pharm- cardio 2 (diuretics + lipids)

carbonic anhydrase inhibitors(CAI) moa

-prevents sodium bicarb reabsorption in the proximal tubule

-to excrete sodium (+ water) and bicarb out of body

what meds are CAIs

acetazolamide

dichlorphenamide (galucoma)

methazolamide (glaucoma)

CAI indications

-edema (with metabolic alkalosis)

-open-angle glaucoma

-altitude sickness

CAI contraindications

-sulfa allergy

-liver disease

CAI SE

-potassium wasting -> hypokalemia/hyponatremia

-metabolic acidosis (HCO3 secretion)

-agranulocytosis / aplastic anemia

loop diuretics moa

-inhibit na/k/ca transport in TAL

-to increase excretion of these minerals (+ water)

-release prostaglandins to dilate afferent arteriole

what is the "most effective" diuretic?

loop diuretics-> increase urine by up to 4L/day

what drugs are loop diuretics

-furosemide

-bumetanide

-torsemide

-ethacrynic acid (no sulfa!)

loop diuretics indications

-pulmonary edema/CHF

-edema from nephrotic syndrome

loop diuretics contraindications

-anuria

-sulfa allergy (except ethacrynic acid!)

-electrolyte depletion

loop diuretics SE

-potassium wasting -> hypokalemia/hyponatremia

-gout

-reversible ototoxicity

thiazide-type diuretics moa

work on na/ca to inhibit reabsorption in the DCT

what drugs are thiazide-type diuretics

-metolazone

-hydrochlorothiazide

-indapamide

-chlorthalidone

thiazide-type diuretics indications

-HTN

-edema

-nephrolithiasis

thiazide-type diuretics contrainidcations

-sulfa allergy

-anuria

-renal impairment (except metolazone)

which thiazide-type diuretic is safe to use in renal impairment(CrCL <30)?

metolazone

thiazide-type diuretics SE

-potassium wasting-> hypoklaemia, hyponatremia

-hyperuricemia and hypercalcemia

-dizziness/hypotension

what diuretics are potassium wasting

-thiazide type

-loop

-CAIs

sodum channel inhibitors moa

-blocks sodium reabsorption in the collecting ducts

-reduce potassium excretion (potassium sparing)

what drugs are sodium channel inhibitors

-triamterene

-amiloride

sodium channel inhibitors indications

-HTN

-CHF

-edema

-offset hypokalemia of other diuretics

sodium channel inhibitors contraindications

-hyperkalemia

-anuria

-severe renal impairment

sodium channel inhibitors SE

-potassium sparing-> hyperkalemia

-large GI se

what drugs to be cautious prescribing with diuretics

-lithium

-NSAIDS

-aspirin

-ACEi/ARB

-other meds that impact electrolytes

aldosterone antagonist moa

-inhibits aldosterone in distal tubules/collecting duct

-enhances sodium/chloride/water secretion

-decreases potassium seceretion (potassium sparing)

what meds are aldosterone antagonists

-spironolactone

-eplerenone

-finerenone

aldosterone antagonist indications

-CHF

-HTN

-ascities

aldosterone antagonist(spironolactone) additional indications

-hypoaldosteronism

-PCOS/acne

aldosterone antagnost contraindications

-severe renal impairment

-addisons disease

aldosterone antagonist SE

-hyperkalemia (potassium sparing)

-hyponatremia

-gout

-gynecomastia (spirnolactone)

what diuretics are potassium sparing?

-sodium channel inhibitors

-aldosterone antagonists

which diuretics are more effective, potassium wasting or sparing?

-wasting

-sparing are typically used as add on, not first line

HMG-CoA reductase inhibitor (statins) moa

-inhibits HMG-CoA reductase to reduce LDL synthesis and increase HDL

-liver then takes LDL from blood to compensate, lowering LDLs more

-antiinflammatory/anti thrombotic events as well

what drugs are HMG-CoA reductase inhibitor (statins)?

atorvastatin

rosuvastatin

simvastatin

lovastatin

pravastatin

pitavastatin

what statins are considered "high-intensity"?

atorvastatin 80mg

rosuvastatin 20-40mg

what statins are considered "moderate intensity"?

atorvastatin 10-20mg

rosuvastatin 5-10mg

simvastatin 20-40mg

pravastatin 40-80mg

lovastatin 40-80mg

what statins are considered "low-intensity"?

simvastatin 10mg

pravastatin 10-20mg

lovastatin 20mg

what indication to immediately start the "high intensity" statin?

LDL >190

HMG-CoA reductase inhibitor (statins) indications

-prevention of CVD

-high lipids/cholesterol

-post MI/stroke

-diabetes

HMG-CoA reductase inhibitor (statins) contraindications

liver disease

pregnancy

statins SE

-hepatotoxic

-myopathy/rhabdo

*CoQ10 may help

-GI

statins put you at a 10% increased risk for developing ____________

DM

statins DDis

CYP3A4 (grapefruit!)

fibrates(fibric acid) moa

-decreases production of triglycerides

-increases production of HDL

what drugs are fibrates

-fenofibrate

-gemfibrozil

fibrates indications

-high triglycerides

-adjunct to statins for dyslipidemia (fenofibrate only)

fibrates contraindications

-CrCL <30

-liver/gallbladder disease

-breastfeeding

fibrates SE

-myopathys (monitor CK)

-gallstones

-hepatotoxic

fibrates DDis

-anticoags

-immunosuppressants

-bile acid sequestrants

which is the only fibrate that can safely be combined with a statin?

-fenofibrate

-do not use gemfibrozil due to increased risk of myopathys

bile acid sequestrants moa

-prevents bile from being reabsorbed

-forcing liver to use up cholesterol to make new bile, lowering LDLs

what meds are bile acid sequestrants?

-cholestyramine

-colestipol

-colesevelam

bile acid sequestrants indications

-primary hypercholesterolemia

-adjunct to statins

bile acid sequestrants contraindications

-pancreatitis

-biliary obstruction

-high TGs

bile acid sequestrants SE

-major GI sx

-pancreatitis/gallstones

-increase triglycerides (potential) **why these meds are not first line compared to statins

bile acid sequestrants patient edu

-take separate from other drugs (take others 1hr before or 4-6hr after)

-take with food

what are the only lipid modifying meds considered safe in pregnancy?

bile acid sequestrants

niacin moa

-inhibits lipolysis in adipose tissue

-increases HDLs

niacin indications

-high lipids/triglycerides

-low HDL

niacin conraindications

-liver disease

-PUD

niacin SE

-face flushing "niacin flush"

*give aspirin before

-GI sx

niacin monitoring

-every 6-12 weeks during first yr then every 6 month

-glucose

-uric acid

-liver enzymes

what drug is a cholesterol absorption inhibitor

ezetimibe

ezetimibe moa

-increases LDL removal from blood

-decreases absorption of dietary cholesterol

ezetimibe indications

-high LDL

-lower risk of CVD

(first line if statins can not be tolerated)

ezetimibe contraindications

liver disease

ezetimibe SE

-URI

-myopathy

-thrombocytopenia

-hepatotoxic

ezetimibe DDis

-Gemfibrozil (fibrate)

-bile acid sequestrants

what drugs are PCSK9 inhibitors?

(also route)

-evolocumab

-alirocumab

-inclisiran

(all subQ)

PCSK9 inhibitors moa

prevents PCSK9 from degrading LDL receptors

PCSK9 indications

-familial hypercholesterolemia (high LDLs)

-CVD

PCSK9 inhibitor SE

-myopathy

-increase risk of infection

-neurocognitive effects

PCSK9 inhibitor limitations

-expensive af

-mabs -> special storage + risk of hypersensitivity

PCSK9 monitoring

measure LDL every 4-8 weeks

fish oil moa

decreases trigylcerides production and increases clearance

what med is an omega-3 fatty acid

icosapent ethyl

fish oil indications

-high triglycerides

-secondary CVD prevention

fish oil SE

-tastes bad -> bad breath

-elevated liver enzymes

-arthlargias

-increased bleeding time

fish oil DDis

-anticoags

-statins

bempedoic acid moa

-inhibits ATP-citrate lyase

-results in more LDL receptors

Bempedoic acid indications

adjunct therapy to statin therapy or in patients with statin intolerance

bempedoic acid SE

-hyperuricemia (gout)

-tendon rupture

most effective lipid-lowering tx?

statins (first-line)