Unit 2 Flashcards
Selective activation of alpha 2 receptors in the CNS, reducing sympathetic outflow to blood vessels and the heart
Centrally acting alpha 2 agonist
Should be used when additional LDL reduction is needed
Bile acid sequestrants
Increases enzyme lipoprotein lipase, which breaks down cholesterol. Used for patients with hypertriglyceridemia severe enough to increase the risk of pancreatitis.
Fibric acid derivatives (gemfibrozil, fenofibrate, clofibrate)
Inhibits conversion of angiotensin I to angiotensin II and increases levels of bradykinin in the lungs
ACEi
Used in pulmonary edema, edema from HF, hepatic origin, or renal origin, uncontrolled HTN
Loops
Used in HTN, edema, can be used to augment diuresis with loop or thiazide
Potassium sparing diuretics
Contraindications:
use with caution when taking other agents that can raise potassium levels
Potassium sparing diuretics
Carries cholesterol from peripheral tissues back to the liver to promote cholesterol removal
HDL
Contraindications:
bilateral renal artery stenosis, pregnancy category D, use of lithium, taking diuretics or NSAIDS
ACEi
Example of dihydropyridine CCB
Amlodipine, nifedipine, felodipine, nicardipine
Blocks angiotensin II receptors in blood vessels, causing vasodilation and decrease in aldosterone release
ARB
Pregnancy category X
Statins
SEs:
bradycardia, decrease in CO, HF, drowsiness, sedative effects, dry mouth, rebound HTN
Centrally acting alpha 2 agonist
Used in HTN and BPH
Alpha 1 blockers
Acts on smooth muscle and the heart, causing vasodilation and increasing coronary artery perfusion, reduction of SA and AV node conduction, and blockade in myocardium (causing decrease in contractility)
CCB- nondihydropyridine
Example of centrally acting alpha 2 agonist
Clonidine, methyldopa
SEs:
angioedema
fetal injury
renal failure
ARB
SEs:
hyponatremia, hypochloremia, dehydration, hypotension, hypokalemia, ototoxicity, hyperuricemia, decrease in cholesterol, decrease in magnesium and calcium
Loops
Used in hypertension only
Direct renin inhibitor
SEs:
orthostatic hypotension, reflex tachycardia, nasal congestion
Alpha 1 blockers
Give ASA 30 min before administering this drug (and why)
Niacin- for flushing and peripheral vasodilation
SEs: hyponatremia hypochloremia dehydration hypercalcemia hyperglycemia hyperuricemia increase in cholesterol decrease in magnesium
Thiazides
Can mask s/s of hypoglycemia, use with caution in patients with DM
BBs
Digoxin toxicity symptoms
Confusion n/v/d dysrhythmias loss of appetite tachycardia
What does low potassium do to digoxin?
Increases binding of digoxin to NA, K ATPase, which leads to more accumulation of calcium and can lead to toxicity
Acts on vascular smooth muscle, causing vasodilation of peripheral arteries and arterioles and reducing blood pressure
CCB- dihydropyridine
Fibrates and niacin do what?
Decrease TG and increase HDL
Blocks action of aldosterone in distal tubule of nephron, causing increased excretion of sodium and water and retention of potassium
Aldosterone antagonist
Does not work if GFR < 40
Thiazides
Blocks absorption of dietary cholesterol in the small intestine and biliary cholesterol without working on bile acids
Ezetimibe (Zetia)
Example of alpha 1 blocker
Doxazosin, prazosin, terazosin
Blunt diuretic effects and reduce efficacy of ACEi
NSAIDs
SEs:
hyperkalemia, nausea, vomiting, leg cramps, dizziness, blood dyscrasia
Potassium sparing diuretics
Used in HTN, HF, diabetic nephropathy, MI, prevention of MI, CVA and death in high CV risk patients
ARB
Can be used in HTN in pregnancy
Methyldopa, BBs, hydralazine
Monitor levels of potassium when taking this drug- when levels are low, binding to NA, K ATPase increases, resulting in toxicity
Digoxin
Used for essential HTN, HF, AMI, LV dysfunction, diabetic or non diabetic nephropathy, prevention of CVA, MI, and death in high CV risk patients
ACEi
Potassium and digoxin do what when present together?
Compete with each other for binding to NA, K ATPase
Can cause hyperglycemia
Niacin, thiazides, loop diuretics
Example of potassium sparing diuretics
Amiloride, triamterene
Used as first-line in HF, don’t give to Black people
BBs
Contraindications:
pregnancy, gout, lithium use, digoxin use (lowers potassium)
Loops
Contraindications:
HF, SSS, heart block, digoxin (can increase heart block further), grapefruit juice
CCB- nondihydropyridine
Used for essential HTN, edema from HF, diabetes insipitus, and protection against postmenopausal osteoporosis
Thiazide diuretics
Inhibits metabolism of most statins, which increases risk of myopathy and rhabdo
Fibric acid derivatives (EXCEPT FENOFIBRATE)
Selective dilation of arterioles, causing decrease in peripheral vascular resistance and arterial BP- mostly likely through inhibiting movement of calcium in vascular smooth muscle- not first- line therapy for HTN
Hydralazine
Increases HDL levels better than any other drug and is also used in treating high triglyceride levels
Niacin
Contraindicated in renal insufficiency, angina, lactation, patients undergoing cataract surgery
Alpha 1 blockers
Before starting a statin, check a baseline _______.
ALT level
Mean arterial pressure equation
Cardiac output x peripheral resistance
Used in angina pectoris, essential HTN
CCB- dihydropyridine
Major cholesterol carrier, role is delivery of cholesterol to non-hepatic tissues
LDL
Contraindicated in pregnancy only
Direct renin inhibitor
Contraindications:
- reflex tachycardia can cause angina
- if high doses, can lose selectivity and act on heart
CCB- dihydropyridine
Can reduce efficacy and intensify diuretics and ACE inhibitors, can also promote sodium retention and peripheral vasoconstriction
NSAIDs
X category in pregnancy
Statins
Blockade of alpha 1 adrenergic receptors, causing dilation of arterioles and veins and relaxation of smooth muscle in bladder neck and prostatic capsule
Alpha 1 blocker
SEs: first-dose hypotension persistent, dry cough hyperkalemia renal failure fetal injury angioedema neutropenia
Acei
Accounts for nearly all of the TGs in the blood- role is to deliver TGs from the liver to adipose tissue and muscle
VLDL
Don’t use in DM
BB and thiazides, niacin
Contraindications: use with caution in patients taking agents that raise potassium levels
Aldosterone antagonists
Can cause hypercalcemia
Thiazide diuretics
Bind to bile acids in small intestine and are excreted in feces, body compensates for reduction of bile acids by converting cholesterol to bile salts and decreasing cholesterol- only effects LDL
Bile acid sequestrants
SEs:
diarrhea, fetal injury/death, angioedema, hyperkalemia
Direct renin inhibitor
Contraindications:
bilateral renal artery stenosis
pregnancy
ARB
Blocks alpha and beta 1 receptors to decrease HR, contractility and vasoconstriction
Beta blockers
Example of nondihydropyridine CCB
Verapamil and diltiazem
Used in angina pectoris, HTN, cardiac dysrhythmias
CCB- nondihydropyridine
SEs:
hyperkalemia, endocrine effects
Aldosterone antagonists
What class are these? gemfibrozil, fenofibrate
Fibric acid derivatives
SEs:
flushing, dizziness, headache, peripheral edema, gingival hyperplasia, eczematous rash, reflex tachycardia with IR, can lose selectivity if used in high doses
CCB- dihydropyridine
Muscle pain, tea-colored urine (myoglobin), increased CK levels
Rhabdomyolysis
Used in HTN, severe pain, ADHD
Centrally acting alpha 2 agonist
SEs:
reflex tachycardia, increased blood volume from sodium/water retention leading to edema, SLE-like syndrome (muscle pain, joint pain, fever, nephritis, pericarditis)
Hydralazine
Acomponent of all cell membranes and required for synthesis of certain hormones and bile salts- synthesis is catalyzed by an enzyme 3-hydroxyl-2-methyglutaryl coenzyme (HMG-CoA reductase)
Cholesterol
What class are these? cholestyramine, colestipol, colesevelam
Bile acid sequestrants
Binds with renin and inhibits cleavage of angiotensinigen to angiotensin I
Direct renin inhibitor
Blocks sodium and chloride reabsorption in the early segment of the distal convoluted tubule, causing water to be retained and increasing urinary flow
Thiazide diuretics
Inhibits ion transport of sodium and potassium directly, causing decrease in reduction and reabsorption in potassium secretion
Potassium sparing diuretics
Acts on thick segment of ascending loop of Henle to block absorption of sodium and chloride
Loop diuretics
Used in HTN, edema, heart failure, premenstrual syndrome, PCOS, acne in young women
Aldosterone antagonist
Inhibits NA, K ATPase enzyme, which promotes calcium accumulation within myocytes and facilitates interaction of myocardial contractile proteins (actin and myosin), leading to increase in contracility
Digoxin