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81 Cards in this Set
- Front
- Back
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At what TG level should you then order a direct LDL?
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TG > 400
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What are 6 secondary causes of hyperlipidemia?
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DM
Hypothyroidism Nephrotic syndrome Chronic renal failure obstructive liver disease Drugs |
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Any 3 of what 5 criteria make a diagnosis of metabolic syndrome?
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TG >150
HDL <40 in males <50 in females Hypertension Fasting Glucose >110 Waist size >40 in male >35 in females |
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What are 5 independent risk factors other than high LDL?
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Age and Gender: Males >45, Females >55
Hypertension Smoking HDL <40 1st Degree Family Hx: male <55, female <65 |
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What is the goal LDL in a pt with CHD?
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<100
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What are the 3 bile acid resins?
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cholestyramine
colestipol colesevelam |
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How do bile acid resins work?
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trap bile in intestine for excretion,
converts liver cholesterol into bile, up regulates LDL receptors |
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What hyperlipidemia drugs are best for pregos and children?
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bile acid resins
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What group of hyperlipidemia drugs may raise TG and should not be used if TG are > 300?
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bile acid resins
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How do statins work?
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inhibit HMG CoA reductase
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When are most statins active?
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2 am
give in evening or at bedtime |
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What are the drugs of choice for lowering LDL?
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statins
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What side effect is possible if a statin is given with a CYP3A4 inhibitor?
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myopathy
give statin at <25% max dose |
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Which hyperlipidemic drugs are contraindicated in liver disease and may raise LFTs?
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statins
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What drugs are cholesterol absorption inhibitors?
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zetia
vytorin |
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What are the drugs of choice for lowering TG?
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gemfibrozil
fenofibrate |
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What hyperlipidemia drugs may cause gallstones and myopathy?
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fibrates
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What is the drug of choice for elevating HDL?
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Niacin
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How does Niacin work?
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decreases hepatic TG synthesis,
enhances activity of lipoprotein lipase, enhances clearance of Apo-A-I, increases HDL |
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What drug may cause insulin resistance, hyperuricemia, and birth defects?
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niacin
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Statins may be given only at 25% of max dose with what other hyperlipidemia drug?
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Niacin
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What are the goal LDL, non-HDL, and TC/HDL in pts with CHD or CHD equivalents?
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LDL = <100
Non-HDL = <130 TC/HDL = <3.5 |
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Which hyperlipidemic drugs are cardioprotective and good for gallstones?
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statins
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What drugs are used 2nd line to lower LDL?
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resins
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How can a non-HDL goal be calculated?
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30 points higher than a LDL goal
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What are contraindications to fibrates?
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children,
prego, gallstones, haptic dysfunction, kidney failure |
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What are some drugs that interact with fibrates?
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statins,
oral anticoags, avandia rapaglinide |
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Niacin toxicity should be considered if LDL is reduced how much?
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> 50%
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How do thiazide diuretics work?
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work at distal convoluted tubule,
increased excretion of sodium and chloride |
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What are some side effects of thiazide diuretics?
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hypotension,
photosensitivity, electolyte abnormalities, hyperclycemia, hyperuricemia, headache |
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How do loop diuretics work?
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block absorption of Na and Cl in proximal and distal tubules and in loop of henle
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What are 3 loop diuretics?
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bumetanide
furosemide torsemide |
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What are side effects of loop diuretics?
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hyperuricemia
hypomagnesemia loss of appetite bladder spasm |
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How do K sparing diuretics work?
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blocks reabsorption of sodium at the DCT and collecting duct
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What are 2 K+ sparing diuretics?
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amiloride
triamterene |
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What are 3 contraindications of K+ sparing diuretics?
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therapy with potassium conserving agents/supplementation,
hyperkalemia impaired renal function |
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What medical tx is given to a pt with stage 1 HTN (140-160/90-100) and no compelling indications?
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Thiazide diuretic
Consider: AceI, CCB, ARB, or BB |
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What medical tx is given to a pt with stage 2 HTN (>160/>100) and no compelling indications?
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Thiazide diuretic
+ AceI, BB,CCB, or ARB |
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How do aldosterone antagonists work?
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reduce BP by blocking aldosterone receptors in the kidney, heart, blood vessels, and brain
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What are the 2 aldosterone antagonists?
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spironolactone
eplerenone |
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What is the most common side effect of aldosterone antagonists?
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headache
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Which beta blocker has both alpha and B effects?
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Labetalol
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How do ACEI work?
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vasodilate blood vessels and help prevent fluid retention, eases the workload of the heart
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What are the 7 ACEI?
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Catopril
Enalapril Lisinopril Quinapril Perindopril Ramipril Trandolapril |
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What is a serious side effect of ACEI?
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angioemema
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What is a very common side effect of ACEI?
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cough
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What are 5 ARBs?
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Candesartan
Irbesartan Losartan Telmisartan Valsartan |
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What are common side effects with ARBs?
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congestion
cough muscle aches back pain |
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Where do ARBs act?
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block binding of angiotensin II at the AT 1 receptor
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Besides HTN, ACEI are a first line treatment for what other condition?
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type 1 diabetic nephropathy and
non-diabetic nephropathy |
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Besides HTN, what conditions do ARBs treat?
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Proteinuria
type 2 diabetic nephropathy |
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How do calcium channel blockers work?
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inhibits calcium ions from entering voltage sensitive areas of vascular smooth muscle and myocardium during depolarization
produces coronary vasodilation |
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What are 5 CCB?
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Nonhidropyridines:
Diltiazem Verapamil Dihydropyridines: amlodipine felodipine nicardipine |
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What are the most common side effects of CCBs?
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flushing
loss of appetitie |
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What are 3 alpha blockers?
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doxazosin
prazosin terazosin |
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What are side effects of CCBs?
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swelling of hands/feet/ankles/lowerlegs
shortness of breath weight gain abnormal vision |
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What are 2 direct vasodilators?
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hydralazine
minoxidil |
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What are side effects of direct vasodilators?
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flushing
headache rash hirsutism chest pain |
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What drugs should be given with direct vasodilators to minimize reflex sympathetic stimulation?
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B-blockers
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What are 4 central acting alpha2 agonists?
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clonidine
methyldopa reserpine guanfacine |
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What are side effects with central actin alpha 2 agonists?
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tiredness
weakness headache |
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What occurs with non compliant patients who are taking central acting alpha 2 agonists?
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rebound hypertension
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How do central acting alpha 2 agonists work?
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decrease in peripheral vascular resistance
decrease in heart rate (2/2 increased vagal tone) |
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What is a B1 selective antagonist?
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nebivolol
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What are contraindications to B1 antagonists?
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bradycardia
cardiogenic shock 2nd and 3rd degree heart block severe hepatic impairment sick sinus syndrome |
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What is the name of a renin inhibitor?
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aliskiren
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What are side effects of aliskiren?
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increased creatine kinase levels
torsades de pointes acute renal failure (monitor diabetic pts) angioedema |
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What is contraindicated in taking aliskiren?
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pregnancy
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What HTN drug is best for a diabetic patient?
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ACEI
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What HTN drugs are best for a pt who had a previous MI?
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BB or ACEI
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What HTN drugs are best for a patient with heart failure?
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ACEI and BB
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What drugs are given IV for a pt with no concurrent diseases, but is having a hypertensive emergency?
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nitroprusside
fenodolpam nicardipine esmolol labetolol |
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What drugs are used IV for CHF patients with hypertensive emergency?
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nitroglycerin
enalaprilate hydralazine |
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What drugs can be given to MI pts with hypertensive emergency?
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Nitroglycerin
esmolol labetolol enalaprilate |
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What drugs can be given to aortic dissection pts with hypertensive emergency?
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esmolol
labetolol |
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What drugs can be given to post-op hypertension patients with a hypertensive emergency?
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esmolol
labetolol |
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What drugs can be given to pts with catecholamine excess with a hypertensive emergency?
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labetolol
esmolol phentolamine |
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What drugs should be avoided in renal pts with hypertensive emergency?
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enalaprilate
nitroprusside |
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How do you give drugs for hypertensive emergency to patients with cerebrovascular disease?
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titrate dose slowly to avoid excessive reduction of BP
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What drug can be given to an eclampsia patient with a hypertensive emergency?
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hydralazine
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How should you reduce BP in a hypertensive emergency?
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reduce BP by 25% immediately
further reduce to <160/100 within 2-6 hrs gradual lowering to <140/90 over a few days in pts with no other diseases |
