Beta Blockers, Corticosteroids, and Cholesterol

First line pharmacotherapeutic management of chronic hypertension

ACE-I, thiazide, and CCB

Second line pharmacotherapeutic management of chronic hypertension

Beta blockers

Used for resistant hypertension

Alpha-blockers

Beta 1 targets…

heart

Beta 2 targets…

lungs

Alpha receptors target…

Blood vessels (vasoconstriction)

Which medications are mixed α/β-blockers?

labetalol, carvedilol

Target for cardio-selective β-blockers

β1 more than β2

Non-cardio-selective β-blockers

propanolol, timolol, nadol, pindolol

-olol classification

β-blockers

MOA for Amiodarone

Class 3 antiarrhythmic

Indication for Amiodarone

used for ventricular arrhythmias

Black box warning for amiodarone (yikes)

hepatotoxicity, pulmonary toxicity, can worsen arrhythmias, do not use with life-threatening arrhythmias

Dronedarone vs Amiodarone

dronedarone- slightly newer and slightly better side effect profile

α-blockers

-(z)osin and -asteride

Indications in both -osins and -asterides

Benign prostatic hyperplasia (BPH)

-osin adverse drug reaction

Priapism

-asteride adverse drug reaction

pregnancy category XI

Corticosteroids

-sone, -olone, -betasol, -sonide, -solide

Hepatic gluconeogenesis and decrease in uptake of glucose in peripheral tissue —>

increase in glucose levels

Lipolysis —>

hypertriglyceridemia

Redistribution of body fat to upper trunk and face

moon face

Increase in gastric acid secretion and blood flow to gastric mucose

peptic ulceration

Increase in growth hormone secretion

increased growth

potentiation of carecholamines and increase in synthesis of epinephrine

increased HR and BP

modulation of bone cell function

osteoporosis and fractures

Glucocorticoid: influenced on brain excitability

influenced mood and behavior, including amnia and psychosis

Decreased eosinophils,monocytes, and basophils, death of B cells, inhibition of neutrophil recruitment

infection

Mineralocorticoids: increase in Na+ reabsorption

increased rater retention

Mineralocorticoids: increase in K+ and H+ renal excretion

hypokalemia and metabolic alkalosis

Tapering to prevent adrenal insufficiency

If starting at a high dose, >20 mg prednisone equivalents and prolonged duration of therapy >2 weeks

Short acting steroids

Hydrocortisone, cortisone acetate

Which steroid medication has equal glucocorticoid and mineralocorticoid potency?

cortisone acetate

Intermediate acting steroids

prednisone, methyl prednisone,fluctocortisone, triamcinolone

Which steroid is purely mineralocorticoid?

fluctocortisone

Long acting steroids

dexamethasone, betamethasone

Which steroids are purely glucocorticoid?

dexamethasone, betamethasone

-Statin MOA

inhibits HMG CoA Reductase, increases HDL, deceases LDL, TG

Adverse effects for -statin

arthralgia (joint pain) and myalgia (joint pain)

Which statins can be used for moderate intensity?

all of them

Which statins are NOT used for low intensity?

Atorvastatin, rosuvastatin, fluvastatin (XL)

WHich statins are high-intensity ONLY?

atorvastatin and rosuvastatin

What to monitor for -statins?

pregnancy category X

MOA for -choles

decreases LDL

Off label therapeutic uses for -choles

chronic diarrhea due to bile malabsorption

adverse effects for -choles

constipation

MOA for -fibrates

lowers LDL, VLDL, TG

increases HDL

MOA for -ocumab

decreases LDL significantly

-thiazides category

diueretics

-semide category

loop diuretics

Available thiazides on the market

chlorothiazide, hydrochlorothiazide, chlorthalidone, indapamide, metolazone

Adverse effect for both -thiazides and -semides

phtosensitivity

Where do -semides work?

ascending loop of henle

Available -semides on the market

furosemide, torsemide, bumetanide, ethacrynic acid

What are diuretics?

water pills, flush extra sodium and water out of your kidneys

K+ sparing diuretics

spironolactone, triamterene, eplerenone, emiloride