Cardiovascular Pharmacology Flashcards
heart failure (ACE-I): contraindications
renal artery stenosis
hx of angioedema (hypersensitivity)
pregnancy
heart failure (ACE-I): side effects
C: cough A: angioedema P: potassium (inc.) T: taste disturbance O: orthostatic hypotension P: pregnancy R: renal failure (avoid in renal artery stenosis) IL: idiosyncratic leukopenia
Note: captopril is an old ACE-I (must be dosed 3 / day so do not use much)
Do not use with ARB
heart failure - why use an ARB over an ACE-I?
use as an alternative to an ACE-I in patients who have side effects from ACE-I
- NO cough
- possibly no angioedema (?)
NOTE: do not use ACE-I and ARB together
heart failure (beta-blockers): adverse effects
worsening HF and fluid retention
fatigue
bradycardia and heart block
hypotention
heart failure (beta-blockers): precautions
asthma
diabetes (can mask hypoglycemia)
peripheral vascular dz
heart failure (aldosterone antagonists): side effects
two drugs:
- spironolactone
- epleronone
hyperkalemia
gynecomastia
- rare with epleronone
heart failure (digoxin): adverse effects
cardiac: dysrhythmias, complete heart block
GI: anorexia, N/V
CNS: HA, fatigue, confusion
digitalis toxicity:
- sinus bradycardia
- AV block
- drowsiness/fatigue
- N/V
- visual hallucinations (halos, diplopia)
heart failure (digoxin): therapeutic serum level
0.5-2 ng/mL
heart failure (loop diuretics): adverse effects
- ototoxicity
- hyperuricemia (caution in gout)
- acute hypovolemia
- K depletion
- hypo-Mg
- hyperglycemia
heart failure (thiazide diuretics): adverse effects
- hyperuricemia (caution in gout)
- acute hypovolemia
- K depletion
- hyperglycemia
- hyperlipidemia
- hyper calcemia: actually cause pt to hold onto Ca++
loop vs. thiazide diuretic - different effects on calcium
loop: causes excretion of Ca++ (hypo-calcemia)
Thiazide: causes retention of Ca++ (hyper-calcemia)
- actually used in tx of osteoporosis
statins - what used, when to administer, how long to see effects
used to decrease cardiovascular risk in patients with high LDL
administer in evening (when HMG-CoA reductase is most active)
max lipid effect: 2-4 weeks
statins: adverse effects
typically well-tolerated
- rhabdomyolysis (track CK)
- proteinuria
- dose-dependent elevations in hepatic transaminases
- death
fabric acid derivatives (Gemfibrozil, fenofibrate) - when used
used to lower TG levels and raise HDL
atrial fibrillation - what is at an increased risk and how to treat
STROKE
- must anti-coagulate!
Warfarin (Coumadin):
- reversible with vit K
- must monitor INR
DOACs / NOAC (“xaban”):
- no reversing agent
- no need to monitor
- bad if non-compliance
