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37 Cards in this Set
- Front
- Back
(P) LOVASTATIN
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ANTI-HYERLIPIDEMICS --> STATIN
4: 1o & combined high cholesterol prevents 2o coronary evnts (MI, stroke) +off-labels MECH: competitively inhibits HMG-CoA reductase (which catalyzes rate-limiting step in cholest. synthesis) = decrs LDL (-21-40%) & incrs HDL CONTRAS: active liver dis (elevated liver func) Preg cat X ADVERSES: - muscle/joint aches - Rhabdomyolysis (muscle damage: CK levels 10,000 U/L+ or +10x upper limit w/ renal problems) - elevated heptatic enzymes - high 1st pass effect (only 5% of PO reaches gen circ) - best absorbed after a meal -metabolized w/ CYP 3A4 (= grapefruit juice = inhibitor = more drug in circ = grtr toxicty risk) - do AST & ALT tests (liver func tests) & baseline CK level B4 |
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high serum lipid levels associated with (4)
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1) hypertension
2) coronary artery disease 3) coronary heart disease 4) other CV disords. |
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cholesterol produced in _____ at rate of _____ mg/day
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liver
1000mg/day |
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hyperlipidemia 冒isk factor for ___?
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atherosclerosis ("paste" buildup)
leads to HPN --> MI & stroke |
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normal a high levels of LDL?
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<100 mg/dL = optimal
>130 mg/dL = high |
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normal and high level for total cholesterol?
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<200 mg/dL = normal
>230 mg/dL = high |
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normal and low levels for HDL?
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40-59 mg/dL = optimal
<35 mg/dL = low |
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何hat are the 冒isk factors for metabolic syndrome?
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hyperlipidemia
insulin resistance obesity HTN |
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how can the endothelium of vessels contribute to vascular homeostasis?
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a well-functioning endothelium has:
vasodilatory anti-coagulant anti-inflammatory functions these are often absent in atherosclerosis |
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何hat is combined hyperlipidemia?
People with this exhibit 何hat? |
an elevated 均evel 之f more than 1 serum lipid
a 据et lipid profile |
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Why are diabetic patients at increased risk when they have hyperlipidemia?
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link btwn hyperlipidemia & nephropathy (an atherosclerotic process occurs to mesangial cells in the kidneys b/c cholesterol binds to them)
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list some of the "therapeutic lifestyle changes" that are recommended 2 reduce LDL levels (8)
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down:
sat fats trans fats cholesterol fatty acids weight up: phys activity soluble fiber plant sterols plant stanols |
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10% reduction in cholesterol level leads to ______% reduction in risk for CHD?
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20 - 30%
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statins pull ___(6)____ down?
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down:
血lood cholesterol uptake 之f modified lipoprotiens by vascular cells CV events inflammatory response (less C-reactive proteins) thrombogenicity 之f the 血lood oxidative stress |
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(P) HYDROCHLOROTHIAZIDE
HTCZ |
PRODUCE DIURESIS --> THIAZIDE DIURETICS
4: hypertension MECH: limits reabsorption 之f Na+ 中n distal tubule by inhibiting ion pumps CONTRAS: Severe renal impairment, anuria, hepatic coma, and hypersensitivity ADVERSES: HYPO-kalemia, -natremia, -chloremia, and -calcemia Orthostatic hypotension - watch Na intake (get baseline) - 作ake sure they 可an get to a toilet - watch 体ody weight changes to 見ee if they're loosing H2O weight |
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(P) FUROSAMIDE
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DRUGS PRODUCING DIURESIS --> LOOP DIURETICS
4: peripheral & pulmonary edema HTN MECH: work in the loop of Henle to inhibit reabsorption of sodium - Highly protein-bound & high-ceiling CONTRAS: Anuria hypokalemia (NOT K-sparing) ADVERSES: Electrolyte imbalance, ototoxicity, alteration in glucose levels Hypovolemia (if OD) * do not give with digoxin or aminoglycoside - WATCH CBC, serum electrolyte & uric acid levels - watch Na intake (get baseline) |
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(P) TRIAMTERINE
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DRUGS PRODUCING DIURESIS --> K-SPARING DIURETIC
4: edema HTN MECH: inhibits reuptake of Na in distal tubules - independent of aldosterone elevates serum uric acid levels CONTRAS: Hyperkalemia, renal or liver disease ADVERSES: Hyperkalemia, nephrotox, thrombocytopenia, UP liver enzymes, headA, and photosens - asses for other drugs that increase K levels (also limit K intake) - give in morning - intracts w/ AMANTADINE |
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(P) MANNITOL
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DRUGS PRODUCING DIURESIS --> OSMOTIC DIURETIC
4: ARF (acute renal failure) reducing intracranial pressure in cerebral edema reducing intraocular pressure MECH: Increases concentration of molecules in glomerular filtrate = MORE H2O flow in2 tubules & more pee. - POORLY metabolized CONTRAS: Severe renal disease, pulmonary congestion, or active intracranial bleeding ADVERSES: Fluid or electrolyte losses, hypOtension, tachycardia - only given in acute care setting - don't give > 15% conc. |
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(P) ACETAZOLAMIDE
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DRUGS PRODUCING DIURESIS --> CARBONIC ANHYDRASE INHIBITORS
4: chronic open-angle glaucoma MECH: Blocks the action of carbonic anhydrase, (needed for active transport of ions across the proximal tubule) --> less H ion secretion, but more Na,K secretion. Decreases formation of aqueous humor--> less introoccular pressure--> lowers pH of body fluids CONTRAS: Kidney & liver disease, adrenocortical insufficiency, COPD, cirrhosis, and closed-angle glaucoma ADVERSES: Anorexia, N & C, CNS d's, paresthesia, ataxia, tremor, and tinnitus - Monitor CBC & platelet counts (Bone marrow suppression can happen...) |
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(P) TOLTERADINE
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DRUGS PRODUCING DIURESIS --> affect bladder funcion --> ANTICHOLINERGICS
4: overactive bladder and incontinence MECH: Competitive cholinergic muscarinic antagonist CONTRAS: Urinary retention, gastric retention, uncontrolled narrow-角ngle glaucoma, or hypersensitivity ADVERSES: 干ry mouth, constipation, abnormal vision, urinary retention, and xerophthalmia - Protein bound |
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Statins bring _____(3)____ up/助elp 何hat?
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助elp:
vascular endothelium availability 之f nitric oxide (helps endothelium) vasodilation -may also prevent Alzheimer's & w/ Tx 之f MS, neuroinflammatory dis, & chronic renal disease |
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Statins are the only class of antilipid drugs shown to____?
also (2) |
Decrease overall mortality in both 1o and 2o (established CAD) prevention
also: 1) decrease risk of stroke 2) are more effective when used jointly |
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do you need a liver panel b4 giving Pravastatin?
why? |
no - becasue it is not metabolized by the CYP-450 class of isoenzymes
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FENOFIBRATE
GEMFIBROZIL |
ANTIHYPERLIPIDEMICS --> FIBRIC-ACID DERIVATIVES
4: hyperlipidemia (high cholesterol) 2ND LINE CONTRAS: hepatic / renal probs ADVERSES: Serious Hepatic & renal Fxs rhabdomyolysis hyperglycemia * sometimes combined with lovastatin if lvls don't come down * |
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NIACIN
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HYPERLIPIDEMIA --> NICOTINIC ACID
4: hyperlipidemia 3RD LINE MECH: reduces LDL - increases HDL * dramatic SUBCUTANEOUS FLUSH (sustained release forms - not so bad now) * |
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CHOLESTYRAMINE
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ANTI=HYPERLIPIDEMICS --> BILA ACID SEQUESTRANTS
4: hyperlipidemia 4TH LINE MECH: Promote oxidation of cholesterol to bile acid (work in GI tract), bind the bile acid and its excreted * Choleterol serum lvls usually down after 1 month Tx * * given b4 meal * |
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Diuresis?
Diuretics? |
ridding body of fluids by inc product of urine - excreting H2O & electrolytes
promote this |
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Diuretics general MECH?
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block reabsorption of Na+ & promote its excretion
- other E-'s may also be blocked from reabsorption (K+) |
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5 classes of Diuretics?
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1) Thiazide
2) loop 3) K+ - sparing 4) Osmotic 5) carbonic anhydrase inhibitors |
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which types of diuretics decrease circulating volume?
where does each work? |
1) Thiazide - (works in distal tubule)
2) loop - (Loop of Henle) 3) K+ sparing - (distal tubule) |
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What do Osmotic diuretics do? (2)
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1) decrease intraoccular & intracranial pressure
2) Tx or prevent Renal failure |
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Carbonic Anhydrase inhibitor MECH?
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Decrease H+ ion secretion by the tubules
Increase excretion of Na+ & H2O LIMITED DIURETIC Fx |
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what are Carbonic anhydrase inhibitors really used for?
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to Tx Glaucoma
DIURETIC FX IS LIMITED |
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drugs w/ anticholinergic Fx do what to the bladder?
Tx what? |
decrease bladder contraction
Tx overactive bladder |
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Finctions of the Renal Sys? (6) - 2 weird
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1) rid body of impurities/waste, excreting H2O & E-'s
2) reg acid-base balance 3) maintain BP 4) manage circ fluid vol 5) ASSIST IN PRODUCTION OF RBC's 6) CONTRIBUTE TO CA+ METABOLISM |
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avg GFR?
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125 mL/min
(99+% of filtered plasma = reabsorbed in the tubules) |
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glomerular filtration?
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the process of E-'s and H2O passing from the vessel through capsular membrane into Bowman's Capsule
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