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Therapeutics 2 - Exam 5 > HTN 3 - olenik > Flashcards

HTN 3 - olenik Flashcards

1
Q

what is the MOA of ACEi?

A

inhibits conversion for angiotensin I to angiotensin II

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2
Q

what does ACEi stand for?

A

angiotensin converting enzyme inhibitors

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3
Q

what is the MOA of ARBs?

A

block effects of angiotensin II by binding to target receptors

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4
Q

what does ARBs stand for?

A

angiotensin II receptor blockers

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5
Q

what is the MOA of renin inhibitors?

A

inhibits the conversion of angiotensinogen to angiotensin I

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6
Q

how does ACEi and ARBs effect HTN?

A

vasodilation
reduced PVR
increased diuresis

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7
Q

what disease states benefit from ACEi treatment?

A

Dm with proteinuria
post-MI
CKD

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8
Q

when should ACEi/ARBs be administered?

A

PM to ensuring BP dipping overnight

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9
Q

how often should ACEi be administered?

A

2-3x per day for Captopril
1-2x for everything else

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10
Q

what drugs are ACEi?

A

benazepril
captopril
enalapril
fosinopril
lisinopril
moexipril
perindopril
quinapril
ramipril
trandolapril

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11
Q

what are the SE of ACEi?

A

angioedema
cough (20%)
high K
acute renal failure with severe bilateral renal artery stenosis

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12
Q

what are the CIs of ACEi?

A

history of angioedema on ACEi
concomitant use of aliskiren in patients with DM
pregnancy/breastfeeding

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13
Q

what is the indication of ARBs?

A

HTN (first line but backup for ACEi if intolerant)

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14
Q

why do ARBs not produce a couhg?

A

does not block bradykinin breakdown

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15
Q

what drugs are ARBs?

A

azilsartan
candesartan
irbesartan
losartan
olmesartan
telmisartan
valsartan

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16
Q

how often should ARBs be administered?

A

1-2 times for losartan
1 qd for everything else

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17
Q

what are SE of ARBs?

A

angioedema
high K
acute renal failure with severe bilateral renal artery stenosis

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18
Q

what are the CIs of ARBs?

A

history of angioedema on an ARB
concomitant use of aliskiren in patients with DM
pregnancy/breastfeeding

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19
Q

how should ACEi/ARBs be monitored?

A

potassium and renal function
at baseline
at 1-2 weeks after initiation if elderly
at 3-4 weeks after initiation for low-risk patients, patients with potassium under 4.5, or if elevated SCr in elderly at 1-2 weeks
every 6-12 months

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20
Q

when should ACEi/ARBs be held or reduced in dose?

A

when K is greater than 5.5
SCr increases by 30%

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21
Q

what is indication of direct renin inhibitors?

A

not first-line for HTN due to cost and simialr efficacy
less cough than ACEi

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22
Q

what drug is a direct renin inhibitor?

A

Aliskiren

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23
Q

how should aliskiren be dosed?

A

qd

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24
Q

what are the CI of aliskiren?

A

pregnancy
concomitant use with ACEi or ARB in patients with DM

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25
what should be monitored when taking aliskiren?
K BUN SCr
26
what are SE of aliskiren?
diarrhea musculoskeletal effects (CK increase) dizziness HA high K renal insufficiency/ARF orthostatic hypotension
27
what are the clinical pearls of angiotensin inhibitors?
discuss contraceptive methods with women at childbearing age do not combine drug classes due to risk of SE assess patients risk for hyperkalemia (CKD, other meds) educate patient on dietary source of potassium (bananas, food seasoning) ACEi/ARBs often preferred over other first line agents in the presence of other compelling indications
28
what is the MOA of CCBs?
inhibit influx of calcium across cardiac and smooth muscle cell membranes leads to coronary and peripheral vasodilation
29
what does CCB stand for?
calcium channel blockers
30
what are subclasses of CCBs?
dihydropyridines (more vasodilation) nondihydrophyridines (more negative ionotropic effects)
31
what is the indication of CCBs?
first line for HTN
32
what populations would benefit the most from using dihydropyridine CCBs?
reynaud's syndrome elderly pts with isolated systolic HTN
33
how are dihydropyridine CCBs dosed?
BID for isradipine and nicardipine QD for everything else
34
what drugs are dihydropyridine CCBs?
amlodipine felodipine isradipine isradipine SR nicardipine SR nifedipine LA nisoldipine
35
what dihydropyridine CCBs have no negative ionotropic effects?
amlodipine felodipine
36
how does dihydropyridine CCBs effect HTN?
vasodilation baroreceptor mediated tachycardia no effect on atrioventricular node conduction
37
what dihydropyridines should be avoided in HTN?
short-acting ones like IR nifedipine/nicardipine
38
what are the SE of dihydropyridine CCBs?
reflex tachycardia flushing dizziness HA peripheral edema (dose-related) gingival hyperplasia
39
what are the warnings of dihydropyridine CCBs?
increased risk of angina/MI in patients with obstructive coronary disease due to reflex tachycardia
40
what are the drug-drug interactions of dihydropyridine CCBs?
grapefruit juice CYP3A4 enzyme inducers/inhibitors
41
what populations may benefit from nondihydropyridine CCBs?
supraventricular tachyarrhythmias (Afib) patients with angina who cannot tolerate a beta blocker
42
what are the effects of nondihydropyridine CCBs?
slows AV node conduction decreases heart rate --> negative ionotropic effects
43
what type of tablet is preferred in nondihydropyridine CCBs?
extended release
44
what drugs are nondihydropyridine CCBs?
diltiazem ER verapamil ER
45
how should nondihydropyridines be dosed?
QD to BID
46
what are the SE of nondihydropyridines CCBs be dosed?
bradycardia HA dizziness AV node block systolic HF gingival hyperplasia constipation (verapamil > diltiazem)
47
what are the drug-drug interactions of nondihydropyridine CCBs?
concomitant use of beta blockers (could increase risk of heart block) grapefruit juice CYP3A4 enzyme inducers/inhibitors
48
what are the CI of nondihydropyridine CCBs?
heart block left ventricular dysfunction
49
what are the clinical pearls of CCBs?
no routine laboratory monitoring required check for drug interactions CCBs are first line for HTN peripheral edema is dose-dependent ER formulations are preferred nondihydropyridine CCB formulations are not interchangeable if a CCB is needed in the HF choose amlodipine
50
when should beta blockers be used in HTN?
not first line unless a compelling indication is present such as HF and CAD
51
what populations would benefit from beta blockers?
tachyarrhythmias tremors migraines thyrotoxicosis
52
how does beta blockers effect HTN?
decreases HR, force of contraction, and CO
53
what are the clinical pearls of beta blockers?
avoid abrupt cessation
54
what drugs are cardioselective beta blockers?
atenolol betaxolol bisoprolol metoprolol tartrate metoprolol succinate nebivolol
55
how is nebivolol unqiue?
has nitric oxide-induced vasodilation
56
how should cardioselective beta blockers be dosed?
BID for metoprolol tartrate QD for everything else
57
what drugs are nonselective beta blockers?
nadolol propranolol IR propranolol LA
58
what are the CI of nonselective beta blockers?
bronchospastic airway disease
59
how should nonselective beta blockers be dosed?
BID propranolol IR QD everything else
60
what drugs are beta blockers with intrinsic sympathomimetic activity (ISA)?
acebutolol penbutolol pindolol
61
what are the CI of beta blockers with ISA?
heart failure IHD
62
how should beta blockers with ISA be dosed?
BID acebutolol, pindolol QD penbutolol
63
what drugs are beta blockers with mixed alpha/beta activity?
carvedilol labetalol
64
how should mixed alpha/beta activity beta blockers be dosed?
BID
65
what are SE of beta blockers?
bronchospasms bradycardia fatigue exercise intolerance depression can masked signs and symptoms of hypoglycemia
66
what populations should use caution of beta blockers?
peripheral artery disease (carvedilol preferred) reactive airway disease (use selective beta blockers)
67
what are the CI of beta blockers?
second or third degree heart block decompensated heart failure post MI (ISA BBs only) severe bradycardia sick sinus syndrome

Therapeutics 2 - Exam 5 (14 decks)

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