CCB, ACE-I, ARBs Flashcards
Different types of CCBs have different effects on
cardiac muscles
What leads to muscle contraction
Ca released from the sarcoplasmic reticulum
Extracellular Ca is required for contraction of what types of tissue
cardiac and smooth muscle, not skeletal muscle, the manner in which it occurs is different
CCBs are used for
angina pectoris, arrhythmias, HTN, some for Raynaud’s syndrome and migraines
3 classes of CCBs
dihydropyridines, phenylalkylamines and benzothiazepines or nondihydropyridines
Drugs of CCBs dihydropyridines
Nifedipine (Procardia), Felodipine (Plendil), Isradipine (DynaCirc), nisoldipine (sular), Nicardipine (cardene) Amlodipine (norvasc), Clevidipine (Cleviprex)
Effects of DHPs
decrease in peripheral vascular resistance, dilate arteries not veins, decrease afterload, little direct* effect on HR and intropy, reduce demand
Exception that most DHPs cause reflex tachycardia
amlodipine (norvasc), has a slower onset of action
Exception that most DHPs do not depress cardiac function
nifedipine (procardia)
Amlodipine (Norvasc) highlights (5)
only available PO, slower onset, used for HTN and angina, most commonly used, ADR is peripheral edema in lower extremities
Nifedipine (procardia, adalat) (4)
immediate release and XL, used for HTN, angina and PAH, Raynaud’s, do not take grapefruit, ADR: reflex tachy*, peripheral edema, etc
Nicardipine (Cardene)
available PO and IV, HTN and acute stroke, quick onset, no grapefruit juice, reflex tachy etc
Drugs to avoid taking with grapefruit juice
Nicardipine (cardene) and Nifedipine (procardia, adalat)
Clevidipine (cleviprex) (4)
newest, only available IV, has to be given in lipid form so can cause hypertriglyceridemia, acute HTN,
only approved for HTN, older, not used much
isradipine (DynaCirc), felodipine (plendil), nisoldipine (sular)
The phenylakylamine drug
verapamil (calan, isoptin, verelan)
verapamil (calan, isoptin, verelan) MOA
less potent dilator than DHPs, slows conduction through SA and AV nodes, decrease HR and inotropy
Verapamil (calan, isoptin, verelan) use
arrhythmias, angina and HTN but better options for these last two
verapamil (calan, isoptin, verelan) Highlights
quick onset, causes constipation, do not use for CHF and certain arrythmias
The benzothiazepine drug
diltiazem (cardizem, cartia, taztia, tiazac)
diltiazem (cardizem, cartia, taztia, tiazac)
based on frequency of CCB, initial reflex tachy, used for HTN, arrhythmias, angina, slows conduction of SA and AV, do not use in CHF
DOC for atrial fib and atrial flutter
diltiazem (cardizem, cartia, taztia, tiazac)
Main effect of DHPs
is on vasculature
Main effect of non-DHPs
is inhibitory effect on HR and contraction in addition to vasodilation
RAAS activated by
Na reabsorption at macula densa, BP sensors in pre-glomerular vessels, B receptor activation in kidney
Effects of Angiotensin II that are associated with rapid vasoconstriction
Direct vasoconstriction, enhanced action of peripheral norepi, increased sympathetic discharge, release of epi from adrenal gland
Effects of Angiotensin II that are associated with a slower pressor response
direct effects to increase Na reabsorption in proximal tubule, synthesis and release of aldosterone causing retention of Na and water, renal vasoconstriction
Effects of Angiotensin II that are associated with vascular and cardiac hypertrophy and remodeling
increase in preload, afterload and vascular wall tension, increase expression of oncogenes
Cardiac remodeling
process where cardiac and vascular muscle become thicker, more fibrotic, and results in decreased efficiency of contraction, major factor of CHF
ACE-I drug names
Enalapril (vasotec), lisinopril (zestril), ramipril (altace), benazepril (Lotensin), quinapril (lotensin), captopril (capoten), fosinopril (Monopril), moexipril (univasc), perindopril (aceon), trandolapril (mavik)
clinical uses of ACE-I
HTN (first line), CHF, CAD, diabetic nephropathy
ACE-I drug overall info
Often seen in combo with other drugs, no huge advantage of one drug over other, old, inexpensive, invaluable for preventing cardiac remodeling
Exception of all ACE-I given orally
Enalapril (vasotec) also available IV
Exception that all ACE-I have long half life for once daily
Captopril (capoten) has a 3 hr half life, give 3 times a day
exception that all ACE-I are eliminated via renal excretion
Moexipril (univasc) is excreted hepatically, and fosinopril (monopril) is excreted hepatically and urinary
ADRs of ACE-I
hypotension, chronic cough, hyperkalemia, angioedema
Contraindications of ACE-I
pregnancy category X, and renal artery stenosis
ARBs clinical uses
HTN, CHF, diabetic nephropathy
Overall info of ARBs
go to drug if pt can’t tolerate ACE-I, many available as combo, only available PO, use cautiously in severe renal impairment
ARB drug names
Losartan (Cozaar), valsartan (Diovan), olmesartan (Benicar), irbesartan (Avapro), candesartan (Atacand), Telmisartan (Micardis), Azilsartan (Edarbi)
ADR of ARB
hypotension, hyperkalemia
Contraindications of ARB
renal artery stenosis, pregnancy category X
Direct renin inhibitor drug
aliskiren (tekturna)
Use of aliskiren (tekturna)
HTN, AMI
Aliskiren (Tekturna) highlights
never use as monotherapy, available in combo, newest option, expensive,
ADR and contraindication of Aliskiren (Tekturna)
hyperkalemia, hypotension, pregnancy category D
Important to keep in mind with using multiple RAAS meds
using many will increase ADRs
