Week 2 cardiac and heartfailure Flashcards
what are the four classes of drugs used to treat HTN
ACEI, ARB, CCB, Thiazide diuretics
what is the suggested initial therapy for hypertension?
thiazide diuretics
what drug class does captopril, enalapril and lisinopril fall into?
ACEI
what drug class does candesartan, losartan, valsartan and ibesartan fall into?
ARB
what drug class does amlodipine and diltiazem fall into?
CCB
what drug class does indapamide fall into?
thiazide diuretic
for all patients with CKD what are the drug classes of choice. regardless of race
ACEI and ARB
what is the mechanism of action for thiazide diuretics
inhibit sodium transport in the distal tubule, and enhanced calcium reabsorption
what kind of monioring is necessary for thiazide diuretics
BP, sodium & potassium monitoring, calcium monitoring, CrCl
at a creatinine clearance of <30 what happens with thiazide diuretics
they tend to lose ofptimaleffect
what kind of dietary problems can negate the effects of thiazides?
high sodium diets
what drug class should be avoided when taking thiazide diuretics and why?
NSAIDs can lead to sodium retention
what is the MOA for ACEIs?
inhibit the enzyme that converts angiotensin 1 to angiotensin 2 and prevents bradykinin activation
what is the overall effect of ACEI drugs
prevent vasoconstriction leading to decreased BP
what benefits to ACEIs have for diabetics?
prevents kidney damage and slows proteinuria
what benefit do ACEIs have on heart failure?
decreasing blood volume and slows cardiac remodeling, decreases preload and afterload
what is the monitoring needed for ACEIs?
potassium: can cause hyperkalemia , BP, respiratory symptoms
While ACEIs can help with renal failure and diabetic nephropathy, what renal condition are ACEIs contraindicated for?
bilateral renal artery stenosis
what is the interaction between ACEIs and bilateral renal stenosis?
reduced GFR and renal failure can occurr
at what point in ACEI treatment can angioedema occur?
anytime in treatment
what drug can substitute ACEIs when dry cough is bothersome and angioedema occurs?
ARBs can be prescribed due to infrequency of reported effects
what is the mechanism of action for ARBs?
antagonize angiotensin 1 at the receptor no bradykinin effect
what condition is ARB drug treatment contraindicated in?
bilateral renal artery stenosis. can lead to decreased GFR and lead to renal failure
what hypertension drug classes are contraindicated in pregnancy?
ACEI and ARBs.
why do ACEIs cause dry cough and angioedema?
due to inhibition of bradykinin
what is the MOA for CCBs
inhibit the influx of calcium in arterial smooth muscle causing relaxation and vasodilation
what is the physical effect of CCBs
decrease arterial smooth muscle tone leading to vasodilation, decrease cardiac contractility, decrease HR
what are the two classes of CCBs?
dihydropyridines and non-dihydropyridines