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Cardiology Drugs > ACE Inhibitors > Flashcards

ACE Inhibitors Flashcards

1
Q

What is the mechanism of action for ACE Inhibitors?

A

ACE Inhibitors work by blocking angiotensin converting enzyme. This enzyme converts angiotensin I to angiotensin II causing vasoconstriction. Blocking this enzyme leads to vasodilation and reduced blood pressure.

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2
Q

ACE Inhibitors are indicated for what 4 things?

A
  1. Hypertension
  2. Heart failure with reduced ejection fraction
  3. Prevention of renal disease in diabetics and those with chronic kidney disease
  4. Post heart attack management
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3
Q

What does ACEI stand for?

A

Angiotensin Converting Enzyme Inhibitor

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4
Q

Contraindications/precautions for ACEI

A
  1. Allergy to any component of ACEI
  2. Box warning: fetal toxicity, avoid in breastfeeding
  3. Contraindicated: history of angioedema, bilateral renal artery stenosis, concurrent use with Aliskiren or Entrensto and within 36 hours of switching to and from Entresto.
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5
Q

What are the side effects of ACEI? TOPCARD

A

Teratogenic
Orthostatic hypotension
Potassium increase
Cough (dry)
Angioedema
Renal impairment
Dizziness

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6
Q

What are ACEI counseling points?

A
  1. Take with or without food at the same time daily.
  2. Monitor potassium levels, creatinine, blood pressure and hypersensitivity reactions
  3. Tell providers about dry cough
  4. Avoid potassium supplements or potassium containing substitutes
  5. Seek help if facial, lip or tongue swelling occurs
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7
Q

Prinivil or Zestril

A

Lisinopril
ACEI

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8
Q

Monopril

A

Fosinopril
ACEI

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9
Q

Vasotec

A

Enalapril
ACEI

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10
Q

Altace

A

Ramipril
ACEI

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11
Q

Altace

A

Ramipril
ACEI

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12
Q

Accupril
Generic name?
Drug class?

A

Quinapril
ACEI

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13
Q

Lotensin

A

Benazepril
ACEI

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14
Q

What does ARBS stand for?

A

Angiotensin II receptor blockers

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15
Q

What is the mechanism of action of ARBS?

A

It works by blocking angiotensin II from binding to its receptors leading to a decrease in blood pressure.

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16
Q

What are ARBS indicated for?

A
  1. Hypertension
  2. Heart failure
  3. Heart attack and stroke prevention
  4. Prevention of renal disease in diabetics
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17
Q

Contraindications/precautions for ARBS

A
  1. Allergy to any components to ARBS
  2. Box warning: fetal toxicity, avoid in breastfeeding
  3. Contraindicated: patients with bilateral renal artery stenosis or concurrent use with Aliskiren in diabetes
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18
Q

What are the side effects of ARBS?
CHOPDAT lettuce for ARBys

A

Cough (occurs less than ACEI
Headache
Orthostatic hypotension
Potassium increase
Angioedema (rare)
Teratogenic

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19
Q

Counseling points for ARBS

A
  1. Take with or without food at the same time daily
  2. Monitor potassium levels, creatinine, blood pressure and hypersensitivity reactions
  3. Avoid abrupt discontinue
  4. Avoid potassium supplements or potassium containing substitutes
  5. Seek help if facial, lip or tongue swelling
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20
Q

Diovan

A

Valsartan
ARBS

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21
Q

Cozaar

A

LosartanCozaar
ARBS

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22
Q

Benicar

A

Olmesartan
ARBS

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23
Q

Atacand

A

Candesartan
ARBS

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24
Q

Micardis

A

Telmisartan
ARBS

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25
Q

Avapro

A

Irbesartan
ARBS

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26
Q

What does CCBs stand for?

A

Calcium Channel Blockers

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27
Q

What are the two subclasses of CCBs?

A
  1. Dihydropyridine
  2. Non-dihydropyridine
28
Q

CCBs are indicated for?

A
  1. Hypertension
  2. Angina
  3. Atrial fibrillation and flutter (Non-DHP CCBs)
29
Q

Contraindications/precautions for CCBs

A
  1. Allergy to any component of the drugs
  2. Caution in patients with aortic stenosis-May reduce coronary perfusion resulting in ischemia
  3. Non-DHP CCBs contraindicated: hypotension, decompensated heart failure, cardiogenic shock, pulmonary congestion, acute MI, 2nd or 3rd degree AV block, and sick sinus rhythm
  4. Increase angina and MI have occurred with initiation or dosage titration of DHP CCBs
30
Q

Mechanism of action of CCBs

A

Ca+ influx causes contraction of heart and vascular smooth muscle. Ca+ channel blockers inhibit L-type Ca+ channels causing decrease Ca+ entry into the cells leading to vasodilation, decrease contractility, and decrease HR.

31
Q

Side effects of CCBs
“Cow-cium channel blockers like to SHRED grass”

A

Slower heart rate
Hypotension/headache
Reflex tachycardia
Edema (peripheral)
Dizziness

32
Q

Norvasc

A

Amlodipone
Dihydropyridine CCBs

33
Q

Plendil

A

Felodipine
Dihydropyridine CCBs

34
Q

Adalat CC
Procardia XL

A

Nifedipine XL
Dihydropyridine CCBs

35
Q

Cardizem

A

Diltiazem
Non-Dihydropyridine CCBs

36
Q

Calan

A

Verapamil
Non-Dihydropyridine CCBs

37
Q

Counseling points for CCBs

A
  1. Monitor for hypotension, peripheral edema, fatigue, dizziness and bradycardia
  2. Diltiazem and verapamil are moderate CYP3A4 inhibitors
  3. Avoid grapefruit juice
  4. Report if angina worsens with initial dose or dose changes
  5. Do not stop abruptly: reflex tachycardia or angina may occur
38
Q

Indications for Beta-Blockers

A
  1. Hypertension
  2. Angina
  3. Prevention of heart attacks
  4. Arrhythmias (atrial fibrillation/flutter, SVT, ventricular arrhythmias)
  5. Heart failure with reduced ejection fraction (metoprolol succinate, carvediolol, bisoprolol - shown to reduce mortality and morbidity)
  6. Glaucoma
39
Q

Contraindications/precautions in Beta-Blockers

A
  1. Allergy to any components of Bet-Blockers
  2. Box warning: do not withdraw abruptly due to reflex tachycardia, hypertension and angina
  3. Contraindicated: sinus bradycardia, 2nd or 3rd degree heart block and sick sinus syndrome
  4. Avoid in patients with active asthma exacerbation
  5. Diabetes: May potentiate or mask signs of hypoglycemia
40
Q

Mechanism of action of Beta-Blockers

A

Beta-Blockers competitively inhibit NE and EPI from binding onto beta-adrenergic receptors causing decrease heart rate, contractility and blood pressure

41
Q

Side effects of Beta-Blockers
beta is a BAD FISH

A

Bradycardia/bronchospaspm
AV block/arrhythmias
Dizziness/depression
Fatigue
Impotence
S/S of hypoglycemia are masked (especially non-selective BBS)
Hypotension

42
Q

Counseling points

A

Take medication with food to help decrease side effects
Monitor for bradycardia or hypotension
Advise diabetics that it can mask symptoms of hypoglycemia
Avoid abrupt discontinuation and gradually reduce dose over 2 weeks

43
Q

Lopressor or Toprol XL

A

Metoprolol
Beta1 selective BB

44
Q

Tenormine

A

Atenolol
Beta1 selective BB

45
Q

Bystolic

A

Nebivolol
Beta1 selective BB

46
Q

Zebeta

A

Bisoprolol
Beta1 selective BB

47
Q

Sectral

A

Acebutolol
Beta1 selective BB

48
Q

Betoptic

A

Betaxolol
Beta1 selective BB

49
Q

Brevibloc

A

Esmolol
Beta1 selective BB

50
Q

Coreg

A

Carvedilol
Non-selective BB

51
Q

Normodynew

A

Labetalol
Non-selective BB

52
Q

Inderal

A

Propranolol
Non-selective BB

53
Q

Indication for Hydralazine

A

Hypertension
Hypertensive emergency
Heart failure with reduced ejection fraction (in combination with isosorbide dinitrate)

54
Q

Contraindications/precautions for Hydralazine

A
  1. Allergy to Hydralazine
  2. Avoid in coronary artery disease or mitral valvular rheumatic disease
  3. Long term administration of >200 mg a day can cause DRUG INDUCED LUPUS ERYTHEMATOSUS (DILE) symptoms like skin reactions, muscle/joint pain, fever and anemia. d/c drug.
55
Q

Mechanism of action of Hydralazine

A

Direct vasodilation of arterioles (little effect on veins) by interfering with Ca+ movement within arterial smooth muscle cells that are responsible for contraction leading to vasodilation, decreased vascular resistance and reduced blood pressure

56
Q

Side effects of Hydralazine
Hydralazine is a HYDRANTS

A

Hypotension
Yakking (vomiting)
Dizziness
Rash
Anorexia
Nausea
Tachycardia (reflex)
Systemic lupus erythema

57
Q

Apresoline

A

Hydralazine

58
Q

Counseling points for Hydralazine

A

Take with food to increase bioavailability
Avoid abrupt discontinuation—> rebound hypertension
Monitor heart rate and blood pressure
Report signs of chest pain, palpitations, hypotension, SLE, hepatotoxic and tachyarrythmias

59
Q

Indications for Clonidine

A

Hypertension (THINK: usually used for resistant hypertension or in patients who can’t swallow since it comes in patch form)
ADHD

60
Q

Contraindications/precautions in Clonidine

A
  1. Allergy to Clonidine or it’s components
  2. Active liver disease
  3. Concurrent use with MAO inhibitors
61
Q

Mechanism of action for Clonidine

A

Stimulates alpha-2 adrenoreceptor receptors in the brainstem that activates an inhibitory neuron —> decrease sympathetic outflow —> decrease systemic vascular resistance, heart rate and blood pressure

62
Q

Side effects of Clonidine
HTN DRUG

A

Headache
Tired
Not able to poop (constipation)
Dizziness
Rash (patch stickiness)
Unable to stay awake
GI side effects N/V

63
Q

Counseling points of Clonidine

A
  1. Avoid abrupt discontinuation due to rebound HTN
  2. Use caution while driving or other tasks requiring alertness because drowsiness is common within the first few weeks
  3. Avoid alcohol and other CNS depressants
  4. Apply patch to a hairless area of the skin (arms and torso)
64
Q

Catapres

A

Clonidine in patch form

65
Q

Kapvay

A

Clonidine ER tablet for ADHD

66
Q

Indications for Nitrates

A
  1. Angina prophylaxis
  2. Angina acute (nitroglycerin)
  3. Anal fissures chronic (nitroglycerin)
  4. Hypertension (nitroglycerin IV and isosorbide)
  5. Heart failure with reduced ejection fraction (isosorbide dinitrate in combination with Hydralazine)
67
Q

Contraindications/precautions for Nitrates

A
  1. Allergy to Nitrates or it’s components
  2. Concurrent use with erectile dysfunction medications (PDE-5 inhibitors like sildenafil) or riociguat (use to treat pulmonary hypertension) can lead to severe hypotension
  3. Contraindicated: hypotension, severe anemia, increased intracranial pressure bradycardia or tachycardia

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