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3. Cardiovascular agents (HTN, angina, arrhythmia) > Antihypertensives and Antianginals > Flashcards

Antihypertensives and Antianginals Flashcards

1
Q

Amlodipine Brand Name

A

Norvasc

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2
Q

Amlodipine Indication/Dosage

A

Treatment of HTN: start at 5mg daily as monotherapy. If added to existing therapy, start at 2.5mg. Titrate over 7-14 days
Chronic stable or vasospastic angina: 10mg daily

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3
Q

Amlodipine Max Dose

A

10mg once daily

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4
Q

Amlodipine Mechanism

A

Calcium Channel Blocker
Inhibits movement of calcium across specific cell membranes in vascular smooth muscle and cardiac muscle (inhibits influx of calcium through slow calcium channels)
More selective for vascular smooth muscle than cardiac muscle
Specific effects:
1) decrease in PVR
2) dilation of coronary arteries and arterioles
3) inhibition of coronary spasm

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5
Q

Amlodipine metabolism and excretion

A

metabolized in liver
excreted in urine as inactive metabolites
93% protein bound

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6
Q

Amlodipine drug interactions

A

may increase plasma levels of simvastatin

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7
Q

Amlodipine CI/precautions

A

rare increase in risk of angina or MI when starting therapy or increasing dose
caution in HF and hepatic impairment
max dose of simvastatin when used with amlodipine is 20mg daily

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8
Q

Amlodipine Pregnancy Category

A

C

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9
Q

Amlodipine ADR’s

A

edema, flushing, headache, fatigue, abdominal pain

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10
Q

Amlodipine patient information

A

may be taken without regards to meals
if dose missed, take ASAP. if taken within 12 hours of the next dose, skip next dose and return to dosing schedule
don’t take OTC cough and cold meds without checking with pharmacist
do not stop therapy unless directed to do so

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11
Q

Amlodipine + Benazepril Brand name

A

Lotrel

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12
Q

Amlodipine + Benazepril indication/dosage

A

Hypertension: one capsule daily
lowest possible dose of amlodipine should be used to avoid peripheral edema
use combination in patients who failed monotherapy or who failed amlodipine without developing edema

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13
Q

Amlodipine + Benazepril dosage forms

A

All Capsules (as Amlodipine/Benazepril)
2.5/10
5/10, 5/20, 5/40
10/20, 10/40

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14
Q

Amlodipine + Benazepril mechanism

A

Amlodipine: CCB, inhibits influx of calcium ions across slow channels in vascular smooth muscle and cardiac muscle. decreases PVR, dilates coronary arteries, inhibits coronary spasms
Benazepril: ACE-I, decreases plasma angiotensin II, which leads to decreased aldosterone secretion. decreases peripheral arterial resistance

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15
Q

Amlodipine + Benazepril metabolism and excretion

A

both metabolized in liver

amlodipine excreted as inactive metabolites in urine

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16
Q

Amlodipine + Benazepril drug interactions

A

Indomethacin: decreases therapeutic effects of Amlodipine + Benazepril
Capsaicin: increases incidence of coughing
use with caution when given with K-sparing diuretics and K supplements
lithium toxicity may occur
amlodipine may increase plasma levels of simvastatin

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17
Q

Amlodipine + Benazepril CI/precautions

A

CI: second and third trimesters of pregnancy
Caution: renal or hepatic impairment, collagen vascular disease (agranulocytosis) or aortic stenosis, and patients undergoing surgery or anesthesia
report signs of facial swelling, difficulty breathing, infection
Rare: increase in angina or MI on initiation of therapy
Caution in HF patients
Max dose of simvastatin with amlodipine is 20mg daily

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18
Q

Amlodipine + Benazepril Pregnancy category

A

D

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19
Q

Amlodipine + Benazepril ADRs

A

cough, headache, dizziness, edema, ANGIOEDEMA, nausea, flushing, fatigue, abdominal pain

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20
Q

Amlodipine + Benazepril patient education

A

without regard to meal
do not discontinue without consultation
avoid nonprescription cough, cold, and allergy meds unless consulted
avoid salt substitutes containing potassium
report signs of facial swelling, difficulty breathing, or infection

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21
Q

Amlodipine + Valsartan brand name

A

Exforge

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22
Q

Amlodipine + Valsartan indication/dosage

A

treatment of HTN in patients not adequately controlled by monotherapy or as initial therapy in patients likely to need multiple medications: start at 5/160 daily, titrate to max dose of 10/320 daily

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23
Q

Amlodipine + Valsartan mechanism

A

Amlodipine: CCB: inhibits influx of calcium ions across slow channels in vascular smooth muscle and cardiac muscle. causes decrease in PVR, dilation of coronary arteries, and inhibition of coronary spasm
Valsartan: ARB, blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to AT1 receptor

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24
Q

Amlodipine + Valsartan metabolism and excretion

A

Amlodipine is metabolized in lever and excreted in urine as inactive metabolites
Valsartan is eliminated as unchanged drug in both feces (83%) and urine (13%)

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25
Q

Amlodipine + Valsartan drug interactions

A

NSAIDS (inc COX-2 inhibitors) may decrease valsartan effects and increase risk of renal function deterioration
amlodipine may increase adverse effects of simvastatin

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26
Q

Amlodipine + Valsartan CI/precautions

A

amlodipine: rare increased risk of angina or MI when initiating therapy. Caution in HF patients.
discontinue in pregnancy
caution in volume or salt-depleted patients (excessive hypotension)
hepatic or renal dysfunction
max dose of simvastatin used with amlodipine is 20mg/day

27
Q

Amlodipine + Valsartan Pregnancy category

A

D. Valsartan has been shown to be excreted in milk of lactating rats, do not use in nursing mothers

28
Q

Amlodipine + Valsartan ADR’s

A

peripheral edema, nasopharyngitis, URTI’s, dizziness

29
Q

Amlodipine + Valsartan patient education

A

without regard to meals
do not take OTC cough/cold meds without consulting
do not dtop abruptly
discontinue in pregnancy
dizziness may occur in first few days, report if persistent

30
Q

Atenolol brand name

A

Tenormin

31
Q

Atenolol indication/dosage

A

HTN: 50mg daily initially, alone or with diuretic. Use 50-100mg/day for maintenance
Angina pectoris: 50-200mg daily. start at 50mg and titrate after 7 days

32
Q

Atenolol mechanism

A

B-blocker, relatively cardioselective for B1

1) decreased HR and CO
2) decreased systolic and diastolic BP
3) inhibition of isoproterenol tachycardia
4) decreased reflex orthostatic tachycardia

33
Q

Atenolol excretion

A

unchanged drug excreted in urine

34
Q

Atenolol drug interactions

A 
may decrease effects of CLONIDINE
NSAIDs may decrease effects
toxic effects increased with VERAPAMIL
increases toxic effects of lidocaine
use with prazosin may increase Ortho Hypo
Ampicillin may decrease effects
35
Q

Atenolol CI/precautions

A

CI: sinus bradycardia, heart block >1st degree, cardiogenic shock, overt cardiac failure
caution: bronchial asthma, HF, DM, hyperthyroidism, and impaired renal function

36
Q

Atenolol pregnancy category

A

D

increased risk of neonatal hypoglycemia and bradycardia in pregnancy and nursing

37
Q

Atenolol ADRs

A

dizziness, fatigue, drowsiness, nausea, bradycardia, hypotension

38
Q

Atenolol patient education

A

take with food
caution while operating machinery or when mental awareness is required
avoid abrupt withdrawal from therapy
DM: be aware that this agent may mask hypoglycemic symptoms

39
Q

Benazepril brand name

A

Lotensin

40
Q

Benazepril indication/dosage

A

HTN: initially 10mg daily, maintenance dose is 20-80mg in 1-2 doses
when used with diuretic: start with 5mg daily, or temporary discontinuation of diuretic
cut first recommendationin half for renal impairment: 5mg initially, max 40mg/day

41
Q

Benazepril mechanism

A

ACE-I
may increase serum potassium
results in decreased peripheral arterial resistance

42
Q

Benazepril metabolism and excretion

A

metabolized to benazeprilat (active) in liver

excreted through urine

43
Q

Benazepril drug interactions

A

DO NOT USE WITH ALISKIREN
indomethacin may decrease therapeutic effects
Capsaicin may increase incidence of coughing
caution when given with K-sparing diuretics or K supplements
lithium toxicity when used together
hypoglycemia may occur when used with sulfonylureas

44
Q

Benazepril CI/precautions

A

CI: ALISKIREN
caution: pregnant/nursing women, impaired renal function, collagen vascular disease, or aortic stenosis, and patients undergoing surgery or anesthesia
Rare angioedema and neutropenia
report signs of facial swelling, difficulty breathing, or infection

45
Q

Benazepril pregnancy category

A

D

46
Q

Benazepril ADR’s

A

cough, headache, dizziness, ANGIOEDEMA, fatigue, nausea

47
Q

Benazepril patient education

A

do not discontinue abruptly
avoid nonprescription cough, cold, allergy meds without consultation
avoid salt substitutes containing potassium
stay hydrated!!!
report facial swelling, difficulty breathing, or infection

48
Q

Bisoprolol + HCTZ brand name

A

Ziac

49
Q

Bisoprolol + HCTZ indication/dosage

A

HTN: iniate at 1 2.5/6.25mg tablet daily. Titrate in 14 day intervals, with max dose of 2 10/6.25mg tablets
usual dose is 1 tablet daily in morning

50
Q

Bisoprolol + HCTZ discontinuation

A

titrate dosage down over 2 week period while closely observing patient to discontinue medication

51
Q

mechanism

A

Bisoprolol: B-blocker, B1 selective without significant membrane stabilizine or ISA
cardioselective at normal doses, becomes less selective (B2) at higher doses
causes decrease CO, inhibition of renin release by kidneys, inhibition of tonic sympathetic outflow from vasomotor centers in brain, or combination of all
HCTZ: inhibits reabsorption of Na and Cl in distal tubule

52
Q

Bisoprolol + HCTZ drug interactions

A

other antihypertensive agents may potentiate actions of this agent
caution with clonidine, verapamil, and diltiazem
may increase therapeutic and toxic effects of lithium
HCTZ absorption may be impaired by cholestyramine or colestipol
both digoxin and B-blockers slow atrioventricular conduction and decrease heart rate, increased risk of bradycardia

53
Q

Bisoprolol + HCTZ CI/precautions

A

CI: cardiogenic shock, overt cardiac failure, second or third degree AV block, marked sinus bradycardia, or anuria
caution: compensated cardiac failure, PVD, bronchospastic pulmonary disease, DM, impaired renal or hepatic function, and during anesthesia
measure serum electrolytes during therapy

54
Q

Bisoprolol + HCTZ pregnancy category

A

C

55
Q

Bisoprolol + HCTZ ADRs

A

fatigue, headache, dizziness, and diarrhea

56
Q

Bisoprolol + HCTZ patient education

A 
may be taken with food
do not stop abruptly
may mask hypoglycemic symptoms
may cause dizziness, operate with caution
usually given in AM due to diuresis
avoid excessive sun exposure
57
Q

Carvedilol brand name

A

Coreg (CR)

58
Q

Carvedilol indication/dosage

A

essential HTN: start at 6.25mg BID, increasing to 12.5mg BID after 7-14 days with SBP 1h after dose as guide
Mild-moderate HF in combination with digitalis, diuretics, and ACE-I, to reduce progression: start at 3.125mg BID
LVEF

59
Q

Carvedilol mechanism

A

nonselective B-blocker with a1 blocking activity
1) reduces cardiac output
2) reduces exercise- and/or isoproterenol-induced tachycardia
3) reduces reflex orthostatic tachycardia
CHF: shown to reduce systemic blood pressure, pulmonary artery pressure, PCWP, SVR, and HR while increasing SV

60
Q

Carvedilol drug interactions

A

rifampin decreases plasma levels
cimetidine increases SS AUC but not Cmax
Quinidine, fluoxetine, paroxetine, and propafenone may increase plasma levels
use with reserpine, clonidine, digoxin, or MAO-Is may produce significant hypotension or bradycardia
diltiazem or verapamil may cause conduction disturbances
may increase digoxin plasma levels
use with 2C9 inhibitors may exacerbate bradycardia

61
Q

Carvedilol CI/precautions

A

CI: NYHA class IV HF requiring IV inotropic therapy, bronchial asthma or related bronchospastic conditions, second- or third-degree AV block, sick sinus syndrome, cardiogenic shock, or severe bradycardia
caution:hepatic impairment, PVD (aggravate symptoms), DM (mask hypoglycemia) and thyrotoxicosis (mask hyperthyroidism)
discontinue at first sign of hepatic dysfunction (pruritis, dark urine, anorexia, jaundice, RUQ pain/tenderness, unexpected flu-like symptoms
Caution during anesthesia (bradycardia

62
Q

Carvedilol pregnancy category

A

C

63
Q

Carvedilol ADRs

A

CHF: dizziness, diarrhea, bradycardia, hypotension, hyperglycemia, visual abnormalities
Same occur in HTN treatment, but at same rate as placebo

64
Q

Carvedilol patient education

A

take with food to decrease ortho hypo
decreased lacrimation in contact lense wearers
do not discontinue without consultation, must taper
may cause drowsiness
avoid nonprescription cough, cold, allergy meds unless discussed with pharmacist/physician

3. Cardiovascular agents (HTN, angina, arrhythmia) (3 decks)

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