Pharma Exam 2 Notes Diuretics and Cardiovascular Drugs PDF

Pharma Exam 2 Notes Diuretics and Cardiovascular Drugs Questions with answers? What is your first line for hypertension? ACE Inhibitors, ARBs, Calcium Channel Blockers and diuretics Which Diuretic? Thiazide, Thiazide What are the first things we do, lifestyle? Stop smoking exercise, eat right, ma...

Pharma Exam 2 Notes Diuretics and Cardiovascular Drugs Questions with answers? What is your first line for hypertension? ACE Inhibitors, ARBs, Calcium Channel Blockers and diuretics Which Diuretic? Thiazide, Thiazide What are the first things we do, lifestyle? Stop smoking exercise, eat right, make lifestyle changes, Antilipemic Agents Limpednis HMG-CoA Reductase Inhibitors: Statins Statins, lower your LDLs, and also lowers VLDL (can increase HDL) Statin Note: Statin has non-lipids functions which include plaque stability, reduction in Cardiovascular events and an increase in bone formation. The increase in bone formation is very useful especially for our older patients. Uses of Statin: lower hypercholesterolemia, Post-MI-Therapy and in patients with Diabetes. Statins are often prescribed to patients with diabetes because people with diabetes have a significantly higher risk of developing heart disease and stroke, and statins effectively lower cholesterol levels, which helps to prevent these cardiovascular complications; essentially, statins are used as a preventative measure to reduce the cardiovascular risks associated with diabetes. Rare Adverse Effects: Myopathy; aches and pains of the joints/ rhabdomyolysis; when the adverse reactions get severe that's when the breaking down of the muscle tissues happens and that's fatal. To measure the muscle breakdown, use creatinine Kinase levels, creatinine kinase is a chemical released when muscle tissue breakdown. Take Statin in the evening when your body makes the most of the cholesterol overnight, Do not give statin to pregnant women, it's a Category X medication so do not prescribe Statin to pregnant women. All patients need to report aches and pains while taking Statins. Understand that Statin can be used with Ezetimibe and fibrates to work together to lower cholesterol also. Interactions with Statin include: Do not drink Grapefruit juice while taking Statin, it can increase the Statin levels in your body. Interactions with Statin include: Cytochrome P450 3A4 (CYP3A4) is an enzyme that plays a crucial role in the metabolism of many drugs. Inhibitors of CYP3A4 can block its activity, leading to increased drug concentrations and potentially altered drug effect. Monitor Lipids, LFTs, and Creatinine Kinase levels -​ Cholesterol absorption inhibitor​ ​ Ezetimibe: used as an add-on to statin,can be used alone as a medication -​ Blocks cholesterol absorption -​ Lowers total cholesterol, LDL, & apolipoprotein B -​ -​ AEs -​ Myopathy / rhabdomyolysis, hepatitis, pancreatitis, thrombocytopenia -​ Monitor LFTs, CK -​  -​ Interactions – BAS, statins, fibrates -​ Grapefruit Juice -​ -​ Nursing -​ Monitor lipids, LFTs, CK -​ Pregnancy Cat X -​ BAS Coles: Bile Acid Sequestrants ( coles-) lowers your Triglycerides levels You can use BAS alone or with a Statin Know that Bile Acid Sequestrants are used for digestion, made from cholesterol produced in the liver. Bile Acid Sequestrant is a non-absorbable resin, it binds to bile acid sequestrant, BAS, binds to bile acids in the body, then takes them out of the body, then the body says it needs more bile acid acid, then the body takes the bodies cholesterol out of the bloodstream and breaks it down and makes more bile. The medication is non-absorbable resin, it stays in the body and the BI tract, binds to bile acid and other GI substrates. You must mix it into fluids and take it because it usually comes in a powder. BAS can interact with other drugs (thiazine, Diuretics, digoxin, warfarin, blood absorption of many drugs). Someadverse effects you can experience with Bile Acid Sequestrants BAS is Constipation; drinking more water will alleviate it. Before you take BAS with any other medication, take those other medications first and then after you take the BAS wait four hours and then take the Bile Acid Sequestrant. Examples of Bile Acid Sequestrants are: Colesevelam, cholestyramine, and Colestipol Let's talk Fibric Acid Derivatives (Fibrate Beta Blockers are not First line drugs to use for Hypertension Metoprolol: Beta blockers that cause vasodilation and are used for hypertension include: carvedilol and nebivolol; both work by blocking alpha-1 receptors, leading to vasodilation, while also selectively blocking beta-adrenergic receptors If a patient has asthma do not give them a beta blocker 2 because it causes adverse effect bronchoconstriction, do not give them a non-selective beta blocker 2 it can interact with their albuterol medication, it wont work. Albuterol is their rescue medication when they cant breathe Glycogenolysis inhibited, something occurs in diabetes, Beta blockers mask the sign of hypoglycemia, with hypoglycemia you experiences tachycardia, and your slowing that down Caution: Pregnancy/ Lactation We do not use the Non-Selective Beta Blockers are not used in asthma or diabetes or any patient with bronchospasm that is not related to asthma and heart failure. Beta Blockers slow everything down, if you have depression, it will worsen the depression be aware of that. Do not take a beta blocker if you have severe allergies, especially if you carry an epipen, do not take a beta blocker. Note: Stage Fright, sometimes we use a beta blocker before a big speech, it's a low dose and the patient does not take it everyday Calcium Channel Blockers Dihydropyridines and Non-Dihydropyridines Dihydropyridines (D-Dipine) Dihydropyridines work by blocking the Calcium Ca2+ channel in the blood vessels, primarily arterioles of the heart. The peripheral Arteries and the arteries of the Heart not in the heart of the heart. Dihydropyridines cause vasodilation and are part of the group of medicine that are a first line 1st defence for Hypertension. Dihydropyridines medication uses are for hypertension (HTN) and Angina Pectoris, Adverse Effects for Dihydropyridines: Gingival hyperplasia, Acute Toxicity, Reflex Tachycardia -​ Vasodilation; Vasodilation → Lowers BP (that’s good but what does that mean for the body, our bodies like homeostasis doesn’t like change, if we lower the blood pressure, the heart says I need to beat harder and faster, my blood pressure is not where it's supposed to be, this is called reflex tachycardia. So what do we do, we give another drug, called a beta blocker. -​ Anytime you lower the blood pressure reflex tachycardia can happen, but it happens more with Calcium Channel Blockers (CCBs), so what do we do as nurses when given a physician's order, we give another drug such as metoprolol so you can take them together. -​ Acute Toxicity, if it gets to high it'll start to affect the heart  -​ Big Side Effects: Orthostatic Hypotension; stand up slowly and another big side effect of Dihydropyridine is Peripheral Edema. If peripheral Edema occurs, give a diuretic. -​ Gingival hyperplasia: overgrowth of the gums, tell patient to brush teeth, floss, gum massage Interactions for Dihydropyridines: -​ Dihydropyridines -​ Cimetidine (antiacid medication), famotidine (antacids medication), grapefruit juice toxicity Non-Dihydropyridines (verapamil​ & diltiazem: They work in the blood vessels and in the heart, in the myocardium in the SA and AV nodes, they decrease the force of contraction, they slow down the heart rate and slow conductions through the AV nodes. Non-Dihydropyridines block the Ca2+ channels in the blood vessels and cause vasodilation. The AV node intentionally slows conduction to allow the atria to fully contract and empty blood into the ventricles before ventricular systole begins. This delay ensures optimal ventricular filling and cardiac output. So in general any of the drugs moving forward that affect the AV nodes, any interaction, it will cause a heart block. If you have a heart block or use any drugs that affect the AV node, you cannot use a non-dihydropyridine instead use a Dihydropyridine. We use this for Angina pectoris, Hypertension (HTN) and cardiac dysrhythmias. Examples of the Cardiac dysrhythmias, AFib; Atrial fibrillation (AFib) is a common heart rhythm disorder where the upper chambers of the heart (atria) beat irregularly and rapidly, A flutter; A fluttering heart is a symptom of atrial flutter, a type of abnormal heart rhythm. Atrial flutter occurs when the upper chambers of the heart (atria) beat too quickly, often causing a fluttering sensation in the chest, Supraventricular Tachycardia (SVT) Non-Dihydropyridines Adverse Effects (No Beta Blockers) -​ Blocks cardiac conduction, BUT reflex cardiac stimulation -​ Net effect – HR, AV conduction, & contractility not noticeably changed, Do not give a beta blockers with nondihydropyridines -​ Constipation; increase fluid intake and fiber and them also, Orthostatic Hypertension, Peripheral Edema -​ Cardiac Effects -​ Suppress cardiac function; slow conduction through AV nodes, caution with non-dihydropyridine in heart failure and do not use this medication in sick sinus syndrome, or in 2nd or 3rd degree heart block. Non-Dihydropyridines Interactions: -​ Digoxin (patient or person) -​ Digoxin (could end up with heart block, if they take verapamil and digoxin monitor using EKG) Beta blockers (Do not give beta blockers with nondihydropyridines) Grapefruit juice Nondihydropyridine calcium channel blockers (e.g., verapamil and diltiazem) affect the SA node because they block L-type calcium channels in the heart, which are responsible for depolarization in pacemaker cells. Mechanism:  ​ SA node cells rely on calcium influx for depolarization. ​ Nondihydropyridines slow calcium entry, decreasing SA node automaticity (slower heart rate) and AV node conduction (prolonged PR interval). ​ This results in negative chronotropic (↓ heart rate) and dromotropic (↓ conduction) effects. Clinical Effects: ​ Can cause bradycardia or even SA node suppression in susceptible patients. ​ Often avoided in patients with sick sinus syndrome or preexisting bradycardia. This is different from dihydropyridines (e.g., amlodipine, nifedipine), which act mainly on vascular smooth muscle and have minimal SA node effects. Calcium Channel Blocker are the best medications for African American- Black Patients. Vasodilation (only used for severe refractory hypertension, all of our first line drugs aren’t working, or a hypertensive crisis? Adverse Effects -Postural Hypotension (Venous only), the vein have found more place for the blood to pool down below like in legs, -Reflex Tachycardia(give patient a beta blocker) - Expand blood volume, the body likes homeostasis, give a vasodilator, the body might say I need to beat faster and hold onto more fluid, give the patient diuretics to get rid of the fluid. We have Vasodilators that are Selective for arterioles, veins and some that work on both vein and arterioles Arteries carry blood away from the heart, veins carry blood back to the heart, Selective Vasodilators (Arterioles, afterload): -​ Decrease cardiac afterload, easier to pump blood out, increased cardiac output, less work for heart to pump out. What happens when we have more blood that tissues, more of an increased tissue perfusion -​ Dilating arteries the heart doesn't work as heart to pump stuff out Selective Medication: HYdralazine