Pharmacology in class notes session: 2

Pharmacology

 

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

 

Antihypertensives

  • 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

 

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.

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s