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Thiazides (like Hydrocholorthiazide) are BEST at preventing complications of HTN and treat Stage ONE HTN. How do they work?
- They reduce blood volume and arterial resistance.
- Inhibit distal tubule Na and Cl re-absorption (causing excretion of Water and solutes)
TRUE or FALSE
Diuretics that act EARLY in the nephron promote the GREATEST diuresis
If the GFR is <15-20ml/min should you use a Thiazide?
NO, must have adequate GFR to work!
What are some SE of Thiazides?
- Retention of Uric Acid=gout
- Inc. LDL & Triglycerides=bad!
- Dec. Mg
- Hypotension (worked too well)
- Electrolyte disturbances (esp. low K)
When should High Ceiling Loop Diuretics be used?
Situations in which rapid or massive mobilizations of fluids is required or if renal impairment (will work even if low GFR!)
What happens if the patient takes an NSAID or ASA with their loop diuretic?
- Causes diuretic to not work as well.
- Inhibits prostaglandin synthesis in kidneys (inhibits renal blood flow)
TRUE or FALSE
ACE inhibitors work well for African American patients
FALSE! They are good for young white DM or MI patients
The patient gets Angioedema from taking an ACE inhibitor. Why did this happen and how is it treated?
It's rapid swelling of the dermis, subQ tissue, mucosa, and submucossal tissues. Related to bradykinin accumulation and increased capillary permeability. Treat w/EPI
What are two other major side effects of ACE inhibitors (besides angioedema)
- Hyperkalemia and Renal impairment/failure
- Monitor BUN/Cr prior to tx and 2weeks after intiation. DC if K+ is high.
TRUE or FALSE
ACE inhibitors (-pril) have synergistic effects with other anti-hypertensive agents
Is it ok for Molly to try and get pregnant while taking an ACE inhibitor?
TRUE or FALSE
ACE-I can produce a serious 1st dose reaction
Start low and gooooooo sloooowwww
Why should Diabetic Roger use caution when taking a betablocker?
- Because Betablockers can make the symptoms of low blood sugar. They can also cause insulin secretion...
- Roger should immediately check BS if he has diaphoresis.
Why shouldn't high cholesterol patient (Jimbo) be on a betablocker?
- It's bad for patients with high cholesterol.
- Can cause dyslipidemia and gluconeogenesis.
Marsha has asthma. Should she take a beta blocker?
It's contraindicated because even Beta1 selective agents can cause bronchospasm but low doses of Atenolol or Metoprolol may be ok....
Roger (diabetic)has a cold. What happens if she takes cold medicine w/his betablocker?
Could worse low BS and decrease HR
How do you taper a dose of Betablocker?
Taper dose in half q4days
Ca Channel blocker Verapamil treats ____ or ___ HTN.
Primary or essential. They have the strongest negative inotropic effect in this class.
When should you avoid using Ca Channel blocker Verapamil?
Avoid in CHF or sick sinus syndrome
What are two major drug interactions with Ca Channel blocker Verapamil?
Beta blockers and Digoxin
Why should you educate your patient to hydrate while on Verapamil?
They could get constipation. Other SE include Dizziness, HA, facial flushing, & peripheral edema.
MAJOR side effects of Ca Channel Blockers?
CHF, AV block, & Bradycardia
Verapamil and Diltiazem act on _____ ____ and the ____.
- smooth muscle and heart.
- They cause peripheral arterial dilation which decreases arterial pressure and increases coronary perfusion.
TRUE or FALSE
Black patients respond better to Ca Channel blockers
Ca Channel blockers block the normal process of heart muscle stimulation, what is that process?
*Doubt Nancy would ask but just in case...*
Normal=norepi-stimulates heart, B1 activation, G protein from GDP to GTP, ATP converts to CAMP. CAMP activates protein kinase, ETC started=chance in Ca Channel & Ca enters cell.
Ca Channel directly effects..
- blocks Ca at the:
- SA node
- AV node
- (indirectly at baroreceptors)
How does Heparin work?
- It enhances anti-thrombin
- Activates clotting factors (thrombin and 10a)
What is the anti-dote to Heparin?
Can you give Heparin PO?
No silly! Only SQ or IV
Is it ok to give Heparin to a pregnant patient?
Yes, can also give for DIC, PE, DVT, heart surgery, & dialysis.
What is an adverse effect of Heparin? Hint, three letters..
- HIT (Heparin Induced Thrombocytopenia)
- Reduced plt count, increase in thrombolytic events
- STOP Heparin
Why does heparin have risk of hypersensitivity reactions?
Because it comes from animal tissues (Bovine lungs?) so you can get s/s of anaphylaxis
Can you use Heparin for a patient having surgery on the eyes, brain, or spinal cord?
What lab level do you monitor for therapeutic Heparin?
- PTT Q4-6hrs during initial phase.
- Normal =40. Therapeutic 60-80.
Why should a patient be on Warfarin?
- Long term prophylaxis of thrombosis.
- Prosthetic heart valves
- TIA or MI
Does warfarin work quickly or slowly?
Has delayed onset. Peak effect takes several days, but it has long half life, so it's effective 2 days after DC
What is the antidote to warfarin?
- Vitamin K!
- (Warfarin inhibits enzymes needed to activate Vitamin K...)
Warfarin blocks the biosynthesis of factors __, ___, ___, and prothrombin.
VII, IX, X
What lab value do you use to monitor Warfarin's effectiveness?
- Prothrombin Time (PT)
- Qd x 5days, then 2x/week for 1-2weeks, then 1x/week for 1M, then q2-4weeks
- INR goal of 2-3
What can happen is someone takes Warfarin during pregnancy?
- Fetal hemorrhage and teratogensis.
- Do not use during pregnancy or breastfeeding.
- Stop several days pre-op but ok for dentist.
A lot of drugs can increase anticoagulant effects of Warfarin. Name some
- Drugs that promote bleeding
- ...so Dose Warfarin to goal INR
Some drugs can decrease anticoagulant effects of Warfarin. Name two
Aspirin is an ant-platelet drug. How does it work?
- It has irreversible inhibition of cyclooxygenase (an enzyme required in thromboxin formation)
- Works on smooth muscle to promote vasoconstriction
- Both actions promote hemeostasis
When is ASA used?
- Ischemic stroke, TIA
- Chronic stable angina, unstable angina
- Coronary stenting
- Acute MI, Previous MI
- Primary prevention of MI