Pharmacology Ch 28, 29, 22

Foods rich in potassium include bananas, dried fruits, peanut butter, broccoli, green leafy veggies, potatoes and tomatoes
Also if pt is on a potassium sparing diuretic and they eat a large amount of foods containing potassium they can develop hyperkalemia
Also salt substitutes are potassium chloride!!! Need to watch your pts use of them!
If unable to control with diet the potassium sparing diuretic may be changed to one that increases potassium excretion also ACE can be changed to an ARB or another medication that doesn’t mess with potassium levels

Fairly common side effect of loop diuretics

Also can be caused by strenuous muscular activity and severe vomiting and diarrhea

Mild hypokalemia is usually treated with diet

More severe hypokalemia is treated with potassium supplements- oral or IV
IV potassium burns when it is infused- pts will complain about the burning sensation up the arm- also if the IV blows the accumulation of K under the skin is painful.
Tablets/capsules are large- it is also available as K-lyte which is dissolved in water and then you drink it

Diuretics are medications that increase urine production, and they are usually not administered after midafternoon to prevent nocturia, which is the need to wake up during the night to urinate. By avoiding diuretics in the late afternoon or evening, it helps to minimize the amount of urine produced at night, allowing individuals to sleep without interruption. This is especially important for individuals who already have difficulty sleeping or who may be at risk for falls during nighttime trips to the bathroom.

Beta-adrenergic blockers are a class of drugs that are commonly used with ACE inhibitors. They work by blocking the action of adrenaline and other stress hormones on beta receptors in the body. By doing so, they decrease heart rate, cardiac output, and blood pressure. This makes them effective in treating conditions such as hypertension and heart failure. Additionally, beta-adrenergic blockers can also be used as bronchodilators, helping to relax and open up the airways in conditions like asthma and chronic obstructive pulmonary disease (COPD).

Most common cause is lack of sufficient blood flow through the kidney

Requires immediate treatment

The cause needs to be quickly identified and treated

CVVH (Continuous veno-venous hemofiltration) or CVVHD (Continuous veno-venous hemo-diafiltration) is used
Some of the potential causes for ARF include heart failure, dysrhythmias, hemorrhage, dehydration, multi-system organ failure
CVVH is similar to dialysis but the treatment is continuous not 3 times per week. Survival rate of ARF requiring CVVH is only about 30%

Treatment is required to remove the buildup of waste products from the blood stream- creat, BUN, lytes

Loop diuretics inhibit the reabsorption of sodium at the ascending loop of Henle, which leads to increased water excretion in the urine. Along with sodium, potassium is also "lost" into the urine. This excessive loss of potassium can result in hypokalemia, which is a condition characterized by low levels of potassium in the blood. Therefore, the given correct answer of "Hypokalemia" is the most appropriate choice based on the information provided.

Digitalis toxicity can cause various symptoms, including anorexia, nausea, vomiting, and blurred vision. These symptoms occur due to the toxic effects of digitalis on the gastrointestinal system and the visual system. Digitalis can irritate the stomach lining, leading to decreased appetite, nausea, and vomiting. It can also affect the nerves responsible for vision, causing blurred vision. Therefore, experiencing anorexia, nausea, vomiting, and blurred vision can be indicative of digitalis toxicity. The other symptoms listed, such as increased renal output, increased potassium level, peripheral edema, pulse deficit, and nocturnal leg cramps, may be associated with other conditions or medications, but they are not specific to digitalis toxicity.

Omega-3 fatty acids are often referred to as fish oil because they are commonly found in fatty fish such as salmon, mackerel, and sardines. Fish oil is a rich source of omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have been shown to have numerous health benefits. These fatty acids are known to support heart health, reduce inflammation, improve brain function, and promote healthy skin. Therefore, fish oil is a commonly used supplement to increase the intake of omega-3 fatty acids in the diet.

Regulate fluid balance

Regulate electrolyte composition

Regulate the acid-base balance of body fluids

Secrete renin and erythropoieten

Produces calcitriol

Excess fluid volume can lead to HTN or CHF and depletion leads to dehydration
Specific amts of electrolytes must be maintained. Imbalances can be fatal
Excessive acids or bases can change the body fluid pH and rapidly result in death if untreated
Renin helps to regulate blood pressure (Renin is an enzyme)
Erythropoieten stimulates RBC production (it is a hormone)
Calcitriol is the active form of vitamin D and is essential for calcium absorption

Furosemide can increase urine output even when blood flow to the kidneys is diminished
Torsemide has a longer half life and can be dosed once a day
Bumex is 40 times more potent than furosemide but has a shorter duration of action
There are other loop diuretics too. There is a lot to watch for with your pts on loops

Cardiac glycosides are a class of medications that increase the strength of contraction of the heart muscles. They work by inhibiting the sodium-potassium pump in cardiac cells, leading to an increase in intracellular calcium levels. This increase in calcium enhances the force of contraction, thereby improving the heart's pumping ability. Cardiac glycosides are commonly used in the treatment of heart failure and certain arrhythmias.

We use vasodilators, inotropic and diuretic therapy.
Vasodilators are used to reduce the strain on the L ventricle by reducing systemic vascular resistance (afterload) this increases tissue perfusion to vital organs and muscles. They also reduce preload so the high volume of blood returning to the heart is decreased. The decrease in preload reduces pulmonary congestion and helps the pt to breathe more easily.
Inotropic agents stimulate the heart to increase the force of contractions which increases cardiac output. This also helps with pulmonary congestion and improves tissue perfusion. With the increase of blood flow to the kidneys (renal perfusion) potent diuretics are administered to enhance sodium and water excretion. This also reduces the workload of the heart and symptomatic relief.

If the pt is on IV therapy they are frequently in the ICU

The correct answer is "Cardiac/ Digitalis glycosides." This is because the letter "D" in HF stands for Digitalis, which refers to a group of medications known as cardiac glycosides. These medications, such as Digoxin, are commonly used in the treatment of heart failure (HF) to strengthen the heart's contractions and regulate its rhythm. Therefore, the correct answer indicates that the letter "D" in HF represents the use of cardiac or Digitalis glycosides in the management of heart failure.

Not as
Thiazide diuretics act on the distal tubule and inhibit the sodium chloride symporter which leads to the retention of water in the urine. Also causes potassium to be "lost" in the urine.
effective in pts with severe renal disease because of the decreased blood flow to the kidneys

Preload refers to the amount of blood that fills the ventricles of the heart just before contraction. It is determined by the volume and pressure of blood in the ventricles during diastole (relaxation phase). When the ventricles stretch due to the increased blood volume, it allows for a greater force of contraction during systole (contraction phase). Therefore, preload affects the amount of stretch in the heart fibers before contraction for systole. Afterload, on the other hand, refers to the resistance that the heart must overcome to eject blood into the circulation.

These are weak diuretics that inhibit the enzyme carbonic anhydrase within the kidney, brain and eye. As a diuretic it promotes the excretion of sodium, potassium water and bicarb.

For example acetazolamide (Diamox) is used to decrease intraocular fluid pressure in the eye for pts with open-angle glaucoma

The correct answer is "Flushing, itching and headache". Niacin, also known as vitamin B3, is commonly used to treat high cholesterol. One of the most common side effects of niacin is flushing, which is characterized by redness and warmth in the face and neck. Itching and headache are also common side effects. These side effects are usually temporary and can be managed by taking niacin with food or using a slow-release form of the medication.

Potassium sparing diuretics, such as spironolactone and amiloride, work by blocking the action of aldosterone, a hormone that promotes the reabsorption of sodium and the excretion of potassium in the kidneys. These diuretics help to retain potassium in the body and prevent its excretion. Therefore, giving potassium supplements or salt substitutes along with potassium sparing diuretics can lead to excessive levels of potassium in the body, which can be dangerous and cause hyperkalemia. Thiazide, loop, and carbonic anhydrase inhibitors do not have the same effect on potassium levels and can be given with potassium supplements or salt substitutes.

Beta blockers are medications that are commonly used to treat various cardiovascular conditions such as high blood pressure, angina, and heart failure. They work by blocking the effects of adrenaline on the heart and blood vessels, thereby reducing heart rate and blood pressure. In the context of heart failure (HF), beta blockers are used to improve symptoms, reduce hospitalizations, and increase survival rates. They help to decrease the workload on the heart and improve its efficiency. Therefore, in the given options, the letter "B" stands for beta blockers, which are an important component of the treatment for HF.

Occurs over months or years

Most common causes of CRF are HTN and DM

Treatment for ESRD includes hemodialysis, peritoneal dialysis (PD) or transplant

ESRD end stage renal disease
HTN- 25% of all new cases and DM 30-40% of all new cases
Without dialysis or transplant pts will die
The third and fourth causes of ESRD are glomerulonephritis (inflammatory disease of the kidney) and polycystic kidney disease

They block sodium and chloride re-absorption
In the loop of henle there is a large amount of sodium so they are very effective at producing a large amount diuresis

These are weak diuretics that inhibit the enzyme carbonic anhydrase within the kidney, brain and eye. As a diuretic it promotes the excretion of sodium, potassium water and bicarb.

For example acetazolamide (Diamox) is used to decrease intraocular fluid pressure in the eye for pts with open-angle glaucoma

HDL stands for high-density lipoprotein, which is considered the "good" lipoprotein. HDL helps remove cholesterol from the bloodstream and carries it back to the liver to be broken down and excreted. Having high levels of HDL is associated with a lower risk of heart disease.

Hyperlipidemia

High level of lipids in the blood

Hypercholesterolemia is elevated cholesterol

Dyslipidemia is an abnormality with one or more of the blood fats
Hypercholesterolemia is the type that is most familiar to the general public
Hyperlipidemia is an increase in cholesterol and triglycerides in the blood
When we talked about metabolic syndrome we talked about CAD which is a major cause of premature death in the US. Major treatable causes include HTN, smoking, DM II, and atherosclerosis (accumulation of fatty deposits in the inner walls of arteries that decreases the blood flow to vital organs) and results in stroke, MI, anding and PVD

ACE inhibitors are the preferred treatment for heart failure because they help to relax and widen blood vessels, reducing the workload on the heart. They also help to lower blood pressure and prevent the progression of heart failure. ARBs (Angiotensin Receptor Blockers) are also effective in treating heart failure, but ACE inhibitors are generally the first line of treatment. Alpha blockers are not typically used for heart failure and are more commonly used to treat conditions like high blood pressure or urinary problems.

Ace inhibitors are a class of medications commonly used to treat high blood pressure. They work by blocking the action of an enzyme called angiotensin-converting enzyme (ACE), which is involved in the production of a hormone called angiotensin II. Angiotensin II causes blood vessels to constrict and also stimulates the release of another hormone called aldosterone, which increases fluid retention. By inhibiting ACE, these medications reduce the production of angiotensin II, leading to relaxation and dilation of blood vessels, which in turn lowers blood pressure. Therefore, the correct answer is "Reduce blood pressure (afterload)".

Afterload refers to the pressure that the heart must overcome in order to eject blood from the left side of the heart into the aorta. It is the resistance that the heart encounters when pumping blood out. This resistance is determined by factors such as the size and elasticity of the arteries, as well as the amount of blood in the circulatory system. Therefore, afterload is the correct answer as it accurately describes the pressure in the aorta that needs to be overcome for blood ejection.

The kidney secretes erythropoietin

This hormone causes an increase in RBC production

Synthetic erythropoietin
Epoetin alfa (Procrit, Epogen)
Darbepoetin alfa (Aranesp)
These will be covered in depth in pharm 2- oncology
Epogen is given 3 times a week- usually SQ unless pt is in ESRD then given through dialysis access for hemodiaysis pts 3 times per week

Aranesp is given every 2 weeks to every month SQ
Your book says it is given until an increase in RBCs is achieved but the dose is usually adjusted to maintain a target hgb of approx 10-11 (still anemic) in renal pts. Need to pay attention to the rate of rise in hgb because of the potential for cardiovascular complications (stroke and HTN crisis) with rate of rise > 1 gm in 2 weeks
Also need for the pt to have adequate iron stores to build the RBCs. Without iron it isn’t possible to build the cells

More info on this is covered with antineoplastic meds (chapter 24)

LIPROPROTEIN LEVELS ARE PREDICTORS OF CARDIOVASCULAR DISEASE.
Cholesterol is not soluble in blood so very little is in the blood in a free form

Lipoproteins are water soluble and can be transported throughout the blood
Cholesterol and other lipids are an inner core of lipid surrounded by an outer shell of protein (lipoproteins)

Increases excretion of Na and water
ACE inhibitors reduce morbidity and mortality associated with heart failure. They reduce afterload (by reducing BP) and preload (by reducing circulating volume)
ACEs are the drug of choice over digoxin (in a few slides) for mild to moderate systolic dysfunction heart failure

HMG-CoA reductase drugs are commonly referred to as statins. Statins are a class of medications used to lower cholesterol levels in the body by inhibiting the enzyme HMG-CoA reductase, which plays a key role in cholesterol production. These drugs are widely prescribed to reduce the risk of cardiovascular diseases and are known for their effectiveness in managing high cholesterol levels.

Right side heart failure occurs when the right side of the heart is unable to effectively pump blood. This can cause a backup of blood into the peripheral veins, leading to peripheral edema (swelling) in areas such as the feet and ankles. It can also result in engorgement of organs like the liver. Therefore, the correct answer is Right side HF.

Digoxin immune fab (Ovine) is given IV

It binds to the digoxin and stops it from reaching the tissues

Rapid onset- less than 1 minute after infusion is started

Digoxin immune fab (Digibind) is given IV to reverse toxic levels of digoxin

Loop diuretics and thiazide diuretics are commonly used to treat conditions such as high blood pressure and edema. These medications work by increasing the excretion of water and electrolytes, including potassium, from the body. Hypokalemia refers to low levels of potassium in the blood. Therefore, the use of loop and thiazide diuretics can lead to hypokalemia due to the excessive loss of potassium.

Diastolic dysfunction refers to abnormalities in the filling of the heart during the relaxation phase. Pulmonary congestion and peripheral edema are common signs and symptoms of diastolic dysfunction. Pulmonary congestion occurs when there is an accumulation of fluid in the lungs, leading to symptoms such as shortness of breath and coughing. Peripheral edema refers to swelling in the extremities, such as the legs and ankles, due to fluid retention. These symptoms occur because the impaired filling of the heart causes increased pressure in the blood vessels, leading to fluid leakage into the lungs and tissues.

The body converts excess dietary carbohydrates into triglycerides (a precursor of cholesterol)

Left side heart failure is the correct answer because when the left ventricle is unable to compensate and blood "backs up" into the lungs, it leads to symptoms such as shortness of breath (SOB) and cough, especially when lying down. This condition is also known as Congestive Heart Failure.

BNP acts on the kidney to increase excretion of sodium and water which decreases BP

Acetazolamide (Diamox)

Diclorphenamide (Daramide)

Methazolamide (NeUses for Diamox: open-angle glaucoma, narrow-angle glaucoma (pre-op), epilepsy, edema (drug induced), acute mountain (high altitude) sickness
Daramide and Neptazane are used for open-angle glaucoma
ptazane)

A resin that removes potassium ions by exchanging them for sodium ions in the large intestine

When the drug is excreted through the feces potassium is eliminated

Available in oral and enema formulations

Glucose and insulin are administered together

This causes potassium to leave the extracellular fluid and enter the cells

VLDL
Is the primary carrier of triglycerides in the blood

High levels of VLDL are associated with pancreatits

The blockage of the exchange keeps sodium to stay in the tubule and leave in the urine- when the sodium is blocked the body retains more potassium
You need to watch dietary intake of potassium as well as supplements and salt subtitiutes
Often used in combo with other diuretics to help prevent hypokalemia

This has been around since 1785.
Increase the force of myocardial contraction (positive inotropic effect)- increases cardiac output

Also slows electrical activity in the heart which decreases HR (negative chronotrophy)
It also reduces the conduction velocity and prolongs the refractory period at the AV node
The result of this is the heart is able to fill and empty more completely which improves circulation- which reduces the systemic and pulmonary congestion and peripheral edema because of the improved perfusion to the kidneys

Used to treat mild to severe systolic heart failure that doesn’t respond to other meds (diuretics, beta blockers and ace) also used for a-fib, a-flutter, and paroxysmal tachycardia.
Digoxin is NOT used to treat diastolic heart failure- it may worsen diastolic heart failure
Too many side effects

Nesiritide (Natrecor) is the correct answer because it is a small peptide hormone that is produced through recombinant DNA technology and is structurally identical to a hormone secreted by the heart. Nitrates and Novian are not small peptide hormones produced through recombinant DNA technology, and they are not structurally identical to a hormone secreted by the heart.

These have weak diuretic properties and act by improving blood flow to the kidneys
Rarely used as diuretics because there are more effective diuretics but….

The correct answer includes Aminophylline and Theophylline. Aminophylline and Theophylline are both types of methylxanthines. Spironolactone and Triamterene are not methylxanthines, so they are not included in the correct answer.

Triglyceride:

Most common lipids

AKA neutral fats

90% of total lipids in the body are triglycerides
Triglycerides are a major storage form of fat in the body
Also the only type of lipid that serves as an important energy source

ALSO KNOWN AS CONTRACTING DYSFUNCTION
The heart usually pumps at a rate to support the body’s need for blood flow and oxygen- to the organs and muscles- systolic dysfunction occurs when the heart doesn’t pump with enough force to pump all of the blood (decreased cardiac output) and this leads to decreased tissue perfusion
Early symptoms are decreased exercise tolerance and poor perfusion to peripheral tissues (what symptoms would you expect to see?)
As the condition progresses the left ventricle enlarges (LVH) and an increase in the blood volume is required to fill the ventricle to maintain cardiac output.
So what causes systolic dysfunction? Damage to the heart- coronary artery disease that leads to MI is the most common cause. Other causes include dysrhythmias, congenital defects, and cardiomyopathies
Usually the left side fails first but as the disease progresses the right side of the heart begins to enlarge because of increased pulmonary resistance and then eventually the right side fails too

Also can effect sodium, and chloride- also can increase plasma uric acid levels (leads to gout)

All of the above options are ways to assess for hydration. Skin turgor refers to the elasticity of the skin, which is reduced in dehydration. Oral mucous membrane can become dry and sticky in dehydration. Vital signs, such as blood pressure, heart rate, and temperature, can provide indications of hydration status. Laboratory changes, such as increased blood urea nitrogen (BUN) and creatinine levels, can also be seen in dehydration. Therefore, all of these options can be used to assess for hydration.