2 Flashcards
(50 cards)
Best for ↑HDL + ↓Triglycerides
NIACIN (Vitamin B3)
Mechanism:
• ↓Fat breakdown → ↓Free fatty acids →↓VLDL (LDL precursor).
NIACIN (Vitamin B3)
Side Effects:
• Flushing (take aspirin 30min before to reduce).
• Itching, nausea, hepatotoxicity (high doses).
Use:
• Combined with statins if HDL low.
NIACIN (Vitamin B3)
1st-line for High Triglycerides
Mechanism: Activate PPAR-α → ↑Lipoprotein lipase → ↓Triglycerides.
Side Effects:
• GI upset, gallstones, myopathy (avoid with statins).
Avoid in: Liver/kidney disease.
FIBRATES (Gemfibrozil, Fenofibrate)
Mechanism: Bind bile acids in gut → Liver uses cholesterol to make more bile → ↓LDL.
Drugs: Cholestyramine, Colesevelam.
Uses:
• Mild LDL reduction (add-on to statins).
• _______ also lowers glucose (Type 2 Diabetes).
Side Effects:
• GI issues (bloating, constipation).
• ↓Absorption of fat-soluble vitamins (A,D,E,K) + other drugs (warfarin, levothyroxine).
BILE ACID SEQUESTRANTS (Resins);
• Colesevelam also lowers glucose (Type 2 Diabetes).
Mechanism: Blocks NPC1L1 in gut → ↓Cholesterol absorption.
Use:
• Add-on to statins (or if statin-intolerant).
• Mild LDL reduction alone.
Side Effects: Rare (diarrhea, fatigue).
EZETIMIBE (Cholesterol Absorption Inhibitor)
Definition:
Heart can’t pump enough blood → fluid buildup & fatigue.
HEART FAILURE (HF)
Cardinal Symptoms:
• Dyspnea (shortness of breath)
• Fatigue
• Fluid retention (edema, lung congestion)
Problem:
Left ventricle weak/stiff
Key Feature:
Blood backs up into lungs → pulmonary edema (dyspnea
Left-Sided HF
Problem: Right ventricle fails
Key Feature: Blood backs up into veins → leg swelling, liver congestion
Right-Sided HF
Problem: Heart can’t contract well
Key Feature: Low ejection fraction (EF < 40%)
Systolic HF (HFrEF)
Problem: Heart can’t relax/fill properly
Key Feature: Normal EF (≥50%) but stiff walls
Diastolic HF (HFpEF)
Compensatory Mechanisms (Short-Term Help, Long-Term Harm):
Faster HR, vasoconstriction.
↑Sympathetic Activity
Compensatory Mechanisms (Short-Term Help, Long-Term Harm):
→ Salt/water retention → ↑Blood volume.
RAAS Activation → Angiotensin II & Aldosterone
Compensatory Mechanisms (Short-Term Help, Long-Term Harm):
Thick/stiff walls → Worsens pumping
Heart Enlargement (Hypertrophy)
Drug Therapy Goals
Improve heart contraction (↑CO)
Reduce heart workload (↓Preload & Afterload)
Reduce Heart Strain
UNLOADERS
1st-line for HFrEF
MOA: Block Angiotensin II → ↓Vasoconstriction, ↓Aldosterone → ↓Afterload & ↓Fluid.
ACE Inhibitors (ACEIs) / ARBs
Lisinopril, Enalapril
ACEIs
Losartan, Valsartan (if ACEI cough)
ARBs
Side Effects:
• Dry cough (ACEIs), Hyperkalemia, Angioedema (rare).
ACE Inhibitors (ACEIs) / ARBs
Spironolactone, Eplerenone
Aldosterone Antagonists
MOA: Block aldosterone → ↓Fibrosis, ↓K⁺ loss.
Use: Advanced HF (NYHA III-IV) + HFrEF.
Side Effects: Hyperkalemia, Gynecomastia
Aldosterone Antagonists
Gynecomastia Treatment
Spironolactone
