TEST: Prescr Meds (Cardiac, Hypertension, Anticoagulant & Hyperlipidemia) Flashcards
Simvastatin (zocor): Type
Statins: (lipitor, zocor, mevacor)
(avoid grapefruit) HMG-CoA Reductase inhibitors- atorvastatin, lovastatin, simvastatin
Simvastatin (zocor): use of statins
Lower cholesterol synthesis by inhibiting hydroxymethylglutaryl CoA reductase
- Lower total and LDL cholesterol
- Lower VLDL while slightly increasing HDL
- Stabilize plaque
- Slow progression of coronary artery disease
Digitalis (digoxin): class & names
digitalis glycosides.
- Digitoxin (crystodigin)
- Digoxin (lanoxicaps, lanoxin)
Digitalis (digoxin): use
- inotropic agent
- Management of congestive heart failure (CHF)
- Antiarrhythmic
- Slows ventricular rate in tachyarrythmias such as atrial fibrillation or flutter
- Used to terminate paroxymal atrial tachycardia
Digitalis (digoxin): implications
•Monitor serum potassium, sodium, calcium, & magnesium levels - avoid hypers or hypos as they may effect heart rhythm
•Hypercalcemia, hypomagnesemia or hypokalemia can percipitate a toxic reaction with anorexia, n&v, cramps, paresthesia, arrhythmias, and confusion
Digitalis (digoxin): increase excretion of
calcium, magnesium, and zinc
Digitalis (digoxin): avoid
calcium supplements or antacids
Digitalis (digoxin): Hypokalemia
•Hypokalemia increases the risk of digitalis toxicity - anorexia, nausea, vomiting, cramps, paresthesia, arrhythmias,and confusion
Digitalis glycosides: potassium
These herbs may cause potassium loss - aloe latex, drug aloe, buckthorn bark and berry, cascara sagrada bark, senna leaf. Report rapid weight gain or edema to physician
•Ensure adequate potassium intake using foods, salt substitutes, or potassium supp
Digitalis glycosides: licorice
•Avoid consuming real licorice as hypokalemia, salt and water retention, hypertension, CHF, and paresthesia may occur. Real licorice contains glycyrrhizic acid which has mineralocorticoid effects.
also avoid use w/ACE inhibitors.
Digitalis glycosides: herbs
- Milkweed, foxglove, and hawthorne leaf with flower may have digoxin like substances and increase risk of digoxin toxicity
- St john’s wort and guar gum (may slow digoxin absorption) use may decrease blood levels of digoxin
herbs that increase digoxin toxicity
Milkweed, foxglove, and hawthorne leaf w/ flower have digoxin like substances and increase risk of digoxin toxicity
herbs that decrease digoxin level
St john’s wort and guar gum (may slow digoxin absorption) and decrease blood levels of digoxin
ACE Inhibitor: meds
Benazepril (lotensin),
Ramipril (altace)
ACE Inhibitor: use
Management of hypertension.
Management of congestive/chronic heart failure.
Improve post myocardial infarction survival.
Inhibit angiotensin converting enzyme (ACE) so less angiotensin II is produced lessening vasoconstriction and production of aldosterone.
ACE Inhibitor: implications
•Monitor serum potassium and avoid high potassium intake, potassium supplements, and salt substitutes as the med decreases potassium excretion and hyperkalemia may occur.
ACE Inhibitor: avoid
natural licorice, pomegranate juice as hypotension may occur
ACE Inhibitor: chronic use
of captopril may cause zinc depletion
ACE Inhibitors: Iron supp
- 1/3 of people taking ACE inhibitors develop dry cough due to increased nitric acid causing lung inflammation, iron supp helps decrease coughing
- Some evidence that iron (high serum ferritin) is linked to CVD so better to cough unless iron deficiency is confirmed. Avoid iron supplements in people with hemochromatosis or iron overload.
Warfarin (coumadin): type & use
warfarin
- Anticoagulant
- Interferes with hepatic synthesis of vitamin K dependent clotting factors- ii, vii, ix, x
Warfarin (coumadin): vit E & C interactions
- Vitamin E supp were reported to increase the anticoagulant effect of warfarin but the a placebo controlled trial found no effect.
- Vitamin C may decrease the anticoagulant effect
Warfarin (coumadin): vit K interactions
•pt should keep steady vitamin K intake.
•large intake of vit K from foods or supp may decrease the anticoagulant’s effect.
•Abrupt decrease in vitamin K intake may increase the anticoagulant effect and result in bleeding.
Warfarin: Vit K foods
asparagus, beans, broccoli, brussels sprouts, cabbage, cauliflower, collards, mustard greens, spinach, cheese, milk, yogurt, fish, pork
Warfarin (coumadin): risk of bleeding
- Hypoalbuminemia may cause an increase in the amount of warfarin in its free fraction in the blood which may increase the effects of the drug and increase risk of bleeding
- Acute alcohol intake
- Abrupt decrease in vitamin K
Wafarin: herbs
- These herbs may have anticoagulant effects: Dong quai, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng, dan shen, devil’s claw, horse chestnut, red clover, others??
- St John’s wort may cause a decrease in plasma warfarin levels.
- Coenzyme Q 10 may interact adversely with warfarin and interfere with its activity
Wafarin: do not
•Do not take iron, magnesium, or zinc within 2 hrs of warfarin as absorption may be decreased.
wafarin + acute alcohol intake
may increase risk of bleeding or hemorrhage
wafarin + chronic heavy alcohol usage
may decrease the anticoagulant
Metoprolol (Lopressor): type
Beta blocker
Beta blockers: use
- Antihypertensive
- Anti-angina
- Antiarrhythmic
- Prevent migraine headaches
- Treat tremors
beta blockers: K
May cause hyperkalemia, do not take K supps, salt substitutes, or a high K diet unless serum potassium is confirmed to be low and MD advises increasing intake.
Beta blockers: implications
May cause hyperlipidemia and hyperglycemia or mask signs of hypoglycemia
Beta blockers: herbs
•Pleurisy root should be avoided
•avoid Natural licorice (glycyrrhizic acid can elevate blood pressure).
meds to avoid licorice
digitalis glycosides
ACE inhibitors
beta blockers
glucocorticoids {antibiotic}
Furosemide (lasix): type
Potassium wasting diuretic {Loop diuretics}
Lasix: potassium
Potassium supp may be needed in some pts, but for some pts w/ chronic kidney disease (CKD) the loss of K may be a benefit since they normally can’t excrete it well.
Furosemide (lasix): use
diuretic medication to control edema, fluid overload, and hypertension
Lasix: electrolytes
Lasix acts on sodium receptor sites in loop of henle kidney tubules and decreases their ability to reabsorb sodium. Sodium, chloride, calcium, potassium, magnesium, and water excretion are enhanced.
Lasix: thiamin
In patients w/ CHF, lasix has been reported to increase thiamin excretion and depletion which may worsen heart function. recommend thiamin supp.
Potassium wasting {thiazide and thiazide-like diuretics}: names
•Chlorothiazide (diuril)
•Chlorthalidone (hygroton)
•Hydrochlorothiazide (esidrex, HCTZ, hydrodiuril)
most end in -thiazide.
Chlorothiazide (diuril): type
Potassium wasting diuretic {thiazide and thiazide-like diuretics}
Chlorthalidone (hygroton): type
Potassium wasting diuretic {thiazide and thiazide-like diuretics}
Potassium wasting diuretics: use
- Diuretic
- Antihypertensive
- Management of edema secondary to congestive heart failure
- Management of hypercalcemia due to cancer
Potassium wasting diuretics: implications
•Excretion of water, sodium, chloride, potassium, magnesium so monitor serum electrolytes.
•Keep a steady intake of sodium, electrolytes, and water.
•be cautious about hyponatremia and dehydration in heat or exercise with sweating.
Potassium wasting diuretics: hypokalemia
•Hypokalemia is possible and some patients will need to increase dietary potassium intake or take a potassium supplement.
•Hypokalemia is less likely in patients who have renal failure or are also taking potassium sparing diuretics or ACE inhibitors.
•Hypokalemia increases the risk of digitalis toxicity- anorexia, nausea, vomiting, cramps, paresthesia, arrhythmias,and confusion.
Potassium wasting diuretic + other drugs
Concurrent use of glucocorticoids, amphotericin B, mezlocillin, piperacillin, or ticarcillin increases risk of hypokalemia
loop vs. thiazide diuretics
Hypokalemia risk is greater with loop diuretics than thiazides.
Potassium wasting diuretics: herbs
- Ginkgo biloba may increase BP in those taking thiazides
- Water loss may be increased by fenugreek
- uva ursi dandelion, juniper dandelion, buchu dandelion, cleavers dandelion, cleavers, horsetail, and gravel root have diuretic effects
Potassium wasting diuretics: avoid
natural licorice
Triamterene (dyrenium): type & use
Potassium sparing diuretic
Spironolactone (aldactone): type & use
Potassium sparing diuretic.
Spironolactone (aldactone) is used to treat hyperaldosteronism.
Potassium sparing diuretic Triamterene (dyrenium): implication
•Triamterene (dyrenium) use has been associated with folate deficiency in rare cases.
Potassium sparing diuretics: herb
Yohimbe conteracts effect of Spironolactone (aldactone) and Amiloride (midamor).
Potassium sparing diuretics: implications
•Unless meds are being used to treat severe refractory hypokalemia, avoid a high potassium intake, salt substitutes, and potassium supps.
•Hyperkalemia risk is increased in patients with/on diabetes, renal failure, elderly and/or ACE inhibitors.
