Antihypertensives
What are the classes of drugs that treat hypertension?
1. ACEi/ARB
2. Diuretics
3. Sympatholytics (beta blockers, alpha-2 agonist)
4. Direct vasodilators (hydralazine and the CCBs)
Which adrenergic drug is used for decompensated heart failure?
Which one is used for compensated heart failure?
1. Dobutamine (can also use digoxin but that's not an adrenergic)
2. Carvedilol is the most common adrenergic drug to treat chronic (non-emergent) heart failure
Which two classes of diuretics are used to treat edema associated with heart failure?
Bonus question: which one is stronger?
Thiazides and loops! They improve symptoms but not mortality :(
Loop diuretics are considered to be stronger than thiazides
Bonus points if you can name the subclasses of class 1 :)
1. Sodium channel blockers
2. Beta blockers
3. Potassium channel blockers
4. Calcium channel blockers
What are the 6 main classes of drugs used to treat hyperlipidemia?
1. Statins (HMG Co-Reductase inhibitors)
2. Cholesterol absorption inhibitors
3. Bile acid sequestrants
4. Niacin
5. Fibric acid derivatives
6. Omega-3 fatty acids
What effects does angiotensin II have on the body?
1. increases blood volume (increased thirst, ADH, aldosterone, and direct sodium retention)
2. vasoconstriction
3. cardiac remodeling/hypertrophy
A combo of what 4 meds can be given to people with HF_EF?
What med is used to treat the other form of heart failure?
HFrEF: ARNI, beta blocker (carvedilol), spironolactone, SGLT2 (please help me understand what this does)
HFpEF: just SGLT2 (something with it acting like a diuretic???)
What are the major side effects of thiazides, loops, and potassium sparing drugs?
(PS sorry I know this question sucks but I'm trying to kill 3 birds (we may be the birds being killed) with one stone (pharm question) #mybraincannotretainanythingelse)
Thiazides: hypokalemia, hypercalcemia, uric acid(???)
Loops: hypokalemia, hyponatremia
Potassium sparing: hyperkalemia
Name each step in this diagram and net ion movement at each step (its making me pay to upload it so I'll just pull it up on my computer lol)
0. Resting membrane potential (which is negative)
1. Depolarization (sodium moves into the cell)
2. SLIGHT repolarization (potassium starts to move out of the cell)
3. Plateau (calcium starts moving into the cell as potassium flows out so they cancel each other out)(cell contracts here)
4. Repolarization (return to resting membrane potential as potassium flows out of the cell)
0. Remember we typically want sodium outside and potassium inside but right now its backwards! So the cell uses sodium potassium pumps to restore the proper ion placement to be able to send more signals
1. Gemfibrozil
2. Fenofibrate
3. Niacin
4. Omega-3 fatty acids
What is the best blood pressure med for someone under 55 and not of African or Caribbean descent?
What about someone over the age of 55 or of African/Caribbean descent?
ACEi/ARB
DHP CCB (amlodipine or nifedipine or hydrochlorothiazide???)
Which medications can be used to improve mortality in moderate heart failure patients? Severe?
Moderate: ACEi/ARB (prevents cardiac remodeling), carvedilol (antioxidant properties and decreases workload on the heart), SGLT2 (SERIOUSLY WHAT DOES THIS DO???)
Severe: spironolactone (maybe cause it's anti-androgenic? men are always the problem so)
What is the only diuretic we learned that is used to directly treat heart failure and not just reduce symptoms?
Which two classes of antiarrhythmics are used to slow stimulation of the SA node (delay phase 4 repolarization) and decrease conduction of signals to the AV node (increase the PR interval)?
**I have a drug list question for y'all about this**
Class 2 (beta blockers) and Class 4 (non-DHP CCBs)
In class 4, increase the PR interval (slowing AV conduction) is the primary effect
Which drugs can increase HDL levels in the blood?
Fibric acids! (Gemfibrozil and fenofibrate)
Update: And niacin apparently!
When would you want to give an ACEi/ARB as a first line treatment for hypertension? (Ignoring the fact that he said that's always first line except if your over 55 or A/C descent)
When you need renal protection (kidney disease or diabetes) or heart protection (systolic heart failure -> want to prevent remodeling via reducing angiotensin II)
What medication combo has been seen to be more beneficial for black heart failure patients?
Hydralazine (dilate your arteries) + nitrates (dilate your veins)
How do we treat angina (___ supply, ___ demand) and what drugs (broadly) do we use to do this?
INCREASE supply, DECREASE demand
We can use beta blockers, CCBs, and nitrates to do both of these things!
What are the 4 main classes of treatments for a-fib and when are they used?
1. Cardioversion (only used for emergent cases)
2. Catheter ablation (acute a-fib when you're young or if you're older and already tried meds)
3. Rate control (preferred for older patients because it's safer but it won't fix the underlying issue)
4. Rhythm control (preferred for younger patients who do not want surgery because it fixes the underlying problem)
Which class of hyperlipidemic drugs agonises the PPAR-alpha receptor in the liver?
Bonus: what does this cause?
Fibric acids!
This causes decreased production of VLDL and more importantly increased lipolysis so triglycerides get broken down into fatty acids
When would you prescribe a combination drug for hypertension?
When their blood pressure is 20/10 mmHg over their goal...use a combo of ACEi/ARB, thiazide, and DHP CCB
Why do we need to give an ARB specifically with Sacubitril?
Sacubitril is a neprilysin inhibitor that stops the breakdown of ANP so pts pee more! (reduce blood volume, reduce preload)
Neprilysin inhibitors also cause an increase in angiotensin II, so we need to block receptors in order to avoid the negative effects of angiotensin II on heart failure
What are allllll the uses of metoprolol (that we have learned about)?
(sorry it's not a diuretic or an angina question, I'm really throwing caution to the wind with the categories)
Indication: hypertension, angina, acute MI, treats supraventricular arrhythmias, prevents ventricular arrhythmia post MI or in heart failure
(Literally does everything except make you pee more or lower your cholesterol)
What is the one antiarrhythmic that doesn't fit into the 4 classes?
Digoxin! It increases contractility while decreasing the heart rate so it's a rate control drug.
However, it can have a lot of toxicities and drug interactions so idk why you wouldn't just use metoprolol but whatever
What are some of the positive and negative side effects of statins?
Negative: myopathy, rhabdomyolysis, liver dysfunction, broken down by CYP system so CYP inhibitors increase statin concentration in the blood)
Positive: endothelial function, anti-thrombotic, anti-inflammatory, immunomodulatory, anti-oxidant, vascular cytoprotective, angiogenesis, plaque stability