Antihypertensives and Antianginals Flashcards
Amlodipine Brand Name
Norvasc
Amlodipine Indication/Dosage
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
Amlodipine Max Dose
10mg once daily
Amlodipine Mechanism
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
Amlodipine metabolism and excretion
metabolized in liver
excreted in urine as inactive metabolites
93% protein bound
Amlodipine drug interactions
may increase plasma levels of simvastatin
Amlodipine CI/precautions
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
Amlodipine Pregnancy Category
C
Amlodipine ADR’s
edema, flushing, headache, fatigue, abdominal pain
Amlodipine patient information
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
Amlodipine + Benazepril Brand name
Lotrel
Amlodipine + Benazepril indication/dosage
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
Amlodipine + Benazepril dosage forms
All Capsules (as Amlodipine/Benazepril)
2.5/10
5/10, 5/20, 5/40
10/20, 10/40
Amlodipine + Benazepril mechanism
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
Amlodipine + Benazepril metabolism and excretion
both metabolized in liver
amlodipine excreted as inactive metabolites in urine
Amlodipine + Benazepril drug interactions
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
Amlodipine + Benazepril CI/precautions
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
Amlodipine + Benazepril Pregnancy category
D
Amlodipine + Benazepril ADRs
cough, headache, dizziness, edema, ANGIOEDEMA, nausea, flushing, fatigue, abdominal pain
Amlodipine + Benazepril patient education
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
Amlodipine + Valsartan brand name
Exforge
Amlodipine + Valsartan indication/dosage
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
Amlodipine + Valsartan mechanism
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
Amlodipine + Valsartan metabolism and excretion
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%)
Amlodipine + Valsartan drug interactions
NSAIDS (inc COX-2 inhibitors) may decrease valsartan effects and increase risk of renal function deterioration
amlodipine may increase adverse effects of simvastatin
Amlodipine + Valsartan CI/precautions
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
Amlodipine + Valsartan Pregnancy category
D. Valsartan has been shown to be excreted in milk of lactating rats, do not use in nursing mothers
Amlodipine + Valsartan ADR’s
peripheral edema, nasopharyngitis, URTI’s, dizziness
Amlodipine + Valsartan patient education
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
Atenolol brand name
Tenormin
Atenolol indication/dosage
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
Atenolol mechanism
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
Atenolol excretion
unchanged drug excreted in urine
Atenolol drug interactions
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
Atenolol CI/precautions
CI: sinus bradycardia, heart block >1st degree, cardiogenic shock, overt cardiac failure
caution: bronchial asthma, HF, DM, hyperthyroidism, and impaired renal function
Atenolol pregnancy category
D
increased risk of neonatal hypoglycemia and bradycardia in pregnancy and nursing
Atenolol ADRs
dizziness, fatigue, drowsiness, nausea, bradycardia, hypotension
Atenolol patient education
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
Benazepril brand name
Lotensin
Benazepril indication/dosage
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
Benazepril mechanism
ACE-I
may increase serum potassium
results in decreased peripheral arterial resistance
Benazepril metabolism and excretion
metabolized to benazeprilat (active) in liver
excreted through urine
Benazepril drug interactions
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
Benazepril CI/precautions
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
Benazepril pregnancy category
D
Benazepril ADR’s
cough, headache, dizziness, ANGIOEDEMA, fatigue, nausea
Benazepril patient education
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
Bisoprolol + HCTZ brand name
Ziac
Bisoprolol + HCTZ indication/dosage
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
Bisoprolol + HCTZ discontinuation
titrate dosage down over 2 week period while closely observing patient to discontinue medication
mechanism
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
Bisoprolol + HCTZ drug interactions
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
Bisoprolol + HCTZ CI/precautions
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
Bisoprolol + HCTZ pregnancy category
C
Bisoprolol + HCTZ ADRs
fatigue, headache, dizziness, and diarrhea
Bisoprolol + HCTZ patient education
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
Carvedilol brand name
Coreg (CR)
Carvedilol indication/dosage
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
Carvedilol mechanism
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
Carvedilol drug interactions
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
Carvedilol CI/precautions
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
Carvedilol pregnancy category
C
Carvedilol ADRs
CHF: dizziness, diarrhea, bradycardia, hypotension, hyperglycemia, visual abnormalities
Same occur in HTN treatment, but at same rate as placebo
Carvedilol patient education
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
