhibits platelet thrombi formation and are anti-inflam. The statins!
Lovastatin
Statin. HMG CoA reductase inhibitor. PRODRUG!
Simvastatin
Statin. HMG CoA reductase inhibitor. PRODRUG!
Atorvastatin
Statin. HMG CoA reductase inhibitor. Very strong.
When to use statins?
All types of hyperlipidemias. Often give in combo with with other anti-hyperlipidemic drugs. Use with diet, exercise, and additional agents.
Statin SE
Liver failure, myopathy (muscle pain happens in 50-20) Severe cases can cause lysis of the liver). Cannot use in pregnancy.
Niacin
Nicotinic acid. Vitamin B3 taken at a much high dose. Is most effective agent for increasing HDL. Reduces ldl levels by 10-20%. Lowers the level of plasma fibrinogen. Use in combo with other agents. Causes cutaneous flush and pruritus. Take aspirin prior to taken to relieve SE. Taken once daily at bedtime. Inhibit secretion of uric acid so may exacerbate gout.
Fenofibrate
Fibrate. Peroxisome proliferator activated receptors (PPAR) that increases lipoprotein lipase. Lower serum triacylglycerols and increase HDL levels. Treat hypertriacyglycerolemias. SE: a predisposition to the formation of gallstone and myositis.
Gemfibrozil
Fibrate. Peroxisome proliferator receptors (PPAR) that increase lipoprotein lipase. Lower serum triacylglcerols and increase HDL levels. Treat hypertriacylglycerolemias.
Bile acid-binding resins
Bile acid is important in allowing the body to absorb the fatty food we eat. Bile acid is made in gall bladder and synthesized in the liver.. The drug will interfere with the recycling of bile acid and will increase the ant being secreted out of the body. Stops FA from being absorbed. This class of drugs is not absorbed by the body. It works in the intestine and then leaves.
Bile acid being resins SE
Constipation, nausea, and flatulence. Impair absorption of fas soluble vitamins (ADKE). Take 1-2 hours before or 4-6 hours after meds to avoid drug interference.
Cholestryamine
Bile acid binding resins
Cholestrol absorption inhibitor
Inhibits absorption of dietary and biliary chorister. Lower LDL and TAG and increases HDL. If you get less chol from your diet then your liver will make more HDL. May not be as effective as sequestering we just talked about.
Ezetimibe
Cholesterol absorption inhibitor
Simcor
Combination of simvastatin and niacin. Must may close attention to muscle problems.
What would you use to treat high cholesterol
A statin
What would you use to treat low hdl
Niacin
What would you use to treat high ldl
Fibrate.
Important apopolipids
B-100: binds ldl CII: lipoprotein lipase E=uptake
Desired chol levels
LDL: < 200TG <150
Doxazosin
Used for HTN. Blocking alpha 1 relaxes the vessels. However alpha 1 tends to be used more often in the treatment of benign prosthetic hypertension. End in suffix odin. Can have first dose hypotension (rapidly decrease BP so the pt faints. Takes only at night) i.e. doxazosin and prazosin.
Prazosin
Used for HTN. Blocking alpha 1 relaxes the vessels. However alpha 1 tends to be used more often in the treatment of benign prosthetic hypertension. End in suffix odin. Can have first dose hypotension (rapidly decrease BP so the pt faints. Takes only at night) i.e. doxazosin and prazosin.
