Cardiac HTN hyperlipidemia Flashcards Preview

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Flashcards in Cardiac HTN hyperlipidemia Deck (17):
1

DIURETICS

Thiazide

Loop

Potassium sparing

ADR's

hctz, chlorathalidone, indapamide, metolozone

furosemide, torsemide, bumetanide

trimaterene, spironolactone, amiloride, inspra

hypotension, decreased GFR, hypo/hyperkalemia, electrolyte abnormalities, metabolic alkalosis, hyponatremia

2

DIURETICS

Inspra




Thiazide- caution with

Loop potential for cross sensitivity with


new, potassium sparing, many interactions (NSAIDS, grapefruit juice, azoles, CCB's
ACEI ARB BB K+ replacement (SO MANY CARDIC MEDS)

hyperlipidemia, high dose increase hypokalemia, uric acid levels, CV outcomes

sulfa

3

ACEI

how they work?

Lowers? without lowering?

Strong evidence for:



What do these end in?

Caution with?

SE

inhibit ACE decrease angiotensin and aldosterone

lower PVR without CO or GFR

decrease risk CV cerebro-vascular risk HF slows renal disease, decrease remodeling after MI, reduce affect of diabetes on kidneys, improve insulin sensitivity

PRIL

AA asians- angioedema

cough, angioedema

4

ARB

end with?

Combined with?'

How many times a day?


artan (losartan, valsartan)

hctz

once a day

5

CCB

Examples: Type I type II

Metabolized by

Caution with

ADR

Patient education


I- diltiazem, verapamil
II- dipine or pidine endings (nifedipine/procardia, **amlodipine/norvasc, felodipine)

Liver

LIVER PATIENTS (pregnancy C)

constipation, dizziness, gingival hyperplasia

no NSAIDS, alcohol
GERD sx increase (decreased SM)

6

Alpha 2 agonist

example
how it works

clonidine

vasodilator centrally

7

Alpha blockers

Action

Treat

Examples- most end with??

block alpha receptors- vasodilatoin

HTN BPH raynauds migraine

OSIN- prazosin, terazosin (HTN)
alfuzosin, silodosin, tamulosin (BPH)
doxazosin (HTN, BPH)

8

Beta blockers

action

block effects catecholamines

selective non selective

mainly HTN post MI

9

Pregnancy
drugs of choice
avoid?

methyldopa, beta blockers, vasodilators

acei, arb

10

HYPERLIPIDEMIA

Groups

CAD
Familial LDL>190
LDL 70-189 (no CAD, have diabetes)
LDL 70-189 (no CAD or diabetes, but 10 year risk)

11

HMG CoA reductase inhibitors

Fibrates

Bile acid sequestrants

Other

statins

MOST HAVE FIBR in the name- gemifibrozil, micronized fenofibrate, bezafibrate

MOST HAVE COL or CHOL- cholestyramine, colestipol, colesevelam

Niacin, zetia

12

HMG CoA reductase inhibitors (STATINS)

block synthesis?
decrease
Pregnancy?

Why two are okay in with interactions like azoles?

Interactions?

ADRS?

Contraindicated in?

Children?

cholesterol

LDL

category X

fluvastatin, rosuvastatin

SO MANY- cardiac (verapimil, diltiazem-ccb) azole, erythromycin, fluoxetine, protease inhibitors, rifampin, phenytoin, phenobarbital, cyclosporin

Myalgia, fatigue, muscle soreness- stop therapy

Active liver disease

Pravastatin only FDA

13

Intensity of statin therapy

High decrease ldl >50
Mod decrease ldl 30-50
Low (usually not on) decrease <30

14

Fibrates

effective at lowering?

Good for which patients?

Do not produce substantial reduction in?

Adr?

Interactions?

triglycerides

DM type II, familial lipid

LDL

n/d, cholelithiasis, phototox, CONSTIPATION

CONCURRENT USE statins/niacin- HEPATOTOXICITY
WARFARIN** protein binding displacement

15

Bile acid sequestrants

Action

Not metabolized by

Okay with what patients?

Can be used with?

ADR?

Interactions?

increase bile acid secretion, enhance conversion cholesterol to bile, increase uptake ldl

bind in intestine, not in liver

LIVER disease patients

Fibrates

constipation, bloating

Interferes with absorption of meds

16

Niacin

adjunctive with

give what 30 min prior

ADR

Interactions

bile acid sequestrant or statin

aspirin to reduce flushing

flushing, abdominal, increase PUD

ALCOHOL (hepatotoxicity)
STATINS, FIBRATES (increase risk of hepatotoxicity or myalgia although see above can be used with statin)

17

Zetia

pregnancy?

not recommended

category C