pharm lipids + hypertension

CK tests for…

myopathy (rhabdomyolysis in severe/rare cases)

bempedoic acid (nexletol)

• added to statin in adults w increased LDL

• avail alone or in combination with ezetimibe

• lowers LDL about 15%

• decrease cardiovascular M&M

bempedoic acid (nexletol) MOA

inhibits an enzyme involved in hepatic cholesterol synthesis → cause up-regulation of LDL receptors

bempedoic acid (nexletol) adrs

• upper respiratory tract infection

• muscle spasms, back pain, extremity pain

• abdominal pain

• anemia

• increases uric acid levels → gout

• tendon rupture

3 bile acid resins (BARs)

• cholestyramine (questran)

• colestipol (colestid)

• colesevelam (welchol)

bile acid resins MOA

• bile acids used to solubilize fats for absorption → reused

• BARs bind to stop reuse

• liver use serum LDLs to make more cholesterol → lowers LDLs

bile acid resins ADRs

• gastrointestinal

  • constipation, bloating, epigastric fullness, nausea, and flatulence

  • only constipation is treatable

  • start w small dose and titrate as tolerated

  • 40% discontinue within a year due to GI ADRs

3 bile acid resins dosage forms

• powder → for suspension

• chewable bars

• tablets

bile acid resins warnings

• drug interaction

• fat soluble vitamins

  • DAKE

  • take >= 4 hours after BARs

2 drugs for lowering triglycerides

• fibric acids

• omega-3 fatty acids

2 fibric acid drugs

• gemfibrozil (lopid)

• fenofibrate (tricor)

gemfibrozil (lopid)

fibric acids

fenofibrate (tricor)

fibric acids

firbric acids MOA

• increase activity of lipoprotein lapase

  • increase breakdown of VLDLs and chylomicrons

• primary activity → lower triglyerides

fibric acids ADRs

• dyspepsia

• abdominal pain

• myopathy

  • avoid concurrent use with statins

  • more common in pts w concurrent renal insufficiency

3 omega-3 polyunsaturated fatty acids

• lovaza

• vascepa

• epanova

lovaza

omega-3 fatty acids

vascepa

omega-3 fatty acids

epanova

omega-3 fatty acids

omega-3 fatty acids use

reduce triglycerides in pts with severe hypertriglyceridemia

omega-3 adverse effects

• inhibit platelet aggregation and bleeding

  • extra caution in pts taking anticoagulants/antiplatelets

• atrial fibrillation

• muscle pain, edema, constipation

omega-3 fatty acids must be swallowed…

whole capsule

1 in … adult americans have …

3; hypertension

natural course of hypertension

• stroke

• coronary heart disease

• retinopathy

• nephropathy

normal blood pressure classification

<120 systolic and <80 diastolic

elevated blood pressure classification

120-129 systolic and <80 diastolic

htn stage 1 blood pressure classification

130-139 OR 80-89 diastolic

htn stage 2 blood pressure classification

>= 140 systolic OR >= 90 diastolic

what happens if blood pressure systolic and diastolic differs

pick highest risk

lifestyle modifications for HTN

• weight reduction

• alcohol intake

• physical activity

• limit dietary sodium

2 qualifications of first line agents for HTN

• continuous use shows decrease in M&M

• tolerable side effects

which 3 thyazide diuretics are antihypertensive agents

• hydroclorothiazide (hydrodiuril)

• chlorthalidone (hygroton)

• metolazone (zaroxolyn)

thiazide diuretics HTN MOA

• initially lower BP through diuresis

• chronically decrease peripheral vascular resistance

t/f: thiazide diuretics are often used in combincation with other anti-hypertensive drugs

true

thiazide diuretics for HTN ADRs

• nausea/diarrhea

• erectile dysfunction

• sun sensitivity

• metabolic

  • hypokalemia

  • hyperglycemia

  • hyperlipidemia

thiazide diuretics for HTN caution in

• pregnant women

• diabetes

• gout

• renal failure

thiazide diuretics for HTN contraindications

anuria

renin-angiotensin-aldosterone system (RAAS)

• angiotensinogen

• renin (kidney hypo-perfusion → cause BP to increase)

• angiotensin I

• ACE

• angiotensin II

  • aldosterone release → sodium and water retention

  • vasoconstriction

  • activate SNS

angiotensin converting enzyme (ACE) inhibitors ends in…

-pril

10 angiotensin converting enzyme (ACE) inhibitors

• benazepril (lotensin)

• captopril (capoten)

• enalapril (vasotec)

• fosinopril (monopril)

• lisinopril (prinivil)

• moexipril (univasc)

• peindopril (aceon)

• quinapril (accupril)

• ramapril (altace)

• trandolarpril (mavik)

benazepril (lotensin)

ace inhibitors

captopril (capoten)

ace inhibitors

enalapril (vasotec)

ace inhibitors

fosinopril (monopril)

ace inhibitors

lisinopril (prinivil)

ace inhibitors

moexipril (univasc)

ace inhibitors

perindopril (aceon)

ace inhibitors

quinapril (accupril)

ace inhibitors

ramapril (altace)

ace inhibitors

trandolapril (mavik)

ace inhibitors

ace inhibitors MOA

• blocks conversion of ANG I to ANG II

  • ANG II = potent vasoconstrictor

  • decrease aldosteron secretion

• blocks degradation of bradykinin (natural vasodilators)

first line agents of HTN

• thiazide diuretics

• ACE inhibitors

• ARBs

• calcium channel blockers

ace inhibitors specific advantages

• heart failure

• chronic kidney disease

ace inhibitors ADRs

• hyperkalemia

• acute kidney failure

  • stop/decrease if serum creatinine > 35%

• angioedema

• persistent, dry cough in 20%

• orthostatic hypotension

• contraindicated in pregnancy

7 angiotensin II receptor blockers (ARBs)

• candesartan (atacand)

• eprosartan (teveten)

• irbesartan (avapro)

• losartan (cozaar)

• olmesartan (benicar)

• telmisartan (micardis)

• valsartan (diovan)

ARBs ends in…

-sartan

candesartan (atacand)

ARBs

eprosartan (teveten)

ARBs

irbesartan (avapro)

ARBs

losartan (cozaar)

ARBs

olmesartan (benicar)

ARBs

telmisartan (micardis)

ARBs

valsartan (diovan)

ARBs

arbs MOA

• angiotensin II receptor antagonist

  • RAAS sources

  • tissue sources

• DO NOT affect bradykinin levels → no coughs

• ADRs similar to ACE inhibitors

  • less angioedema (maybe none)

6 calcium channel blockers (dihydropyridine)

• amlodipine (norvasc)

• felodipine (plendil)

• isradipine (dynacirc)

• nicardipine (cardene)

• nifedipine (adalat, procardia)

• nisoldipine (sular)

calcium channel blockers dihydropyridine ends in…

dipine

2 calcium channel blockers (non-dihydropyridine)

• diltiazem (cardizem)

• verapamil (calan)

amlodipine (norvasc)

calcium channel blockers (dihydropyridine)

felodipine (plendil)

calcium channel blockers (dihydropyridine)

isradipine (dynacirc)

calcium channel blockers (dihydropyridine)

nicardipine (cardene)

calcium channel blockers (dihydropyridine)

nifedipine (adlat, procardia)

calcium channel blockers (dihydropyridine)

nisoldipine (sular)

calcium channel blockers (dihydropyridine)

diltiazem (cardizem)

calcium channel blockers (non-dihydropyridine)

verapamil (calan)

calcium channel blockers (non-dihydropyridine)

calcium channel blockers MOA

• blocks influx of calcium across cell membrane

  • → cornary and peripheral vasodilation

• both type have = effective for HTN

• have negative inotropic effects

  • less force/energy of heart muscles’ contractions

dihydropyridine CCBs ADRs

• dizziness

• flushing

• headache

• peripheral edema

non-dihydropyridine CCBs ADRs

• anorexia and nausea

• peripheral edema (less than DHP CCBs)

• constipation (verapamil)

alternative agents for HTN

• direct renin inhibitors

• beta blockers

• alpha blockers

• central alpha agonists

1 direct renin inhibitors

aliskiren (tekturna)

aliskiren (tekturna)

direct renin inhibitors

direct renin inhibitors MOA

blocks renin’s activity to convert angiotensinogen to angiotensin I

direct renin inhibitors ADRs

similar to ACE inhibitors

• pregnancy warning

• ADRs

  • orthostasis

  • angioedema

5 beta-blockers (cardioselective)

• atenolol (tenormin)

• betaxolol (kerlone)

• bisoprolol (zebeta)

• metoprolol (lopressor, toprol XL)

• vebivolol (bystolic)

5 beta-blockers (non-selective)

• carvedilol (coreg)

• labetalol (normodyne, trandate)

• nadolol (corgard)

• propanolol (inderal)

• timolol (blocadren)

most beta-blockers ends in…

-olol

atenolol (tenormin)

beta-blockers (cardioselective)

betaxolol (kerlone)

beta-blockers (cardioselective)

bisoprolol (zebeta)

beta-blockers (cardioselective)

metoprolol (lopressor, toprol XL)

beta-blockers (cardioselective)

nebivolol (bystolic)

beta-blockers (cardioselective)

carvedilol (coreg)

beta-blockers (non-selective)

labetalol (normodyne, trandate)

beta-blockers (non-selective)

nadolol (corgard)

beta-blockers (non-selective)

propranolol (inderal)

beta-blockers (non-selective)

timolol (blocadren)

beta-blockers (non-selective)

3 beta blockers (intrinsic sympathomimetic activity)

• acebutolol (secral)

• penbutolol (levatol)

• pindolol (visken)

acebutolol (secral)

beta blockers (intrinsic sympathomimetic activity)

penbutolol (levatol)

beta blockers (intrinsic sympathomimetic activity)

pindolol (visken)

beta blockers (intrinsic sympathomimetic activity)