Cardiovascular Pt 2
Statins and Ezetimibe inhibit cholesterol production/absorption in what organs?
Statins = production in the Liver
Ezetimibe = absorption in the small intestines
True or False: Insulin is used to treat all patients with T1DM and T2DM
True
How do PPIs work? List some examples of PPIs.
These drugs work by inhibiting the proton pump in parietal cells of the stomach, which produce stomach acid. They can prevent stomach ulcers from occurring.
Ex: Omeprazole, Pantoprazole, Esomeprazole
Which drug is commonly used to treat Hyperthyroidism, and which drug is indicated for those who are pregnant?
Hyperthyroidism = Methimazole
Indicated for pregnancy w/ Hyperthyroidism = Propylthiouracil
Which drug class has a cross allergy with PCN?
Cephalosporins
1. Diuretics - used to reduce volume overload and lessen the workload of the heart
2. RAAS inhibitors - reduce afterload dilating arteries making it easier for the heart to pump, reduce preload by inhibiting sodium and water reabsorption causing less volume, and improve ventricular remodeling preventing hypertrophy.
3. Beta Blockers - improve CO by reducing sympathetic stimulation = slowed HR to allow for more adequate filling
4. SGLT-2 Inhibitors - cardio renal benefits are not completely clear, but research has shown positive outcomes in HF. They work by increasing the amount of glucose in the urine to extract it from the body.
When mixing fast-acting and long-acting insulins how should they be drawn up?
Draw up clear before cloudy to prevent contaminating a short-acting insulin with a long-acting insulin
How do H2 blockers work? List some examples of H2 blockers.
These medications inhibit histamine receptors in parietal cells in the stomach that encourage gastric acid production because they are antisecretory agents = they turn down the production of acid.
Ex: Famotidine, Cimetidine
In emergent situations like Myxedema Coma, which drug is used via IV to treat this condition?
IV Levothyroxine (Synthroid)
True or False: Tetracyclines are safe to use during pregnancy?
FALSE! Tetracyclines cause fetal harm and should not be used in those breast feeding.
MOA of Catecholamines and examples used for HF
MOA: Stimulates beta 1 receptors to increase cardiac contractility and rate.
Result: Improves cardiac output, which, in turn, improves perfusion to the kidneys and improves kidney function.
Ex: Dopamine, Dobutamine
What oral non-insulin agent is the first line of treatment for DM, has no risk for hypoglycemia, and the patient can eat at irregular intervals?
METFORMIN
Which H2 Blocker inhibits CYP450 enzymes and can cause drug toxicities with Warfarin and Phenytoin and also causes decreased libido and gynecomastia in men?
Cimetidine
When taking Bisphosphonate to treat osteoporosis, how should this drug be administered?
1. Before drinking/eating anything in the morning
2. With a full glass of water
3. Remain sitting straight or standing upright for at least 30 minutes
Which drugs inhibits bacterial cell wall synthesis and is a common treatment for strep throat, otitis media, and cellulitis?
Penicillin Family
Amiodarone a potassium channel blocker is indicated for what serious condition? What food should be avoided because it inhibits the metabolism of this drug?
Used for serious atrial and ventricular dysrhythmia.
AVOID grapefruit and grapefruit juice
Which patients should avoid Metformin?
1. Patients with renal impairment
2. Patients should hold their Metformin 48 hours prior to procedures with contrast dyes
What classification is the drug Sucralfate and what is it's MOA?
What condition is it indicated in because it promotes healing?
Sucralfate is a mucosal protectant that form a gel-like substance.
It is indicated in the treatment of stomach ulcers because the gel substance covers and protects ulcers which promotes healing.
What regimen of medications is used to treat RA?
1. NSAIDS
2. Glucocorticoids
3. DMARDS
Which drug is used to treat C. Diff, MRSA, other Gram+ bacteria and can cause ototoxicity, nephrotoxicity, with a risk for red man syndrome?
Vancomycin
Digoxin and what electrolyte have a toxicity risk and can also alter the therapeutic effects of Digoxin?
POTASSIUM
High Potassium: Decreases Digoxin binding, leading to a lower therapeutic effect.
Low Potassium: Increases Digoxin binding, which can produce Digoxin toxicity.
Which DM agent has a diminished effect when combined with Beta Blockers?
Sulfonylureas (Glipizide, Glimepiride)
1. How do antacids work?
2. What is a concerns for taking antacids with other meds and a concern for those with HF?
1. They neutralize already existing stomach acids
2. Antacids reduce stomach acid pH, which can block the absorption of some meds. Antacids also contain a lot of sodium causing water retention and for the heart to work harder.
Prevention: Allopurinol, Febuxostat, Probenecid
Treatment: NSAIDS, Colchicine, Prednisone
What are common uses for Fluoroquinolones?
1. Complex respiratory tract infections
2. UTIs
3. Anthrax Exposure
4. Skin/bone infections
5. GI tract infection