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Pharmacology > CCB, ACE-I, ARBs > Flashcards

CCB, ACE-I, ARBs Flashcards

1
Q

Different types of CCBs have different effects on

A

cardiac muscles

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2
Q

What leads to muscle contraction

A

Ca released from the sarcoplasmic reticulum

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3
Q

Extracellular Ca is required for contraction of what types of tissue

A

cardiac and smooth muscle, not skeletal muscle, the manner in which it occurs is different

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4
Q

CCBs are used for

A

angina pectoris, arrhythmias, HTN, some for Raynaud’s syndrome and migraines

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5
Q

3 classes of CCBs

A

dihydropyridines, phenylalkylamines and benzothiazepines or nondihydropyridines

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6
Q

Drugs of CCBs dihydropyridines

A

Nifedipine (Procardia), Felodipine (Plendil), Isradipine (DynaCirc), nisoldipine (sular), Nicardipine (cardene) Amlodipine (norvasc), Clevidipine (Cleviprex)

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7
Q

Effects of DHPs

A

decrease in peripheral vascular resistance, dilate arteries not veins, decrease afterload, little direct* effect on HR and intropy, reduce demand

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8
Q

Exception that most DHPs cause reflex tachycardia

A

amlodipine (norvasc), has a slower onset of action

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9
Q

Exception that most DHPs do not depress cardiac function

A

nifedipine (procardia)

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10
Q

Amlodipine (Norvasc) highlights (5)

A

only available PO, slower onset, used for HTN and angina, most commonly used, ADR is peripheral edema in lower extremities

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11
Q

Nifedipine (procardia, adalat) (4)

A

immediate release and XL, used for HTN, angina and PAH, Raynaud’s, do not take grapefruit, ADR: reflex tachy*, peripheral edema, etc

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12
Q

Nicardipine (Cardene)

A

available PO and IV, HTN and acute stroke, quick onset, no grapefruit juice, reflex tachy etc

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13
Q

Drugs to avoid taking with grapefruit juice

A

Nicardipine (cardene) and Nifedipine (procardia, adalat)

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14
Q

Clevidipine (cleviprex) (4)

A

newest, only available IV, has to be given in lipid form so can cause hypertriglyceridemia, acute HTN,

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15
Q

only approved for HTN, older, not used much

A

isradipine (DynaCirc), felodipine (plendil), nisoldipine (sular)

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16
Q

The phenylakylamine drug

A

verapamil (calan, isoptin, verelan)

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17
Q

verapamil (calan, isoptin, verelan) MOA

A

less potent dilator than DHPs, slows conduction through SA and AV nodes, decrease HR and inotropy

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18
Q

Verapamil (calan, isoptin, verelan) use

A

arrhythmias, angina and HTN but better options for these last two

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19
Q

verapamil (calan, isoptin, verelan) Highlights

A

quick onset, causes constipation, do not use for CHF and certain arrythmias

20
Q

The benzothiazepine drug

A

diltiazem (cardizem, cartia, taztia, tiazac)

21
Q

diltiazem (cardizem, cartia, taztia, tiazac)

A

based on frequency of CCB, initial reflex tachy, used for HTN, arrhythmias, angina, slows conduction of SA and AV, do not use in CHF

22
Q

DOC for atrial fib and atrial flutter

A

diltiazem (cardizem, cartia, taztia, tiazac)

23
Q

Main effect of DHPs

A

is on vasculature

24
Q

Main effect of non-DHPs

A

is inhibitory effect on HR and contraction in addition to vasodilation

25
Q

RAAS activated by

A

Na reabsorption at macula densa, BP sensors in pre-glomerular vessels, B receptor activation in kidney

26
Q

Effects of Angiotensin II that are associated with rapid vasoconstriction

A

Direct vasoconstriction, enhanced action of peripheral norepi, increased sympathetic discharge, release of epi from adrenal gland

27
Q

Effects of Angiotensin II that are associated with a slower pressor response

A

direct effects to increase Na reabsorption in proximal tubule, synthesis and release of aldosterone causing retention of Na and water, renal vasoconstriction

28
Q

Effects of Angiotensin II that are associated with vascular and cardiac hypertrophy and remodeling

A

increase in preload, afterload and vascular wall tension, increase expression of oncogenes

29
Q

Cardiac remodeling

A

process where cardiac and vascular muscle become thicker, more fibrotic, and results in decreased efficiency of contraction, major factor of CHF

30
Q

ACE-I drug names

A

Enalapril (vasotec), lisinopril (zestril), ramipril (altace), benazepril (Lotensin), quinapril (lotensin), captopril (capoten), fosinopril (Monopril), moexipril (univasc), perindopril (aceon), trandolapril (mavik)

31
Q

clinical uses of ACE-I

A

HTN (first line), CHF, CAD, diabetic nephropathy

32
Q

ACE-I drug overall info

A

Often seen in combo with other drugs, no huge advantage of one drug over other, old, inexpensive, invaluable for preventing cardiac remodeling

33
Q

Exception of all ACE-I given orally

A

Enalapril (vasotec) also available IV

34
Q

Exception that all ACE-I have long half life for once daily

A

Captopril (capoten) has a 3 hr half life, give 3 times a day

35
Q

exception that all ACE-I are eliminated via renal excretion

A

Moexipril (univasc) is excreted hepatically, and fosinopril (monopril) is excreted hepatically and urinary

36
Q

ADRs of ACE-I

A

hypotension, chronic cough, hyperkalemia, angioedema

37
Q

Contraindications of ACE-I

A

pregnancy category X, and renal artery stenosis

38
Q

ARBs clinical uses

A

HTN, CHF, diabetic nephropathy

39
Q

Overall info of ARBs

A

go to drug if pt can’t tolerate ACE-I, many available as combo, only available PO, use cautiously in severe renal impairment

40
Q

ARB drug names

A

Losartan (Cozaar), valsartan (Diovan), olmesartan (Benicar), irbesartan (Avapro), candesartan (Atacand), Telmisartan (Micardis), Azilsartan (Edarbi)

41
Q

ADR of ARB

A

hypotension, hyperkalemia

42
Q

Contraindications of ARB

A

renal artery stenosis, pregnancy category X

43
Q

Direct renin inhibitor drug

A

aliskiren (tekturna)

44
Q

Use of aliskiren (tekturna)

A

HTN, AMI

45
Q

Aliskiren (Tekturna) highlights

A

never use as monotherapy, available in combo, newest option, expensive,

46
Q

ADR and contraindication of Aliskiren (Tekturna)

A

hyperkalemia, hypotension, pregnancy category D

47
Q

Important to keep in mind with using multiple RAAS meds

A

using many will increase ADRs

Pharmacology (61 decks)

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