L-type Ca channel blockers Verapamil, Diltiazem Miscellaneous adenosine receptor agonist Adenosine Miscellaneous ↑ vagal tone Digoxin

- Long half life - Contraindicated in :AV blocks, uncontrolled ventricular arrhythmias, severe renal impairment - Only used for rate control only after BB, verapamil, or diltiazem cannot be used or are inadequate - SIDE EFFECTS: GI most common, visual disturbances such as yellow vision, green halos around lights (signs of toxicity) - Toxicity occurs with levels greater than 2 o Patients with a higher heart rate when it was previously controlled with CG, indicates toxicity not the need to increase the dose o 7. Peripheral Vasodilators - Treats resistant htn/ 3 rd line tx for HTN , PVD - Hydralazine & minoxidil - Use cautiously with cardiac disease - Interacts with nitrates and other antihypertensives, MAOI’s NSAIDS - Fluid retention may occur/ weight daily report gain 5lb in 1 week or greater than 1lb/day, swelling 8. Antilipidemic - Niacin- reduces VLDL, LDL o Cutaneous flushing in the face and upper body have occurred - Fibric acids derivatives (gemfibrozil, fenofibrate) o ADR: rhabdomyolysis o Interactions: warfarin- increases its effects - Bile acid sequestrants (cholestyramine, colestipol) o Exchange chloride ions for negatively charged bile acids o s/s: GI including SEVERE constipation o interactions: warfarin- decrease its effect - HMG-CoA reductase inhibitors (statin) o Have anti-inflammatory properties o Warning about high glucose levels along with concentration and memory issues o ADR: rhabdomyolysis o Interactions: warfarin: increases its effects - EZETIMBE (ZETIA)- blocks absorption of cholesterol across intestinal border 9. Diuretics - Loop diuretics o Inhibit sodium reabsorption in loop of HENLE o Increase potassium excretion - Thiazide diuretics

o Act on the distal renal tubule to inhibit sodium reabsorption- effects longer lasting- less brisk diuresis o Increases potassium excretion - Potassium sparing diuretics- o aldosterone antagonist - Metabolism of diuretics o Liver - When GFR <30 o Replace loop diuretics with loop - What conditions would you cautiously prescribe diuretics - Gout, renal calculi, diabetes - Pregnancy o Spironolactone - Replace mg before potassium - Warfarin with diuretics o Loop & spironolactone- diminish effects of warfarin o Loop- increase effects of warfarin - Tx of HTN o Thiazide are best choice - Heart failure o Loop are best choice - When adding diuretics to regimen with existing htn meds reduce htn doses to prevent hypotension and orthostasis - When Ccr <25 loops are effective, thiazides aren’t as effective Chapter 20 Antacids - Aluminum based products o Inhibit smooth muscle contraction o Slow gastric emptying o Cause constipation o Increased use in renal failure results in worsened dialysis osteomalacia - Calcium based products o Use: deficiency related to post menopause states, and to bind phosphates in CRF o Cause excessive gas & constipation o Daily dose limit- 2,000mg - Magnesium based antacids o Use: tx deficiencies related to malnutrition, alcoholism, magnesium depleting drugs