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CDM 1 Exam 1 > Hypertension - Lecture 2 (CCB Drugs) > Flashcards

Hypertension - Lecture 2 (CCB Drugs) Flashcards

1
Q

CCB MOA

A

Vasodilator activity by inhibiting Ca influx across slow channels of vascular smooth muscle and myocardium during depolarization, relaxing coronary vascular smooth muscle and coronary vasodilation

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2
Q

Non-Dihydropyridine CCB MOA

A

Decrease contractility -> decrease SV -> decrease CO

**Cardiac smooth muscle CC

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3
Q

Dihydropyridine CCB

A

dilate peripheral arterioles -> Decrease PVR

**periphery smooth muscle channels

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4
Q

Dihydropyridine CCB MOA

A

act on vascular smooth muscle, dilate peripheral arteries (decrease PVR)

Most used

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5
Q

Amlodipine (Norvasc) Dose and Frequency

A

5-10mg, Daily

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6
Q

Nifedipine long acting (Adalat CC, Nifedical XL, Procardia XL) Dose and Frequency

A

60-120mg, Daily

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7
Q

Non-Dihydropyridine CCB MOA

A

Decrease HR and conduction across AV node
Negative inotropic and chronotropic effects

decrease contractility -> decrease SV -> decrease CO

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8
Q

Diltiazem (Cardizem CD/LA/DR, Cartia XT, Dilacor XR, Taztia, Tiazac) Dose and Frequency

A

120-540mg, Daily

Non-D

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9
Q

Verapamil long acting (Calan SR)

A

120-480mg, Daily…sometimes BID

Non-D

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10
Q

Verapamil (Calan PM)

A

100-400, Daily in PM

Non-D

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11
Q

Dihydropyridine Clinical Considerations

A

1st line therapy w/o compelling indication

Preferred in black people

Effective older people w/ Isolated Systolic Hypertension

Indicated in stable CAD

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12
Q

Non-Dihydropyridine Clinical Considerations

A

indicated for cardiac focused benefit

Angina
Atrial fibrillation/flutter
PSVT
*Verapamil = migraine prophylaxis

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13
Q

ADE of non-Dihydropyridine

A

Bradycardia

Constipation w/Verapamil

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14
Q

ADE of Dihydropyridine

A

Reflex tachycardia

Pedal Edema

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15
Q

ADE common to both CCB

A

Gingival Hyperplasia
Headache
Orthostatic Hypotension
Dizziness

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16
Q

What to monitor with CCB?

A

BP
HR
Orthostatic
Edema

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17
Q

Non-DHP contraindications?

A

Heart Block
HF (Amlodipine/felodipine OK)

Avoid B-blockers

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18
Q

Drug interactions CCB

A

Simvastatin Dosing limitations

no more than 20mg w/ Amlodipine
no more than 10mg w/ Verapamil/Diltiazem

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19
Q

Alcohol effects on CCB?

A

increased effects

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20
Q

Direct Vasodilator MOA

A

Act directly on vascular smooth muscle to dilate arterioles

can have reflex tachycardia

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21
Q

Hydralazine (Apresoline) Dose and Frequency

A

20-200mg, 2-4/day

22
Q

Clinical Considerations Direct Vasodilators

A

4th line

Likely add-on resistant HTN

23
Q

What to monitor with Direct Vasodilators?

A 
BP
HR
SCr
Hypotension
Edema
24
Q

Topical Minoxidil indicated in….

A

alopecia due to side effect

25
Q

ADE of Direct Vasodilators

A 
Reflex Tachycardia, palpitations
Headache/dizziness
Na/H2O retention
Hirsutism
Lupus-like Syndrome
26
Q

Where do Thiazide diuretics work?

A

DCT

Inhibit NaCl reabsorption

27
Q

Where do K+ Sparing Diuretics work?

A

Collecting Duct

limit Na+ reabsorption/K+ secretion

28
Q

Where do Loop Diuretics work?

A

Ascending Limb

inhibit NaCL reabsorption

29
Q

Thiazide Diuretics MOA

A

increase NA and H2O excretion

Decrease Vol -> Decrease preload -> decrease SV -> decrease CO

30
Q

HCTZ Dose and Frequency

A

12.5-25mg, Daily

31
Q

Chlorthalidone Dose and Frequency

A

12.5-50mg, Daily

32
Q

Which thiazide is better?

A

Chlorthalidone (more potent), w/ better outcomes but we use HCTZ more

But HCTZ comes in come combos

33
Q

Which allergy should you not use HCTZ with?

A

Sulfonamides (Bactrim)

34
Q

When switching between HCTZ and Chlorthalidone, what’s equivalent?

A

12.5mg Chlorthalidone = 50mg HCTZ

35
Q

thiazide Clinical Considerations

A

if CrCl <30ml/min = not useful

Dose over 50mg/day chlorthalidone = potential hypokalemia

dose >25mg/day HCTZ = increased ADE

36
Q

Loop Diuretics MOA

A

increase NA and H2O excretion

Decrease Vol -> Decrease preload -> decrease SV -> decrease CO

More potent than thiazides

37
Q

furosemide (Lasix) Dose and Frequency

A

20-80mg, 1-2/day

38
Q

Loop Diuretics Uses…

A

used more in patients who have fluid accumulation

39
Q

Dosing equivalents Loops

A

Bumetenide 1mg
Torsemide 20mg
Furosemide 40mg

All equal

40
Q

Clinical Considerations Loops

A

Can result in hypokalemia, give w/ K+ supplement if needed

Work at CrCl < 30ml/min

** Sulfa allergy should avoid if serious allergy**

41
Q

K+ sparring diuretics Clinical Considerations

A

not recommended for initial treatment of HTN

Weak diuretics
Avoid in patients with significant CKD
Contraindicated if K >5.5, receiving K+ supp, or meds that increase K+

42
Q

People with gout should be cautious of which diuretics?

A

Thiazide and loops cause they can increase uric acid levels

43
Q

Drug interactions Diuretics?

A

NSAIDs (can cause water retention)
ACEi/ARBs (K+ Sparring only)

high salt food = less efficacy

44
Q

What to monitor when on Diuretics?

A 
Cr
Bun
Electrolytes (Na,K,Etc)
Uric Acid
Blood Glucose
45
Q

Diuretic side effects?

A

Dehydration

Hypotension w/ position change

46
Q

Stimulation of a1 results in…

A

Vasoconstriction
Bladder sphincter contraction
Reduced lipolysis

47
Q

Stimulation of a2 results in…

A

Decrease pre-synaptic NE release (Reduced sympathetic outflow)

48
Q

Example of DHP CCB

A

Amlodipine

Nifedipine

49
Q

Example of Non-DHP CCB

A

Verapamil

Diltiazem

50
Q

Verapamil and Diltiazem are substrates of which CYP?

A

P450

51
Q

What to monitor with vasodilators?

A 
BP
HR
Hypotension
Edema
Scr

CDM 1 Exam 1 (14 decks)

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