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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
ADE of Direct Vasodilators
``` Reflex Tachycardia, palpitations Headache/dizziness Na/H2O retention Hirsutism Lupus-like Syndrome ```
26
Where do Thiazide diuretics work?
DCT Inhibit NaCl reabsorption
27
Where do K+ Sparing Diuretics work?
Collecting Duct limit Na+ reabsorption/K+ secretion
28
Where do Loop Diuretics work?
Ascending Limb inhibit NaCL reabsorption
29
Thiazide Diuretics MOA
increase NA and H2O excretion Decrease Vol -> Decrease preload -> decrease SV -> decrease CO
30
HCTZ Dose and Frequency
12.5-25mg, Daily
31
Chlorthalidone Dose and Frequency
12.5-50mg, Daily
32
Which thiazide is better?
Chlorthalidone (more potent), w/ better outcomes but we use HCTZ more But HCTZ comes in come combos
33
Which allergy should you not use HCTZ with?
Sulfonamides (Bactrim)
34
When switching between HCTZ and Chlorthalidone, what's equivalent?
12.5mg Chlorthalidone = 50mg HCTZ
35
thiazide Clinical Considerations
if CrCl <30ml/min = not useful Dose over 50mg/day chlorthalidone = potential hypokalemia dose >25mg/day HCTZ = increased ADE
36
Loop Diuretics MOA
increase NA and H2O excretion Decrease Vol -> Decrease preload -> decrease SV -> decrease CO More potent than thiazides
37
furosemide (Lasix) Dose and Frequency
20-80mg, 1-2/day
38
Loop Diuretics Uses...
used more in patients who have fluid accumulation
39
Dosing equivalents Loops
Bumetenide 1mg Torsemide 20mg Furosemide 40mg All equal
40
Clinical Considerations Loops
Can result in hypokalemia, give w/ K+ supplement if needed Work at CrCl < 30ml/min ** Sulfa allergy should avoid if serious allergy**
41
K+ sparring diuretics Clinical Considerations
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
People with gout should be cautious of which diuretics?
Thiazide and loops cause they can increase uric acid levels
43
Drug interactions Diuretics?
NSAIDs (can cause water retention) ACEi/ARBs (K+ Sparring only) high salt food = less efficacy
44
What to monitor when on Diuretics?
``` Cr Bun Electrolytes (Na,K,Etc) Uric Acid Blood Glucose ```
45
Diuretic side effects?
Dehydration | Hypotension w/ position change
46
Stimulation of a1 results in...
Vasoconstriction Bladder sphincter contraction Reduced lipolysis
47
Stimulation of a2 results in...
Decrease pre-synaptic NE release (Reduced sympathetic outflow)
48
Example of DHP CCB
Amlodipine | Nifedipine
49
Example of Non-DHP CCB
Verapamil | Diltiazem
50
Verapamil and Diltiazem are substrates of which CYP?
P450
51
What to monitor with vasodilators?
``` BP HR Hypotension Edema Scr ```

CDM 1 Exam 1 (14 decks)

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