HTN4 Flashcards
what is the first line option for HTN in CKD?
ACE-I’s
what effect do ACE-I’s have on peripheral vascular resistance?
decrease peripheral vascular resistance and increases vasodialation
what effect does angiotensin II have?
potent vasoconstrictor
what major effect do ACE-I’s have on CHF
decrease risk of death
what are 4 evidence based benefits of ACE-I’s
- decrease morbidity and mortality in CHF
- decrease CKD progression
- decreases CV events in high risk pts
- protect kidneys in diabetic pts
what is the most common adverse effect of ACE-I’s?
dry cough (20%)
what is the most severe adverse effect of ACE-I’s often seen in the ER?
angioedema (swelling of face)
what are some contraindications with ACE-I’s
- pregnancy
- angioedema
- bilateral renal artery stenosis
- unilateral stenosis
what are some adverse effects of ACE-I’s
- angioedema
- dry cough
- acute renal failure
- hyperkalemia
- sexual disfunction
- rash
7 neutropenia
what should be monitored with pt’s on ACE-I’s
- renal function (BUN and SCr)
- K levels
- BP
If a patient has a high potassium level and is on an ACE-I, especially with acute renal failure, what should be done?
withhold ACE-I for a while until K levels normalize
what is ACE-I’s affect on AKI and CKD
ACE-I’s may cause AKI, but protects kidney in CKD.
d/c ACEI’s with AKI until acute symptoms are gone
what artery condition is contraindicated with ACE-I’s
renal artery stenosis (bilateral or unilateral)
what are the only non-prodrug ACEI’s?
lisinopril and captopril
what is the MOAof ARBs?
what are its effects on vasculature?
inhibit angiotensin II type 1 receptor
increase vasodilation and decrease PVR
ARB’s have the same adverse effects, monitoring and contraindications as what
ACE-I’s
what type of CCB is most advantageous in HTN
dihydropyridines
name the dihydropyridine CCBs
- nifedipine
- amlodipine
- felodipine
- nicardipine
- isradipine
what is the MOA of CCBs
inhibit L-type calcium channels to prevent calcium influx to cardiac and smooth muscle cells
nondihydropyrimines act in what area that dihydropyridines do not?
act in nodal tissue, effecting heart conductance
dihydropyridines effect what system the most?
how?
periphery
vasodilation
what are some adverse effects of dihydropyridines
peripheral edema
flushing
headache
reflex tachycardia
what effect do dihydropyridines have on FOC?
HR?
no effect on force of contraction
no effect, to very little on dihydropyridines
what are some contraindications of dihydropyridines?
- lower extremity edema
- angina
- MI
- HF
