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Calcium channel, ACEI, ARB Flashcards

1
Q

What are the Calcium Channel Blockers?

A
  • **Amlodipine (Norvasc)
  • **Nicardipine (Cardene)
  • Diltiazem (oral)
  • Nifedipine
  • Verapamil
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2
Q

Prescription for Amlodipine (Norvasc)?

A 
	Amlodipine
10 mg
One tablet daily
•	Maintenance AND the max dose
	Most start at 5 mg
	Range = 2.5-10 mg
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3
Q

Prescription for Nicardipine (Cardene)?

A

 Nicardipine infusion
Start at 5 mg/hour and titrate to effect every 15 minutes up to a maximum of 15 mg/hour
 Once up to 15 mg/hour and BP controlled, drop dose to 3 mg/hour as maintenance

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4
Q

How do calcium channel blockers work?

A

o Normally calcium flows in to muscle cells resulting in smooth muscle contraction and cardiac myocyte contraction
 Calcium channel blockers do exactly that, block calcium from entering muscle cells
• Reduce smooth muscle contraction and reduce myocyte contraction
• Reduced blood pressure

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5
Q

What are the differences of calcium channel blockers?

A
  • Pharmacokinetics: Amlodopine and Felodipine are only ones that can be once a day. All other ones are extended release.
  • Effect on cardiac conduction: Verapamil has biggest effect
  • Adverse Drug Reactions
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6
Q

What are the Adverse Drug Reactions of the calcium channel blockers?

A
  • Dihydropyridines: Vascular side effects
  • Non-dihydropyridines: Cardiac conduction effects
o	That AV node effect
	Bradycardia or…
	AV block
o	That vasculature effect
	Excessive hypotension
	Dizziness
	Peripheral edema
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7
Q

Indications for Amlodipine?

A

 Treatment of hypertension
 Treatment of symptomatic chronic stable angina, vasospastic angina
 Prevention of hospitalization due to angina with documented CAD

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8
Q

Indications for Nicardipine (oral and intravenous)?

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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9
Q

Indications for Diltiazem?

A
  • Primary hypertension

- Chronic stable angina or angina from coronary artery spasm

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10
Q

Indications for Nifedipine?

A
  • Treatment of hypertension (sustained release products only)
  • Management of chronic stable or vasospastic angina
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11
Q

Indications for Verapamil?

A
  • Treatment of hypertension
  • Angina pectoris (vasospastic, chronic stable, unstable)
  • Supraventricular tachyarrhythmia (PSVT, atrial fibrillation/flutter )
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12
Q

Are the Calcium Channel Blockers a 1st line drug?

A

NO!!!
Diuretics are first line in the newly diagnosed hypertensive patient with no other cardiovascular diseases

Then a choice of:
ACE inhibitor
Calcium channel blocker
Beta blocker

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13
Q

What are the advantages for the Calcium Channel Blockers?

A

No metabolic effects, no increase in lipid levels and safe in mild to moderate renal failure

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14
Q

What do all the Calcium Channel Blockers interact with?

A

β-blockers –> additive or synergistic effects
o All interact with CYP3A4 –> ↑ level of CCB
o All interact with General Anesthetics –> Potentiation of cardiac effects and vascular dilation of anesthetic agent

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15
Q

What are the ACE inhibitors?

A
  • Lisinopril (Zestril)
  • Captopril (Capoten)
  • Ramipril (Altace)
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16
Q

Prescription for Lisinopril?

A


20 mg
One tablet daily
• Antihypertensive dose, need at least this for optimized dose
 Starting dose = 10 mg
 40 mg is also a good dose, 80 mg is too high
 Watch K+ levels and renal function

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17
Q

Prescription for Captopril?

A 
	
50 mg
One tablet three times a day
	Good for Diabetic nephropathy
	If go up to 100 mg, can get bad side effects, but 50 mg is a good dose
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18
Q

How do the ACE inhibitors work?

A

o Block the conversion of angiotensin I to angiotensin II
 Lower arteriolar resistance
 Increase venous capacity
 Increased cardiac output and cardiac index, stroke work and volume
 Lower renovascular resistance
o Reduce the progress of diabetic nephropathy
o

19
Q

Besides blocking the conversion of angiotensin I to angiotensin II, what else do they do?

A
  • Cut down on breakdown of bradykinin, so get more bradykinin which leads to more vasodilation and lower BP.
  • Also get increased prostaglandin synthesis, so NSAIDS can block this effect
20
Q

What is the main difference between ACE inhibitors?

A
  • Half life –> Captopril is short acting, and Lisinopril is long acting
21
Q

Indication 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 myocardial infarction within 24 hours in hemodynamically-stable patients to improve survival
 Treatment of left ventricular dysfunction after myocardial infarction

22
Q

Indication for Captopril ?

A

 Management of hypertension
 Treatment of heart failure
 Left ventricular dysfunction after myocardial infarction
 Diabetic nephropathy

23
Q

Indication for Enalapril?

A
  • Treatment of hypertension
  • Treatment of symptomatic heart failure
  • Treatment of asymptomatic left ventricular dysfunction
  • Only injectable
24
Q

Indication for Ramipril?

A
  • Treatment of hypertension, alone or in combination with 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
25
Q

What do ACEI inhibitors reduce?

A

reduce mortality in post-myocardial infarction patients and help prevent the development of heart failure

26
Q

When are ACEI inhibitors contraindicated?

A
  • pregnancy –> fetal death
  • o Renal artery stenosis (Bilateral)
    o Previous angioedema associated with ACE inhibitor therapy
27
Q

What are the side effects for the ACEI inhibitors ?

A 
o	Hypotension
o	Cough
o	Hyperkalemia
o	Headache, dizziness, fatigue
o	Renal impairment
o
28
Q

What are the Angiotensin Receptor Blockers (ARBs)?

A
  • Losartan (Cozaar)

* Valsartan (Diovan)

29
Q

Prescription for Losartan?

A 
	Losartan
50 mg
One tablet daily
	Range = 25-100 mg
	Can be dosed 25 mg, two times a day
30
Q

Prescription for Valsartan?

A

 Valsartan
160 mg
One tablet daily
 Max dose is 320 mg

31
Q

How do the ARBs work?

A

o Block the receptor site where angiotensin II activates all of the “bad” effects
 Blockade that results in  Drop in blood pressure
o Get rid of vasoconstriction and aldosterone

32
Q

What is the indication for Losartan?

A

 Treatment of hypertension
 Treatment of diabetic nephropathy in patients with type 2 diabetes mellitus and a history of hypertension
 Stroke risk reduction in patients with HTN and left ventricular hypertrophy

33
Q

What is the indication 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 postmyocardial infarction
 Treatment of heart failure (NYHA Class II-IV)

34
Q

What is the indication for Azilsartan?

A

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

35
Q

What 2 ARBs are approved for heart failure?

A
  • Valsartan (Diovan™)

- Candesartan (Atacand™)

36
Q

What are the Adverse drug reactions of ARBS?

A

o Same as ACEI
o ↑ risk of cancer

  • But lower incidence of dry cough
37
Q

What is the renin antagonist?

A

Tekturna (Aliskiren)

38
Q

What is the prescription for Tekturna?

A

 Tekturna
300 mg
One tablet daily
 There is a 150 mg

39
Q

How does the renin antagonist (Tekturna) work?

A

Blockade of conversion of angiotensinogen to angiotensin I

40
Q

What are the side effects of the renin antagonist?

A

Side effects same as ACEI and ARBs

41
Q

Why don’t people used the renin antagonist?

A

VERY VERY Expensive and have same clinical outcome as ACEI and ARBs, so not used

42
Q

What are the generic combinations of the antihypertensive drugs?

A
  • ACEIs and thiazides
  • ARBs and thiazides
  • ARBs and calcium channel blockers
  • Calcium channel blockers and “statins”
43
Q

Should you use combinations of the antihypertensive drugs?

A

NO, resist!

  • Start off with a single agent 1st, so you can adjust.
  • only use with the elderly if they’re always on it and have good effects; this way easier to remember and possibly may be cheaper

Pharm HTN (3 decks)

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