Pharmacology in class notes session: 2



Session 2:

This is a very dense set of notes and will take a while to get through. at the end there are some missing single drugs that I will add into flash cards or med cards. The main points of this lecture was diuretics, beta blockers, ace inhibitors, and digoxin.

appendix t of the davis drug guide KNOW these drugs for anaphylaxis



  • used for Hypertension


Guidelines for high BP

  • normal >120/80
  • Pre 120-139/80-89
  • Stage 1: 140-159/90-99
  • stage 2: >160/>100

who needs treatment?

  • can be younger people now due to obesity
  • black people and females


what reduces it?

  • exercise
  • stress relief
  • anti-anxiety and sedatives
  • weight loss, can be as little as 10 lbs


what causes it?

  • obesity
  • smoking
  • caffeine, OTC cold medications


Weight loss and diet are 10x as effective as drugs


there are specific recommendations for african americans

  • resistant to ACE inhibitors
  • sensitive to calcium channel blockers and diuretics



  • act on kidney nephron
  • effects calcium, glucose and uric acid
  • classes
    • proximal tubule diuretics
      • Diamox (acetazolamide) – used for altitude sickness
      • will increase Blood sugar levels in DM
    • Osmotic diuretics
      • Mannitol – big molecule that pulls water in and you pee it out.  
      • usually given IV in an emergent situation.
      • fluid shifting into blood stream
      • forms shards or crystals on the shelf, need to warm it up and use a filtered needle to use.
      • know the effect of the drug by measuring the output
    • Thiazides – hydrochlorothiazide (HCTZ)
      • inhibits Na and Cl reabsorption in early distal tubule
        • excrete water, Na, Cl, K, Mg
      • may increase Ca, Glu, and uric acid
      • inhibits release of insulin
      • moderate urine output
      • side effects
        • hyponatremia and hypovolemia
      • not for pregnant women or unstable diabetes
      • supplement with K in the diet
    • Loop diuretics
      • very common
      • Furosemidie (lasix)
        • inhibit- reabsorption of Na and chloride in the loop of Henley
        • similar to thiazides but more powerful
        • drug interactions
          • Digoxin, lithium
          • NSAIDS
        • OD: hypovolemia, electrolyte imbalances
        • Education: orthostatic hypotension, sun shine, need K foods,
        • sulfa allergies
  • K sparing diuretics
    • spironolactone (aldactone)
      • block action of aldosterone in distal tubule
      • excretes water and NA
      • can be used with a thiazide
      • when combined with ace inhibitors K levels can get too high

Ways that the heart is controlled.

Inotropic – increases force of contraction

chronotropic – increase heart rate

dromotropic – increase conduction velocity


receptor review

  • beta 1: heart stimulation = increase heart rate
  • beta 2: lungs stimulation = dilation


beta blockers

  • B2 broncho constriction (selective)
    • Pts with asthma, CHF, emphysema at risk
    • not the best for these people
  • both selective and nonselective drop all the “-tropic” traits of the heart lowering BP


  • Non-selective – decrease Cardiac contractility, drops bp and renin release
    • HTN, tachycardia, and angina
  • Some are more lipid soluble and more water soluble
  • Education – don’t change the regimen
    • OTC cold meds with pseudoephedrine/ phenyleprine
    • HR <45 don’t give
    • orthostatic hypotension
  • don’t stop the regime or the opposite effects happen, HTN, rapid HR

calcium channel blocker

  • verapamil
    • decrease force of contraction
    • decreases automaticity of SA node
    • edema
  • indications – HTN: african descent responds well.
    • angina
  • Education
    • do not chew or crush for timed release or sustained released
    • check HR before dose

ACE inhibitors

captopril (Capoten)

  • indications
    • CHF
    • DM
      • for renal protection
  • SE: dry cough, HyperK
    • angioedema
  • NSAIDS antagonize effects
  • Education: category X do not use in pregnancy
    • No K supplements
    • do not use in renal artery stenosis

Angiotensin II receptor blocker

  • Losartan (Cozaar)
    • Actions – more specific than ACE


Direct Renin inhibitors

  • Aliskiren (tekturna)


some drugs are combined

  • -zide: HTN and diuretic
  • not splittable


Nipride – can become cyanide when exposed to light


pulmonary HTN – Macitentan,  not curable Dx


cardiac glycosides

  • Digitalis from foxglove
  • narrow TP range
    • toxicity is life threatening


    • digoxin – positive inotropic, negative chronotrope, neg dromotrope
      • increased cardiac contractility
      • decreased conduction
      • indications: CHF, AFIB
      • use loading doses
      • SE: bradycardia, av block, anorexia, vision issues, green- yellow tint, halo around lights, gynecomastia with long term use.


  • apical pulse for 1 full min


    • changes in K can cause toxicity in Digoxin
      • most common cause of OD HypoK
    • Immune Fab (digibind) binds digoxin and excretes it from the kidney


need to know SE, Education, Indications, Contraindications (safety to us and pt), system affected and downstream, she does not test normal therapeutic dose.



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