Renal
Goal of all diuretics
MOA Diuretics
Goal: decrease ECF and PVR
Loop: Inhibit NA reabsorption in thick ascending loop of Henle
Thiazide: Inhibit NA reabsorption of NA ad distal renal tubule
Ald Antagonist: inhibit K excretion distally
Osmotic: limits reabsorption of water in tubule
4 things electrolytes affect
& Normal water needed/day
Muscle, neuro, water balance, bone formation
Water: 70-80oz
MOA of Typical vs atypical antipsychotics
Typical (1 Gen) Antagonize Dopamine receptors
Atypical (2 GEN) Antagonize dopamine and serotonin receptors
Screening tools for anxiety, depression, and ADHD
Antiety GAD 7
Depression: PHQ 9
ADHD: Kids Vanderbilt, adults DIVA, WHO ADHD self-report scale
HTN treatment, classes, and MOA
Lifestyle: wt loss, DASH, limit ETOH, Exercise
CCB: vasodilate (T1 rate control as well)
ACEI: decrease A2 and ALD lowers vascular resistance w/o decreasing CO or GFR
BB: beta antagonist
Periph vasodilators: relax/dilate SM leading to decreased PVR
Thiazides decrease ECF
ADR's of all diuretics
Hypotension, decreased GFR, electrolyte abnormalities, Metabolic alkalosis, hyponatremia
Hypokalemia
Normal range, causes, treatment
3.5-5
Cause: K-wasting diuretics, GI loss, excessive musc activity
Tx: mild K rich foods
severe IV (cardiac SE, needs acute care)
MOA of Antidepressants: TCA, MAOI, SSRI, SNRI
Tricyclic: prevent reuptake of Norepi and Serotinin from presynaptic nerve
MAOI: Block breakdown of MAO -> decreased distruction norepi, dopamine, and seratonin in the brain
SSRI: Prevents reuptake of serotonin at presynaptic terminals
SNRI Prevents reuptake of Norepi and Serotonin at PSC
MOA and ADRs of Buspirone and GABAergics
Buspirone: unknown, serotonin full agonist pre and partial agonist post
Benzo: gaba agonist
Buspirone: Contraindicated Renal/Hepatic
Dizziness, decreased risk of SE or dependance but takes 3-4 weeks to work
Benzo: Contraindicated Pregnancy, lactation, <6, hepatic or renal desease, glaucoma
Abuse/WD
Classes for Dysrhythmias, monitoring, and pt education
1: Na channel blockers, 2: BB, 3: K channel blocker, 4: CCB
Monitoring parameters: check UN, CR, drug levels, EKG
ED: take as prescribed, don't double, monitor HR, monitor BP
Precautions for all diuretics
hx gout or renal calculi, caution in diabetics, older adults risk for hypotension, must evaluate tinnitis
Hyperkalemia Treatment
>5, needs acute care usually
Mild: restrics K rich foods, decrease or replace K sparing diuretics
Severe: IV Lasix, Insulin/D50, Ca for cardiac protection, HCO3 if acidic, Kayexalate
MOA and ADR's of atypical antidepressants
Bupropion: inhibits presynaptic reuptake of dopamine and norepi
ADR: lowers SZ threshold
Mirtazapine: antagonizes presynaptic @a2 and postsynaptic serotonin receptors. High affinity for H1
ADR: sedation, weight gain
Things to know about Alzheimer's and Parkinsons meds
Restore dopamine block ach
Caution: cardiac or psych hx, ulcer disease. Monitor LFT, ADR N/V, hallucinations, dizziness, DD interactions, ortho hypo
Alzheimers:
Cholinesterase inhibitors: indirect acting parasympathomimetic
Namenda: Decrease glutamate
Symptom management: SSRI, Atypica APS, Anxiolytics
Nitrates indications and contraindications
Angina...
Low dialed veins decrease Preload
High dose: Decrease afterload
LA: use if pt can't take BB
Contraindicated: glaucoma, head trauma, cerebral hemorrhage, volume depletion, prego
Monitoring and Patient Education
Monitor: BP, HR, Edema, Wt gain, dyspnea, cough, urine output
Educate: Take early, don't skip/double dose (take the next day if you accidentally skipped), monitor weight, drink fluids
Hypernatremia
Symptoms and treatment
NA >145
Fatigue, weak, musc twitch, convulsions, AMS, decreased LOC, similar to hyponatremia
Mild: low NA diet/drink water
Severe: diuretics or IV D5
ADR of TCA, MAOI, SSRI, SNRI
TCA: histamine and ACH action, Ortho hypo, Cardiac events, death via OD
MAOI: HTN crisis, serotonin synd (SS), ortho hypo (not often used)
SSRI: GI, sexual dysfunction, SS, most used**
SNRI: DD HTN, GI, HA, Insomnia, Sexual SE
Lithium
Mood Stabilizer, Therapeutic level: 0.6-1.5, may take 2 weeks for it to work, blood check Q3-6 mo.
Baseline labs: renal, cardiac, thyroid, electrolytes
Tox: N/V, ataxia, SS, tremor, tinnitus, blurred vision
>2.5 can have SZ, coma, death Tx: Dialysis
DD interactions: flagyl Increases Tox, anticonvulsants increase tox risk of both, diuretics risky
Other drugs for angina and their MOA
BB, CCB, ACEi, ASA, Statins
BB recommended initial therapy for all
CCB initial choice for coronary artery vasospasm associated angina
ACEI: recommended for all w/ stable angina (decrease risk of MI and death and symptoms)
7.35-7.45
Buffer, Resp, Kidney
Hyponatremia
Main S/S, normal range, and treatment
135-145
Early: n/v, abd cramping, loss of appetite
Late: confusion, not themselves
Tx: Na tablets
IV (if hypotensive or N/V)
Main ADR's & Precautions of antipsychotic's
1 Gen: EPS, Tardive dyskinesia,
Contraindicated: glaucoma, BM depression, severe liver or cardiac disease
2 Gen: Weight gain -> metabolic syndrome, clonazapine fatal agranulocytosis
Contraindicated: Hepatic or renal disease
All APS: BBW for increased mortality in elders
Serotonin syndrome S/S and Tx
SS: HARMFUL
Tx: stop the med, supportive measures
Drugs for HF
(stages A-D)
A: lifestyle MOD, ACE for diabetics (arbs if can't do ACE)
B: ACE or ARB, +BB
C: ACE, BB, Diuretic (spirinolactone), DIG
D: All the things.... plus, transplant, LVAD, hospice...