Mixed deck two Flashcards
verapamil and Ditiazem predominantly treat what two conditions?
Atrial Fibrillation
paroxysmal SVT
Diltiazem is a non-dihyr CCB in class __________
Verapamil is a non-dihyr CCB in class___________
D (Benzothiazepines)
V (phenylalkylamine)
Effects of Nitrates
veno-dilation results in decreased preload
coronary artery vasodilation helps treat ischemia and thus reduces anginal pain
Pulmonary vascular resistance is decreased because preload is decreased
Effects of Nitrates
*doesn’t really affect HR/BP/ barely lowers CO
veno-dilation results in decreased preload
coronary artery vasodilation helps treat ischemia and thus reduces anginal pain
Pulmonary vascular resistance is decreased because preload is decreased
Effects of Nitrates
- doesn’t really affect HR/BP/ barely lowers CO
- does dilate arteries and veins, headache can results from meningeal arterial dilation
veno-dilation results in decreased preload
coronary artery vasodilation helps treat ischemia and thus reduces anginal pain
Pulmonary vascular resistance is decreased because preload is decreased
adverse effects of Nitrates?
hypotension in large doses (dizzyness & syncope possible)
- -a drop in blood pressure can trigger reflex sympathetic stimulation of the heart and actually paradoxically worsen angina pectoris
- headache
adverse effects of Nitrates?
*Viagra (Sildenifil) is an absolute contraindication with nitates because both ^cGMP, augment nitrate effect….HYPOTENSIONS & MYOCARDIAL ISCHEMIA
- hypotension in large doses (dizzyness & syncope possible)
- -a drop in blood pressure can trigger reflex sympathetic stimulation of the heart and actually paradoxically worsen angina pectoris
- headache
Dihydropyridine
“dipine”
CCBs
- peripheral vasodilation to help decrease BP…better for low renin HTN like african americans and old people
- the potential for reflex increase in HR and myocardial contractility and increased oxygen consumption IS A RISK to reduce efficacy
Dihydropyridine
“dipine”
specific for vasculature
CCBs
- peripheral vasodilation to help decrease BP…better for low renin HTN like african americans and old people
- the potential for reflex increase in HR and myocardial contractility and increased oxygen consumption IS A RISK to reduce efficacy
NON-DIHYDROPYRIDINE CCBs
*equipotent for cardiac tissue and vasculature!!
- Heart rate moderating
- reduced iontropism & peripheral and coronary vasodilation
What do the nonDHP CCBs do that the DHP don’t do??
- slow the recovery of the channel
- reduce cardiac ionotropy, slow AV conduction, and slow pacemaker firing
What do all CCBs do ?
- increase the time that calcium channels are closed, reduce the magnitude of the calcium current
- only arterial smooth muscle dilates so DECREASES AFTERLOAD but not preload
What do all CCBs do ?
CCBs have short half life except for isradipine and Felodipine
- increase the time that calcium channels are closed, reduce the magnitude of the calcium current
- only arterial smooth muscle dilates so DECREASES AFTERLOAD but not preload
regular CCB side effects
excessive vasodilation, nausea, peripheral edema, coronary steal
verapamil & diltiazem
side effects
bradycardia, Astystole, AV block
CHF,, constipation
What do CIMETIDINE/ ERYTHROMYCIN/ GRAPEFRUIT JUICE AND nonDHP CCBs have in common?
They inhibit CYP3A4 and would delay metabolism of each other if given together
Rifampin and phenobarbital ____
induce CYP3a4 to reduce levels of nonDHPCCBs
Theophylline, Statins, and cyclosporine must be given
in lower doses with NONDHPCCBs because ….
there will be less CYP3A4 around to metabolize them
NITROGLYCERIN tolerance
very common
TWO WAYS:
1. volume overload
2. cysteine depletion (required to achieve active form of drug)
