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Definitions |
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HCTZ ADR
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digoxin
NSAIDS
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Ezetimibe adverse effects
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myopathy
rhabdomyolysis
hepatitis
pancreatitis
thrombocytopenia (watch platelets)
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Blocking agents
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Ezetimibe (Zetia)
inhibits cholesterol absorption in small intestine
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revascularization therapy
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CABG
Percutaneous transluminal coronary angioplasty (PTCA)
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Nitro drug interactions
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hypotensive drugs
phosphodiesterase type5 inhibitors
BB's, verapamil, diltiazem
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Calcium Channel blockers
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diltiazem(cardizem) and nifedipine(procardia)
blocks calcium channels in VSM
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Variant angina (prinzmetal's-vasospastic) pathophysiology
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coronary artery spasm
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apolipoprotiens
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recog. sites for cell-surface receptors
activate enzyme that metabolize lipoprotiens
increases structural stability of lipoprotiens
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sodium lost at the PCT
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60-65%
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Chronic stable angina (exertional)
pathophysiology
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emotional excitement
large meals
cold exposure
coronary heart disease
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variant angina Tx
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inc. cardiac O2 supply
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CCB adverse effects
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reflex tachycardia (from hypotension)
dilation of peripheral arterioles
hypotension
bradycardia
heart failure
AV block
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HMG-CoA reductase inhibitors (statins)
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Atorvastatin (Lipitor)
most effective
reduces LDL
elevates HDL
Reduces triglycerides
Non lipid action: promotes plaque stability, reduces risk for CV event, inc. bone formation
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acute corornary syndrome
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unstable angina or MI
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Active secretion
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"pumps"
organic acids and organic bases
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Re-absorption
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key factor with diuretics
What is reabsorbed and where is it re-absorbed?
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Cholesterol
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component of all cell membranes and membranes of intracellular organisms
required for synthesis of certain hormones (reproductive) and bile salts
deposited in stratum corneum of skin
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unstable angina Tx
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maintain O2 supply
dec. O2 demand
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determinants of O2 supply
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myocardial blood flow
myocardial perfusion only in diastole
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streptokinase therapeutic uses
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acute coronary thrombosis (acute MI)
Large deep venous thrombosis
massive pulmonary emboli
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Spironolactone ADR
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ACE inhibitors (lisinopril): inc. K+ retention
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Na+ lost at the DCT (early segment)
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10%
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HCTZ uses
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initial HTN Tx (mild - moderate)
Vasodilation (diuretic effect dwindles but this stays)
Ca++ spilling in urine (helps reabsorb higher rates of calcium)
slows osteoporotic process
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streptokinase (streptase)
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binds to plasminogen to form active complex
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Gemfibrozil Therapeutic uses
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reduces high levels of plasma triglycerides and VLDLs
less effective than statins in reducing LDL
can raise HDL (not approved for this)
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Ezetimibe therapeutic uses
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reducing total cholesterol, LDL, and apolipoprotien B
approved for monotherapy and combonation with statins (slightly inc. risk for liver damage)
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dietary cholesterol
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produces only small increase in blood levels
inhibits endogenous cholesterol production
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furosmide drug interactions
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Digoxin (potentiates toxicity due to low K+ levels)
aminoglycosides (also produce ototoxicity)
cephalosporins (compete in gut with lasix for transfer into body, Tx inc. lasix)
NSAIDS (dec. effectiveness of lasix, Tx change pain med)
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diuretics that work at the early segment of the DCT
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thiazides (hydrochlorothiazide)
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spironolactone cautions
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monitor serum and sodium levels
no K+ salts or substitutes
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LDL in atherosclerosis
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begins with transport of LDL's from arterial lumen into endothelial cells, then to the space underlying the arterial epithelium
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Chronic stable angina Tx
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inc. cardiac O2 supply
dec. O2 demand
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Low density lipoprotiens (LDL)
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transport from liver to body periphery
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adjunct Tx or High LDL cholesterol
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Therapeutic lifestyle changes
TLC diet
weight control
excercise
smoking cessation
Drugs should be used only if these fail
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diuretics that work at the PCT
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manitol osmotic diuretic
carbonic anyhydrase inhibitor
used for: mountain climbers - high altitude - swelling of the brain
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diuretics that work at the ascending limb of loop of henle
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Loop diuretics (furosemide)
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three families of antianginal agents
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1. organic nitrates (e.g. nitro, isosorbide (isordil))
2. CCB's (diltiazem, nifedipine)
3. BB's (propanolol, metoprolol)
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diuretics that work at the late segment of the DCT
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Potasium sparing diuretics/aldosterone antagonist
(spironolactone, aldactone)
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Filtration
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non-selective process
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thrombolytic drugs
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streptokinase(streptase): fibrinolytic, causes lysis of thrombus
Altepase (tPa)
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Ezetimibe drug interactions
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statins
fibrates
bile-acid sequesterants
cyclosporine
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Gemfibrozil adverse effects
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rashes
GI disturb.
gallstones
myopathy
liver injury (hepatotoxic)
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Beta Blockers
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propanolol(inderol) and metoprolol(lopressor)
Dec. cardiac O2 demand
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determinants of oxygen demand
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HR
myocardial contractility
intramyocardial wall tension (preload/afterload)
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Bile Acid Sequesterants
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Colesevelam (Welchol)
previously first line drugs but now adjunt to statins
reduction in LDL
inc. in VLDL (in some Pts)
not absorbed in GI, Binds with bile acids
also lowers LDL by inc. LDL receptors on hepatocytes
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variant angina therapeutic agents
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CCB's
Organic nitrates
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very low density lipoprotiens (VLDL)
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tryglycerides
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CHD risk factors
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Diabetes
inc. age
HTN
smoking
dec. HDL, inc. LDL
Family Hx
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Hmg co-A reductase
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enzyme to sythesize cholesterol
inhibited by statins
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nitro therapeutic uses
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acute anginal therapy
sustained anginal therapy
IV for perioperative control of blood pressure, and Tx of heart failure with MI, unstable angina, and uncontrolled exacerbations of chronic angina
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HMG-CoA R.I. therapeutic uses
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hypercholesterolemia
primary and secondary prevention of CV events
post MI therapy
diabetes?
dec. risk of stroke
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Spironolactone SE
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steroid structure (inc. testosterone like effect)
profound hyperkalemia
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diuretics work to...
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counter/alter normal renal Fx
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spironolactone uses
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HF, MI (aldosterone antagonist properties)
used with lasix?
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BB's adverse effects
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bradycardia and hypotension
dec. AV conduction
reduction of contractility
asthmatic effects
depression insomnia and bizzare dreams
sexual dysfuntion
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streptokinase adverse effects
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bleeding- excessive fibrinolysis can be reversed with aminocaproic acid (amicar)
antibody production
hypotension
fever
intercranial hemorrhage
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Na+ lost at the DCT (late segment)
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5%
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HCTZ cautions
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FVD
Hypokalemia (not as severe as lasix)
all electrolyte deficit (except Ca++)
inc. CBG's
lipid changes
ototoxicity
hypercalcemia
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the faster the diuresis
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the more complications arise
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Nicotinic Acid adverse effects
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skin (flushing, itching): initially intense preTx w/ ASA
Gastrointestinal: hepatotoxicity
hyperglycemia
gouty arthritis
raise blood level of homocysteine (inc. risk for CHD)
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unstable angina pathophysiology
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symptoms of angina at rest
new-onset exertional angina
intensification of existing angina
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time is takes for myocardium to die
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20 minutes
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HMG-CoA R.I. dosing
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once daily in evening
greatest impact when given in evening because endogenous cholesterol syn. goes up in the night
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fursosemide cautions
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take in morning
leg cramps are not RLS
K+ supplement
watch BP
hyponatremia
drug interactions
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furosemide misc SE
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hyperglycemia
inc. LDL and HDL (watch lipid profile)
inc. uric acid (gouty attacks)
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high density lipoprotiens (HDL)
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take cholesterol from periphery where it is stored
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HMG-CoA R.I. adverse effects
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Common: HA, Rash, Gi disturb.
Rare: myopathy(muscle pain, weakness, tenderness)/rhabdomyolysis(muscle dissolves)
hepatotoxicity(monitor LFT, baseline, then 6-12 Months)
peripheral neuropathy
maybe connection with parkinsons
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Angina pectoris
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O2 supply to heart is insufficient to meet O2 demand
sudden pain beneath sternum, often radiating to left shoulder and arm
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Bile Acid Sequesterants adverse effects
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Constipation
does not decrease uptake of fat-soluble vitamins (as other bile sequesterants do)
does not significantly reduce absorprtion of statins, warfarin, or digoxin
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drugs used to prevent MI and death
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antiplatelet drugs
cholesterol lowering drugs
ACE inhibitors
antianginal agents
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organic nitrates (nitroglycerin)
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works directly on vasc. smooth muscle for Venodilation
dec. cardiac workload
dec. pre/afterload= dec. O2 demand
inc. O2 supply
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furosemide (lasix) action
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keeps sodium in lumen of tubule
last around six hours
PO: diuresis w/in 60 min
IV: diuresis within 5-10 min
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HMG-CoA R.I. drug interactions
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most lipid lowering drugs (except bile acid sequesterants)
Drugs that inhibit CYP3A4 (macrolide antibx, antifungals,
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Fibric acid Derivatives (fibrates)
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most effective drugs for lowering TG levels
can raise HDL
Little to no effect on LDL
can inc. risk for bleeding for Pts on warfarin(watch PT-INR)
can inc. risk for rhabdomyolysis in Pts taking statins
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Na+ lost at the ascending limb of the loop of henle
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20 %
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nicotinic acid (niacin)
Niaspan (long acting niacin)
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Reduces LDL and TG levels (better at dec. TG)
inc. HDL more effectively than any other drug
dec. production of VLDL
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