Unit 2 Flashcards by Katherine Milley

Selective activation of alpha 2 receptors in the CNS, reducing sympathetic outflow to blood vessels and the heart

Centrally acting alpha 2 agonist

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Should be used when additional LDL reduction is needed

Bile acid sequestrants

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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)

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Inhibits conversion of angiotensin I to angiotensin II and increases levels of bradykinin in the lungs

ACEi

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Used in pulmonary edema, edema from HF, hepatic origin, or renal origin, uncontrolled HTN

Loops

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Used in HTN, edema, can be used to augment diuresis with loop or thiazide

Potassium sparing diuretics

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Contraindications:

use with caution when taking other agents that can raise potassium levels

Potassium sparing diuretics

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Carries cholesterol from peripheral tissues back to the liver to promote cholesterol removal

HDL

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Contraindications:

bilateral renal artery stenosis, pregnancy category D, use of lithium, taking diuretics or NSAIDS

ACEi

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Example of dihydropyridine CCB

Amlodipine, nifedipine, felodipine, nicardipine

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Blocks angiotensin II receptors in blood vessels, causing vasodilation and decrease in aldosterone release

ARB

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Pregnancy category X

Statins

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SEs:

bradycardia, decrease in CO, HF, drowsiness, sedative effects, dry mouth, rebound HTN

Centrally acting alpha 2 agonist

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Used in HTN and BPH

Alpha 1 blockers

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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

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Example of centrally acting alpha 2 agonist

Clonidine, methyldopa

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SEs:
angioedema
fetal injury
renal failure

ARB

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SEs:
hyponatremia, hypochloremia, dehydration, hypotension, hypokalemia, ototoxicity, hyperuricemia, decrease in cholesterol, decrease in magnesium and calcium

Loops

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Used in hypertension only

Direct renin inhibitor

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SEs:

orthostatic hypotension, reflex tachycardia, nasal congestion

Alpha 1 blockers

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Give ASA 30 min before administering this drug (and why)

Niacin- for flushing and peripheral vasodilation

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SEs:
hyponatremia
hypochloremia
dehydration
hypercalcemia
hyperglycemia
hyperuricemia
increase in cholesterol
decrease in magnesium

Thiazides

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Can mask s/s of hypoglycemia, use with caution in patients with DM

BBs

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Digoxin toxicity symptoms

Confusion
n/v/d
dysrhythmias
loss of appetite
tachycardia

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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

Unit 2 Flashcards

(82 cards)