what is the MOA for loop diuretics?

block Na/K/Cl cotransport in the thick ascending limb of the loop of henle

loop are reserved for patients with what?

-coexisting renal insufficiency
-heart failure (fluid overload)

what are some adverse effects of loops?

-electrolyte disturbances -hypokalemia most often
-hyperuricemia - may precipitate gout

what are some monitoring parameters of loops?

-sulfa allergy
-electrolytes, especially potassium
-dehydration

patient counseling for loops

take in the morning and early afternoon to avoid nocturnal diuresis; watch for cramps or muscle weakness (hypokalemia)

what is the MOA for potassium sparing diuretics?

block sodium channels from the late distal convoluted tubule (DCT) to the collecting duct; directly inhibit potassium secretion

when should potassium sparing diuretics be used?

if previous diuretic treatment caused hypokalemia

adverse effects of potassium sparing diuretics?

-electrolyte disturbances
-gynecomastia

monitoring parameters for potassium sparing diuretics:

electrolytes
renal function

patient education fot potassium sparing diuretics?

take in the morning, excessive potassium intake should be avoided

what is the MOA for aldosterone antagonists?

aldosterone antagonism in the distal renal tubules -->increased NaCl and water excretion while conserving potassium and hydrogen ions

when are aldosterone antagonists not recommended?

if CrCl < 30 mL/min
potassium should be <5 when initiating therapy

adverse effects of aldosterone antagonists

-electrolyte disturbances- hyperkalemia
-gynecomastia (spironalactone)
-worsening renal failure

monitoring parameters for aldosterone antagonists

-potassium
-sodium
-renal function

patient education for aldosterone antagonists

take in the morning, watch for cramps or muscle weakness

what are the 6 caridoselective beta blockers?

BE A MAN
-Betaxolol
-Esmolol
-Atenolol
-Metoprolol
-Acebutolol
-Nebivolol

what beta blockers do ou use in a patient to reduce erectile dysfunction?

Nebivolol (Bystolic)

what are caridioselective beta blockers good for?

-bronchospasms
-diabetics

what is the MOS for beta blockers?

inhibit beta-adrenergic receptors, resulting in a decrease in cardiac output, a decrease in renin release, and a decrease in peripheral vascular resistance

are beta blockers usually first line?

no, unless co-morbid conditions
-taper to discontinue

contraindications of beta blockers

-HR < 60 bpm
-SBP < 90 mmHg
-severe asthma
-heart block
-acute decompensated heart failure

cautions for beta blockers

-bradycardia
-diabetics (tight glycemic control)-may mask signs of hypoglyccemia
-asthma/COPD (use cardioselective)
-noncompliance

what are the adverse effects of beta blockers?

-bradycardia
-bronchial constriction
-discontinuation syndromes
-CNS
-sexual dysfunction (use nebivolol)
-worsening depression
-weight gain

what do you need to monitor for beta blockers?

heart rate (bradycardia)

what are some counseling points for beta blockers?

-patients w diabetes: monitor blood sugar
-compliance to avoid rebound HTN

what is the MOA for alpha-1 blockers?

block the activation of postsynaptic alpha 1 receptors by circulating catecholamines --> vasodilation

alpha 1 blockers are usually used in patients with what?

HTN and BPH (benign prostatic hyperplasia)

adverse effects with alpha 1 blockers

-first-dose syncope
->rise slowly to decrease risk of orthostatic hypotension and syncope
caution in the elderly - fall risk
-headache
-drowsiness
-fatigue
-weakness

what is the MOA for alpha 2 agonists?

stimulate alpha 2 receptors in the brain, inhibiting the release of NE centrally and resulting in decreases sympathetic outflow and increased vagal tone --> vasodilation --> decreased heart rate, cardiac output, systemic vascular resistance, and plasma re

what drug is most effective with an alpha 2 agonist?

diuretic to reduce fluid retention

alpha 2 agonists should be used cautiously in who?

the elderly

alpha 2 agonists:
clonidine (catapres)

-short duration
-dosed BID-TID
should not be dosed QHS for HTN

alpha 2 agonists:
methyldopa (aldomet)

-safe in pregnancy
-side effect profile usually makes clonidine a better choice (except pregnancy)

adverse effects of clonidine (catapres)

-sedation
-dry mouth
-rebound HTN
-skin irritation w/ patch

adverse effects of methyldopa (aldomet)

- somnolence
- postural hypotension
- hemolytic anemia
-positive antinuclear antibodies
- fever
-liver dysfunction

what is the MOA for direct vasodilators?

smooth muscle relaxation for vasodilation

adverse effects for direct vasodilators

-headaches
-tachycardia
-lupus-like syndrome (hydralazine)
-fluid retention
-hirsutism (minoxidil)

what is the MOA for direct renin inhibitors?

inhibits the conversion of ANG I to ANG II by directly inhibiting plasma renin activity

adverse effect of direct renin inhibitor?

- cough
- hyperkalemia
- elevated creatine kinase
-dizziness
- angioedema
- diarrhea

what do you need to watch for in direct renin inhibitors?

CYP3A4 substrate- drug interactions

contraindications for direct renin inhibitors?

-pregnancy
-concomitant use with an ACEi/ARB in those with diabetes

monitoring parameters for direct renin inhibitors

potassium
renal function (BUN, SCr)

patient education for direct renin inhibitors

-administer at the same time daily
-high fat meal reduces absorption so consistent administration with regards to meals recommended

do direct renin inhibitors cause bradycardia

no