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71 Cards in this Set
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Definition: VLDL
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Triglyceride-carrying particle that is converted to LDL in the liver.
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Definition: LDL
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Lipid-carrying particle that contains relatively low amounts of protein and high amounts of cholesterol; considered to be "bad" cholesterol. Carries cholesterol away from liver to tissues for use (makes plasma membrane components or steroid) or storage (can cause plaque build-up)
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Definition: HDL
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High-density lipoprotein (HDL) Lipid-carrying particle in the blood that contains high amounts of protein and lower amounts of cholesterol; considered to be "good" cholesterol. Carries cholesterol away from tissues to liver for removal.
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Definition: Reverse cholesterol transport
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The process by which cholesterol is transported away from body tissues to the liver by HDL.
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Definition: Rhabdomyolysis
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Breakdown of muscle fibers usually due to muscle trauma or ischemia. Caused by statins. Can lead to toxicity due to cell contents in blood.
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Mechanism of Action: HMG-CoA reductase or Statin
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Statins inhibit HMG-CoA reductase, a critical enzyme in the biosynthesis of cholesterol. These agents are safe and effective for most patients and are drugs of choice in reducing blood lipid levels.
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Mechanism of Action: Bile Acid Resin
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The bile acid resins bind bile and cholesterol and accelerate their excretion. These agents can reduce cholesterol and LDL levels but are not drugs of choice due to their frequent adverse effects.
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Classes of drugs used for dyslipidemia (abnormal lipid levels)
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Statins
Bile Acid Resins Niacin Fibric Acid Agents Cholesterol Absorption Inhibitors |
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How do lipids travel in the blood?
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As lipoproteins.
lipid + aproprotein. |
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Mechanism of Action: Nicotinic Acid or Niacin
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Nicotinic acid can be effective at lowering LDL cholesterol when given in large amounts. It is not a drug of first choice, but is sometimes combined in smaller doses with other lipid-lowering agents such as the statins.
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Mechanism of Action: Fibric Acid Agents
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Fibric acid agents lower triglyceride levels but have little effect on LDL. They are not drugs of choice because of their potential side effects.
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Mechanism of Action: ezetimibe (Zetia)
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ezetimibe acts by inhibiting the absorption of cholesterol across the small intestine. Its role in treating hyperlipidemia is in combination with statins to achieve an additive reduction in LDL cholesterol.
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STATINS:
Prototype Side Effects Contraindications Interactions Things to Know |
Prototype: atorvastatin (Lipitor)
Side/Adverse effects: myalgia, rhabdomyolsis, GI complaints, possible liver damage Contraindications: Arthritis, serious liver disease, pregnancy Interactions:grapefruit inhibits metabolism of drug, ^ risk of myositis when taken with niacin or fibric acid agents Things to know: Take with food, 2wk onset, goal is to reduce risk of MI and stroke. |
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BILE ACID RESINS:
Prototype Side Effects Contraindications Interactions |
Prototype drug: cholestyramine (Questran)
Adverse effects: GI tract only- such as bloating and constipation Contraindications: biliary obstruction Interactions: Can bind other drugs, increasing potential for drug interactions (digoxin, penicillins, thyroid hormones, thiazide diuretics. Things to Know: Do not give with food/or other drugs. May have to supplement Vitamins B, D, E, K, zinc, folic acid to avoid nutrient depletion. Mix with liquid. Other drugs +2hrs before or 4hrs after admin. |
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FIBRIC ACID AGENTS:
Prototype Side Effects Contraindications Interactions Things to Know |
Prototype drug: gemfibrozil (Lopid)
Side Effects: dyspepsia, diarrhea, nausea, cramps,increases likelihood of gallstones, affects liver function Contraindications: hepatic impairment, renal dysfunction, gallbladder disease Interactions: potentiates anticoagulants and antidiabetics, not for use with statins Things to Know: watch for bleeding with clients on anticoagulants (thins the blood), may decrease blood counts, Hgb, Fatty foods decrease efficacy. Take with a meal. |
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NIACIN:
Prototype Side Effects Contraindications Interactions |
Prototype drug: niacin
Adverse effects: flushing, hot flashes, hepatotoxicity and gout possible, raise blood glucose Contraindications: Diabetes, impaired liver function, menopausal women. Interactions: Things to Know: Often give aspirin prior to administering will reduce hot flash effects, use in combination with other drugs |
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ZETIA:
Side Effects Contraindications Interactions |
Prototype drug: ezetimibe (Zetia)
Primary use: modest reduction in LDL Adverse effects: No serious side effects Use along with a statin |
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Combination drug that includes statin and ezetimibe.
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Vytorin- combination drug – p. 292
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List of Drugs: Statins
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REMEMBER "STATIN"
*atorvastatin (Lipitor) fluvastatin (Lescol) Lovastatin (Mevacor) pitavastatin (Livalo) pracastatin (Pravachol) rsouvastatin (Crestor) simvastatin (Zocor) |
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List of Drugs: Bile Acid Resins
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*cholestyramine (Questran)
colesevelam (Welchol) colestipol (Colestid) |
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Lifestyle Changes for lowering lipid levels.
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Monitor blood-lipid levels
Maintain weight; exercise Reduce dietary saturated fats and cholesterol Increase soluble fiber in diet Reduce or eliminate tobacco use Use of plant sterols and stanols Be culturally aware of dietary habits* |
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List of Drugs: Fibric Acid Agents
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REMEMBER "FIB"
clofibrate (Atromid-S) fenofribrate (Tricor) fenofibric acid (Triplix) *gemfibrozil (Lopid) |
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Most common form of Cardiovascular Disease
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Hypertension (HTN)
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Stages of Hypertension
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Prehypertension - 120-139 / 80-89
Stage I- 140-159 / 90-99 Stage II- 160 + / 100 + |
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Three factors affecting blood pressure.
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Cardiac Output
Blood Volume Peripheral Resistance |
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Effects of HTN on organs.
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Brain: TIA, CVA
Heart: Heart Failure Kidney: Renal failure Retina: Visual impairment/blindness |
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NonPharm methods of controlling HTN.
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Limit alcohol usage
Restrict sodium consumption Reduce saturated fat and cholesterol; increase fresh fruit and vegetable intake Increase physical activity Discontinue tobacco use Reduce stress Maintain optimum weight |
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Types of Drugs used to treat Hypertension and which HTN factor they correct.
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Diuretics- Blood Volume
Calcium Channel Blockers- Cardiac Output ACE Inhibitors- Blood Volume and Cardiac Output Angiotensin Receptor Blockers (ARB's)- Blood Volume and Cardiac Output Beta-Blockers- Cardiac Output Alpha1 Blockers - Peripheral Resistance Alpha2 Agonists - Cardiac Output and Peripheral Resistance Direct Vasodilators- Peripheral Resistance |
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Three types of Diuretics.
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Thiazide
Potassium-sparing Loop |
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Mechanism of Action: Diuretics
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Reduce blood volume by urinary excretion of water and electrolytes.
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Adverse effects of Diuretics.
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Thiazide: hydrochlorothiazide (Microzide).
loss of potassium, increase blood-glucose and uric-acid levels Postassium –sparing: spironolactone (Aldactone) not a potent diuretic, Gynecomastia and hirsutism, hyperkalemia Loop diuretics: furosemide (lasix) most potent, hypokalemia, Hypotension Hearing loss (these drugs are ototoxic) |
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Mechanism of Action: Calcium Channel Blockers
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Block calcium ion channels; cause vasodilation, decreasing B/P
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Mechanism of Action: ACE Inhibitors
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Block effects of angiotensin II, lowering peripheral resistance and decreasing blood volume
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Mechanism of Action: Angiotensin Receptor Blockers
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Block angiotensin receptors in arterial smooth muscle and adrenal glands. Dilate arterioles and increase sodium excretion.
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Mechanism of action: Beta Blockers
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Decrease heart rate and contractility; blockade beta1-receptors in juxtaglomerular apparatus
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Mechanism of action: Alpha1 Blockers
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Block sympathetic receptors in arterioles leading to vasodilation
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Mechanism of action: Direct Vasodilators
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Cause vasodilation by direct relaxation of arterial smooth muscle
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Definition: Heart Failure
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Inability of ventricles to pump enough blood for body’s needs
Weakening of heart muscle due to aging or disease |
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S&S with Left Sided HF
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Blood backs up into lungs
Cough and shortness of breath result |
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S&S with Right Sided HF
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Causes peripheral edema and organ engorgement
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Goal of Pharmacotherapy in HF
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Slow heart rate
Increase contractility Reduce heart workload *Affect Cardiac Output |
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Types of Drugs used to treat HF
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ACE Inhibitors
Diuretics Cardiac Glycosides Beta-Adrenergic Blockers Vasodilators Phosphodiesterase Inhibitors |
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Definition: Coronary Artery Disease (CAD)
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Develops when your coronary arteries become damaged or diseased. Cholesterol-containing deposits are usually to blame for coronary artery disease.
Diminished blood flow may cause chest pain (angina) or shortness of breath. A complete blockage can cause a heart attack. |
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Definition and Characteristics: Angina Pectoris
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Acute chest pain due to insufficient O2 to myocardium.
Steady, intense pain in anterior chest, Pain radiating to left shoulder, left arm, spine, jaw Pallor, dyspnea, diaphoresis Tachycardia, elevated blood pressure Pain diminishes with physical rest and/or stress reduction discomfort subsides in 5 to 10 minutes. |
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Definition: Myocardial Infarction (MI)
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Occurs when a blood clot blocks the flow of blood through a coronary artery. Interrupted blood flow can damage or destroy myocytes within 20 min.
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Types of Drugs used for Angina.
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Nitrates
Beta Blockers Calcium Channel Blockers |
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Types of Drugs used for MI
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Thrombolytics
Opiods for pain |
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Anti-platelet Drugs
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ASA-low dose
Plavix |
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Mechanism of Action: Alpha2 Agonists
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Decrease outflow of sympathetic nerve impulses from CNS to heart and arterioles. Remember: Centrally Acting
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Anticoagulant Drugs
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Heparin
Coumadin Lovenox |
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Types of Drugs for Dysrhythmias
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Sodium Channel Blockers Class I
Beta Blockers Class II Potassium Channel Blockers Class III Calcium Channel Blockers Class IV Others: digoxin and adenosine |
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NonPharm methods to treat Dysrhythmias
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Cardioversion and defibrillation
Electrical shock stops all electrical impulses in heart and allows SA node to regain control |
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Side effects of this antihypertensive agent includes tachycardia, angina, reversible lupus-like syndrome
? propranolol (Inderal) ? mecamylamine (Inversine) ? hydralazine (Apresoline) ? diazoxide (Hyperstat) |
hydralazine (Apresoline)
see page 321 |
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Calcium channel blocker: vasodilation, less likely to have direct cardiac effects:
? nifedipine (Procardia, Adalat) ? diltiazem (Cardiazem) ? verapamil (Calan, Isoptin, Verelan) ? hydrochlorothiazide (Microzide) |
nifedipine (Procardia, Adalat)
Non-selective. see page 307 |
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A patient presents with a blood pressure of 160/110 mm Hg. The patient has a history of coronary vascular disease, resulting in angina, but has no evidence of congestive heart failure. The patient also has asthma and has been treated mainly using terbutaline (Brethine)by aerosol inhalation, Propranolol (Inderal) was prescribed to manage essential hypertension. Was this action appropriate?
? Propranolol (Inderal) is appropriate because it will reduce heart rate and cardiac output. It is an effective antihypertensive agent ? Propranolol (Inderal) is inappropriate because it is only useful in mild hypertension; a better drug would be minoxidil or hydralazine because they are more effective in lowering blood pressure ? Propranolol (Inderal) is appropriate because it is an effective, low-cost antihypertensive. It will augment the effects of terbutaline, an additional benefit ? Propranolol (Inderal) is inappropriate because its use is contraindicated in a patient with asthma. |
Propranolol (Inderal) is inappropriate because its use is contraindicated in a patient with asthma.
See page 364 |
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Vasoconstriction, aldosterone secretion, and renin release suppression occur upon activation of the renin-angiotensin-aldosterone system. How would captopril (Capoten) affect these responses?
? blocks all three ? blocks only vasoconstriction ? blocks all except vasoconstriction ? no effect |
blocks all three
see pg 310-311 |
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An elderly male patient has essential hypertension, congestive heart failure, and type I insulin-dependent diabetes. His congestive failure developed secondary to coronary vascular disease associated with hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this patient?
? chlorothiazide (Diuril) ? captopril (Capoten) ? propranolol (Inderal) ? metoprolol (Lopressor) |
captopril (Capoten)
Rationale: Beta blockers are contraindicated in congestive heart failure, since beta-blockade reduces myocardial contractility; Beta-blockers are also contraindicated in diabetic patients because these drugs block symptoms of hypoglycemia. Beta-blockers also increase serum lipids.Thiazide diuretics worsen control of hyperglycemia and hyperlipidemia--they tend to increase serum triglycerides and LDL cholesterol. |
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Optimal levels of Lipids.
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HDL >60
LDL<100 Triglycerides <150 |
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Things to report when taking Lipid-lowering drugs.
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Statins: numbness, tingling, muscle tenderness/pain, effects that hinder ADL's
Bile Acid: severe nausea, heartburn, constipation, straining with stools, tarry stools, yellowing of sclera or skin Niacin: flank, joint, stomach pain, yellowing Fibric Acid: unusual bleeding/bruising, RUQ pain, muscles cramps, stool color change INSTRUCT PT TO RETURN PERIODICALLY FOR LAB WORK. |
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List of Drugs: Thiazide Diuretics
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chlorothiazide (Diuril)
*hydrochlorothiazide (Microzide) methylclothiazide (Enduron) cholrthalidone (Hygroton) metolazone (Zaroxolyn) indapamide (Lozol) |
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List of Drugs: K Sparing Diuretics
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amiloride (Midamor)
eplerenone (Inspra) spironolactone (Aldactone) triamterene (Dyrenium) |
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List of Drugs: Loop Diuretics
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REMEMBER "IDE"
bumetanide (Bumex) furosemide (Lasix) torsemide (Demadex) |
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List of Drugs: Calcium Channel Blockers
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Selective: REMEMBER "PINE"
amlodipine (Norvasc) felodipine (Plendil) isradipine (DynaCirc) *nifedipine (Procardia) nisoldipine (Nisocor) Non-Selective: diltiazem (Cardizem, Dilacor) verapamil (Clan, Isoptin, Verelan) |
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List of Drugs: ACE Inhibitors
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REMEMBER "PRIL"
benazepril (Lotensin) captopril (Capoten) *enalapril (Vasotec) fosinopril (Monopril) lisinopril (Prinivil, Zestril) moxexipril (Univasc) quinapril (Accupril) ramipril (Altace) trandolapril (Mavik) |
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List of Drugs: ARB's
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REMEMBER "TAN"
candesartan (Atacand) eprosartan (Teveten) irbesartan (Avapro) losartan (Cozaar) olmesartan (Benicar) relmisartan (Micardis) valsartan (Diovan) |
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List of Drugs: Beta Blockers
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REMEMBER "OLOL"
Acebutolol (Sectral) Atenolol (Tenormin) Betaxolol (Kerlone, Betoptic) Bisoprolol (Zebeta) Metoprolol (Lopressor, Toprol). nadolol (Corgard) pindolol (Visken) propranolol (Inderal) timolol (Timoptic) |
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List of Drugs: Alpha 1 Blockers
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REMEMBER "ZOSIN"
*dozazosin (Cardura) prazosin (Minipress) terazosin (Hytrin) |
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List of Drugs: Alpha 2 Agonists
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clondine (Catapres)
methyldopa (Aldomet) |
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List of Drugs: Adrenergic Neuron Blockers
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reserpine (Serpasil)
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List of Drugs: Direct Vasodilators
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hydralazine (Apresoline)
nitroprusside (Nitropress) minoxidil (Loniten) |
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Control center for blood pressure regulation.
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Vasomotor center.
Baroreceptors and chemoreceptors in aorta and internal carotid. Renin-Angiotensin system. |