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Final- Old Stuff Flashcards

1
Q

Dixogin

A

MOA-

  • inhibits Na/ K/ ATPase pump.
    • Intracellular Na+ & Ca+ increases.
      • Increase Ca+→ increased contractility (+ inotrope).
  • Increase vagal efferent efferent
    • redueces SA firing→ decreased HR,
    • slows conduction velocity in AV mode

Renal clearnace

DDI- quinidine, verapamil, amioarone

Hypokalemia can cause toxicity (watch for duretic use)

  • GI- nausea/ vomitting
  • confusion/ neurological changes
  • visual changes cardiac toxicity
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2
Q

Lidocaine

A

Anti-arrhythmic Class 1b- Na channel blockers- short refractory period

Ventricular arrhythmia ONLY

ONLY IV

CNS toxicity- paresthesia, confusion, seizure, tremor

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3
Q

Hydrocholorothiazide

A

Thiazide diuretic- inhibt Nacl luminal synporter

Inital therapy for hypertention not goog for renal disease but good for kidney stones caused by hypercalciuria

ADR- Hypokalemia, hypercalcemia, hypomagnesemia, hyperuricemia

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4
Q

Glyburide

A

Sulfonylureas (oral)- first generation

MOA- initally bind to high affinity 140-kDa SU receptor and block K channel in beta cell in increase insulin release , works on pancreas in the K channels in the beta cells

Works independent of glucose load- insulin porduced even if glucose is not present so take with food

ADR- Hypoglycemia (highest in class), weight gain

Use in caution in older patients and those with renal impairment

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5
Q

Esmolol

A

Class 2- Beta blockers

MOA- supression of abnormal pacemaker activity by cloking sympathetic (beta 1- receptor) activity in SA/ AV node

IV- short acting acute arrhythmia

Preferred for rate control

ADR

  • Bronchospasm, AV block, Hypotension, exercise intolerance, sexual dysfunction, masking hyperglycemia
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6
Q

Nateglinide

A

Glinide

MOA- initally bind to high affinity 140-kDa SU receptor and block K channel in beta cell in increase insulin release , works on pancreas in the K channels in the beta cells

Works independent of glucose load- insulin porduced even if glucose is not present so take with food

Rapid onset of action best for post prandial glucose- take before meal

ADR- Hypoglycemia, weight gain (both less then SU)

Use in caution in older patients and those with renal impairment

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7
Q

Metformin

A

Biguanide

MOA- Activatio of AMP- Kinase (supress hepatic glucose production (gluconeogenesis)- mean mechanism, increase insulin sensitivity of peripheral tissue (increase number of Glut-4 receptor), works on liver, muscle adipose tissue (AMP-K), Glut-4

ADR- Diarrhea, anorexia, metallic taste, GI (titrate to minimize GI effect), increse plasma lactate( lactic acidosis), less B12 absorption

NO hypoglycemia with monotherapy

causes weight loss or neutral

Renal consideration- eGFR < 30 no not use

Titrate- 500 mg BID with meals to start then increase 500 mg increment every 5-6 days

MAX dose- 2000 mg daily

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8
Q

Ethacrynic Acid

A

Loop diuretic- inhibits luminal Na/K/2Cl

DOC diuretic class for renal disease, can be used in sulfa allergy

ADR- Hypokalemia, hypocalemia, hypomagnesemia, hyperuricemia

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9
Q

Nisoldipine

A

DHP CCB

Can be used in HF but only treats the hypertension in HF

Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)

ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)

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10
Q

Chlorthalidone

A

Thiazide diuretic- inhibt Nacl luminal synporter

Inital therapy for hypertention not goog for renal disease but good for kidney stones caused by hypercalciuria

ADR- Hypokalemia,hypercalcemia,hypomagnesemia, hyperuricemia

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11
Q

Lispro U-100

A

Rapid- Acting Insulin

MOA- stablized in hexamer

Less hypoglycemia then short acting

used in insulin pump

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12
Q

Lixisenatide

A

GLP-1 receptor agonist- incretin mimetic (injectable)

MOA-

  • slows gastic empty which reduces post-pradial rise in blood glucoe (feels fuller longer)
  • Decreases in appetitie- WEIGHT LOSS
  • Increase insulin secretion by activating beta cells
    • glucose dependent (safer then SU)
  • Supresses glucagon release

ADR- Nausea (less nausea with weely formulations),mide hypoglycemia, pancretitis, weight loss

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13
Q

Clevidipine

A

DHP CCB

Can be used in HF but only treats the hypertension in HF

Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)

ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)

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14
Q

Adenosine

A

Adenosine receptors found in AV nodal tissue and vascular smooth mucle

  • Slows AV nodal conduction

ADR-

  • Vasodilation→ flushing hypotension
  • Chest pain
  • Dyspnea
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15
Q

Chlorothiazide

A

Thiazide diuretic- inhibt Nacl luminal synporter

Inital therapy for hypertention can use for renal disease (only one in class) but good for kidney stones caused by hypercalciuria

ADR- Hypokalemia,hypercalcemia,hypomagnesemia, hyperuricemia

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16
Q

Repaglinide

A

Glinide

MOA- initally bind to high affinity 140-kDa SU receptor and block K channel in beta cell in increase insulin release , works on pancreas in the K channels in the beta cells

Works independent of glucose load- insulin porduced even if glucose is not present so take with food

Rapid onset of action best for post prandial glucose- take before meal

ADR- Hypoglycemia, weight gain (both less then SU)

Use in caution in older patients and those with renal impairment

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17
Q

Linaglipton

A

DPP-4 Inhibitor

MOA- inhibits the action of the DPP-4 enzyme which inhibits the breakdown of endogenous GLP-1. Inhibits incretin breakdown

Useful in patients with low levels of incretin/ GLP-1

ADR- Headache, nasopharyngitis, rash, URI, joint aches

Renal adjustment NOT required- only one in class

Not replacing incretin- just inhibiting the thing thats breaking down incretin (DPP-4)

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18
Q

Verapamil

A

Class 4- Ca+ channel blockers (non DHP- CCB)

MOA- slows conduction in AV node by blocking Ca channels (phase 2),

Good for asthma and COPD patients for rate control

DO NOT USE IN HF

ADR- Constipation, hypotension, AV block,

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19
Q

Ramipril

A

ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough)

Diminish proteinura (good for diabetics)and stabilize renal funtion

Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD,

Potential increase in SCr initially then declines- CAN CAUSE AKI

ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)

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20
Q

Disopyramide

A

Anti-arrhythmic Class 1A- Na channel blockers

MOA- blocks Na+ channel moderately and K+

Negative inotrope

Antimuscarinic effects (Hot, dry fast crazy), exacerbates, heart failure, increases digoxin toxicity

All 1a drugs can precipitate new arrhythmia

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21
Q

Benzepril

A

ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough)

Diminish proteinura (good for diabetics)and stabilize renal funtion

Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD,

Potential increase in SCr initially then declines- CAN CAUSE AKI

ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)

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22
Q

Eprosartan

A

ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough)

Diminish proteinura (good for diabetics)and stabilize renal funtion

Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD,

Potential increase in SCr initially then declines- CAN CAUSE AKI

ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)

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23
Q

Canagliflozin

A

SGLT-2 inhibitor

MOA-inhibitrs SGLT-2 transporter in kidney to decrease reabsorption of glucose thus increasing urinary glucose excretion

ADR- Polyuria, increased risk of genital myoctic infection and UTI, increased LDL, volume depletion ( with diuretis double the risk), increased risk of amputations

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24
Q

NPH- Humulin, Novolin

A

Intermediate acting

MOA- recombinant human insulin complexed with zinc and protamine to delay absorption and extend action

Often combined with rapid acting insulin

Highest rate of hypogylcemia

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25
Dulaglitide
GLP-1 receptor agonist- incretin mimetic (injectable) MOA- * slows gastic empty which reduces post-pradial rise in blood glucoe (feels fuller longer) * Decreases in appetitie- **WEIGHT LOSS** * Increase insulin secretion by activating beta cells * **glucose dependent (safer then SU)** * Supresses glucagon release ADR- **Nausea (less nausea with weely formulations),**mide hypoglycemia, pancretitis, weight loss
26
Novolin
Short- Acting (regular insulin) MOA- hexamer complex with zinc **IV in-patient for diabetics for DKA** **Higer risk of hyopglycemia then rapid acting**
27
Glipizide
Sulfonylureas (oral)- second generation MOA- initally bind to high affinity 140-kDa SU receptor and block K channel in beta cell in increase insulin release , **works on pancreas in the K channels in the beta cells** **Works independent of glucose load- insulin porduced even if glucose is not present so take with food** **ADR- Hypoglycemia, weight gain** **Use in caution in older patients and those with renal impairment**
28
Captopril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia,AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
29
Metolazone
Thiazide diuretic- inhibt Nacl luminal synporter **Inital therapy for hypertention can use for renal disease (only one in class) but good for kidney stones caused by hypercalciuria** ADR- Hypokalemia,**hypercalcemia,**hypomagnesemia, hyperuricemia
30
Propranolol
Class 2- Beta blockers MOA- supression of abnormal pacemaker activity by cloking sympathetic (beta 1- receptor) activity in SA/ AV node **thyrotoxicosis induce arrhythmia** **Preferred for rate control** **ADR** * Bronchospasm, AV block, Hypotension, exercise intolerance, sexual dysfunction, **masking hyperglycemia**
31
Telmisartan
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
32
Sacubitril; Valsartan (entresto)
Neprilysin inhibitor- stops the breakdown down of vasodilators ADR- hyperkalemia, cough/angioedema/ ARF/ AKI/ hypotension (more then enalapril) **Demonstrated superiority to enalapril**
33
Dronedarone
Class 3- K+ channel blocker MOA- block **K+** channelsto delay repolarization (phase 3) (increase AP duration, Increase the refractory period), **Na+, Ca+** **Strong CYP 34A interactions** **ADR** * GI intolerence, * lacks pulmonary, thyroid, or hepatic effects vs amiodarone **_LESS ADRs then amiodarone but not as effective_** **_CANNOT USE IN HF_** **_All Class 3 drugs can increase the risk of subsequent arrhythmias, most notably torsades (QTc prolongation)_**
34
Olmesartan
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
35
Afrezza
Inhaled insulin- rapid acting MOA- absorb onto technosphere microparticles for pulmonary administation, dissoves in neutral pH **Good for people who dont want to inject themselves, bad for asthma/ COPD** **less hypoglyemia then aspart** **ADR- cough,** sore throat, hypoglycemia, bronchitis, weight gain Monitor- PFT- ar baseline, 6 months and anually
36
Alogliptin
DPP-4 Inhibitor MOA- inhibits the action of the DPP-4 enzyme which inhibits the breakdown of endogenous GLP-1. Inhibits incretin breakdown **Useful in patients with low levels of incretin/ GLP-1** ADR- Headache, nasopharyngitis, rash, URI, joint aches **Increased HF admissions with someone already with HF** **Renal adjustment required** **_Not replacing incretin- just inhibiting the thing thats breaking down incretin (DPP-4)_**
37
Empagliflozin
SGLT-2 inhibitor MOA-inhibitrs SGLT-2 transporter in kidney to decrease reabsorption of glucose thus increasing urinary glucose excretion ADR- Polyuria, increased risk of genital myoctic infection and UTI, increased LDL, **volume depletion ( with diuretis double the risk),**
38
Indapamide
Thiazide diuretic- inhibt Nacl luminal synporter **Inital therapy for hypertention can use for renal disease (only one in class) but good for kidney stones caused by hypercalciuria** ADR- Hypokalemia,**hypercalcemia**,hypomagnesemia, hyperuricemia
39
Flecainide
Anti-arrhythmic Class 1c- Na channel blockers Dizziness **Metallic taste** **_NORMAL HEARTS ONLY_**
40
Saxagliptin
DPP-4 Inhibitor MOA- inhibits the action of the DPP-4 enzyme which inhibits the breakdown of endogenous GLP-1. Inhibits incretin breakdown **Useful in patients with low levels of incretin/ GLP-1** ADR- Headache, nasopharyngitis, rash, URI, joint aches **Increased HF admissions with someone already with HF** **Renal adjustment required** **CYP 3A4 interacts CYP 3A4 inhibitors** **_Not replacing incretin- just inhibiting the thing thats breaking down incretin (DPP-4)_**
41
Bromocriptine
Prefferable for Parkinson and Diabetes
42
Pramlintide
Amylin Analog MOA- supression of high postprandial hyperglycemia, slows gastic emptying, and increased satiety **Indicated for use with mealtime insulin but must reduce inulin dose by 50% to avoid hypoglycemia _(BLACK BOX WARNING)_** **ADR- Nausea,** vomiting, anorexia**, increased risk of insulin-induced hypoglycemia** **Used in Type 1 DM**
43
Procainamide
Anti-arrhythmic Class 1A- Na channel blockers **MOA-** blocks Na+ channel moderately and K+ IV Hypotension, **lupus-like syndrome**, arganulocytosis, nasuea, diarrhea Cleared though kidneys **All 1a drugs can precipitate new arrhythmia** **Most likely to cause torsades**
44
Valsartan
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
45
Mexilteine
Anti-arrhythmic Class 1b- Na channel blockers- short refractory period **Ventricular arrhythmia ONLY** IV and PO Longer duration of action CNS toxicity- paresthesia, confusion, seizure, **tremor (sign of toxicity)**, GI upset
46
Perindopril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
47
Sotalol
Class 3- K+ channel blocker MOA- **block K+** channelsto delay repolarization (phase 3) (increase AP duration, Increase the refractory period), **K+**and **Beta receptors** Treatment of ventricular arrhythmias and afib **Do not use if LVEF \<25%** **Renally cleared** **_All Class 3 drugs can increase the risk of subsequent arrhythmias, most notably torsades (QTc prolongation)_**
48
Liraglutide
GLP-1 receptor agonist- incretin mimetic (injectable) MOA- * slows gastic empty which reduces post-pradial rise in blood glucoe (feels fuller longer) * Decreases in appetitie- **WEIGHT LOSS** * Increase insulin secretion by activating beta cells * **glucose dependent (safer then SU)** * Supresses glucagon release ADR- Nausea, mide hypoglycemia, pancretitis, weight loss **Requires dose titration to reduce nausea**
49
Quinapril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia,AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
50
Quinidine
Anti-arrhythmic Class 1A- Na channel blockers **MOA**- blocks Na+ channel moderately and K+ Most toxic in the class HA, vertigo, tinnitus, **GI distrubance**, thrombocytopena, hemolyic anemia, hepatitis **All 1a drugs can precipitate new arrhythmia**
51
Losartan
ARB- Blocks recepotrs for angiotension II Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (lower then ACE ), Angioedema, Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
52
Amlopdipine
DHP CCB **_Can be used in HF but only treats the hypertension in HF_** **Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)** **ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)**
53
Moexipril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
54
Felodipine
DHP CCB **_Can be used in HF but only treats the hypertension in HF_** **Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)** **ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)**
55
Nifedipine
DHP CCB **_Can be used in HF but only treats the hypertension in HF_** **Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)** **ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)**
56
Spironolactone
K- sparring diuretic- collecting duct- Na excretion and K reabsorbtion **Aldosterone antagonist- can be used for acne, Increases the expression of Na channels** **DO not use with diabetics with protein in their urine, can use in sulfa allergy** **least likely to cause gout​** ADR- **Hyperkalemia,** gynecomastia (adrogen recepotor blockade),
57
Lisinopril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)** and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia,AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
58
Acarbose
Alpha- Glucosidase Inhibitor MOA- inhibits enzymes in small intestine that hydrolyze polysaccharides (starches) into simple sugars→ delays the absorption of dietary CHO→ reduced post parandial glucose Taken at the start of each meal- before meal because drug must be available in the intestine ADR- poor absorption, **flatulence,** bloating, abdominal pain
59
Humulin
Short- Acting (regular insulin) MOA- hexamer complex with zinc **IV in-patient for diabetics for DKA** **Higer risk of hyopglycemia then rapid acting**
60
Fosinopril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
61
Pioglitazone
Thiazolidinediones (TZD) MOA- Activate PPAR- gamma in muscle, liver and fat * increase GLUT1 and GLUT4 transpsporter expression * Increases insulin sensitivity * Decrease gluconeogenesis * Decrease TG in ciruclation (increase lipoprotein lipase) ADR- **_WEIGHT GAIN, edema→ exacerbate CHF,_** increased LFTs, increase bone fracture, anemia Delayed clinical effect- 8-12 weeks combine with metformin **Increased risk of bladder cancer if use over 1 year**
62
Degludec
Ultra- Long acting MOA- **forms multihexamer** upon injection, resulting in a large depot. Gradual remocal of zinc leads to slow dissociaion into dimers and monomers
63
Glargine
Ultra- Long acting MOA- same as insulin glargine U-100; given at one thrid of volume
64
Diltiazem
Class 4- Ca+ channel blockers (non DHP CCB) MOA- slows conduction in AV node by blocking Ca channels **Good for asthma and COPD patients for rate control** **_DO NOT USE IN HF_** **ADR- Constipation, Flushing** hypotension, AV block
65
Colesvelam
Approved for pregnancy weight lowering
66
Amiodarone
Class 3- K+ channel blocker MOA- has class 1, 2 & 4 electrophysiologix properties **Lowest risk of torsades in class 3** Long half life **DDI (MANY)- digoxin, warfarin, etc** **Lipophilic** **Monitor- TFTs, LFTs, PFTs/ CXR (yearly)** **ADR** * **Pumonary fibrosis, hepatic dsyfunction, _grey-blue skin,_ corneal deposits, _hypo/hyperthyroidism (iodine based)_** **_All Class 3 drugs can increase the risk of subsequent arrhythmias, most notably torsades (QTc prolongation)_**
67
Aliskiren
Direct Renin Inhibitor- prevents the generation of angiotension I DO NOT COMBINE WITH ACE/ARB **ADR- hypotension, hyperkalemia, AKI/AKF, rare angioedema, teratogenic**
68
Propafenone
Anti-arrhythmic Class 1c- Na channel blockers ## Footnote **Mild Beta blocking properties** **NORMAL HEARTS ONLY**
69
Furosemide
Loop diuretic- inhibits luminal Na/K/2Cl **DOC diuretic class for renal disease** ADR- Hypokalemia, hypocalemia, hypomagnesemia, hyperuricemia
70
Amiloride
K- sparring diuretic- collecting duct- Sodium channel blockers Na excretion and K reabsorbtion ## Footnote **DO not use with diabetics with protein in their urine, can use in sulfa allergy** **ADR- Hyperkalemia,**
71
Miglitol
Alpha- Glucosidase Inhibitor MOA- inhibits enzymes in small intestine that hydrolyze polysaccharides (starches) into simple sugars→ delays the absorption of dietary CHO→ reduced post parandial glucose Taken at the start of each meal- before meal because drug must be available in the intestine ADR- poor absorption, **flatulence**,bloating, abdominal pain
72
Glulisine
Short- Acting (regular insulin) MOA- hexamer complex with zinc **IV in-patient for diabetics for DKA** **Higer risk of hyopglycemia then rapid acting**
73
Azilsartan
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
74
Glargine
Long acting MOA- soluable at & injected as an acidic solution (pH-4). After injection the acidic solution is neutralized leading to formation of mcroprepitates. Small amount of glargine are slowly released from assportion
75
Asoart
Short- Acting (regular insulin) MOA- hexamer complex with zinc **IV in-patient for diabetics for DKA** **Higer risk of hyopglycemia then rapid acting**
76
Torsemide
Loop diuretic- inhibits luminal Na/K/2Cl **DOC diuretic class for renal disease** ADR- Hypokalemia, hypocalemia, hypomagnesemia, hyperuricemia
77
Rosiglitazone
Thiazolidinediones (TZD) MOA- Activate PPAR- gamma in muscle, liver and fat * increase GLUT1 and GLUT4 transpsporter expression * Increases insulin sensitivity * Decrease gluconeogenesis * Decrease TG in ciruclation (increase lipoprotein lipase) **_ADR- WEIGHT GAIN, edema→ exacerbate CHF,_** increased LFTs, increase bone fracture, anemia Delayed clinical effect- 8-12 weeks combine with metformin
78
Nimodipine
DHP CCB **_Can be used in HF but only treats the hypertension in HF_** **Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)** **ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)**
79
Ibutilide
Class 3- K+ channel blocker MOA- **block K+ channels** to delay repolarization (phase 3) (increase AP duration, Increase the refractory period), **Na+** and **Beta receptors** **_Treatment of acute afib- most effective when given within seven days of onset_** **All Class 3 drugs can increase the risk of subsequent arrhythmias, most notably torsades (QTc prolongation)**
80
Nicardipine
DHP CCB **_Can be used in HF but only treats the hypertension in HF_** **Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)** **ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)**
81
Defetilide
Class 3- K+ channel blocker MOA- block K+ channelsto delay repolarization (phase 3) (increase AP duration, Increase the refractory period) **Must be strated inpatient; provider must be registered to perscribe& pharmacy to dispense** **DDI- HCTZ, verapamil** **_All Class 3 drugs can increase the risk of subsequent arrhythmias, most notably torsades (QTc prolongation)_**
82
Metoprolol
Class 2- Beta blockers MOA- supression of abnormal pacemaker activity by cloking sympathetic (beta 1- receptor) activity in SA/ AV node **Preferred for rate control** **ADR** * Bronchospasm, AV block, Hypotension, exercise intolerance, sexual dysfunction, **masking hyperglycemia**
83
Isradipine
DHP CCB **_Can be used in HF but only treats the hypertension in HF_** **Potenial reflex tachycardia so combine with Beta blockers (beta 1- antagonist)** **ADR- Peripheral edema (dose- related), flushing (dose-related), palpitations (dose- related), reflex tachycardia (give with beta blocker)**
84
Enalapril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia,AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
85
Semaglutide
GLP-1 receptor agonist- incretin mimetic (injectable) MOA- * slows gastic empty which reduces post-pradial rise in blood glucoe (feels fuller longer) * Decreases in appetitie- **WEIGHT LOSS** * Increase insulin secretion by activating beta cells * **glucose dependent (safer then SU)** * Supresses glucagon release ADR- **Nausea (less nausea with weely formulations),**mide hypoglycemia, pancretitis, weight loss
86
Trandolapril
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
87
Exenatide
GLP-1 receptor agonist- incretin mimetic (injectable) MOA- * slows gastic empty which reduces post-pradial rise in blood glucoe (feels fuller longer) * Decreases in appetitie- **WEIGHT LOSS** * Increase insulin secretion by activating beta cells * **glucose dependent (safer then SU)** * Supresses glucagon release ADR- **Nausea (less nausea with weely formulations),** mide hypoglycemia, pancretitis, weight loss
88
Eplerenone
K- sparring diuretic- collecting duct- Na excretion and K reabsorbtion **Aldosterone antagonist- can be used for acne, Increases the expression of Na channels** **DO not use with diabetics with protein in their urine, can use in sulfa allergy** **least likely to cause gout** **ADR- Hyperkalemia,** gynecomastia (adrogen recepotor blockade)
89
Sitagliptin
DPP-4 Inhibitor MOA- inhibits the action of the DPP-4 enzyme which inhibits the breakdown of endogenous GLP-1. Inhibits incretin breakdown **Useful in patients with low levels of incretin/ GLP-1** ADR- Headache, nasopharyngitis, rash, URI, joint aches **Renal adjustments** **_Not replacing incretin- just inhibiting the thing thats breaking down incretin (DPP-4)_**
90
Chlorpropamide
Sulfonylureas (oral)- first generation MOA- initally bind to high affinity 140-kDa SU receptor and block K channel in beta cell in increase insulin release, **works on pancreas in the K channels in the beta cells** **Works independent of glucose load- insulin porduced even if glucose is not present so take with food** **ADR- Hypoglycemia , weight gain** **Use in caution in older patients and those with renal impairment**
91
Candesartan
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
92
Glimeperide
Sulfonylureas (oral)- second generation MOA- initally bind to high affinity 140-kDa SU receptor and block K channel in beta cell in increase insulin release , **works on pancreas in the K channels in the beta cells** **Works independent of glucose load- insulin porduced even if glucose is not present so take with food** **ADR- Hypoglycemia, weight gain** **Use in caution in older patients and those with renal impairment**
93
Detemir
Long- Acting MOA- Neurtral pH. Has stron molecular association once injected, **98% bound to albumin** once in circulation to slow distrubution into tissue **In hypoalbuminemia causes hypoglycemia becase there is more free drug**
94
Irbesartan
ACE- inhibits the conversion of angiotension I to II, increase bradykinin (dry cough) Diminish proteinura **(good for diabetics)**and stabilize renal funtion Uses- hypertension, post MI, LV systolic dysfunction, systolic heart failure, CKD, **Potential increase in SCr initially then declines- CAN CAUSE AKI** **ADR- Dry cough (change to ARB), Angioedema (cannot switch to ARB), Hyperkalemia, AKF, tetratogenic, Redued efficiacy in African Americans (use HCTZ)**
95
Bumetanide
Loop diuretic- inhibits luminal Na/K/2Cl **DOC diuretic class for renal disease** ADR- Hypokalemia, hypocalemia, hypomagnesemia, hyperuricemia
96
Dapagliflozin
SGLT-2 inhibitor MOA-inhibitrs SGLT-2 transporter in kidney to decrease reabsorption of glucose thus increasing urinary glucose excretion ADR- Polyuria, increased risk of genital myoctic infection and UTI, increased LDL, **volume depletion ( with diuretis double the risk), increased risk of amputations**
97
Triamterene
K- sparring diuretic- collecting duct- Sodium channel blockers Na excretion and K reabsorbtion ## Footnote **DO not use with diabetics with protein in their urine, can use in sulfa allergy** **ADR- Hyperkalemia,**

Pharm (9 decks)

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