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Pharmacology II > 9-3-13 > Flashcards

9-3-13 Flashcards

1
Q

How do calcium channel blockers work?

A

Calcium flows in to muscle cells resulting in smooth muscle contraction and cardiac myocyte contraction.

Calcium channel blockers block calcium from entering muscle cells to reduce smooth muscle contraction and reduce myocyte contraction.

Cause reduced blood pressure!

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2
Q

What are the calcium channel blockers to remember?

A

Amlodipine - Norvasc

Nicardipine - Cardene

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3
Q

Where do calcium channel blockers differ?

A

Pharmacokinetics.
Effect on cardiac conduction.
Adverse drug reactions.
-Dihydropyridines - vascular side effects
-Non-dihydropyridines - cardiac conduction effects.

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4
Q

Indications for Amlodipine

A

Treatment of HTN

Treatment of symptomatic chronic stable angina, vasospastic angina.

Prevention of hospitalization due to angina with documented CAD.

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5
Q

Indications for Nicardipine (oral and intervenous)

A

Management of hypertension (immediate and sustained release products) - parenteral only for short-term use when oral treatment is not feasible.

Chronic stable angina (immediate-release product only).

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6
Q

Indications for Diltiazem (oral)

A

Primary HTN

Chronic stable angina or angina from coronary artery spasm.

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7
Q

Indications for Verapamil

A

Treatment of Hypertension

Angina pectoris (vasospastic, chronic, stable, unstable).

Supraventricular tachyarrhythmia (PSVT, atrial fibrillation/flutter)

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8
Q

What are examples of dyhydropyridines?

A 
Amlodipine - Norvasc
Clevidipine - Cleviprex
Felodipine - Plendil
Isradipine - Dynacirc CR
Nicardipine - Cardene
Nifedipine - Procardia
Nimodipine - Nimotop
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9
Q

What is an example of phenylakylamine?

A

Verapamil - Isoptin

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10
Q

What is an example of a benzothiazepine?

A

Diltiazem - Cardizem

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11
Q

What are the advantages of calcium channel blockers?

A

No metabolic effects

No increase in lipid levels and safe in mild-to-moderate renal failure.

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12
Q

What are are the first line agents in newly diagnosed HTN patients with no other cardiovascular disease?

A

Diuretics

Then a choice of: ACEI; Calcium Channel Blocker, or Beta Blocker.

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13
Q

What are the adverse drug reactions of calcium channel blockers?

A

The AV node effect causing Bradycardia or tachyarrythmias (verapamil)
AV block.

The vascular effect:

  • Excessive hypotension
  • Dizziness
  • Peripheral edema
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14
Q

Amlodipine

A

Amlodipine
10 mg
one tablet daily

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15
Q

Nircardipine Infusion

A

Nircardipine Infusion

Start at 5 mg/hour and titrate to effect every 15 minutes up to a maximum of 15 mg/hour

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16
Q

What drugs potentially interact with Verapamil?

A 
Alpha-1 Blockers
Amiodarone
Dofetilide
HMG-CoA reductase Inhibitors
Midazolam
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17
Q

What is the lowest dose of Amlodipine?

A

2.5 mg per day

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18
Q

What is the max dose of Amlodipine?

A

10 mg per day

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19
Q

What drugs have potential interactions with all calcium channel blockers?

A

Beta Blockers
CYP34A Inhibitors
General Anesthetics

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20
Q

What drugs have potential interactions with Diltiazem?

A

Amiodarone
HMG-CoA Reductase Inhibitors
Midazolam

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21
Q

What is the usual maitainance dose of Nicardipine?

A

3mg/hour

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22
Q

How do ACE Inhibitors work?

A

Block the conversion of angiotensin I to angiotensin II which:
lowers arteriolar resistance,
increases venous capacity,
increases cardiac output and cardiac index, stroke work and volume,
lowers renovascular resistance

Reduce the progress of diabetic neuropathy.

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23
Q

Onset of Captopril

A

1-1.5 hours

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24
Q

Duration of Captopril

A

Dose Related

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25
Q

Half-Life of Captopril

A

1.9 hours

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26
Q

Protein Binding of Captopril

A

25-50%

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27
Q

Onset of Enalapril

A

1 hour

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28
Q

Duration of Enalapril

A

12 to 24 hours

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29
Q

Half Life of Enalapril

A

2 hours

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30
Q

Protein Binding of Enalapril

A

50%

31
Q

Onset of Lisinopril

A

1 hour

32
Q

Duration of Lisinopril

A

24 hours

33
Q

What are the ACE Inhibitors to remember?

A

Lisinopril - Zestril
Captopril - Capoten
Ramipril - Altace

34
Q

Half-Life of Lisinopril

A

11 to 12 hours

35
Q

Protein Binding of Lisinopril

A

25%

36
Q

Onset of Ramipril

A

1 to 2 hours

37
Q

Duration of Ramipril

A

24 hours

38
Q

Half-Life of Ramipril

A

13 to 17 hours

39
Q

Protein Binding of Ramipril

A

73%

40
Q

Does only Ramipril have a decease in mortality?

A

No! All ACEI have this effect.

41
Q

Indications for Captopril

A

Management of hypertension.

Treatment of heart failure.

Left ventricular dysfunction after myocardial infarction.

Diabetic nephropathy.

42
Q

Indications for Enalapril

A

Treatment of hypertension.

Treatment of symptomatic heart failure.

Treatment of asymptomatic left ventricular dysfunction.

43
Q

Indications for Lisinopril

A

Treatment of hypertension, either alone or in combination with other antihypertensive agents.

Adjunctive therapy in treatment of heart failure.

Treatment of acute MI within 24 hours in hemodynamically-stable patients to improve survival.

Treatment of left ventricular dysfunction after MI

44
Q

Indications for Ramipril

A

Treatment of hypertension, alone or in combination with a thiazide diuretic.

Treatment of left ventricular dysfunction after MI.

To reduce risk of MI, stroke, and death in patients at increased risk for these events.

45
Q

Characteristics of ALL ACEI:

A

Have similar antihypertensive efficacy (Captopril is a short-acting agent as opposed to all other agents).

Reduce mortality in post-MI patients and help prevent the development of heart failure.

Contraindicated in pregnancy

46
Q

Common side effects of ACEI

A 
Cough
Hyperkalemia
Renal Impairment
Hypotension
Headache, dizziness, fatigue
47
Q

Contraindications of ACEI

A

Bilateral renal artery stenosis

Previous angioedema associated with ACEI therapy.

48
Q

What causes the nagging cough with ACEI?

A

increased levels of bradykinins

49
Q

Lisinopril

A

Lisinopril
20 mg
one tablet daily

50
Q

Captopril

A

Captopril
50 mg
one tablet three times a day

51
Q

What are the angiotensin receptor blockers?

A

Losartan - Cozaar

Valsartan - Diovan

52
Q

MOA of ARBs

A

Block the receptor site where angiotensin II activates all of the “bad” effects.

Blockade results in drop in blood pressure.

53
Q

What is the max dose for Lisinopril?

A

40 mg (up to 80!)

54
Q

What must you watch with Lisinopril therapy?

A

Potassium levels

Renal function

55
Q

What is the max dose for Captopril?

A

100 mg

56
Q

What are the differences in ARBs?

A

Dosing - all once per day dosing except for Losartan and Eposartan which can be once or twice per day.

For Heart Failure - only two are approved (Valsartan - Diovan, Candesartin-Atacand)

No differences in hypertension or potency.

57
Q

Indications for Lorsatan

A

Treatment of HTN

Treatment of diabetic nephropahty in patients with type II diabetes mellitus and a history of HTN

Stroke risk reduction in patients with HTN and left ventricular hypertrophy.

58
Q

Indications for Valsartan

A

Alone or in combination with other antihypertensive agents in the treatment of primary hypertension.

Reduction of cardiovascular mortality in patients with left ventricular dysfunction post -MI

Treatment of heart failure (NYHA Class II-IV)

59
Q

Indications for Azilsartan

A

Treatment of hypertension; may be used alone or in combination with other antihypertensives.

60
Q

What are positive characteristics of ARBs?

A

Dry cough incident rate drops.

61
Q

What are ARBs adverse drug reactions?

A

Same as ACEIs

Cancer???

62
Q

Are ARBs first-line drugs?

A

No!!! Not cost effective.

63
Q

How do you choose an ARB?

A

The const efficient agent.

Interchangeability for hypertension versus heart failure.

64
Q

What are the injectable ARBs?

A

None!

65
Q

Valsartan

A

Valsartan
160 mg
one tablet daily

66
Q

Max dose for Valsartan

A

320 mg

67
Q

Losartan

A

Losartan
50 mg
one tablet daily

68
Q

MOA of renin antagonists

A

Blockade of conversion of angiotensinogen to angiotensin I

69
Q

What are the ADRs of renin agonists?

A

Same as ARBs and ACEIs

70
Q

Who uses renin antagonists?

A

Patients who benefit from an ACEi or ARB and have become refractory.

EXPENSIVE!!

71
Q

What is a renin antagonist?

A

Tekturna

72
Q

Tekturna

A

Tekturna
300 mg
one tablet daily

73
Q

What are good HTN combinations?

A

ACEIs and thiazides
ARBs and thiazides
ARBs and calcium channel blockers
calcium channel blockers and statins

74
Q

When do you use “combos”?

A

Resist using unless patient struggles to adhere to drug therapy or when combination product is less expensive than taking the drugs separately.

Pharmacology II (9 decks)

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