Pharm test 2

Widaplik

Combination of telmisartan (angiotensin 2 blocker) amlodipine (dihydropyridine calcium channel blocker)

Indapamide (thiazide like diuretic)

Can any drugs that target the RAAS system be prescribed for hypertension during pregnancy?

No

Lasartan

Blocks angiotensin 2 type 1 receptor

Metoprolol

Used as a first line agent to treat primary hypertension

Aliskiren

Is a renin inhibitor

Blocks interaction between renin and angiotensinogen

Drugs on the RAAS system

Common for treating BP

Canagliflozin

Use in diabetes patients and possible diuretic to use to reduce glucose reabsorption

Acetazolamide

Weak diuretic, used to treat glaucoma, motion sickness and CSF accumulation in Brian

Thiazide

Diuretic. Works in DCT by blocking NaCl cotransporter

Furosemide

loop diuretic. Blocks Na K Cl cotransporter in thick ascending loop of henle

Mannitol

Use in recent stroke patients

Increased intracranial pressure

Aquaretics

Not a diuretic

Used to treat hyponatremia

Diuretics

Blocks reabsorption of Na and water so increased excretion

Potassium sparing diuretics

Aldosterone (opposite)

Collecting tubes (decrease potassium secretion)

Mineral corticoids ( spironolactone and eplerenone prevent aldosterone effect)

Sodium lumen (increase amount which increases excretion)

Carbonic acid ( reduced excretion which can lead to acidic)

Nitroglycerin

Requires drug free intervals

Beta blockers

First line treatment for chronic effort angina and management of it

Minoxidil

Common side effect is hair growth with this vasodilator

Hydralazine

Best used for blacks used for heart failure and hypertension

Calcium channel blockers

They vasodilate arteriole smooth muscle, decrease myocardial contractility, decrease conduction velocity in AV nice, prevent cerebral vasospasm

MOA: inhibit calcium through L-type calcium channels

They DO NOT reduce skeletal muscle contractility

Nitrites

Activation of guanyl cyclase to increase cAMP activity, inhibition of ROCK, removal of calcium from smooth muscle, nitric oxide combining with heme group of guanyl cyclase.

NO ROLE with cGMP activity and actin: myosin interaction

MOA: produce NO

Nitroprusside

Vasodilator can cause toxicity due to cyanide molecules

Fenoldopam

MOA: stimulates D1 receptors that cause increase in cAMP and reduce vascular resistance

Amiodarone

Can have a thyroid dysfunction if increased amounts of iodine in body

Unstable angina

Due to imbalance between oxygen requirements in the heart and those that supplied those vessels

Potassium blockers

Used to treat atrial arrhythmias

Most antiarrythmia agents treat

Re-entry movements

Group 1B sodium channel blockers

Contradicted in patients with 2nd and 3rd degree heart block

Anti-arrhythmia drugs

Common side effect is 1A, 1C and 3 torsades de pointes

Can occur after AED stimulation too

Class 4 drugs

Slow conduction velocity of heart by blocking channels in SA and AV nodes

Class 3 drugs

Block delayed rectifier potassium currents which increase action potential refractory periods

Atrial fibrillation

Caused by sick sinus syndrome

Sodium

Cardiomyocyte depolarization occurs due to an influx in muscle during phase O

Heparin

Possible side effect is thrombocytopenia

Binds to anithrombin protein to inactivate factor Xa

Warfrin

Blocks factor VII, IX, X and anticoagulant proteins C and S

Asprin

Inhibits thromboxane A2, reduce platelet aggregation

Blood clots

Don't need plasmin for clot, all clots begin with vessel trauma, prothrombin activator converts prothrombin to thrombin, factor V binds to phospholipids to form prothrombin activator, both intrinsic and extrinsic pathway mechanisms require presence of calcium

Resins

Bind bike acids and salts to prevent reabsorption and further production of bile acids.

Contraindicated in bile obstruction, bowel obstruction and hypertriglycerdemia

Statins

Increase risk for hepatic toxicity and muscle complications as well as increased for type 2 diabetes

Niacin

Prescribed for dyslipidemia because they decrease movement of fatty acids to liver and reduced production and secretion of VLDL. Common side effect is cutaneous flush

Eztimibe

Indicated for dyslipidemia, reduces cholesterol by inhibiting cholesterol absorption in intestines by targeting NPC1L1

LDL

Used in synthesis of cell membrane can be removed from plasma liver where it is converted into bile salts

HMG-CoA Reductase Inhibitors

Increase high affinity LDL receptors, usually doses/taken at night, can increase creatine kinase levels with heavy exercise, decrease secretion of VLDL, no target on enzymes in stomach

Goal of dyslipidemia agents

Used in patients with familial hypercholesteriema, not used in children less than 8, avoided in pregnant patients, require monitoring and work well with a healthy diet

Fibric acid derviates

Used for serum levels of LDL and triglycerides, may induce induce gall stones and abdominal pain

Bile Acid Sequestrants

Indicted for high levels of serum LDL and triglycerides. Should be avoided to reduce risk of elevated VLDL

Clonidine

Contraindicated with patients taking anti depressants.

Bc it is a central alpha-2 adrenergic agonist

Thiazoldinediones

Weight gain can be side effect

Linagliptin

Inhibits enzyme responsible for breaking down GLP-1. So increases GLP-1 levels

Metformin

Reduces glucose production in liver and improves insulin sensitivity in peripheral tissues, which is different from increasing insulin release or renal glucose excretion

Glimepiride

Stimulates insulin secretion regardless of blood glucose, increases risk for hypoglycemia ecspecially if patient skips meal

Empagliflozin

An SGLT2 inhibitor marketed as Jardiance. Does not affect insulin release or GLP-1 secretion

Glucagon

Secreted by pancreatic alpha cells when blood glucose is low, promotes glycogenesis and gluconeogenesis, countering insulin effects

Amylin

Modulates gastric emptying

Glp-1

Is an incretin that enhances insulin release but doesn't stimulate Glycogenolysis

Octreotide

Indicated for use in people with neuroendocrine tumors

Menotropin

Made from urine in postmenopausal women. Stimulates follicular growth and maturation

Used in patients with low levels of FSH and LH

Atosiban

Inhibits oxytocin receptors

Indicated to reduce uterine contractions in pre-term labor

Insulin lispro

Indicated in type 1 diabetes for fast actin insulin for post- meal glucose control

Leuprolide

GnRH analog, continuous therapy used to suppress gonadotropin and gonadal hormone synthesis, especially in concert with gonadotropin for ovulation induction and in prostatic carcinoma

GLP-1/ GIP

Increases insulin

Decreases glucagon

Delays gastric emptying

GLP agonist

End in glutide except exenatide

Dual GLP-1 and GIP agonist

Tirzepatide

DPP4Is

All end in gliptin

Inhibit enzyme that breaks down GLP-1

Sulfonylureas

Block k/ATP channel and promote depolarization which increases release of insulin

Glyburide, glipizide, glimepiride

Thiazolidinediones

Glitazones

SGLT2 inhibitors

-gliflozin

Biguanides

Decrease liver gluconeogenesis and Glycogenolysis

Increase glucose uptake up muscles and fat

Alpha glucosidases inhibitors

Prevent carb absorption and prevent digestion of complex carbs

Hypoglycemia

Insulin, amylin, SU, glinides

No hypoglycemia

GLP-1, DPP4 inhibitors, Metformin, thiazolodinediones, alpha glucosidase inhibitors

SGLT2 inhibitors

Insulin products fast vs slow

Fast: insulin lispro

Short acting: regular

Intermediate: NPH

Long acting: insulin detemir

Longest acting: insulin glargine