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pharm > ACE, ARB'S, CCB, antiarrhythmics > Flashcards

ACE, ARB'S, CCB, antiarrhythmics Flashcards

1
Q

Renin- angiotensin-aldosterone system (RAAS) in hypertension

A

angiotensinogen uses renin to convert to angiotensin 1
angiotensin 1 uses ACE to convert to angiotensin 2

Angiotensin 2 increases aldosterone, sodium and water retention, thirst, systematic nervous system
AND causes vasoconstriction, vascular fibrosis, and myocardial hypertrophy.

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2
Q

ACE inhibitors are most commonly used for

A

Hypertension which is high risk for CAD
Relaxes arteries and allows blood flow

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3
Q

ACE inhibitors indications

A

patients with diabetes, diabetic nephropathy, post MI, or high CAD risk/hypertension
ALL patients with ejection fraction less then or equal to 40%

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4
Q

ACE inhibitors dosing considerations

A

start low and go slow until target dose
benefits not seen right away
hypotension more common with hyponatremia

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5
Q

ACE inhibitors side effects

A

hypotension and dizziness (orthostatic hypotension)
cough and angioedema (swelling around mouth)
renal dysfunction
hyperkalemia

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6
Q

ACE inhibitors side effects (renal dysfunction)

A

decrease in GRF not usual but less then 20%
highest risk of ARF: volume depleted, renal vascular disease, vasoconstricting drugs

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7
Q

ACE inhibitors side effects (hyperkalemia)

A

usual increase in less then 1mEq/L
Baseline for SCr more then 1.6mg/dl = greatest risk for increase potassium.

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8
Q

ACE inhibitors warnings

A

avoid in pregnancy
do not use with bilateral renal artery stenosis (major risk for ARF)

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9
Q

ACE inhibitors interactions

A

potassium supplements
NSAID’s (especially with diuretics and dehydration)
cyclosporine

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10
Q

ACE inhibitors TOP 200 list

A

147 & 150 benazepril
4 & 51 lisinopril
201 ramipril

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11
Q

ACE inhibitors end with

A

pril

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12
Q

Angiotensin 2 receptors antagonist (ARB’s)

A

most similar to ACE inhibitors with less cough and angioedema
same side effects
similar but not superior efficacy with HF

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13
Q

ARB’s indications

A

treats hypertension, congestive heart failure, and diabetic nephropathy

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14
Q

ARB’s dosing considerations

A

start low and go slow until target dose
benefits not seen right away
hypotension more common with hyponatremia

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15
Q

ARB’s side effects

A

hypotension and dizziness (orthostatic hypotension)
cough and angioedema (swelling around mouth)
renal dysfunction
hyperkalemia

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16
Q

ARB’s warning

A

avoid in pregnancy
do not use with bilateral renal artery stenosis (major risk for ARF)

17
Q

ARBS TOP 200 list

A

Lrbestartan
losartan
olmesartan
telmisartan
valsartan

18
Q

neprilsyin inhibitor indications

A

treatment of chronic heart failure.
superior to ACE inhibitors
higher risk of hypotension and angioedma then ACE inhibitors
Lower risk of cough and renal dysfunction

19
Q

neprilysin inhibitor TOP 200

A

Sacubitril and valsartan

20
Q

aldosterone antagonist indications

A

Treatment of chronic HF hypertension, chronic kidney disease associated with DM and hyperaldosteronism

anti-aldosterone actions, potassium-sparing diuretic effects (hypotension, hyperkalemia, gynecomastia)

21
Q

aldosterone antagonists TOP 200

A

Spironolactone
Eplernone

22
Q

calcium channel blockers indications

A

inhibit transmembrane influx of calcium (act at SA/SV node and or vascular smooth muscle, vasodilation and or decreased heart rate)

23
Q

CCB TOP 200

A

Diltiazem and verapamil (negative inotropic and chronotropic effects)
dihydropyridines (no effects on conduction in vivo)

24
Q

CCB Top 200 (dihydropyridines)

A

Amlodpine
nifedipine

25
Q

CCB side effects

A

headache
flushing
pedal edema
constipation
hypotension
reflex tachycardia
bradycardia, av block CHF

26
Q

CCB interactions

A

verapamil and diltiazem (can cause drug interactions, can change metabolism and or transport of drugs)

Amlodipine (subject to many interactions, sensitive to changes cause by other drugs)

27
Q

anti-arrhythmic indications

A

treat heart rate arrhythmia

28
Q

properties of anti arrhythmic

A

I: Na+ channel blockade
II: Beta-blockade
III: Prolonged repolarization
IV: Ca2+ channel blockade

29
Q

Anti arrhythmic TOP 200

A

amiodarone

30
Q

anti arrhythmic warnings

A

highly effective but serious toxicities and unusual pharmacokinetics

31
Q

Amiodarone

A

loading dose often used( high amounts for up to 4 weeks then lower dose)

32
Q

Amiodarone side effects

A

Pulmonary fibrosis, pneumonitis
Cardiotoxicity (bradycardia, hypotension – IV)
Thyroid toxicity
Liver toxicity
Ophthalmic toxicities
Dermatologic toxicity
Drug interactions

33
Q

Flecaindie

A

used for A-FIB (patients without struck HD)

34
Q

Flecainide side effects

A

Dizziness, visual disturbances, dyspnea, QT prolongation/TdP

35
Q

Anti arrhythmic TOP 200

A

Amiodarone
Flecainide

pharm (2 decks)

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