NURS 615 Exam 3 Drug Chart Miles.

Class Medication What it treats MOA S/E Monitor/BBW/Comments Anti-Gout Colchicine (Colcrys) Treat and prevent gout attacks and also Behcets syndrome Lower dose (1.2 mg followed by 0.6 mg one hour later) is just ...

Class Medication What it treats MOA S/E Monitor/BBW/Comments Anti-Gout Colchicine (Colcrys) Treat and prevent gout attacks and also Behcets syndrome Lower dose (1.2 mg followed by 0.6 mg one hour later) is just as effective as high dose but with less side effects Inhibits microtubule formation at cellular level, limits neutrophil migration and aggregation to tissues, and inhibits mitosis **decrease inflammatory response to urate crystal deposits; used in acute attacks** DIARRHEA GI upset: N/V/D, abdominal pain *taking with food helps decrease GI side effects Check renal function before and during treatment (BUN/Creatinine) Impaired renal or hepatic function requires decreased doses or frequency to prevent s/e including neuromyopathic symptoms *Interacts with NSAIDS (AVOID) **Report immediately: proximal muscle weakness, myalgia, and neuropathy (usually resolve in 3-4 weeks after stopping med) Xanthine Oxidase Inhibitor Allopurinol (Zyloprim, Lopurin) Chronic management of hyperuricemia in patients with gout 100 mg and 300 mg tablets; FDA approval for up to 800 mg/d in divided doses *uric acid reducer: prevents kidney stones Competitive inhibitor of XO enzyme. Has feedback on salvage pathway effect and decreases total purine production **inhibit synthesis of uric acid by inhibiting xanthine oxidase conversion of hypoxanthine and xanthine to uric acid** Rare occurrence of severe allopurinol hypersensitivity syndrome. S/E: Skin rash, flu symptoms, painful or little urination, drowsiness/dizziness *STOP if maculopapular rash is seen Interactions with various antibiotics, antiepilepsy medications, immunosuppressants, warfarin, and diuretics. *AVOID with azathioprine and mercaptopurine. Renal clearance dose modification needed. May rarely cause decreased blood counts MONITOR: Liver and Kidney function *Interacts w/ ACE inhibitors (AVOID) Xanthine Oxidase Inhibitor Febuxostat (Uloric) Chronic management of hyperuricemia in patients with gout 40 mg and 80 mg tabs; FDA approved for 80 mg/day Hepatically metabolized non-purine analog; acts with non-competitive inhibition **inhibits synthesis of uric acid by inhibiting xanthine oxidase conversion of hypoxanthine and xanthine to uric acid** S/E: gout flares, nausea, mild rash, liver problems, heart attack symptoms *Hepatically metabolized *Symptoms may get worse initially: patients should be treated concurrently with NSAID or colchicine for up to 6 months Monitor Liver Function: Liver disease is a contraindication to use. AVOID with azathioprine and mercaptopurine. Class Medication What it treats MOA S/E Monitor/BBW/Comments Uricosuric Agent Probenecid (Benemid, Probalan) Chronic management of hyperuricemia in patients with gout 500 mg tablets: FDA approval for BID dosing for a total dose of 2,000 mg/day or less *Uric acid reducer Blocks the transport of acidic media across transporters in the kidneys **inhibit renal tubular reabsorption of urate and therefore increase excretion of uric acid via the kidneys and decrease serum uric acid** S/e: frequent urination, N/V, headache, dizziness, skin rash  NOT used in acute attacks *ENCOURAGE FLUIDS r/t risk of stone development and possible development of nephrolithiasis *monitor CBC for blood dycrasias Monitor BUN/Creatinine clearance *do not take aspirin or salicylates Take medication with food or milk to decrease GI s/e Corticosteroid Prednisone Acute gouty arthritis RA, lupus, asthma, allergies Variable dosing: 35 mg/d and 0.5 mg/kg daily dosing over 5-10 days Inhibits gene transcription for COX-2, cytokines, cell adhesion molecules, and inducible nitric oxide synthase. Creates multi-level suppression of inflammation High BP, weight gain, muscle weakness, insomnia, systemic immunosuppressant, potential for decreased wound healing and increased infectious risk, acute development of hyperglycemia, increased intra-ocular pressure, mood changes, peripheral edema, easy bruising Adrenal Suppression occurs with longterm therapy MONITOR BLOOD SUGARS r/t causing hyperglycemia Patient may need vitamin supplements (vitamin D, calcium, bisphosphonate) to help prevent osteoporosis After 6 months worry about osteoporosis Report black/tarry stools and abdominal pain Adrenal suppression w/ long-term therapy (malaise, myalgia, fever, HTN) Tapering is necessary to prevent withdrawal symptoms If dose exceeds 1 gram, prescribe a PPI (omeprazole) **Do not take with active infections: may worsen fungal infections Class Med What it treats MOA S/E Monitor/BBW/Comments NSAID Naproxen (Aleve, Naprosyn, Anaprox) Indomethacin (Indocin) Sulindac (Clinoril) Aspirin Mild to moderate pain (375-500 mg BID) Acute gouty arthritis (50 mg. TID) Acute gouty arthritis (150-200 mg BID) Mild to moderate pain. (350-650 mg. q 4 hours; 500 mg q 6 hours) RA (500 mg q 4-6 hrs; 1000 mg q 4-6. Hrs; 1950 mg bid Heart attacks prevention w/. 81, 162, or. 325 mg daily Variably selective inhibitors of the COX-1 & COX-2 isoenzymes, leading to decreased prostaglandin formation and inflammatory tissue response **Inhibit COX activity and prostaglandin synthesis S/E: may impair renal/liver function, N/V, rash *Indomethacin is associated with depression and psychosis *BBW increased risk of CV events (MI, stroke, thrombus, CV disease) and GI bleed (increased risk for elderly and w/ increased dose) *Drug interactions w/ Warfarin (increased bleeding) Encourage fluids (renally excreted) Monitor: CBC annually when pt is on long term aspirin therapy: if high dose-also check salicylate level and urine pH. Prescribe H2 blocker (ranitidine) if taking aspirin and pt c/o heartburn *Early sign of aspirin toxicity is tinnitus *Avoid aspirin 1 week prior to surgery: can cause thrombosis w/ Coumadin and Heparin Cautious use in CHF, HTN, PUD, Renal dysfunction, advanced age AVOID IN PREGNANCY *1st line treatment for pain, especially inflammatory pain Analgesic and Antipyretic Acetaminophen (Tylenol) Mild to moderate pain (< 3g/day in elderly or with liver issues <4 g/d) *max dose is now 2 g/d. (was 4 g/d) Highly selective cox-2; inhibit central and. Peripheral prostaglandin synthesis Serious s/e: hypersensitivity rxs, kidney damage, anemia, thrombocytopenia, angioedema, SJS, and liver damage Metabolized by the liver *Toxic to liver in large doses *do not give to patients’ w/ liver disease/alcoholics *In overdose, contact poison control; if ingestion is more than 150 mg/kg or unknown, obrtain serum acetaminophen level (>300mg/mL liver damage has occurred) *tx Gastric lavage w/in 4 hours and oral nacetylcysteine is specific antidote Class Medication What it treats MOA S/E Monitor/BBW/Comments Biguanides Metformin DM2 *also lowers cholesterol, triglycerides, and can aid in weight loss *1st line for adults and children >10 Decrease hepatic glucose production, decrease intestinal absorption of glucose, and improve insulin sensitivity by increasing peripheral glucose uptake and utilization S/e: N/V/D *Diarrhea is BIG s/e Take with food to decrease GI s/e MONITOR renal function (serum creatinine initially, then annually C/I: renal disease or dysfunction, metabolic acidosis (Can cause lactic acidosis) *hold 48 hrs after radiological studies *can reduce B12 and reduce TSH Sulfonylureas *RIDES Glimepiride, chlorpropamide, glipizide, glyburide DM2 (Drug recommended for older adults w/ DM2, is 3rd generation Sulfonylureas) Decrease BG by stimulating insulin release from pancreatic beta cells Hypoglycemia, weight gain, GI upset, hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia *glipizide causes diarrhea MONITOR: CBC if c/o fever/sore throat Take with food except glipizide. (don’t. take with food) *This class is usually added to metformin for additive therapy (Step 2 therapy b/c significant risk of hypoglycemia) C/I: sulfa allergy, hypersensitivity type I, infections/trauma Alpha-Glucosidase Inhibitors Acarbose, miglitol DM2 (50-100 mg taken @ 1 st bite of each meal. Few people can tolerate more than 300 mg/day) Inhibits absorption of carbs, decreases amount of glucose available for absorption s/e: flatulence, diarrhea, abdominal pain (decrease dose if s/e occur) Monitor serum creatinine and serum electrolytes C/I: IBD Take with first bite of each meal *used as adjuvant medication Thiazolidinediones (TZD) *GLITAZONES Rosiglitazone (Avandia) Pioglitazone (Actos) DM2 Off label use to tx PCOS Decrease insulin resistance and improve insulin sensitivity S/e: WATER RETENTION, edema, heart failure *BBW: bone fracture possible BBW: cardiotoxicity, bladder cancer C/I: Class 3 or 4 HF Actos can cause bladder cancer if taken >1 yr *Can cause bone fractures Monitor Weight Watch carefully in patients with decreased ventricular function *Do not initiate when ALD> 2.5 the upper limit of normal. Use back up birth control w/ Pioglitazone Meglitinides *GLINIDES Repaglinide Nateglinide DM2 Close ATP-dependent potassium channels in the beta cell membrane by binding at specific receptor sites which depolarizes the beta cell and leads to an opening of the calcium channels which increases the secretion of insulin. AKA: Stimulates pancrease to produce more insulin S/e: hypoglycemia (less likely b/c shorter ½ life), weight gain *take at start of meal and do NOT take if meal is not eaten *do NOT take at bedtime Dipeptidyl Peptidase-4 Inhibitors (DPPD-4) *GLIPTINS Sitagliptin, alogliptin, linagliptin, sitagliptin DM2 Blocks DPP4 by increasing incretin levels. Increase incretin levels (GLP-1 and GIP) which inhibits glucagon release, which increases insulin secretion, decreases gastric emptying, and decreases BG NO major s/e NO hypoglycemia, no weight gain ADVANTAGE of this drug is LOW risk of hypoglycemia Gliptin and metformin are best for patients w/ high cholesterol Administration of gliptin w/ ACE inhibitor increase risk of angioedema Monitor renal function Digoxin has increased concentration when given with a gliptin Caution use in renal disease Glucagon-like Peptide Agonists. (GLP-1 Agonists) *TIDES Exenatide (Byetta), liraglutide (Victoza), Trulicity DM2 *adjunct therapy w/ metformin or sulfonylureas or both *reduces blood pressure *reduces triglycerides Acts on the incretin system and binds to GLP-1 receptors. GLP-1 agonists mimic GLP-1 hormone and bind to GLP-1 receptors to slow gastric emptying and stimulate insulin release. *increase insulin secretion from beta cells and suppress glucagon release from the alpha cells and slows gastric emptying Has lower risk. Of causing hypoglycemia S/e: GI, weight loss Byetta: Administer 60 min before meal BID at lease 6 hours apart Avoid concurrent use w/ digoxin, lovastatin, and warfarin (monitor digoxin and INR levels) C/I: GI disease Cautious use in patients with renal impairment or end-stage disease *monitor renal function, thyroid, and pancreas Selective Sodium Glucose Cotransporter Inhibitors (SGLT-2) *FLOZINS Canagliflozin (Invokana), Dapagliflozin (Farxiga), Emagliflozin (Jardiance) DM2 (used alone or in combination w/ metformin or other diabetic meds) Inhibition of SGLT-2 to prevent reabsorption of glucose and facilitate glucose excretion in urine. Lowers the threshold for glucosuria and spills sugar into the urine at 140 instead of 180, thus there is less reabsorption of sugar into the body s/e: yeast infections, UTIs, increased urination, kidney problems-renal insufficiency, hypoglycemia, hyperkalemia, GI upset, fatigue, urinary discomfort, and weight loss Increase LDL C/I in patients w/ kidney disease or on dialysis BBW: Necrotizing fasciitis of the perineum *Do not take canagliflozin w/ primizide *Monitor patients on digoxin Canagliflozin can increase effects of ACE inhibitors and ARBs. Monitor renal function and potassium levels frequently Amyline Agonist Pramlintide (Symlin) DM1 and DM2 Synthetic analogue of human amylin: Acts on glucagon secretion, slowing emptying and suppression of appetite Decreases BG after meals S/e: increased risk of hypoglycemia w/ insulin C/I: hypoglycemia unawareness, and confirmed gastroparesis BBW: increased risk of hypoglycemia when used in combination with insulin *Give immediately prior to each meal Rapid Acting Insulin Lispro Aspart Novolog Humalog DM 1 & DM2 RAI: Onset: 15 min Peak: 1 hours Duration: 3-5 hours SAI: Onset: 30 min Peak: 2-3 hours Duration: 4-6 hours IAI: Onset: 1 hours Peak: 4-10 hours Duration: 10-16 hours LAI: Onset: 1 hour Peak: none Duration: up to 24 hours Insulin binds to a glycoprotein receptor on the surface of the cell. **Insulin increase peripheral glucose uptake by skeletal muscle and fat S/E: hypoglycemia, hypokalemia *when switching from NPH to Glargine, decrease dose by 20% to avoid hypoglycemia * Newer premixed insulins work better to decrease hgb A1C than long-acting insulins *when mixing insulin, mix clear to cloudy Short Acting Insulin Regular Humalin R Novalin R Intermediate Acting Insulin NPH (QD or BID dosing) Long Acting Insulin Glargine Detemir Levemir Thyroid Replacement Levothyroxine (Synthroid, Hypothyroidism (high TSH, low TH) Synthetic T4 hormone, also to prevent recurring S/e: hyperthyroid s/s Increased HR, CI: recent MI Levoxyl, T4), Liothyronine (Cytomel T3) thyroid cancer. increased O2 demand on the heart, A-flutter, A-fib, chest pain, tremors, nervousness, insomnia, irritability, N/V/D, weight loss, menstrual irregularity, heat intolerance Elderly: monitor for tachycardia and angina Take 30 min before food on empty stomach Do not take OTC thyroid preps Labs to monitor: Free T4/TSH every 4-8 weeks after starting then at 6 months then at 12 months Long term use and high doses associated with decreased bone density Thyroid replacement during pregnancy requires dose increases and monitoring *teach pt to HOLD if pulse >100 Do not change brands-would need dose adjustments and lab monitoring Antithyroid Agents Propylthiouracil (PTU) Hyperthyroidism Inhibits TH synthesis. Works in thyroid and peripherally S/e: agranulocytosis (report fever/sore throat-CBC), vasculitis, temporary alopecia, aplastic anemia BBW for PTU: liver failure-report headache, malaise, weakness, yellowing of skin or eyes Monitor CBC w/ diff, liver function-prior to treatment Safer in pregnancy Monitor lithium and warfarin levels closely Antithyroid Agents Methimazole Hyperthyroidism Toxic Goiter Thyroid synthesis inhibitor ONLY works in the thyroid s/e: agranulocytosis, vasculitis, hepatotoxicity, pancreatitis, jaundice, pruitis, dark urine, acholic stools, abdominal pain, fatigue, fever (report and stop immediately if s/s agranulocytosis) *Preferred in all patients w/ Graves disease except in 1st trimester b/c it is teratogenic (aplasia cutis) NOT SAFE IN PREGNANCY *May have to take for 6-12 months before in an euthyroid state *Started in higher doses (10-20 mg daily) to restored euthyroidism followed by maintenance 5-10mg daily *may need a beta blocker to decrease cardiac rate *monitor T3/T4 after 4 weeks of starting treatment then every 4-8 weeks until euthyroid state then every 3-4 months *CBC w/diff (fever/sore throat/rash) ACE Inhibitors “prils” Captopril-short ½ life Lisinopril HTN Diabetic patients with Works on RAAS to decrease AgII and Aldosterone, facilitates S/E: dry hacking cough, hypotension Monitor renal function, LFTs, and electrolytes (check K+ levels prior to starting and w/in 1 week) Enalapril Wuinapril Ramipril cardiovascular disease (HTN) Reduce adverse effects of diabetes on the kidneys-slow the onset of diabetic neuropathy in patients w/ microalbuminuria and DM1 breakdown of bradykinin to decrease bp and protect kidneys *Act on AT1 and AT2 receptors by decreasing AgII production Rare/Serious S/e: angioedema-increased risk when coadministered with gliptins Drug interactions: may increase lithium levels leading to lithium toxicity Avoid NSAIDS-reduce effect r/t increased sodium retention Alcohol increases hypotension Take 1 hour apart from antacids-inhibits absorption Decrease ACE dose in creatinine >2.5 C/I: Bilateral renal artery stenosis, pregnancy, and angioedema If dry hacking cough develops, switch to ARB Discontinue diuretics 2-3 days before starting on an ACE inhibitor if potassium depleting r/t risk of hyperkalemia Angiotensin receptor blockers (ARBs) “sartins” Losartan Valsartan HTN Block binding of angiotensin II to the AT1 receptor on cell membrane Similar s/e profile of ACE inhibitors C/I: bilateral renal artery stenosis, pregnancy, angioedema, hyperkalemia Monitor renal/hepatic function, and electrolytes (K+ level prior to starting and 1 week after) Does NOT increase bradykinin so no dry, hacking cough Avoid NSAIDS Give antacids 1 hour apart Calcium Channel Blocker (CCB) Amlodipine Felodipine Amlodipine is used for HF and chest pain; also good for LV Mainly affect arterial vascular smooth muscle and lower blood S/e: hypotension with beta blocker & amlodipine CCBs first line treatment for African Americans Dihydropyridines “Pine” Isradipine Nifedipine Nicardipine Nimodipine nitrendipine failure & HTN pressure by causing vasodilation Block the influx of calcium Reduce afterload significantly and reduce the force of contraction Do not work on heart, only work on vasculature Amlodipine increases blood flow to the heart to relieve angina PERIPHERIAL EDEMA Reflex tachycardia Photosensitivity, dizziness, headache, hypotension, syncope, peripheral edema, palpitations, flushing, optic neuritis, bradycardia, constipation Can worsen proteinuria in patients with peripheral neuropathy Can increase edema of hands and feet No grapefruit juice-increases amlodipine levels Check TSH and Free T4 with Amlodipine Report any eye problems to provider immediately (optic neuritis) Check TSH every 6 months if patient has hypo/hyperthyroidism Do not give nifedipine in angina (reflux tachycardia) Calcium Channel Blocker (CCB) Nondihydropyridine s Diltiazem Verapamil Hypertension Angina Arrhythmias Esophageal disorders Verapamil can treat migraines Verapamil decreases workload-do not give in HF: use for angina: also used to tx SVT Diltiazem: decrease workload and HR, and causes vasodilation: used for arrhythmias S/E Verapamil: bradycardia, heart block, constipation S/E: hypotension, dizziness, headache, syncope, can worsen or lead to HF Do not take verapamil with statins (risk of myalgia) or in patient’s w/ HF (can worsen HF) Do not give with beta blocker; give with ACE inhibitor to decrease proteinuria in DM patients C/I unstable angina r/t risk of tachycardia Avoid use after Mi, avoid in patients with peripheral edema; hepatic impairment, pregnancy category c; avoid in lactation Monitor LFT prior to starting therapy and during therapy Change positions slowly, avoid exercise in hot weather Cardiac Glycoside Digoxin HF and A-fib, Aflutter, slows HR Strong, highly selective inhibitor of sodiumpotassium-adenosine S/E: Gi (N/V/D), anorexia, fatigue, disorientation, Crosses placenta and BBB C/I: renal impairment and AV blocks; triphosphatase system Increase cardiac output and causes ventricles to empty more completely. Digoxin reduces the ventricular rate hallucinations, visual disturbances Toxicity S/S: GI, visual disturbances (yellow vision/green halos), atrial arrhythmias, AV blocks, PVCs pregnancy category C Not 1st line Cautious use and monitor electrolyte abnormalities (K+, Ca+, and Mg) b/c will worsen toxicity Cautious use in elderly r/t renal function and protein levels (require slower digitalization and careful monitoring) Toxicity levels > 2mg/mL (elderly at increased risk for toxicity) Monitor renal function and digoxin levels Eat high potassium diet-milk 1 hour later; high fiber may decrease absorption Take at same time each day; report s/s toxicity and worsening HF and to check pulse Do not take w/ verapamil, amiodarone, erythromycin, epinephrine Hypokalemia leads to dig toxicity Antiarrhythmics Class I: Sodium channel blockers 1a: procainamide and Quinidine 1b: lidocaine SVT and ventricular arrhythmias 1a: lengthens the duration of the action potential and reduces the duration of the action potential 1a S/e: N/V, increased HR, widened QRS, prolonged PR & QT, lupus like syndrome, hypotension, Procainamide has a short ½ life and it needs to be dosed every 3-4 hours 1a drugs: Monitor for CHF if administered after MI/ACS (Difficulty breathing, 1c: flecainide, propanfenone bradycardia 1b S/e: drowsiness, confusion, CV depression 1c S/e: may exacerbate arrhythmias, malignant arrhythmias, dizziness, fatigue peripheral edema, JVD) With procainamide, there is a chance of systemic lupus erythematosus development Monitor CBC and ANA Procainamide may lead to drug induced fever Antiarrhythmics Class II: Beta receptor blocker “olol” Propranolol Metoprolol Hypertension Blocks beta-receptors in the heart causing decreased HR, decreased force of contraction, and decreased rate of AV conduction s/e: bradycardia, lethargy, GI disturbances, CHF, hypotension, depression Contraindicated in asthma Antiarrhythmics Class III: Potassium channel blocker Amiodarone Sotalol SVT s/e: N/V, taste disturbances, bradycardia, heart blocks, dysrhythmias, prolonged QT, hepatitis, hypo/hyperthyroidism, interstitial lung disease, pulmonary fibrosis Blue colored skin, optic neuropathy, eye problems No grapefruit juice (metabolism issues) Not used in pregnancy Monitor chest x-ray, pulmonary function every 3-6 months Inhibits enzyme that converts T4T3 Monitor TSH every 6 months Skip missed doses Antiarrhythmics Class IV: Calcium channel blocker Verapamil Diltiazem Nifedipine Cardizem See above See above Peripherial edema Facial flushing See above Nitrates Glyceryl trinitrate Nitroglycerin Angina Acute MI Severe HTN Coronary artery spasms Reduce preload and after-load Plasma volume expansion in the depletion of intercellular s/e: orthostatic hypotension, bradycardia, syncope, flushing, and headache (ha common and will decrease over time) Do not take with erectile dysfunction meds (causes profound hypotension) Nitrate tolerance with continuous exposure and they lose effectiveness; All regimens should be tailored to provide 10-12 hours self-hydro pro-factors nitrate free interval to decrease tolerance C/I: head trauma or cerebral hemorrhage Peripheral vasodilators Hydralazine Minoxidil Severe refractory HTN Peripheral vasodilation through a direct relaxation of vascular smooth muscles Adverse reaction: rebound HTN, dizziness, tachycardia ETOH and nitrates may potentiate orthostatic hyotension Cautious use in CV disease and pulmonary HTN In people with intolerance to ACEIs and ARBs who have significant kidney dysfunction, the use of combined hydralazine and isosorbide nitrate is effective alternative that has been shown to reduce mortality in people with moderate heart failure, especially African Americans Do not give diuretics with Lithium (lithium toxicity risk greatly increased) Thiazide Diuretics HCTZ Edema in CHF/liver cirrhosis, or kidney disorders HTN HCTZ-deplete body sodium and reduce fluid volume Vision problems, dry mouth, thirst, N/V, drowsiness, restless, dizziness, tachycardia, muscle pain/weakness, red/blistering-peeling skin NSAIDS can decrease diuretic effect Loop Diuretics Furosemide (Lasix) Edema in CHF, liver disease, or kidney disorders such as nephrotic syndrome Inhibit Na-K-Cl cotransporter in the loop of Henle by binding to the chloride transport channel, thus these electrolytes to be losses in urine S/e: increased urination, thirst, muscle cramps, itching/rash, weakness, dizziness, diarrhea Monitor serum potassium NSAIDS can decrease diuretic effect Caution w/ digoxin Potassium sparing diuretics Spironolactone (Aldactone) 1 st line therapy for HTN s/e: hyperkalemia, headache, dizziness, thirst, muscle cramps, N/V/D, stomach cramps NSAIDS can decrease diuretic effect Use of both potassium-sparing diuretics and ACE inhibitors can cause hyperkalemia HMG COA inhibitors Statins Lovastatin Simvastatin Rosuvastatin High cholesterol Blocks HMG-CoA reductase, which block the pathway for synthesizing cholesterol in the liver S/e: liver damage, rhabdomyolysis, DM, neuropathy, sexual dysfunction Before starting on statin get baseline liver function and creatine Ezetimibe (Ezetrol) is an adjunct to diet and statins to reduce total cholesterol/LDL/triglycerides Take in evening, report any muscle weakness/tenderness Avoid grapefruit juice Pt should report muscle cramps/weakness and/or dark colored urine immediately: check CPK Do not give to people w/ 1st or 2nd degree relatives w/ history of muscle issues when started on statins Bile Acid Resins Cholestyramine Colesevelam Questran High Cholesterol Exchanges chloride ions for bile acids so that they can’t be reabsorbed in GI tract S/e: constipation, abdominal pain, bloating, N/V/D, weight loss, flatulence, heartburn Fibric Acid Derivatives Fenofibrate (Tricor) Gemfibrozil (Lopid) High Cholesterol; mainly high triglycerides Increase lipolysis of triglycerides S/e: GI upset (N/V/D), inflammation of liver, back pain, flatulence, headache, abdominal pain, bloating Not 1st line treatment Lopid: Minimal effect on LDL, raises HDL Tricor: lowers LDL Interacts w/ statins and other anti-lipid drugs (cause increase risk of rhabdomyolysis) Niacin (B3) Nicotinic acid High Cholesterol Decrease production of LDL/triglycerides/total cholesterol, increase HDL S/e: Headache, flushing, pruritis d/t vasodilation ER: less flusing Take w/ food and avoid alcohol!! Prior to giving Niacin, give 325 mg ASA 30 min before to help with flushing Monitor creatinine and LFTs Anticoagulant Warfarin Prevention of thrombosis and thromboembolisms Inhibits vitamin K epoxide reductase enzyme that recycles oxidized vitamin K after it has participated in the carboxylation of several blood clot blood coagulation proteins S/e: severe bleeding, red or brown urine, black or bloody stool, severe headache or stomach pain, joint pain Can be reversed w/ vitamin K Avoid vitamin K rich foods (kale, spinach) C/I in pregnancy, hepatic dysfunction, bleeding Monitor INR: therapeutic 2-3 CHF: 1 st line therapy: treat w/ ACE (or ARBs) and diuretic first (coreg and losartan); or use hydralazine/nitrates in African Americans. Add BB especially those w/o A-fib then add beta blocker if not working to help with heart failure 2 nd line therapy: digoxin 3 rd line therapy: diuretics Systolic HTN: treat w/ diruteic and CCB MI: treat with BB (ACE systolic) Angina (BB) Tachycardia (BB) DM2 and proteinuria (ACE) DM2 (ACE) ACE and ARBs help in treating diabetic neuropathy Protein restriction helps slow diabetic neuropathy