Nifedipine (Procardia), amlopidine (Norvasc), felodipine (Plendil) Verapamil has strongest negative inotropic effect and should be avoided in patients with HF. Using CCB/ACE combination decreases peripheral edema by 50 % vs. those on CCB high dose alone. Glycosides Digoxin: highly selective inhibitors of the ATPase system Inhibition of this pump results in sodium and calcium buildup inside the cell , which leads to increased contractility of heart muscle. Amiodarone can cause blue skin discoloration b. Understand positive and negative chronotropism and inotropism and which drugs exhibit which Negative chronotropic effect lowering conduction through AV node fix tachycardia. Non-dihydropyridines CCB CCB Block the influx of calcium, reduction in contractility (negative inotropism), c. Know recommended fiber intake Increased soluble fiber intake (10 to 25 gm/day) Dietary fiber of 20 to 30 gm/day d. Signs/symptoms to look out for side effects of statins; rank relative statin potency Common statin adverse effects: HA , myalgia , fatigue, GI intolerance, flu-like symptoms Myopathy: occurs in 0.2% to 0.4% of patients, some agents more likely Reduced by using lowest effective dose
Cautiously combining statins with fibrates Avoiding drug interactions Increase in liver enzymes not enough to warrant frequent labs 5. Gastrointestinal/Gentourinary a. Chapter 20 Drugs Affecting the Gastrointestinal System i. Precautions for using antacids Precautions and contraindications b. Abdominal pain of unknown cause c. Calcium-based antacids contraindicated if patient is hypercalcemic or has renal calculi. d. Magnesium-based antacids contraindicated in patients with renal failure or renal insufficiency. e. Aluminum-based antacids should not be used in patients with renal failure on dialysis. f. Sodium content may affect patients with hypertension, congestive heart failure, or renal failure. i. Antidiarrheals, MOA of loperamide Loperamide (Imodium) binds to opioid receptors and slows gastric motility. ii. Antiemetics (which to use in pediatrics) Dimenhydrinate (Dramamine) and diphenhydramine (Benadryl) can be used to treat nausea in children over 2 years old Ranitidine (zantac)and famotidine (Pepcid) use approved in children (H2RAS) for ulcers g. Chapter 34 Gastroesophageal Reflux and Peptic Ulcer Disease
i. MOA of drugs, side effects, , steps in therapy Step 1 h. Lifestyle modifications and over-the-counter antacids or H 2 blockers Step 2 i. H. pylori testing j. Treatment with PPIs Step 3 k. Treatment for H. pylori All regimens include a PPI plus antibiotics to treat H. pylori. Triple therapy: PPI plus Clarithromycin: 500 mg twice daily, or Metronidazole: 500 mg twice daily Amoxicillin: 1 gm twice daily Treat for 10 to 14 days. Quadruple therapy: PPI plus Metronidazole: 250 mg four times/day Tetracycline: 500 mg four times/day Bismuth subsalicylate: 525 mg four times/day Treat for 14 days.
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