pharm test1

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Drug interactions of Statins?

(Zocor) Simvastatin and (mevacor) lovastatin(CYP 3A4 inhibitors), Atorvastatin(parital CYP 3A4 inhib), Fluvastatin(CYP 2D9 inhib/hardly any drugs inhibit), Pravastatin(sulfonation), Gemfibrozile(fibrinic acid) interacts withh all statins except Fluva

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Common side effects of Statins?

Constipation, bloating, cramps, heartburn, myopathy(algias), insomnia and sleep disturbances(Lovastatin and simvastatin), Rhabdo(fibrates, niacin and cyp 450 inhibitors(macrolids, keto) increase chances, Myoglobinurea.

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What should you monitor if on a statin?

LFTs at start 2,6, mo(AST/ALTcan cause cirrhotic hepatitis), CPK if complaints of myopathy(can cause myositis which leads to rhabdo which causes kidney failure)

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Effects of Statins on lipids?

Reduce LDL-C 18-55%, Reduce TG 7-30%, Raise HDL-C 5-15%, Reduce coronary events, CHD mortality, PTCA/CABG, Stroke and total mortality

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CYP 3A4 Inhibitors

Macrolides, itraconazole, ketoconazole, Grape Fruit

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Contraindications of Statins

Liver Disease, EtOHlics, muscular diseases,castion with gemfibrozile, not as much with fenofibrate, cat X

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Most effective Statin and longest 1/2 life

Rosuvastatin (crestor), Atorvastatin (lipator)/ dose anytime!

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Statin non lipid benefits

inprove endothelial fx, dec. plt aggregation and thrombin formation, reduces inflamation

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Fibric Acids - drugs, effects, side effects and contraindications

Gemfirbozile (lopoid), Fenofibrate (Tricor) Lower TG 20-50%, may raise LDL-C with High TG lower LDL-C 5-20% with low TG Raise HDL-C 10-20%, SE: dyspepsia, gallstones, myopathy; CI: severe renal, severe hepatic disease, gall stones

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Fibric Acids - Efficacy and interactions

Fenofibrate (Tricor) is preferred over Genfibrozile (lopoid) due to fewer DI, can be used with Statins with minimal risk of Rhabdo and is more effective

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Fibric Acid - indications

Hypertriglyceridemia to the point of pancreatitis; Hypertriglyceridemia with low HDL-C especially w/ DM, insulin resistance and metabolic syndrome

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Niacin - Effects and Side effects

Lowers LDL-C 5-25%, TG 20-25%, and raises HDL-C 15-35%; SE: Flushing(major), Itching(major), GI Distress(major/ pretreat w/ asa or ibpro Low dose), piss off PUD, Hyperglycemia, Hyperuricemia, Hepatotoxicity (more prev. w/ SR/ 2gm or more) Monitor LFTs,

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Niacin - Contraindications and interactions

Absolute: Chronic Liver Disease, Gout; Relative: DM, hyperuricemia, PUD; Interactions: Simvastatin (Zocor) and Lovastatin (Mevacor) inc. risk of Rhabdo,

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Niacin - Dosing

IR given .5 hr after ASA or NSAID, take w/ food avoid hot liquids, ER given HS reduces flushing and is also pretreated, avoid SR(hepatotoxic)

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Bile Acid Binding Resins - Drugs, Effects, Side Effects, Contraindications

Colesevelam (welchol), Cholestyramine (Queastran); reduce LDL-C 20% by inhib bile acid recycle, conjuct statin(better than stat alone), small inc in TG & HDL, Diarrhea and Liver failure; SE: cons, fecal impac, bloating, flat; CI: Abs: TG>400; Rel: TG>200

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Bile Acid Binding Resins - Dosing, Drug interactions

Colesvelam (welchol) 6 pills/small, Cholestryramine (questran) taste like a gritty paste; Inhibits absorption; Dose other meds 1 hour before or 4 hours later, (Welchol) does not inhibit absroption

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Ezetimibe (Zetia) - Effects, Side Effects, Contraindications

Reduces cholesterol 20% by inhib abs, 22% above statin in conjuction; SE: Rhabdo(rare/ higher w/ statin lfts too), GI upset; CI: liver disease

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Calcium Channel Blockers - Dihydropyridines

Vascular; Amlodipine (norvasc), Nifedipine(Procardia XL); Potent vasodil in periphery, affects Coronary but not as much

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Calcium Channel Blockers - Non Dihydropyridines

Verapamil(Calan, Isoptin, Verelan), Diltiazam(Cardisem, Tiazac); Less vasodil; more negative ionotropic and chronotropic effect

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Calcium Channel Blockers - Mechanism

Promote Vasodil by blocking the influx of CA into Vascular SM, Interferes with AGII and alpha 1 mediated Vasocon

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Calcium Channel Blockers - Indications

Systolic HTN(AA), Angina/verapimil(symptoms persist/SE limit), Coronary Spasm(pribzmetal's variant), Reynuads, Stents(prevents reclosure, AA pop., A fib(LD, IHD, active LVH);

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Calcium Channel Blockers - Advantages

Do not alter serum lipids(thiazidses), glucose(BB), Uric acid(thiazide), or electrolytes(Diruetics), Protective against strokes,

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Calcium Channel Blockers - Side Effects

Hypotension(orthostatic), lower extremity edema, contipation(verapamil), Bradycardia(BB), AV blcokade, aggrevate CHF(verapimil>Diltaziam>Dihydro), caution in HF

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Calcium Channel Blockers - Drug interactions

Grapefruit juice, inc. dig levels, coumadin(inc. potentcy), cimetadine(inhibs metab), macro and azole(inhib met), Barbs(accel met), immunosuppres(tacrolimus, cyclosporine, sirolimus)

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Thiazides - Effects, indications

HCTZ, Blocks NA reab in early distal tubule H2o is excret less PVR, Ind: 1st line HTN, ca kidney stones, osteo;

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Thiazides - Side effects

SE: Hypo k(most comon/ chlorith worst), hyperuricemia, weakn, lethardy, leg cramps, volume deple, hyperglycemia, importence, photo sens, hypomagnesmia, hypercalemia, slight increase in cholesterol and LDL, Hypocalcuria

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ACE-I - Drugs, effect, Side effects

Captopril(Capoten), Lisinopril(Prinivil, Zestril); peripheral arterial vasodilation= red SVR=reduced afterload; SE: cough, Hyperkalemia(inhibs aldost) angioedema(AA), Rare: rash, taste, agranulo

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ACE-I - Indications & contraindications

Indi: LV sys HF, DM(renal protect), Post MI CAD(stop aldost remodel), KD, HTN; Contra: RAS, Preggers(CAt x), Lupus, AA(reduced renin response)

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ACE-I - Drug interactions

LI(inhibs excretion), NSAIDs(reduce antHTN), K+ and K+ sparing diuretics; works well with thiazides

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ARB - Drugs, Effect, & side effects

Losartan(Cozaar), Valsartan(Diovan), Olmesartan(Benicar)/most potent; peripheral arterial vasodilation= red SVR=reduced afterload; SE: no cough

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ARB - Indications, Contraindications, Drug interactions

Indi: CAD, CHF, DM, post MI, HTN, KD; Contra: RAS, Preggers, Lupus, AA; DI: LI, K+ and K+ sparing diuretics; works well with thiazides

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Beta Blockers - Drugs and Effects

Propranolol(Inderall), Naldalol(corgard), Selective(Atenolol(tenormin), Metoprolol(Lopressor, Toprol XL) Carvedolol(Coreg); negative inotropic,chronotropic, and dromotropic effects, less o2 demand, lower sympathetic reflex, lower renin rel, red periph NE

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Beta Blockers - Indications

Indi: HF, CVD, angina, MI, CAD, AFIB(activr. thyrotoxic, n/CHF or LD), DM, Inderal(migraine, essent Tremor, Performance anx,

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Beta Blockers - Side Effects

drowsiness, fatigue, vasoconstrict periph(reynauds), depression(inderall), impotence, inc BS, mask hypoGly

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Beta Blockers - Drug interactions

Verapamil & diltiazem(inc. conc and additive brady), cimetidine(inhibs met), Dig and amiodorone(delayed AV conduction)

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Heart Failure - which combos are best

ACE-I or arb, B Blocker, Diuretics, Aldosterone antag, Dig, ionotropes, ASA

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Loop Diuretics - Drugs, effects, Side effects, Indications, & drig interactions

Furosemide(Lasix); block NA reab in thick ascending limb, lots of pee; SE: more hypo K, hypocalcemia, ototox; Indi: relieve symptoms of HF, edema; DI: NSAIDs(inhib antidi), Dig, hypoglycemics, Li; works well w/ thiazides

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Digoxin - drug, effects, Side/Toxic effects, and what to monitor

Lanoxin; positive inotropic effect, dec symp outflo, dec AV conduxtion; SE: bradycardia TE: nausea, anorexia, visual distrubances(yellow), mental confusion, cardiac arrythmia, heat block; Monitor: K, Mg

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Digoxin - Indications

HF(dec symptoms), inc exercise tol, dec hospitolization (does not improve survival), Afib(CHF, n/ active of WPW)

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Digoxin - Drug interactions

quinidine, verapamil, amiodarone(reduce by 50% could lead to block), oral aminoglycosides(decrease serum levels of Dig), erythro, keto, carbam(inhib met), PPI(inc abs), atb(dec abs, non K+ sparing diuretics

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Afib - agents to use

RATE CONTROL!1st line: Dig(CHF not active or WPW), BB(active, thyrotoci not chf or COPD/asthma), CCB(LD, IHD, active, LVH, not HF), 2nd amiodarone, Warafarin(high or medium risk for CVA), ASA(no risk)

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Amiodarone - drug, effect, Side effects, Drug interactions, Indications, half-life/metablosim

Cordarone; incr refractory period and AP, acutely depress AV; SE: photosen rash, grey/blue skin, thyroid, pulm fibro, nightmailrs, LFTs; DI: dig, warfarin(reduce clearance); Indi: atrial and vent arrhythmias, acute rx/propho; 54 day 1/2 life, heaptic met

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Amiodarone - monitoring

thyroid, live, lung, DI(DIG, antiarrhyth, warfarin)

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ASA

blocks COX from making thromboxane 2 which is prothrombotic, irreversibly(10 Days) inhibits plt aggreg; SE: Bleeding, GI bleeds,(contra: PUD); Indi: IHD, CVA, MI in UA/SA, artifical valves and angioplast, PVD

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Clopidogril

Plavix; inhibits adp receptor express; irreversible inhibs plt aggregation; SE:Bleeding, SJS, angioedema, slower onset and longer withdrawl; inidcations: can't take ASA, acute coronary syndrome, 1y post MI;

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