test2 chart

7/25/2019 Test2 Chart

1/31

DIURETICSCarbonic Anhydrase Inhibitors= @proximal tubule CA = luminalmembrane & cytoplasm; critical for HCO3

- reabsorption

DRUG EFFECTS USES ADVERSE EFFECTS

Acetazolamid

e

Hyperchloremic metabolic acidosis

(HC!"reab#or$tion%; milddiuresis

FE of Na+('% & +()'%

HCO3-#ecretiona*+eo+#

,+mor & CSF $ro-+ction (al#oCSF $H%

!rinary al"alinization(+ric aci- & c.#tinee/cretion%;#laucoma(I0%$etabolic al"alosis1to excess diuretics+#e(H2lo## in CD% or acute resp% acidosisAcute mountain sic"ness(C3S%

Hyperchloremic metabolic acidosis

&enal stones($,o#$,at+ria4 ,.$ercalci+ria%

+ 'astin(,.$o5alemia (correct 67 Cl

replacementor combo t/%; Aller(icr/n#

C)I= cirrhosis (3H82e/cretionC3S #/%

*oop iuretics= ,- Na+ )+). Cl- symport@thic" asc% *OH (l+minal% General = ra$i-l. ab#orbe-4 bo+n-$la#ma $rotein#4 #ecrete- b. OA/sin 0CT


Furosemide(Lasix%/orsemide

0umetanide

Ethacrynicacid

NaCl4 $(.+4 +4&H+excretion

Ca.+ excretion(miti9ate- in DCT%

isruptcritical #te$ in $ro-+cin9hypertonic medullary interstitium

S.#temic :eno+# ca$acitanceFurosemide=

&0F& redistributesRFmi-corte/

$O1/ e22icaciousa9ent#; 1eere edema(pulm% edema4 CHF4 cirr,o#i# 67 a#cite#%Acute hypercalcemia (m+#t 9i:e #alinetoo% or hyper"alemia; hyponatremia

A&F= urine 2lo'; im$ro:e ob#tr+ction#

Anion oerdose(m+#t 9i:e #aline too%

Hypo"alemic metabolic al"alosis; ECF4depletion; hypoma(nesemiaOtotoxicity= dose"relate-; +#+all.reersible

Hyperuricemia= ,.$o:olemic"a##oc< +ric

aci- reab#or$tion in 0CT

9o+t attac5#Aller(icr/n# = mo#t are #+lfonami-e#)I= N1AIsbluntloo$ -i+retic effect#

/hiazides& /hiazide-li"e iuretics= ("% Na+ )Cl - symport@C/(l+minal% Ca12acti:e reab#or$tion controlle- b. 5/H(in#ert# a$ical Ca12c,912excretion+'astin(67 H2e/cretionCa.+ reabsorption(lo6er ?3a2i

3a27Ca12ba#olateral e/c,an9e%

54&:ia action# on :a#c+lar S>

$ild edemaa##oc< 67 CHF4 li:er & 5i-ne.-i#ea#e4 & corticosteroidt,era$.; H/N

Nephro(enic I ($la#ma :ol+meGFRfiltere- loa- to -i#tal t+b+le#+rine

:ol+me%I-io$at,ic ,.$ercalci+ria6 Ca .+ nephrolithiasis

Hypo"alemic metabolic al"alosis

Hyperuricemia4 hyper(lycemia4hypercalcemia4 ,.$oma9ne#emia

**; im$otence; hyponatremia;

ECF4 depletion7 Aller(icr/n# = are#+lfa

+-1parin( iuretics = @collectin(& late distal tubules; TH t.$e# +#e- to preent hypo"alemia& enhance natriuresis67 loop &thiazides

DRUG T0E EFFECTS USES ADVERSE EFFECTS

1pironolacton

e

Eplerenone

Aldosterone

Ranta(onists

1mall(1'% excretionof filtere-

loa- (limite- ca$acit. of late DCT& CD to reab#orb #ol+te#%

Excretionof + 6 H+6 Ca.+ 6 $(.+

(-+e to l+men"ne9ati:e

tran#e$it,elial $otential%

5ost-$I; t/ H/N; T/mineralocorticoid excessB

8= Conn# #.n-< or ecto$ic

ACTH; 1= CHF4 cirrhosis

Hyper"alemia metabolic acidosis(ri#5 67 renal-i#ea#e or -r+9#renin relea#e%S.nt,etic #teroi-#(ynecomastia4 impotence4

men#tr+alirre(ularities

/riamterene

Amiloride

Na+ channel

inhibitors

T/*ithium-induceddiabetes insipidus

Triamterene"idney stones;A&Fif combo 67

indomethacin; Amilori-enausea4 diarrhea

1


2/31

Al-o#terone net effect# = l+minal Na+conductance& basolateral3a2"2A/5ase; Na+delieryto C, potential+ )H+ secretiono Relea#e =

ratio +)Na+#en#e- b. a-renal corte/ cell#; 1N1or renal a22erentart stretchreninATIIal-o#terone3a24 2

2


3/31

Osmotic iuretics= action# @proximal tubule4 descendin( *OH4 & C $!1/be 2reely 2iltered4 NO/ reabsorbed4 & metabolicall. inert


$annito

l

$!1/9i:e b. I4; medullary tonicity= e/tract 6ater from

ICFe/$an- ECF com$artment("% renin relea#eRF (e#$ar5e-

urine

olume; excretionnearl. all e"l.te# (3a24 24 Ca124 >9124 Cl"4 HC!"%

Natriuresis lesst,an 'ater diuresis,.$ernatremia (initial ,.$onatremia%

T/ A&For renal insu22iciency .

to nephrotoxins

U#e- toIC5& IO5(9la+coma%

T/ dialysis dise9uilibrium synd%

(ra$i- #ol+te remo:al#mEC%

ECF olume expansion

(in CHF can2ran"

pulmonary edema%;37V; H7A; ehydration: hypernatremia

AH anta(onists = anta9oni#t# of 4.AHR# @collectin( ducts Dr+9# t,at can ca+#e SIADH = $#.c,otro$ic me-#4 #+lfon.l+rea#4 al5aloi-#DRUG EFFECTS USES ADVERSE EFFECTS

Coniapta

n

/olaptan

cA$5; Coni:a$tan4

(anta9oni#t @48aR#%

T/ 1IAH(,.$onatremia; 1to $+lm< -i#ea#e4 C3S in+r.4 $o#t"o$4 -r+9#%T/ CHF6,en olume replacement not desired(ADH 1to V%

Nephro(enic I

ARF; ,.$ernatremia

Chan(esin !rinaryElectrol.te 0attern# & o-. $H Im$ortant Dr+9 Interaction#

Gro+$ NaCl NaHCO

3

+

o-.$H

Im$ortantDr+

3SAID#4 #alt & -econ9e#tant#diminished diureticre#$on#e

CAinhibitors + +++

+

toto/ic -r+9#enhance ototoxicityof loop-i+retic#

*oopa9ent# ++++ ;

+

A

DISEASE 0RE> TREAT>E3T

ES

CHF

Refle/ control #ee# ,.$o:olemia3a7H1retention$reloa-; E/ce## 3a7H1retentione-ema in $eri$,er. & l+n9#

*oop -i+retic# or comboloop + thiazide -i+retic#

Com$lication# = e/ce## +#e can2illin( 5; metabolic al"alosis

can com$romi#e car-iac f/n; hypo"alemiaarr,.t,mia#

&enal disease

Glomer+lar -i#ea#e (D>4 SE%3a7H1 retention

Diabetic ne$,ro$at,.,.$er5alemia

3e$,rotic #.n-


4/31

of intra:a#c+lar :ol+me4 hypo"alemia& metabolic al"alosis

3

Essential H/N Hi9, #.#temic 0 &estrict dietary Na+inta5e4 thiazide-i+retic or combo t,era$.

Nephrolithiasi

s

&enal stones(calci+m $,o#$,ate or o/alate% /hiazide-i+retic#urinary Ca.+concentration#

I3ot re#$on#i:e to ADH; t/ = a-e*+ate H1 inta5e /hiazide-i+retic#2luid deliery todilutin( se(ments:ia

$la#ma :ol+me#F&ma/ :ol+me of -il+te +rineHypercalcemi

a

E/ce##i:e Ca12 *oop-i+retic# 67 conc+rrent #aline inf+#ion to $re:ent :ol+mecontraction; ma. nee- to a-- 2a# 6ell

4


5/31

A3TIARRHTH>ICSClass I 9eneral c,ar< = Na + channelbloc5er#4 act on 2ast responsecell#4 threshold for firin9 in abnormal $acema5er4 slo' A5 upstro"e

Class IA= slo's phase ;-e$olariation in :entric+lar m+#cle fiber#4 A5 duration& C46 E&5 H.$er5alemiato/icit. for A cla## I -r+9#DRUG EFFECTS USES ADVERSE EFFECTS

5rocainamid

e

loc5# INa(%4 Ir(1% (intermediate5inetic#%

Directl. pacema"er rate(SA7AV no-e#%

5artial (an(lionic bloc"ade0VR05*iermetaboli#mNA5A; renal elimination

Effecti:e for most atrial& entriculararr,.t,mia# e#$< #.m$tomatic 0VC#4 V"tac,.ndor 3rdDC (after lidocaine4 amiodarone%sustained entriculararr,.t,mia#" acute $I


6/31

;B eliminatedb. "idney unchan(ed Effecti:e conertin( AFsinus r,.t,m If com$romi#e- renalf/ntoxic leels

1otalol

-bloc"in(effect# (Cla## II%; A5

duration:ia bloc5in9 +ch%(Cla## III%

/hresholdof car-iac -efibrillation

T/ life"t,reatenin9entriculararr,.t,mia#>aintain# sinus r,.t,m in $t# 67 AF5eds= t/ 14 &entriculararr,.t,mia#

ose"relate- inci-ence of torsade de pointes

*4 2xnin $t# 67 o:ert CHF

6


7/31

Class I4= *-type Ca.+ channelbloc5er#; ,- A5in 1A& A4 nodes; C4& E&5; 5& interal; bloc5# 0O/Hacti:ate- & inacti:ate- Ca12c,AInteract# 67 Na+)+-A/5ase4 +: Ca.+c,annel#

/orsade de pointes

i(italis toxicity

$uscle 'ea"nessin o:er-o#e

5acema"er cell# A0 (slo' response%B 0,a#e ;= upstro"e; o$enin9 of 4-(ated Ca.+c,annel#; #ome contrib+tion :ia 3a2f+nn. c,aor c+rrent# = non-selectie I2(pacema"er4 Na

+

%& I8(in'ardrectifier4 out'ard

+

%o Factor# t,at rate= slope-ia#tolic -e$olariation & max-ia#tolic potential (51N14 AC,%; shi2tin t,re#,ol- a'ay from Em

Non-pacema"ercell# A0 (2ast response%B 0,a#e ;= rapidupstro"e; V"9ate- Na+c, slope:iaBo 0loc"Na+or Ca.+c,annel#ratio of 3a2(or Ca12% to +$ermeabilit. R indirectlyb. bloc"in( +chronotropiceffect# of NE

7


8/31

Dr+9 tar9et# for abnormal conduction= slo'con-+ction; induce bidirectionalbloc5 in ob#tacle; dispersionin re2ractory$erio-# Hyper"alemia= A5-+ration4 C44 pacema"er rate& arr,.t,mo9ene#i#4 ectopic pacema"er#ite# are more sensitieto +

8


9/31

A3TIH0ERTE3SIVES/hiazide iuretics= ("% Na+ )Cl - symport@C/Na)H.Oexcretion 0lac"$t# 9enerall. respond bettert,an 6,ite $t#


Hydrochlorothiazide(HCT%

Chlorothalidone

(moreeffecti:e%

54

preload

CO

05

O7 contin+e- t/54& :ia

direct actionson :a#c+lar S>;Kresettin(ofbaroreceptorsL

8st line R 67 certain otherantihypertensies to control2luidretention : edema#ome of t,e#ea9ent# ca+#e

Hypo"alemia = sensitizes myocardiumto arrhythmiasHyper(lycemia; hyperuricemia

Hyperlipidemia(c,ole#terol4 VD4 & D%>etabolic al5alo#i#4 ,.$onatremia4 ,.$o:olemia

CC0s(*-type

Ca

.+

Channelloc5er#%B

Non"-i,.-ro$.ri-ine# =

4erapamil&

iltiazem(DH0#%

ihydropyridines=

Ni2edipine&

AmlodipineDRUG EFFECTS USES ADVERSE EFFECTS

Ni2edipine

Amlodipin

e

C,< bloc5a-e on :a#c+lar S>asodilation; dihydropyridines,a:e e22ect

on 04s4 6,ile non-dihydropyridines,a:e e22ecton heart; 0O/H

cla##e#05(preload:a2terload%

8st lineR incombo67 t,iai-eor RAAS mo-ifier

An"le edema; an(ina pectoris67

short actin($re$ of ni2edipine

Fl+#,in94 tran#ient H7A4 #li9,t HR

ACE Inhibitors Enala$ril & i#ino$ril = ONCE daily Ca$to$ril = /I 0t# 67 lo' plasma renin(mo#t blac"$t#% ma. NO/ respond as 'ell


Enalapril

*isinopri

lCa$to$ril

,- ACE

brady"inin &

A/II;

05b7c

A/II& aldosterone(NO edema%

5reload& a2terloadNOeffect on contractilit. or HR

E22ectiein most pts6,en +#e- aloneR in combo67

thiazide6 CC04 or -bloc"er

U#e- after ac+te >I4 for CHF & renal

im$airmentris"of $I6 stro"e4 & diabetic

nephropathy

Hyper"alemia4 dry cou(h4dys(eusia; ,.$oten#ion (#t-o#e%C)I= $t# 67 0* renal a%stenosis& pre(nant F


*osartan; /elmisartanOlmesartan

A&0sCompetitie inhibitorsA/II bindin(A/8&s; preload& a2terload

Do NO/effect car-iac f/n; -o NO/bra-5ininNOco+9,1imilar to

ACE

inhibitors

Hyper"alemia4 dizzinessC)I= samea# ACE"I#

Alis"iren&enin

Inhibitor

In contrastto ACE"I# & AR#4 does NO/ plasma renin actiity

*i"eACE"I# & AR#4 preload& a2terload?)Oaffectin9 car-iac f/n

Hyper"alemia4 diarrheaC)I= samea# ACE"I#

JIntrinsic 1ympath% Act (ISA% = partial a(onist@R#lessHR & m.ocar-ial -e$re##ion & NO0VR :#< "onl. bloc5er#T,e samei# al#o tr+e 67 mixed : bloc5er#

?hite& youn($t# respondbettert,an blac5 & el-erl. $t#

EFFECTS USES ADVERSE EFFECTS C7I & CAUTI3S

H&& FCCO05 $ore seere H/N= +#e- in

combo67 thiazides4 &AA1

Fati(ue4(eneral tiredness4& exercise C)I=Asthma)CO5; sinus bradycardia

Cautions= $; 54; ariant an(ina9

Non-selectie

-bloc"ers

8-selectiebloc5er# $ixed

:

LipidSoluble WaterSoluble Lipid Soluble Water Soluble LipidSoluble

5ropranolol4 TimololJ5indolol

3a-olol >eto$rolol Atenolol J*abetalolCaredilol


10/31

Re#+lt# in re2lex 1N1

acti:it. & 54&

&eninrelease

modi2iers4 or H5CC0sIHD; arrhythmias; CHF

tolerance; 54&; bradycardia4 myocardial

depression; ** & H*

*ipid #ol+bledepression& other CN1#/

pectoris; -o NO/ stopchronica-mine/ico e/ce$t 6,en +#e- for an(ina pectoris6 CHF6 arrhythmias6 : post-$I

10


11/31


5razosin

8

selectiebloc"ers

05b. preload& a2terload

(arterial) enous asodilator%;

H*)**

T/ H/N(NO/8stline%; t/ 05H 5ostural hypotension (8st-o#e%&e2lextachycardia4 H7A4 incontinence4im$otence4 na#al con9e#tion

Clonidine

$ethyldop

a

Central

.

a(onists

In C3S1N1& 51N1acti:it.;

NE release@peripheral 1N1 n%

U#e- to 0 in $t# 6,o ,a:e notrespondedto ot,er combo#CANK/+#e a# monotherapy

$ental depression; sedation4 drymouth4 & constipation; Abrupt )Cafter $rotracte- +#ehypertensie crisis

&eserpine

5ost

1N1bloc"er

,- 4$A/.on :e#icle# in 3E ner:e#

NE depletion in $eri$,er. & C3S

Combined67 -i+retic for mil- to

mo-< H/N(not 6i-el. +#e- b7c C3SA7E%

CN1(#e-ation4 psychic depression%; CV

(04 HR%; -iarr,ea4 aci-4 na#al con9+#cle%; selectielydilate arteriesNO/ einspreloadC'or"& O.demandDRUG EFFECTS USES ADVERSE EFFECTS

Hydralazin

e

Ca.+ aailabilitya2terload Orallyeffecti:e VD# +#e- in adanced sta(e of H/Nto 0in $t# 6,o ,a:e not re#$on-e- a-e*+atel. to ot,er combo#;

$!1/be (ien67 loop diuretic :

-bloc"er; C)I= $t# 67

IH; refle/1N1& &AA1ma.an9ina & i#c,emic

arr.,t,mia#

>a.1*E-li"e syndrome

(art,ral9ia4 #5in ra#,e#4fe:er%

$inoxidil

Opens +

channels,.$er$olariation & S>

relaxation

a2terload

Hypertrichosis(,air%

Dr+9# U#e- to /x Hypertensie Crises= acute

0567 05 88;or 105 8;; emer(ency= acutetar9et or9an dama(e; ur(ency= NO/$re#ent

DRUG 0R0ERTIES EFFECTS ADVERSE EFFECTS

Nitroprussid

e

I4; effect# -i#a$$ear 67inmin+te# of D7C inf+#ion

ilates 0O/Harteries& einsAct# on E&F-&(#C%releases NO

Cyanide toxicity67 $rolon9e- (P8Q,% or too ra$i- inf+#ionC)I= -+rin9 pre(nancy

HydralazineU#e- forhypertensie emer(enciesinpre(nancy relate- toeclampsia See abo:e

*abetalol &apidon#et4 la#t# 3- hrs loc5# :

8st line dru(sfor t/ H/N= thiazide-i+retic#4 &AA1mo-ifier# (ACE"I#4 AR#4 Renin In,ibitor#%4 & CC0s

Dr+9 interaction = A/ modi2iers& N1AIsimpaired renal 2unctione#$< in elderly & olume depleted$t#

+sparin(-i+retic# (1pironolactone& /riamterene% = NO/+#e- a# solea9ent; +#e- in combo67 thiazide& loop-i+retic#+loss *oop-i+retic# (Furosemide% = +#e- 67 antihypertensie a(entst,at cause pronounced 2luid retention; mo#t effecti:e -i+retic b+t mo#t to/ic N)' lifetime $robabilit. of -e:elo$in9 HT3 5rehypertension = S0 8.;"!N or D0 ;"QN 1ta(e 8HT3 = S0 8>;"N or D0 ;"NN If NO/controlle-$I4 an(ina$ectori#4 arrhythmias4 #+--en death4 renal 2ailure4 stro"e4 & isual disturbances

11


12/31

A3TIA3GI3A DRUGSOr(anic Nitrate 4asodilators = NO(2% #Cc#$5dephosphorylation of myosin li(ht chainsascular 1$ relaxation

DRUG 0R0ERTIES EFFECTS USES ADVERSE EFFECTS

Nitro(lycerin

Isosorbide

dinitrate

Isosorbide-G-mononitrate

*ipid-soluble; rapidlyab#orbe- & de(radedin lier/olerance deelops rapidly67 lon("actin9 a9ent#4nee- daily hr dru(-2ree periods1ublin(ual(3G% = route o2 choicefor acuteattac5#;ma/ effect# !") min; -+ration DL hr

Oral(all% = prophylaxis; -+ration 8"1 ,r#/ransdermal(3G% = prophylaxis; Q"8 ,r#I4(3G% = 8st.> hrsin $t# 67 UA73STE>I (AC1%

5reload4 a2terload4 & 'all

tensionO.demand

8 capacitanceV#; -ilate

resistanceV# hi(herDo#e# titrated#o no more

t,an 8; mmH9

05(P -ro$refle/ S3S%

Coronar. a< asospasm

1tablean9ina4ariantan9ina (al#o+#+all. re*+ire CC0s%!nstablean9ina (UA%& N1/E$I(can co"

a-min 67

-bloc"ersmortality%

H)A; orthostatic

05

H&& syncope(D%

)I= 5EG inhibitorse/treme ,.$oten#ion

-0loc"ers ')o I1A= 5ropranolol6 $etoprolol6 Atenolol = FC*4E4& m.ocar-ial 'or"(correct 67 N#%; abrupt 'ithdra'alsxrea$$earEFFECTS USES ADVERSE EFFECTS

FC & 0O.demandHRdiastolic per2usiontime

1table an9ina= cornerstoneof t/ (can co"a-min nitratesor CC0s%;

1ilenti#c,emia (')o$ain%; !A& N1/E$I(co"a-min 67 oral nitrates%

NO/:ariant an9ina; mortalityin #ettin9 of acute $I

Se-ation4 2ati(ue4 impotence4 A4 bloc"C)I=Asthma)CO5; $; decomp%HF)I= additie67 ot,er cardio-depressants

CC0s = bloc5 *-typeCa.+

ch%

tran#membrane Ca12

in2luxB In ,eart =

FC4

1A rate& AV con-+ction &elax ascularS> (arterioles:en+le#%DRUG T0E EFFECTS USES ADVERSE EFFECTS

4erapami

l

iltiazem

NH

50O/Ht.$e# = asodilationa2terload(ma@or% &

enodilationpreload(minor%O.demand

DH0# =FC& H&diastolic per2usion; bl+nt refle/

HR

5rophylactic t/ stable&ariantan9ina (acutely

asospasm%

H5s= $t# 67 hx 14/4 A-2iborA-2lutter

Constipation7acute HF;A4 bloc"; )I= additie67 ot,er car-io"-e$re##ant#

Ni2edipine H5 $ore selectieon 04s0 Hypotension; re2lex H&

t,er A9ent# = li$i- lo6erin9 a9ent# (mo#t fre*+entl. 1tatins%#er+m **ris" ischemicCV e:ent# Diet & life#t.le mo-ification# in-icate-

DRUG >A EFFECTS & USES ADVERSE EFFECTS

&anolazin

e

,- *ate INain ,eart>o-ifie# FAO

O.demand; FA mo-ification ma. im$ro:e 1+tiliation; +#e- for prophylaxis

in chronican9ina (NO/ac+te attac5%; )I= CM53A inhibitorsto/icit.I; improes mortality rates in @ri#5 $o$+lation#;

: durationof i#c,emic attac5# in $t# 67 CA

!A(no#i9n#% & N1/E$I(eleatedbiomar5er# of -ama9e% = $t# 67 UA ,a:e 8G-.;B ris"of acute $I67in 8" 65#; a99re##i:e txris"b. G;Bo T/ = N#(8st.>h%lon(-actin(oral nitrate& co"a-min

-bloc"ers; A1A4 heparin4 ot,er anti$latelet# (G0IIb"IIIa & AD0"R anta9oni#t#%

1/E$I= pla9ue ruptureoccludesa


13/31

!nstable (!A% or KAcceleratin(L An9ina = occ+r# @rest; $ain e/,ibit# in character4 & duration; tonein epicardialaaI 1table(classic4 exertional% an9ina = atherosclerotic pla9ue limitsflo6 +#+all. in lar(e conduitaaaor -eterminant# of m.ocar-ial O.-eman- = 'all stress (preload4 a2terload4 & :entric+lar 'all tension%4H&4 &contractility

13


14/31

TREAT>E3T F HEART FAIURE AGE3TS ?I/HO!/0SITIVE I3TR0iuretics= essential for symptomatic HF67 2luid retention; preent$ro9re##ion from hypertrophyHF; spironolactoneimproes surial

Aldosterone= 3a27H1 retentionedema; + 'astin($otential for arr,.t,mia#; mo-+late# colla9en -e$o#ition (2ibrosisin heart& 04s%o Effect# of al-o#terone 2 3a2oxidatie stress:a#c+lar in2lammation4 dama(e4 & fibro#i# 04s= endothelial dys2xn& remodelin(

o >anife#tation#B V# = H/N4 atherosclerosis4 i#c,emia rain (baroreceptor dys2xn% = stro"e &enal 2ailure

Heart (:entric+lar hypertrophy& remodelin(4 +1N1% = heart 2ailure4 SCD4 $I

DRUG >A EFFECTS & USES ADVERSE EFFECTS

Furosemide

0umetanide

,- Na+)+). Cl-

@thic" asc% *OH

3aCl7H1 excretion; preload& a2terload; edemaNO eidencefor mortality bene2it/hiazides similareffect# to loop4 b+t lessefficacio+#

*oop & /hiazides= +6 Na+6 metabolic

al"alosis4 hyperuricemia6 0+1N1)&AA1*ooponl. = $(.+4 ototoxicityHC/ ,-Na

+)Cl-@C/

1pironolacton

e

Eplerenone

Aldosterone

anta(onists @Cs4

heart4 & arterial 'all

Natriuresis; $reloa-; aderse remodelin(in ,eart& V#;

mortality; T/ 1ta(e III-I4 CHF; recentor

currentCHF #/; t/ hyperaldosteronism& H/N; +

Hyper"alemia;endocrine abnormalities(9.necoma#tia4 im$otence4 men#tr+al irre9+laritie#4-ee$ene- :oice%

Coniaptan

/olaptan

4.& anta(onists

solute-2ree+rineSer+m Na+in CHF $t#; +#e- in hospitalfor acute decompensated HF(,a:e AHDle:el of CHF%; for

euolemic ,.$oten#ion; NOeidencefor mortality

ACE-Is = ,- ACE

A/II; ("% 5inina#e II

brady"ininasodilation& 5# release ATII =

4C4 +1N14

aldosterone& AHrelea#e

A&0s = competitie inhibitorsATII bin-in9 +#+all. @A/8&s A/8R# = 4C& proli2eratieaction# A/.R# = 4& anti$roliferati:e action#DRUG EFFECTS USES ADVERSE EFFECTS

Enalapril

Captopri

l

5reload& a2terload05

&CO; aldosteroneV

Aderse cardiac remodelin(

1lo's :entric+lar -ilation

0ene2its in A**cla##e# of CHF(asymptomaticto

seere%; H/N; diabetic renal disease; improessx;

mortality

ACE-Is =05(#t-o#e%4 renal 2xn4 +4

cou(h4 an(ioedema; C)I= intolerance4 0*renal a% stenosis4 pre(nancy4 ARF

A&0s = +4 an(ioneurotic edema*osartan

Efficac. NO/ e9ualACE-Is(for $t# intolerantto ACE"I#%

$ortalitye#$< in $t# 67 seere systolic HF(EF 8)'%

-0loc"ers = ,- cardiotoxicityof catecholamines; +1N1)&AA1; H&4 preload4 & a2terload; anti"i#c,emic4 anti",.$erten#i:e4 & anti"arr.,t,mic


$etoprolo

l

Caredilol

$ortality; improessx & surial;aderse remodelin(of ,eart; sudden

cardiac death; ,o#$italiation#

1ymptomaticHF; asymptomaticV-.#f/n (EF !"8)'%; a2teracute$I

Can co"a-min 67 ACE-Is

054 2ati(ue4 2luidretention4 HR4 heartbloc"C)I=asthma; A4 bloc"(+nle## $ace-%; ac+te

car-iac decompensation; #e:ere 0

4asodilators)4enodilators

DRUG >A & EFFECTS USES ADVERSE EFFECTS

Isosorbide

dinitrate

4enodilator= NO release(2% GCpreload&

$4O.; $+lm< e-ema; coronar. VDmyocardialper2usion; arterial VDa2terload05

Acute& chronicHF 67 myocardialischemia; orthopnea& 5N; nitrate#2 ,.-ralaine in ACE"I intolerant $t#

H)A; orthostatic 05; H&

)I= #.ner9i#tic 67 5EG-Is; a--iti:e67 ot,er :a#o-ilator#

14


15/31

Hydralazine Arterial asodilator = NO synthesisa2terload Hydralazine2 nitrates= mortality 1*E-li"e synd%; fl+i- retention4 HRNitroprusside $ixedasodilator= preload& a2terload Acute cardiac decompression; hypertensieemer(encies; A)E= E/ce## 0

15


16/31

TREAT>E3T F HEART FAIURE 5O1I/I4E INO/&O5ICAGE3TS +Inotropict,era$. = maymortality(except for di(oxin%; #ome +#e in re2ractoryCHF; NO/for +#e a# chronict,era$.

o >.oc.te cA>0 = o$en# slo'in6ar- Ca.+c,annel+inotropy; Ca12stora(eb. SR+lusitropy(m.ocar-ial relaxation%i(italis #lycosides= ,- Na+)+-A/5asePNa+Qi& Na

+)Ca .+e/c,an9e Net e22ect= more Ca.+aailable for lon9er -+rin9 A0contractility

DRUG EFFECTS USES C3TRAI3DICATI3S

i(oxi

n

Natriuresis; 1N1& &AA1;

a(altone (atrial rate & A4C4%Normalizesarterial barore2lex

Chronic symptomaticHF (if noade9uate responseto ACE-Is2

diuretics2 -bloc"ers; combo 67 ACE"I# 2 -i+retic# if #/

$er#i#t%; t/ A-2ib(for rate control%; -oe# NO/improesurial

in CHF

A-:ance-A4 bloc"4 H&or sic"

sinus (67o $acin9%; 54Cs& 4-

tach; +; ?5?#.n-< 67 A-2ib

-a(onists= ,+ AC

cA$5(2% 0phosphorylates Ca.+ch%

Ca.+ in2lux

FCC Gi:en I4only /oxicity = arrhythmiasDRUG EFFECTS USES

obutamine 8-selectie (minor.&8%; 8H&4 FC0 & C T/ acute decompensated HF; intermittentt,era$. in chronicHFto sxopamine(A%

*o'-o#e = 84in :i#cera4 heart; hi(h-o#e = 8FC

4ery hi(h-o#e = 8VC05

T/ acute decompensatedHF& shoc"

0ipyridines =0DE"I# (5hosphodiesterase In,ibitor#%

DRUG >A EFFECTS USES TICIT

$ilrinone;Inamrinone ,- 5E-3

brea"do'nof cA$5

Contractility& asodilation T/ acute decompensated HF Arrhythmias

>ana9ementof acute HFB Acute $I(27" $re"e/i#tin9 CHF% = t/ 67emer(ency reascularization(e:en if #+cce##f+l4 ac+te HF ma. -e:elo$

o T,era$. (8I4ro+te% = -i+retic (2urosemide= >C%; A ordobutamine($t# 67 seere 05%; :a#o-ilator# (nitroprusside6 N#%

Nesiritide(0N5 a(onist%VD; Coniaptanfor e+:olemic ,.$oten#ion ($t# 67

AH% CC0s= C)Ifor acute HF

1C (S+--en Car-iac Deat,% 5reentionB 8= G;-R;B$t# 67 lo' EF& symptomaticHF ,a:e e$i#o-e# of nonsustained 4-tacho $ost antiarrhythmic-r+9# ,a:e ,- inotropiceffect# & can ris"of #erio+# arr,.t,mia; e#$< ,i9, for 9ro+$# IA4 I04 & #ome III(#otalol%

Amiodarone= noeffect on #+r:i:al in $t# 67 lo' EF& HF; +#e- to preent recurrent AFor #.m$tomatic :entric+lar arr,.t,mia#

o IC= for . preentionof 1C from4-tach in $t# 67 ot,er6i#e (ood clinical 2xn &pro(nosis

*o' outputHF = diastolic-.#f/n (hypertrophy& sti22ness; C4 EF o"% & systolic-.#f/n (e#$< post-$I4 C & EF8'%

Com$en#ator. mec,ani#m# = Fran"-1tarlin( (intrin#ic%; neurohormonalre#$on#e (

1N14 &AA14 & AH; reset barore2lex%; hypertrophy Sta9e A= @ris"for HF4 NO-i#ea#e or #/; 9oal# = t/H/N4 lipids&metabolic#.n-


17/31

orca#erinSelecti:e a9oni#t of "HT 1C"R;

a$$etite6ei9,tA-+nct for o:er6ei9,t or obe#e $t# 67 2comorbi-itie#

H7A4 URTI4 -iine##4 na+#eaC7I = $re9nanc.; D7I = SSRI#

17


18/31

A3TIH0ERI0IDE>IC AGE3TSNiacin= .x**4 >xH*4 3x/#s(4**%4 & cholesterol (in VD & D% )I= hypotensionin $t# t/ 67 asodilators

DRUG

>A USES ADVERSE EFFECTS

Niaci

n

in-# #5C&on a-i$oc.te#H1*li$ol.#i#FFA&

/#s; ,- hepatic 4** production;

tLof apoAIHD$O1/ e22ectiefor

H*; t/ FH&

FCH

Cutaneous 2lushin((67 E"R; ta"e A1A priorto%;na+#ea4 predisposition to (out4 G4 hepatoxicity

Fibrates= **4 3xH*4 >x/#s NO/for 2amilial,.$erchylomicronemia C)I= seerehepatic& renal-.#f/n R (allbladder-i#ea#e $t#

DRUG >A USES ADVERSE EFFECTS

#em2ibrozi

l

Feno2ibrate

*i(andsfor nuclear-& 55A&-

*5* transcriptionhydrolysisof

/#sin C$s& 4**

T/ disorders 6784** &

dysbetalipoproteinemia;preentin( pancreatitisin $t# 67

seere /#s

S5in ra#,e#4 mil- GI -i#tre##; (allstone 2ormation&habdomyolysisin $t# ta5in9 bot, 2ibrates& statins)I= com$ete 67 coumarinfor

00

anticoa(ulation

0ile Acid 1e9uestrants = 3x**4 H* NOe22ecton $t# 67 homozy(ous FH(NOf+nctional **-&s% Cholestyraminefor C. difficilem9mt


Cholestyramine

Colestipol

in- bile aci-#7#alt#excretedin

2eces

bile acidconcx**4 .xH*4 .x/#s .benefit# = $t#hospitalizedfor in2luenzat,at 'ere on statins,a- >;B mortality:#A USES ADVERSE EFFECTS

Atorastatin

1imastatin

5raastatin

&osuastatin

,- H$#-CoA reductase=committe- #te$de noo

cholesterol synthesis; 1=

IC c,ole#terol

**-&s

T/ disorders67 **& cholesterol

in A**,.$erli$o$roteinemia t.$e#

ON*Mcla## of -r+9# to mortalityin

8

: .

preention o2 C4

&habdomyolysis= +ncommon; most o2tenin elderly F67 hi(h-o#e# or 6,en statins+#e- in combo67 ot,er# (e


19/31

In $t# 67 $ree/i#tin9 ,.$ertri9l.ceri-emia4 ma. #er+m TG le:el#

19


20/31

DRUGS AFFECTI3G D CTTI3GAnticoa(ulantsB Eno/a$arin=LMWH4Lovenox t,er direct thrombin-Is9i:en I4; t/ HIT; elimination = e$ir+-in (renal%; Ar9atroban (,e$atic%

DRUG T0E & >A 0HAR>ACI3ETICS ADVERSE EFFECTS

Heparin

(UFH%

Indirect thrombin inhibitors

Allosteric enhancersof antithrombin=de(rades clottin( 2actor proteases4 e#$& ot,er#4 dietary 4it Antidote= 4it 8(phytonadione% 2 FF0

&iaroxiban

irect 2actor a inhibitor; U#e# =preents4/(after oint replacement%

& embolismin $t# 67 non-alularA-2ib

8x daily 5O;NOmonitorin9 nee-e-&enal& hepaticelimination

/x&

recurrenceof 4/& 5E

0leedin((NOanti-ote%)I= CM53A>& 5-(pin,ibitor#

abi(atran

irect thrombin competitie inhibitor

$O&E e22ectiet,an 'ar2arinfor stro"epreentionin $t# 67 non-alularA-2ib

0I5O; NOmonitorin9 nee-e-

0ro-r+9; 8renalelimination

0leedin((NO antidote%

C)I = $t# 67 mechanical,eart ales)I= 5-(ptran#$orter in,ibitor#

Antiplatelet A(ents A5= ca+#e# platelet a((re(ation TT0 = T,rombotic T,romboc.to$enic 0+r$+ra IRR = Irre:er#ible


Aspirin I&& acetylation of CO,- /A.synthesis 8prophylaxisof $I; .preentionin $t# 67 hxascular eents; 0CI

Clopido(rel

(Plavix%

I&& bloc"adeof A5 &s(5.M8.%,-a((re(ation

5rodru(,+b. CM5.C8()I& (enetic ariation%

Recent$Ior stro"e; e#tabli#,e- 5A;AC1; 0CI; often +#e- 67 ASA & 00I

0leedin(; //5; D7I = me$raole &ot,er 00I# ($anto$raole be#t c,oice%

5rasu(rel 3e6 a9ent in samec,emical class as aboe; NO/affecte- b. 5>G; (enotype#tat+# lee-in9 ri#5/ica(relor &eersible bloc"adeof A5 &s; already actie U#e- for ACS; A1A-o#e $!1/8;; m()day; blee-in94 HR4 -.#$neaAbciximab I&& bloc"s#5 IIb)IIIa &("% fibrino9en cro##"lin5in9 Gi:en I4for 5CI(0erc+taneo+# coronar. inter:ention%

Fibrinolytic ru(s= catalyzecon:er#ion of plasmino(enplasmin= #erine $rotea#e de(rades 2ibrin; A 9i:en I4

DRUG >A USES & ADVERSE EFFECTS

1trepto"inase Combines67 endo(enous actiator 0E4 #e:ere DVT4 ac+te >I; a#cen-in9 t,rombo$,lebiti#A7E = bleedin(; imm+ne re#$on#e to #tre$to5ina#e; antidote= aminocaproic acidAlteplase(tPA%4 Uro5ina#e Act# directly

/A.& "HT = ca+#e# platelet a((re(ation &asoconstriction; Ca.+= lin5# clottin( 2actors(-carboxy(lutamate residues%actiatedcell# Coa(ulationca#ca-e = #tart# 67 interaction of /F(/issue Factor% & Factor 4II(TF0I in,ibit# t,i# interaction%; en- $ro-+ct = thrombin(IIa%

20


21/31

o 5roteins C& 1= ,-cofactor#4a& 4IIIa HI/ tx= )C,e$arin4 startdirect thrombin inhibitor(-abi9atran% or 2ondaparinux

Fibrinolysis= tissue plasmino(en actiatorcon:ert# plasmino(enplasmin 5AI; .Antiplasmin= ("% $la#min not a##oc< 67 clot#

21


22/31

Antidotes & ru(s !sed in 0leedin( isorders 4it 8= NO/ e22ectiefor ,emorr,a9ic -iat,e#i# from li:er fail+re


5rotamine sul2ate a#ic $rotamine 2 aci-ic ,e$arin#table #alt Antidote for heparin; 9i:en IV 37V4 04 ana$,.la/i#; bleedin(4it 8

(phytonadione%Co-2actor-carboxylation#lu residueson

2actorsII64II6 I6 4C4 1; la( timefor onset

Antidotefor 'ar2arin; 9i:en to A**ne'bornsto $re:ent 4it de2%

If I4 9i:en too2astdyspnea4

chest& bac" pain4 death

Aminocaproic acid in-# $la#mino9en & ,- conersionplasmin Antidotefor 2ibrinolytics; ,emo$,iliac#&is"for thrombosis; C7I = DIC

esmopressin Factor 4IIIactiity; AHact%(analo9+e% Hemo#ta#i# in $t# 67 ,emo$,ilia A4 :OD *ess 1$ contractiont,an ADH

Factor 4IIa(recomb% in-# 67 tissue 2actor,+ extrinsicpath Hemo#ta#i# in $t# 67 ,emo$,ilia4 VII -ef /hrombosis; ,.$er#en#iti:it.

H0THAA>US & 0ITUITAR HR>3ES (HT"0 AIS%HT"0"GH A/i#B #H= polypeptide4 pulsatilerelea#e in sleep #hrelin= al#o #H#ecretion *aron d'ar2ism= #H-&mutationNOIGF"

DRUG >A USES & 0HAR>ACI3ETICS ADVERSE EFFECTS

1ermorelin #H&H ia(nostic(etiolo(yof short stature% = if $t 67 !-eficienc.4 a-minGH Sale a# Kanti-a(in(L

1omatotropi

n

Recomb #HI#F-8

#ecretion b. li:er

T/ #H-dependent(ro'th retardation= bone (ro'th& cartila(e synthesis;t/ #H de2icientadults= lean m% mass4 6a#tin9 in HIV $t#; 9i:en 1C-ail.

Children= scoliosisAdults= e-ema4 m.al9ia

5e(isomant

Selecti:e #H-&

anta(onistI#F-8

.nd -line; t/ acrome(aly(somatotropha-enoma in adults; in "ids(i(antism%

in $t# 6,o ONK/respond7tolerateot,er t/; 9i:en 1C-ail.

(5E#.late-

tL%

*ieren.me#; size

of tumor(yearly $&I%

1omatostatin ,- &elease#H4 insulin *imitedt,era$e+tic useb7c many e22ects& rapidly cleared; al#o ,- 5&*4 /1H Hyper(lycemia

Octreotide

1omatostatin analo(=potency6 #H"selectie

T/ acrome(aly4 #I bleedin((#$lanc,nic bloo- flo6%4 secretory diarrhea4carcinoid syndrome4 & 4I5omas; 9i:en a# depot1Cinection monthly

Nausea4 #I motility4

#in+# bra-.car-ia

HT"0"0rolactin A/i#B actotro$,# = tonic ,-b. A$ortal #.#tem disruption5&*= ,- #n&H release:(onadtrophsensitiityin2ertility

DRUG >A USES & 0HAR>ACI3ETICS ADVERSE EFFECTS

0romocriptin

e

Caber(oline

A a(onists=er(ot-eri:< bind.-&s

T/ hyperprolactinemia4 in2ertility4 & acrome(aly(

t+mor size%; romocri$tine

daily4 neuroleptic mali(nant #.n- (off"label%; Caber9oline.x)'ee"4

nausea

Nausea4 H7A4 ort,o#tatic

0; psychmani2estations

HT"0"T,.roi- A/i#B T,.roi- hormone replacement= e22ectiet,era$. for ,.$ot,.roi-i#m If 8

= $t ,a#

/1H leels

DRUG

T0E USES & 0HAR>ACI3ETICS ADVERSE EFFECTS

/&H

/1H

TRH = synthetictripeptide; 9i:e I4

ia(nosis hypothyroidismetiolo(y; if .= a-min /1Hthyroid

,ormone#; if 3= a-min /&H/1H; TRH tW = 8 min; /&H= al#o 5&*

relea#e

Nausea4 +r9e to urinate4 metallicta#te4 li9,t",ea-e-ne##4 tran#ient HT3

HT"0"Re$ro-+cti:e A/i#B A** 3,ormone# ,a:e same & di22 "#+b+nit#; *H& hC#are nearlyidentical A**$re$# 9i:en 1Cor I$

DRU T0E EFFECTS USES ADVERSE EFFECTS

22


23/31

G

F1H!ro2ollitropin= $+rifie-urineextract

Follicle deelopment4 #teroi-o9ene#i#;(ameto(enesis

Induce oulationin F 67 anoulation

1to ,.$o9ona-otro$i#m4 0CS4obe#it. (& no re#$on#e to ot,er t/%;

controlledo:ar. #tim+lation in A&/;t/ in2ertility

Oarian hyperstimulation4

ri#5 multiple$re9nancie#;H7A4 -e$re##ion4 e-ema;

(ynecomastiain >*H

*utropin al2a= recomb< Oulation tri((er; steroido(enesis(>7F%

hC# 0+rifie-urine extract Action# :ia *H &s; +#e- insteadof *H

23


24/31

SE HR>3ESGona-al Hormone S.nt,e#i# In,ibitor# Te#to#terone & e#tro9en (usually% = ,- #n&H4 *H4 & F1H In,ibin#("% FSH; acti:in(2% FSH

DRUG T0E & EFFECTS USES ADVERSE EFFECTS

*euprolide

#oserelin

#n&H a(onists= CON/IN!O!1-o#einitial,+;

t,endesensitization,- *H : F1H release

5remeno$a+#al F 67 adanced breast CA;le+$roli-e for prostate CA(effecti:e ascastration%4en-ometrio#i#4 precocious puberty& IVF

Hot fla#,e#4 impotence4

(ynecomastia4 libi-o;ri#5 of $& C4

Finasterid

e

/ype II G-reductase competitieinhibitors,-

local H/$ro-+ctionslo's$ro#tate(ro'th

T/ 05H4 male pattern baldness*ibido & E; ,- $

2etal#e/ -e:elo$ment

*etrozoleAna#troole

Aromatase competitieinhibitors

estro(en;induce oulationb.

,- 2eedbac"T/ estro(en-drien metastatic breast CA(moree22ectiet,an 1E&$s%; I4F($t# t,at failclomi$,ene%

3a+#ea4 fati9+e4 ,otfla#,e#; osteoporosis

#anirelix#n&H anta(onist=preent *H sur(e;immediate

Controlled oarian hyperstimulationin I4F

1E&$s(Selecti:e Estro(enRece$tor >o-+lator#% = mixed a(onists)anta(onists; ER"& = tissue& li(anddependente#tro9en tar(et speci2icityDRUG EFFECTS USES ADVERSE EFFECTS

/amoxi2en )/lo'er affinit. t,an e#tro9en; a(onistin endometrium4 bone Estro(en-drienbreast CA Hot fla#,e#; endometrial CA

&aloxi2ene

A(onist in boneON*M(NOeffect on endometriumNO

$re-i#$o#ition to CA%;

bone resorption;

**le:el#

Osteoporosisin postmeno$a+#al

F; preentbreast CAin hi(h ris"$t#

Hot fla#,e#4 37V;

thromboembolic eents

Clomiphen

e

Anta(onistin H/& ant% pituitaryrelie2of ,- 2eedbac"b.

estro(en#n&H; partial a(onistin oaries2ollicle

(ro'th

F1H& *HInduces oulation

(/I$IN#i# 5e.% in anoulatoryF

$ultiple 2ollicles;

oary

size; #el-omHS (:#< F1H%

Andro(en &eceptor Competitie Anta(onistsB 1pironolactone= al#o can in-+ce normal menstrual periods67 anoulatory hyperandro(enism


Flutamide;ical+tami-eNonsteroidal; #ince ("% AR#GnRH4 +#e- '7 leuprolide $etastatic prostate CA; 0H #ynecomastia4 N)44

hepatitis

1pironolactone ,-Andro(en synthesis; mild anti-andro(en$ro$< T/ hirsutism4 perimeno$a+#al acne

5ro(esterone(0G% &eceptor Competitie Anta(onist 5#& A&s= $O1/closely related 5#= s endometrium$roliferati:esecretory

DRUG EFFECTS USES A7E

$i2epriston

e (&!->%

eathof deciduablastocyst dies& detaches

,CGcor$+# l+te+m in:ol+te#5##.nt,e#i#8st trimester abortions(+#e- 67 misoprostolcontraction#%;

t/ en-ometrio#i# & 0G"-e$en-ent CA; #Canta9oni#tExcess a(inal

bleedin(

H&/= +#e lo'estdosesfor shortesttime & #tart sooner(@onset% Estradiol= patch4 to$ical; $remarin = 0 Te#to#terone c.$ionate = I$


5remarinCon@u(ated estro(ens= A*?AM167pro(estinin F 67 intact uterus

&elieemenopausesx(hot 2lashes4UG atrophy4 & preent osteoporosis%

N)44 $o#tmeno$a+#al blee-in94 edema6 breast2ullness4 mi(raines

24


25/31

Fluoxymesteron

e

/estosterone deriatie9i:en 5O(normal te#to#terone CANK/b7c hi(h 8st

passmetaboli#m%; muscle mass;

bioa:ailabilit. transdermal(best%

T/ hypo(onadism; libido4 #enile

o#teo$oro#i#4 hereditary an(ioedema4

breast CA

F= masculinization 4 men#tr+al irre9+laritie#;C)I= pre(nancy; $= (ynecomastia4

$ria$i#m4 impotence4 #$ermato9ene#i#4@aundice4 HCCids= premature epiphyseal closure

25

C i E $O1/ di l (E % (E % i l (E % 5 i d 2i i l b " h h bl di


26/31

ContraceptionB E#tro9en#B $O1/$otent = estradiol(E1% P e#trone (E% P estriol(E!% 5ro(estinde2iciency= latebrea"throu(h bleedin(


Combination

,- #n&H4 *H4 & F1H#ecretion,- oulation; cerical

mucous& endometrial s; PNN' effecti:e ta"en as directed

(N1'%; mono" = constantamt; bi" & tri$,a#ic $re$# amt

$ro9e#tin

total amounta-min; *o'"-o#e estro(en(ethinyl

estradiolor mestranol% = blee-in94 $otentiate# $ro9e#tin(A*?AM19i:en ') pro(estin%

5ro(estin(norethindrone4 nor(estrel% = ("% o:+lation )"Q)'& $re9nanc. MN'; ne'er67 anti- (a% or andro(enicactCC infant -eat, 0reterm = ! 65#; $remat+re = lb# 3ormal = 8) 65# 0o#t"term = 81 65#; Xri#5 of meconi+m

/.tocic# = for labor inductionor au(mentation abor = contraction# optional; Sta9e#B 8= cer:ical -ilation; -eli:er. of infant (.% & $lacenta (3%


Oxytocin

0oth&2orceof contractions;

ON*Meffecti:e @endof $re9nanc.

(dependent on oxytocin &s%

*abor induction& au(mentation(:ia

constant in2usion%; mil" Tlet-do'nU(:ia

na#al #$ra.%; 8postpartum hemorrha(e

HT3 cri#i#4Na+4 arr,.t,mia4 +terine

r+$t+re4 fetal -eat,; C)I= fetal distress4abn%fetal $re#entation4 prior maor #+r9er.

$isoprostol (5#E8% 5rosta(landinscan initiate laborANMtimein $re9nanc. (:#< o/.tocin%

In-+ce labor4 ripen cerix(:a9inal in#ert% 37V4 -iarr,ea4 abnormal contraction#

Carboprost (5#F.

% ON*Mto #to$ postpartum bleedin( N)44diarrhea4 fe:er; C7I = a#t,ma

$ethyler(onoineEr(ot al"aloid,+

&sintense4

prolon(edcontraction; NO/b.I4

ON*Mfor control or preentionofpostpartum hemorrha(e

Ac+te >I4 CVA4 an9ina4 HT34 bra-.car-ia;C7I = HT3 or Ra.na+-# #.n-rome

/ocolytics= +#e- to delay preterm delieryhrs-days#o GC# can fetal l+n9 mat+rit.; al#o +#e- #o infant# in breec, $o#ition can be t+rne-DRUG EFFECTS USES ADVERSE EFFECTS

Indomethacin(3SAID#% 0ro#ta9lan-in #.nt,e#i# = $O1/e22icacious@delayin( pretermbirt, 67 leastA7E OCfor 0T be2ore 3. '"s; m+#tmonitor 0DA to en#+re flo6 P #afe le:el $ayinci-ence of necrotiin9 enterocoliti#& neonatal renal in#+fficienc.Ni2edipine H5 CC0= S>"#electi:e; ("% SR Ca12relea#e T/ 0T 3.-3> '"s9e#tation Fl+#,in94 -iine##4 H7A

/erbutaline.-a(onist= cA>0(2% 0A>C$,o#$,or.lationS> rela/ation

Dela. labor for 8Q ,r# (limite- b.

desensitization%Tremor4 $al$itation#4 04 $+lm< e-ema4HR; can cross$lacenta

$( sul2ateUn5no6n >A; com$ete# 67 Ca12& #tabilie#

cell membrane; inci-ence of cerebral $al#.OCfor preention o2 eclampsia; t/

unpleasantfor $t#I distress4 sensation o2 oerheatin(4

s'eatin(4 37V4 H7A4 HR; C7I = >GNitro(lycerin Ra$i-l. rela/ :eno+# & +terine S> 3ot eno+9, e:i-ence for 0T Diine##4 H7A

8R -hydroxypro(esterone caproate= 9i:en I> 6ee5l. T/ in .ndtrimester,el$# ris"of preterm birthin hi(h ris" pts

26

I3SUI3


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I3SUI3= all subcutaneous(1C% inection# T.$e 8(I$% = seere insulinopenia-+e to loss o2 cells; dependenton exo(enousin#+lin to $re:ent DA & -eat, T.$e .(NI$% = $C; insulin resistance& secretory de2ect; NO/dependenton e/o9eno+#4 ma. re*+ire in $erio-# of stressor if re2ractoryDRUG 0R0ERTIES 0 D EFFECTS F I3SUI3 THER

*ispro(Humalog%

&apid-actin(= mo-ification# preent

2ormationof hexamers

absorption

ratefrom 1Cinection #ite

;%.

G

)4 b+tform# microprecipitatea2ter 1Cinection

etemir*on(-actin(= fa#ter ab#or$tion4 b+t slo'releasefrom bindin(to albumin "1

#luca(on=

secretionin $t# 67 insulin de2iciency; ener(y mobilization4 rapid

(lyco(enolysis& (luconeo(enesis; emer(encytx hypo(lycemia

DRUGS FR T0E 1 D> = all orala9ent# exceptincretin mimetic# & am.lin analo9.nd#eneration1ul2onylureas(SU#% = in#+linsecreta(o(ue; 1n-9eneration -r+9# D8;; times more potentt,an 8st9eneration (ionic bindin()I%

DRUG >A4 EFFECTS4 & 0HAR>ACI3ETICS ADVERSE EFFECTS

#lipizide

#lyburide

#limepirid

e

,- A/5-dependent + ch%on -cellsdepolarizationPCa .+ Qi

insulin release; can insulin resistance; HbA8c; NO/e22ectie

in t/ /ype 8 $(NO2xn"cell#%; hi(hly boundto albumin(non-ionicbin-in9%; 0O/Hhepatic& renalelimination

Hypo(lycemia4 'ei(ht (ain4 GI r/n#4 #5in ra#,e#; C7I =

pre(nancy

Hypo(lycemia= sul2onamides(displace1!sfrom albumin%;

H1bloc5er# (metaboli#m%; "bloc5er#?orsenin( (lycemic control= rifam$in; t,iai-e#; GC#

$e(litinides = in#+lin secreta(o(ue; postprandial 0# le:el; more YY t,an SU#; alternatieto SU# if $t ,a# im$aire- renal 2xnor eats sporadically


&epa(linid

e

,- A/5-dependent+channels@#ite di22erentfrom 1!s; ta5en be2ore eachmeal (rapid onset& short duration%; hepaticmetaboli#m b. CM5>G;

Hypo(lycemia4 'ei(ht (ain; )I= #er+m le:el#

ma. be

b. erythromycin& b. ri2ampin

-#lucosidase Inhibitors = antihyper(lycemiceffect;

postprandial (lucose; nota# effecti:e# a# ot,er cla##e#


Acarbos

e

Hydrolysis rate of disaccharides& complex carbsdelayin(

productionof (lucose& ot,er monosaccharides; renalelimination

#I e22ectsb7c 2ermentationof unabsorbed carbs in colon;hepatotoxicity; C)I= $t# 67 renal impairment

27


28/31

28

0i(uanide in#+lin sensitizer; 8st line a9ent; $O1/ 'idely used -r+9 for type . $; antihyper(lycemic effect re9uires $re#ence of insulin


29/31

0i(uanide = in#+lin sensitizer; 8st -linea9ent; $O1/ 'idely used-r+9 for type . $; antihyper(lycemiceffect re9uires$re#ence of insulin


$et2ormin("lucop#age%

,+ A$5(cA$5"acti:ate- protein"inase%hepatic (lucose

output& insulin sensitiity; /#s& **; renalelimination

Comparable e22icacyto 1!s; ca+#e# 'ei(ht loss:#< (ain#een 67 1!s

ose-related #I effect# (nausea4 metallic taste%; potentialforlactic acidosis; C)I= pre(nancy4 alcoholism4 -i#ea#e# t,atpredisposeto acidosis(C0D4 CHF%; impairedrenal 2xn

/hiazolidinediones (TD#% K-(litazonesL= in#+lin sensitizers; ma. ris" o2 $I(FDA restricteduseof rosi(litazone%; #,o+l- monitorlier 2xn


5io(litazone&osi(litazon

e

#ene expressionb. bindin( to 55A&

cell responsesto insulin

Insulin resistanceperipheralti##+e#; HbAc5io9litaone ,a# bene2icialeffect# on #er+m lipids(rosi" ,a# A)E%Hepaticmetaboli#m = bothC0.C4 pio9litaone C03A>al#o

Fluid retention4 edema4 & 'ei(ht (ain; bone losse#$al#o de(rades other$e$ti-e#

Amylin Analo(= 9i:en 1C67 mealto postprandial (lucose; ad@unctietherapyfor type 8:.$ Amylin= #+b#tance releasedfrom cells

DRUG EFFECTS ADVERSE EFFECTS

5ramlintide(S$mlin% ,- #luca(on release; delays(astric emptyin( N)44 H)A4 anorexia;

ris"of hypo(lycemia6,en +#e- 67 insulin

THRIDDRUG EFFECTS USES ADVERSE EFFECTS

*eothyroxine Synthroid= #.nt,etic />; lon(tW; conertedT! OChypothyroidism 3er:o+#ne##4 HR4 'ei(ht loss4 T*iothyronine /3(most$otent%; 2aster actin(4 shorttW; 2eedbac" ,-of /1H $yxedema coma(T8% 0o##ible a-:er#e car-iac effect#

$ethimazole,- /3)/>synthesisb. competin(67 /#(t,.ro9lob+lin%

,- peroxidase; delayedon#et (65#%Hyperthyroidism Ra#,4 na+#ea4 GI -i#tre##4 (oiter4

cretinismin 2etus(C)I%

5ropylthiouracil5/!=samea# met,imiaole4 b+t onl. 8)8;tha# potent,- peripheral conersionof T8T!(alsobloc5e- b. #Cs%

Can +#e in pre(nancy(lo' dose%; al#o thyroid storm

Iodides(3a4 4 I1% Hi9, -o#e#,-T!7T8secretion; rapid actin(; tolerance -e:elo$# Glan- #ie be2ore sur(ery; thyroid storm

29

At l l 5 l l l ti bl " t l i - - b - i t OC th id t


30/31

Atenolol 5ropranolol= non"#electi:e; -bloc"erscontrol #/ in-+ce- b. a-rener9ic tone; OC thyroid storm838I= permanenthypot,.roi-i#m

30

3E >I3ERA H>ESTASIS


31/31

3E >I3ERA H>ESTASISHormone# T,at Affect Ca12Homeo#ta#i# 3et Ca12ab#or$tion = M"1)'; 3et 08= M)' At #tea-. #tate4 renal e/cretion = ab#or$tion

HR>3E

0R0ERTIES ACTI3S 0ATHG

5/H

0ol.$e$ti-e #ecrete- from chie2 cell# in

parathyroidin re#$on#e to lo' Ca.+:erall =

Ca.+4 5O>$la#ma leels; idneys= Ca12& 08reabsorption; calcitriol(actieVit D% #.nt,e#i# (Ca.+from GI%; 0oneB 5rolon(ed

0THRA3osteoclasts; brie20THosteoblast-ifferentiationanabolic

4itamin

R-dehydroCVit 3(cholecalciferol% in

s"in

.G-,OH D!(calci2erol% in lier

86.G-,OH.3(calcitriol% in "idney

:erall =Ca.+4 5O>

#I= Ca12& 08upta"e; GC# anta9onie effect# @GI0one resorption(osteoclastZ & act%

Deficienc.so2tenin(of bones;

in "ids= ric"ets;in adults= osteomalacia

Calcitonin0ol.$e$ti-e #ecrete- from para2ollicular cell# of thyroidin re#$on#e to hi(h Ca.+

:erall =Ca.+4 5O>

0one resorptionb. ("% o#teocla#t#

E/ce## = fl+#,in94 na+#ea

HypercalcemiaB Ca+#e# = Vit D; o:ertreatment 67 t,iai-e# S/ = K9roan#4 moan#4 bone#4 #tone#4 $#.c,iatric o:ertone#L HypocalcemiaB Ca+#e# = ,.$o$arat,.roi-i#m4 renal i##+e#4 $,enobarbital S/ = m< tetan.4 con:+l#ion#4 abnormal be,a:ior

T/ Hypercalcemia= if #e:ere eno+9, $t ,a# #/&E

o Alendronate= slo'sbone turnoer4 ("% formation79ro6t,7-i##ol+tion of cr.#tal#; a$$ro:e- for $re:ention & t/ o#teo$oro#i# 5hosphate salts= bone 2ormation; ta5en 0; 2astest 'ayto Ca124 b+t ,aar-o+#; +#e- ON*Mif ot,er abo:e met,o-# fail

T/ HypocalcemiaB /hiazides= Ca.+excretion 4it = Ca12+$ta5e @GI; +#e- for ,.$o$arat,.roi-i#m4 Vit D -eficienc.4 malab#or$tion Directl. $la#ma Ca12B Ca (luconate= OCfor seere,.$ocalcemia; 9i:en I4

o Ca carbonate= con:erte-Ca12#alt# in #tomac, b. HClconstipation; for mild,.$ocalcemia & maintenancet,era$.

#teo$oro#i# = >C in postmenopausal F t,er ca+#e# = #Cs4 alcohol4 1$OIN# $a@orityof remodelin(in trabecular(NO/cortical% bone

DRUG EFFECTS & 0R0ERTIES USES ADVERSE EFFECTS

Alendronate(Fosamax%

0isphosphonate= concentratein bone matri/

more resistantto osteoclastre#or$tion; 0$

more t,an ralo/ifene; orallyacti:e4 *O?bioa:ail

test2 chart

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