NR508 Pharmacology Final
1st line treatment for HTN (non-black, no CKD) - ACEI (arb), thiazide, ccb
1st line treatment for HTN for black pts (no ckd) - thiazide, ccb
1st line option for HTN for anyone with CKD - ACEI (arb)
Types of diuretics - thiazides, loop diuretics, k-sparing
preferred diuretic with renal impairment - loop-diuretics
diuretics - S/E & D/I - S/E All - hypokalemia, arrhythmia, metbolic alkalosis, fatigue, postrual
hypotension, hyperlipidemia
S/E for k-sparing - hyperkalemia, gynecomastia, peptic ulcer)
S/E for thiazides - hyperglycemia & hypercalcemia
S/E for loop hypocalcemia
D/I All- digoxin (hypokalemia/toxicity risk), NSAIDs (reduce diuresis), lithium (toxicity risk),
corticosteroids (enhance hypokalemia), anti-diabetic drugs (decrease anti-diabetic levels)
D/I for thiazides - BB's - increase hyperglycemia/ hyperlipidemia
D/I for loops - aminoglycosides = ototoxicity & nephrotoxicity
which diuretic causes post diuretic sodium retention - loop diuretics
,post-diuretic effect, a compensatory sodium-retention process that begins as the diuretic action wanes.
Diuretics that do not contain a sulfonamide derivative - ****ethacrynic acid***
also: amiloride, hydrochloride, eplerenone, spironolactone, and triamterene (safe for pt with allergy to
sulfa)
CHF drugs including diuretic choices - First line: ACEI's or ARB, Beta-blocker, diuretics (loop & potassium
sparing)
-ACEI's & ARB's decrease mortality
-if ACEI contraindicated: use ARB or Hydralizine & Isosorbide (decrease mortality/less effective than
ACEI)
-Beta-blockers: decrease mortality, NEVER when active failure, ONLY after diuresed & other medications
-Digoxin: add if needed for systolic HF
**if 1st line tx not enough.........*******
Spironolactone & Eplerenone
Nitrates and hydralazine (lower mortality in class 3&4 for African American)
Calcium channel blockers
(Can worsen hf use caution **BUT NEVER IN SYSTOLIC DYSFUNCTION - thats for digoxin)
, (DA BD is aa sad)
Diuretics
ACE inhibitors
Beta-Blockers (after acute)
Digoxin (Syst. HF/A-fib/diuretic failure)
Know migraine management and prophylactics - *NSAIDS or APAP
*Triptans (sumatriptan/imitrex, zolmatriptan/zomig, rizatriptan/maxalt)
-nasal, oral, subq
-use no more than 2d/wk
-C/I-recent use of MAOIs, ergots, or SSRIs, CVD, CAD, TIA, HTN, pregnancy
*Ergots (ergotamine tartrate/cafergot) not used often, expensive
-nasal, oral, rectal, IM, IV, siblingual
-CI-recent use of triptans, CVD, CAD, TIA, HTN, pregnancy
*Caffeine (Excedrin)
*antiemetics
Migraine prevention
*beta blockers (metoprolol, propranolol, timolol)
- 2-3 months for effect- decrease frequency & severity by 50%
-A/E- drowsiness, exercise intolerance, depression
-CI-CHF, asthma
1st line treatment for HTN (non-black, no CKD) - ACEI (arb), thiazide, ccb
1st line treatment for HTN for black pts (no ckd) - thiazide, ccb
1st line option for HTN for anyone with CKD - ACEI (arb)
Types of diuretics - thiazides, loop diuretics, k-sparing
preferred diuretic with renal impairment - loop-diuretics
diuretics - S/E & D/I - S/E All - hypokalemia, arrhythmia, metbolic alkalosis, fatigue, postrual
hypotension, hyperlipidemia
S/E for k-sparing - hyperkalemia, gynecomastia, peptic ulcer)
S/E for thiazides - hyperglycemia & hypercalcemia
S/E for loop hypocalcemia
D/I All- digoxin (hypokalemia/toxicity risk), NSAIDs (reduce diuresis), lithium (toxicity risk),
corticosteroids (enhance hypokalemia), anti-diabetic drugs (decrease anti-diabetic levels)
D/I for thiazides - BB's - increase hyperglycemia/ hyperlipidemia
D/I for loops - aminoglycosides = ototoxicity & nephrotoxicity
which diuretic causes post diuretic sodium retention - loop diuretics
,post-diuretic effect, a compensatory sodium-retention process that begins as the diuretic action wanes.
Diuretics that do not contain a sulfonamide derivative - ****ethacrynic acid***
also: amiloride, hydrochloride, eplerenone, spironolactone, and triamterene (safe for pt with allergy to
sulfa)
CHF drugs including diuretic choices - First line: ACEI's or ARB, Beta-blocker, diuretics (loop & potassium
sparing)
-ACEI's & ARB's decrease mortality
-if ACEI contraindicated: use ARB or Hydralizine & Isosorbide (decrease mortality/less effective than
ACEI)
-Beta-blockers: decrease mortality, NEVER when active failure, ONLY after diuresed & other medications
-Digoxin: add if needed for systolic HF
**if 1st line tx not enough.........*******
Spironolactone & Eplerenone
Nitrates and hydralazine (lower mortality in class 3&4 for African American)
Calcium channel blockers
(Can worsen hf use caution **BUT NEVER IN SYSTOLIC DYSFUNCTION - thats for digoxin)
, (DA BD is aa sad)
Diuretics
ACE inhibitors
Beta-Blockers (after acute)
Digoxin (Syst. HF/A-fib/diuretic failure)
Know migraine management and prophylactics - *NSAIDS or APAP
*Triptans (sumatriptan/imitrex, zolmatriptan/zomig, rizatriptan/maxalt)
-nasal, oral, subq
-use no more than 2d/wk
-C/I-recent use of MAOIs, ergots, or SSRIs, CVD, CAD, TIA, HTN, pregnancy
*Ergots (ergotamine tartrate/cafergot) not used often, expensive
-nasal, oral, rectal, IM, IV, siblingual
-CI-recent use of triptans, CVD, CAD, TIA, HTN, pregnancy
*Caffeine (Excedrin)
*antiemetics
Migraine prevention
*beta blockers (metoprolol, propranolol, timolol)
- 2-3 months for effect- decrease frequency & severity by 50%
-A/E- drowsiness, exercise intolerance, depression
-CI-CHF, asthma
