Let`s study together!

[NAPLEX08]

Would be great to get together and work through the chapters. This forum was extreemely helpful to me in the past and as we are all so close to be liscened would be great to encourage each other and exchange the knowledge!

So, I'm working on heart. Hypertension, Diuretics and now CHFailure. So far my biggest problem is to memorize the dosage and not major name brands for ACE and AT II inhibitors espessially. Diuretics are fun! Through out something you working on!!!!

[arabella]

What book are you using naplex 08?

[NAPLEX08]

APha, CPR and 1500 Q and Answers. How about you?

[lexipharm]

Hi NAPLEX08, I would like to join these discussions. Since you said you're studying heart failure, I started going over that subject too. And I have some interesting points to share. HF is usually accompanied by other comorbidities. Medication must be tailored accordingly:

• If renal insufficiency is present, Diuretics and ACE inhibitors must be avoided. (I think its because ACE inhibitors may furthur impair renal function and diuretics cannot function well if the kidneys are impaired. Please write back if you disagree with me on this).
• Arthritis can also be present. NSAIDs are usually used to treat arthritis. NSAID's have been associated with inc risk of HF. Also NSAIDs may cause renal function and MAY ANTAGONISE EFFECTS OF DIURETICS AND ACE INHIBITORS (both these are HF medications). Also, NSAID's inc risk of GI bleeding with may worsen anemia and in turn worsen HF.
• Atrial fibrillation may coexist with HF. B-blockers and digoxin can target both conditions. Use of ACE inhibitors and angiotensin 2 receptor blockers is qeustionable.
• B-blockers should not be taken without diuretics in patients with current or recent history of fluid retention to avoid its development and to maintain sodium balance....DOES ANYONE UNDERSTAND THIS? i DIDN'T QUITE UNDERSTAND WHY B BLOCKERS CANNOT BE TAKEN WITH DIURETICS IN THIS CASE???

I hope this information has been helpful. I think if we all share with each other information which we think is important, we will cover the topic well!
lexi

[NAPLEX08]

• Atrial fibrillation may coexist with HF. B-blockers and digoxin can target both conditions. Use of ACE inhibitors and angiotensin 2 receptor blockers is qeustionable.
• B-blockers should not be taken without diuretics in patients with current or recent history of fluid retention to avoid its development and to maintain sodium balance....DOES ANYONE UNDERSTAND THIS? i DIDN'T QUITE UNDERSTAND WHY B BLOCKERS CANNOT BE TAKEN WITH DIURETICS IN THIS CASE???

Hi lexipharm! great info!
Well, concerning NSAID they decrease the effects of ALL antihypertensive and majority of CHF medications.
You last question.... B-blockers slow the heart rate down(negative chronotrop effect) ,which could in CH can cause edema(systematic and pulmonary) }Since B-bl. block norepinephrine and cause vasodilation. Diuretics promote sodium and}water excretion. That`s why in CHF diuretics should be taken with B-blockers or ACE. Contraindications for B-bl would be asthma, hypotension and fliud retension when diuretics have to be used.

You had a suggestion that diuretics cannot be used if there is renal insufficiency. I think Thiazides will not be effective( under creatinin cl. less than 30) since they act in a distal tubules, but Loop diuretics will still be effective untill creatinine cl is less than 5ml/min. However they are not preffered for long term, better for acute conditions.

[pikatchou]

I am in with you, I need all the help I can with studying for the Naplex (graduated in 1992, a long time ago!!) I'll start the chapter tonight, and hopefully can join the discussion soon!!
pikatchou

[lexipharm]

Hello everyone,
First of all, thankyou NAPLEX08 for your reply. I was reading about loop diuretics being preferred in heart failure over thiazide diuretics. This is because loop diuretics are more potent. CPR explains that another reason is that loop diuretics have the added advantage of reducing venous return, independent of diuresis. Can anyone elaborate on this point please?

[savirahes]

Hi lexipharma

May be this info is helpful
Reducing venous return<---volume depletion ( increased out put)<---The high degree of efficacy due to the unique site of action. The action on the distal tubule is independent of any inhibitory effect on carbonic anhydrase and aldosterone.

reduced venous in turn causes reduced hypertension.

[lexipharm]

Hello everyone, I hope you are all still intersted in sharing what we're learning. I have moved on to hypertension now. I know NAPLEX08 has already covered this topic. So maybe you can answer my question. It says on APhA that patients with hypertension and chronic kidney disease can be treated with ACEI's or ARB's. But these drugs can cause renal impairement right? So how come they are used in hypertension when chronic kidney disease is a compelling indication?
Thank you

[NAPLEX08]

Originally Posted by lexipharm

Hello everyone, I hope you are all still intersted in sharing what we're learning. I have moved on to hypertension now. I know NAPLEX08 has already covered this topic. So maybe you can answer my question. It says on APhA that patients with hypertension and chronic kidney disease can be treated with ACEI's or ARB's. But these drugs can cause renal impairement right? So how come they are used in hypertension when chronic kidney disease is a compelling indication?
Thank you

ACE are used in CHF and Hypertension treatment. They decrease fluid retension and peripheral resistance by blocking the conversion AT1 into AT II as we all know ACE should NOT be used if patients have renal artery stenosis. Renal insufficiency occur only when predisposing factors are present and patients should be constantly tested for those. Renal function (creatinine clearance) should be monitored,Potassium levels. Patients with renal insufficiency have higher risk of getting neutropenia, proteinuria and renal impairment, that`s why patients should be monitored for renal function. However, ACE positive effects with relatively least of the side effects ( constant monitoring on renal function) are indicated in patients with"compeling indications". Basically, as with all medicine there are always side effects and we need to figure out which benefits will outweight the side effects with the monitoring. overall, I believe, ACE do have least side effects exept for cough, skin rash and others that are similar to all hypotensives( vertigo, dizziness, fatigue, first-dose hypotension..)
Tell me what you think.