Statins (HMGs)-statin suffixatorvastatin (Lipitor)simvastatin (Zocor)Lower rate of cholesterol production First line treatmentforhypercholesterolemia reduce triglyc.reduce. LDLincr. HDLKidney failureLiver failureOral anticoagulants (bleed risk)CYP3A4 inhibitors: erythromycin, grapefruit juice, etc Myopathy- potential rhabdomyolysis & kidney damage6-8 weeks for therapeutic effectMeasure CPK levels Take at bedtime Check for muscle painBile acid sequestrantcholestyramine (Questran)Prevent bile acid resorption, can’t absorb cholesterolType II hyperlipoproteinemia Can use w/ statinsConstipationHeartburn, nauseaDiarrhea General GI issuesAdverse effects decrease over timeNiacin (Vitamin B3) Increase lipase tobreak down lipidsIncr. HDLHyperlipidemia FlushingItchingTake at nightTake low dose ASA before niacin to prevent flushFibric acid derivativegemfibrozil (Lopid)Activate lipase Hyperlipidemia Statin- myalgia riskOral anticoagulantsAbd discomfortDiarrhea, nauseaIncreased liver enzymesCholesterol absorption inhibitorezetimibe (Zetia)Inhibits absorption of cholesterolOften combined with statins Garlic (herbal) Lipid reducer AntispasmodicAnti-HTNAnti-platetlHyperlipidemiaWarfarinDiazepamNSAID bleed riskV/DDermatitis Flax (herbal) Diabetes medsAnticoagulants DiarrheaAllergic reactionsOmega 3 (fish oil) Fish allergies BelchingAllergic reactionsNitratesnitroglycerin Anti-anginalDilate coronary vessels -> incr. oxygen to myocardial tissuePrevent/treat angina Rapid-acting sublingual (ER). Long-acting transdermal preventsSildenafil (Viagra) severe hypotension Other HTN drugs or alcohol (hypotension)Regular/PVC IV tubingHeadaches, reflex tachycardia (BB, calcium ch blocker treat), ortho hypotension, Tolerance develops quicklySublingual, transdermal, IV bypasses liver/first-passRemove patch at night, new one in AMDark glass vial for 3 months shelf lifeBeta Blockers-ololBeta-1 decrease HR, cardiac contractility to lower demand Prevent anginaAfter an MI (protect from catecholamines)Anti-HTNCardiac dysrhythmiaMigraine, tremorVasodilators are bronchoconstrictors(caution in asthmatics) Heart rate below 60Small doses for cardiac issues compared to anti-HTNCalcium channel blockersPeripheral arterial vasodilationReduce heart workload/ decreased oxygen demandEssential HTNPrevent anginaSupraventricular tachycardiaPrinzmetal anginaShort-term afibConstipation First choice for African-Americans ACE inhibitors-prilLisinopril, captopril, enalaprilDiuresis by inhibiting aldosterone, decreases work of heartAngiotensin II receptor blockers (ARBs)-sartanVasodilate; prevent angiotensin II from binding. DecreasesValsartan (Diovan), irbesartan (Avapro)afterload (pressure heart pumps)Beta blockers-olol Metoprolol, carvedilol (Coreg)Reduce heart rate, block sympathetic systemNegative chronotrope Aldosterone antagonist Potassium-sparring diuretic (doesn’t allow you to hold in sodium)Reduce symptoms of heart failure dobutamine (Dobutrex) Increase contractility Increase renal perfusion PositiveinotropicMust have its own dedicated IV lineTachycardiaAnginaDysrhythmia IV only- own lineVery potentB-type natriuretic peptides nesiritide (Natrecor)Sodium diuresisVasodilationIndirectly Hypotension (severe)DysrhythmiaFinal effort for life-threateningincreases cardiac outputSupp. renin-angiotensin HeadacheAbdominal painPhosphodiesterase inhibitormilrinone (Primacor)Positive inotropic(increase contractility)Short term heart failure, when not responding to other drugsVent. dysrhythmia AnginaHypotensionHypokalemiaTremorThrombocytopeniaDedicated line and IV pump onlyCardiac glycosidesdigoxin (Lanoxin)Positive inotropeNegative chronotropeNegative dromotrope Heart failureSVT (supraventricular tachycardia)Afib/flutter Low potassium levelsv-fibdigoxin toxicityHigh fiber diets (fiber binds with digoxin) Diuretics (potassium levels even lower)MANY DRUGSAntidysrhythmics CNS- headache, confusionGI- anorexia, N/V/DEye- color vision, flickering, halos (toxicity symptomNarrow therapeutic window 0.5-2.0 ng/mlMonitor electrolytes (K)Digibind (Fab)- antidote Class I: sodium channelblockersClass IaDelay repolarization Block sodium channelAfib, premature a & v contraction, v-tachGrapefruit juice (toxicity)Anti-HTN (hypotension)Prolonged QTGI upset (take w/ food to diminish)Quinidine:Tinnitus (temporary)Procainamide: infection riskquinidine (long term)procainamide (Pronestyl) (short term)disopyramide Quinidine: digoxin & coumadin toxicityProcainamide: systemic lupus erythematosus, agranulocytosisClass 1blidocaine (Xylocaine)Accelerate repolarization Ventricular dysrhythmias onlyReduce by 50% dose for those w/ liver dysfunction or alcoholismAbnormal sensations, numbness of lips during infusion SeizureRespiratory arrestLots of severe side effects Class Icflecainide (Tambocor)Block sodium channel (pronounced)Severe vent dysrhythmia AfibDigoxin (increases levels of dig)Beta blockers/Ca channel blockers: potentiate cardiac effectsWorsen heart failure: SOB, fear, cough frothy sputumProlong QT intervalPulmonary edemaClass II Beta blockerBlock symp, nervous system stimulationSupravent- and vent dysrhythmias AnginaBradycardia can lead to reduced cardiac output andDon’t stop abruptlyPropranolol (Inderal) Anti-HTN heart failureRaynaud’s syndrome Class IIIPotassium channel blockeramiodarone (Cordarone)Prolong repolarizationPotassium channel blockerDifficult to treat dysrhythmias v-tachresistant afib Multiple drug interactions Pulmonary toxicity w/ long-term use Blue skinEye sensitivityWear sunglasses, eye exams Class IV Calcium channel blockerverapamil (Calan)Ca channel blockerDepress depolarizationReduce AV node conductionRate control for afib Systolic BP <90 orHR <60: hold doseHypotensionBradycardiaPeripheral edema & SOB- heart failureUnclassified Immediate AV node conduction slowing: emergency sinus Asystole for a few seconds Only works for 10 secondsadenosine (Adenocard) rhythm Fast IV push