Exam 6 lecture 2 Flashcards
ACEi inhibits conversion of
ANG I to ANG II
How do ARBs work
Block the effects of ANG II by binding to target receptors
Renin inhibitors MOA
Inhibit Antiotensinogen to ANG I conversion
All ACe I drugs end with
-pril
ACE i dosing
Most are dosed once a day
captoptril is dosed 2-3 times a day
Dosing strategy for ACE i drugs
Never start on a max dose, always start on lowest possibel dose
Dose at night for BP dip overnight
adverse effects of ANg i
Angioedema, cough, hyperkalemia, acute renal failure
CI of ACE i
Hx of angioedema on an ACE i
concomitant use of aliskiren in pts with DM
Pregnant/nursing
if hx of angioedema/cough of ACE we use
ARB
ARBs all end with
-sartan
Dosing of ARBs
Losartan and Eprosartan only doses given twice
All other once
adverse effects of ARBs
Angioedema, hyperkalemia, acute renal failure
CI of ARBs
Angioedema on ARBs
Concomitant use of aliskiren in pts with DM
Pregnancy/nursing
ACEi/ARB monitoring
check baseline for K and renal function
Check BMP within 1 week for elderly
In low risk pts or ots with K<4.5 wait 3-4 weeks before initial assesment
check 3-4 weeks after initiation if elevated Scr or K at 1-2 weeks
When to hold or reduce ACI/ARB dose
if K>5.5
Scr>30%
direct renin inhibitor drug name
Aliskiren
CI of aliskiren
Concomitant use with ACE or ARB in DM pts
Dosing of Aliskiren
QD
Monitoring parameters for aliskiren
K, BUN, SCr
Adverse effects of Alsikiren
NO cough
Diarrhea, h/a, hyperkalemia, renal insufficiency, dizziness
CCB MOA
inhibit influx of Ca across cardiac and smoth muscle causing vasoddilation
Which CCB has more vasidilation
DHP
What patient population would have additional benefits for CCBs
Reynauds syndrome
elderly pts with isolated systolic HTN
Which CCB can cause baroreceptor mediated tachycardia
DHP
DHP drugs
All end in -pine
Amlodipine, nifedipine
How often are CCBs dosed
QD except for Isradipine and nicardipine (BID for both)
Adverse ffects of CCBs
Reflex tachycardia, flushing, dizziness
Warnings for CCB
increase risk of angina/MI in pts with obstructive coronary disease due to reflex tachycardia
Patients with additional benefits for non DHP CCBs
Supraventriculat tachycardia
A fib
pts with Angina who can not tolerate BB
How do non DHP CCBs affect AV node conduction and HR
Decrease both
NON DHP CCBs drug names
Verapamil and diltiazem
How often are diltiazem and verapamil dosed
QD or BID
Adverse effects of NON DHP CCBs
Bradycardia, H/A, Dizziness, AV node block, (Constipation in verapamil)
If a CCB is needed for HF choose
Amlodipine
Amlodipine side effects
Might cause swollen ankles (decrease dose to combat this)
COmpression stockings could help
WHich CCB helps with both BP and Angina
NON-DHP CCBs (diltiazem and verapamil)
Compelling indication for the use of B blockers
Stacle ischemic heart disease
HFrEF
Important counseling point for BB
AVOID abrupt cessation
What are some cardioselective B blockers
Atenolol, Betaxolol, Bisoprolol, Metoprolol tartrate and metorpolol succinate, Nebivolol
WHich cardioselective B blocker is short acting and is dosed BID
Metorprolol tartrate
All others dosed QD
How does nebivolol differ from other B blockers
It induces NO, causes vasodilation
Non-selective B blockers
Nadolol
Propanolol IR
Propanolol LA
Which non selective B blocker is dosed BID
Propanolol IR
What type of patients should never use NON selective B blockers
bronchospastic airway disease pts (Asthma, COPD)
B blockers with intrinsic sympathomimetic activity (ISA) drugs
Acebutolol-BID
Penbutolol- QD
Pindolol- BID
IMPORTANT What type of pts should never use ISA BB
Pts with HF and ischemic heart disease
Bixed alpha/beta drugs
Carvedilol
Labetalol
How are mixed a/b blockers dosed
BID
B blocker adverse effects
Bronchospasm, bradycardia, fatigue, exercise intolerance, depression
Can also mask symptoms of hypoglycemia
what BB is preferred in PAD (peripheral artery disease)
Carvedilol
What BB is preferred in airway diseases
Selective BB
contraindications of BBs
2nd and 3rd degree heart block
Bradycardia
HF
Post MI of ISA BBs
