CHAPTER 27 (ANTILIPEMIC DRUGS)

HMG-CoaA REDUCTASE INHIBITORS -statins: most effective for lowering LDLs after lifestyle changes, may also slightly raise HDLs and decrease triglycerides

MOA: decrease rate of cholesterol production

treat: post-MI, hyperlipidemia, etc.

interactions: other lipid-lowering drugs, drugs that inhibit CYP3A4, pregnancy (Preg X)

• atorvastatin

• fluvastatin

NIACIN (vitamin B3): decrease LDL and triglyceride levels, but little/no benefit for preventing CV events

adverse effects: flushing, itching (give aspirin/NSAID 30 mins prior), GI issues, hepatoxicity, hyperglycemia

BILE ACID SEQUESTERANTS c[h]oles- : used with statins to reduce LDL cholesterol

adverse effects: constipation

• cholestryamine

• colestipol

• colsevelam

FIBRATES: most effective in lowering triglycerides, may also raise HDLs, no effect on LDLs

• gemfibrozil

Misc Drugs:

• ezetimibe: selectively inhibits cholesterol absorption in s intestine, may be used with statins

DO NOT use with fibrates !

Herbs/etc :

• flax: may be used in pregnancy

• garlic: need about 4 cloves daily to reach efficacy

• lovaza (omega 3 fatty acid)

CHAPTER 26 (COAGULATION MODIFIER DRUGS)

ANTICOAGULANTS: inhibit the action and formation of clotting; used to prevent clot formation but no effect on existing clots

• heparins: inactive clotting factors IIa & Xa; monitor aPTT & INR -parin

  • heparins: derived from animal sources (pig intestinal lining)

  • low molecular weight heparins (LMWHs): synthetic molecules; no specific monitoring needed; contraindicated by indwelling epidurals

    • enoxaparin: keep the air bubble in pre-filled syringe

    • dalteparin:

• coumarins: inhibit vitamin K dependent clotting factors

  • warfarin: monitor PT & INR, contraindicated by pregnancy

• direct thrombin inhibitors: inhibit factor IIa (thrombin) -tran/-ban

  • argatroban

  • dabigatran

• selective factor Xa inhibitors: have an x & a

  • fondaparinux

  • rivaroxaban

ANTIPLATELET DRUGS: prevents platelet plug formation by inhibiting platelet aggregation

• aspirin: may cause Reye syndrome in children or adolescents with influenza

• clopidogrel: black box!! for pt with genetic abnormalities; decreased effectiveness with amiodarone, CCBs, NSAIDs, PPIs, etc.

HEMORHEOLOGIC DRUGS: alter platelet function without preventing platelets from working

THROMBOLYTIC DRUGS: lyse cells or thrombi that have formed -ase

• alteplase

ANTIFIBRINOLYTIC DRUGS: promote blood coagulation; prevent/treat conditions associated with excessive bleeding

• aminocaproic acid

• desmopressin

• tranexamic acid

CHAPTER 22 (ANTIHYPERTENSIVE DRUGS)

ADRENERGIC DRUGS: centrally acting (brain) or peripherally acting (blood vessels & heart)

• alpha 2 receptor agonists: centrally acting; decrease norepi production

  • clonidine

  • methyldopa

• alpha 1 receptor blockers: peripherally acting; may also be used for BPH -azosin

  • doxazosin

  • prazosin

  • terazosin

• beta receptor blockers: peripherally acting; always check BP & HR (<60 hold!) -olol

  • propanolol

  • metoprolol

  • atenolol

• alpha 1 + beta receptor blockers: peripherally acting

  • carvedilol

  • labetalol

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS -pril

common side effect is dry cough

monitor potassium levels (hyperkalemia)

• captopril: effective for L) ventricular dysfunction

• enalapril: only ACE inhibitor available as oral and parenteral (patch) forms

• lisinopril

ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs) -sartan

CALCIUM CHANNEL BLOCKERS (CCBs)

DIURETICS

VASODILATORS: act directly on smooth muscle to cause relaxation and direct peripheral vasodilation (often used in emergency situations)

CHAPTER 10 (ANALGESIC DRUGS)

MIGRAINE HEADACHES: throbbing, N/V, sound or light sensitivity, family history and hormonal components; may be triggered by emotions, foods, substances, weather, etc.

• migraine with aura: preceded by visual symptoms

• migraine without aura: no warning

treatment: abortive (stops an ongoing attack) or preventative (prevents attack from happening)

• amitriptyline

• ergot alkaloid

• sumatriptan

• beta blockers

CLUSTER HEADACHES: each attack (1-2 every day for 2-3 months) lasts 15 minutes-2 hours (occurs in a series), severe unilateral pain near the eye

treatment: prophylaxis

TENSION HEADACHES: feeling of a tight band around the head