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3. Cardiovascular agents (HTN, angina, arrhythmia) > Antihypertensives and Antianginals > Flashcards

Antihypertensives and Antianginals Flashcards

(64 cards)

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1
Q

Amlodipine Brand Name

A

Norvasc

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2
Q

Amlodipine Indication/Dosage

A

Treatment of HTN: start at 5mg daily as monotherapy. If added to existing therapy, start at 2.5mg. Titrate over 7-14 days
Chronic stable or vasospastic angina: 10mg daily

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3
Q

Amlodipine Max Dose

A

10mg once daily

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4
Q

Amlodipine Mechanism

A

Calcium Channel Blocker
Inhibits movement of calcium across specific cell membranes in vascular smooth muscle and cardiac muscle (inhibits influx of calcium through slow calcium channels)
More selective for vascular smooth muscle than cardiac muscle
Specific effects:
1) decrease in PVR
2) dilation of coronary arteries and arterioles
3) inhibition of coronary spasm

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5
Q

Amlodipine metabolism and excretion

A

metabolized in liver
excreted in urine as inactive metabolites
93% protein bound

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6
Q

Amlodipine drug interactions

A

may increase plasma levels of simvastatin

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7
Q

Amlodipine CI/precautions

A

rare increase in risk of angina or MI when starting therapy or increasing dose
caution in HF and hepatic impairment
max dose of simvastatin when used with amlodipine is 20mg daily

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8
Q

Amlodipine Pregnancy Category

A

C

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9
Q

Amlodipine ADR’s

A

edema, flushing, headache, fatigue, abdominal pain

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10
Q

Amlodipine patient information

A

may be taken without regards to meals
if dose missed, take ASAP. if taken within 12 hours of the next dose, skip next dose and return to dosing schedule
don’t take OTC cough and cold meds without checking with pharmacist
do not stop therapy unless directed to do so

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11
Q

Amlodipine + Benazepril Brand name

A

Lotrel

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12
Q

Amlodipine + Benazepril indication/dosage

A

Hypertension: one capsule daily
lowest possible dose of amlodipine should be used to avoid peripheral edema
use combination in patients who failed monotherapy or who failed amlodipine without developing edema

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13
Q

Amlodipine + Benazepril dosage forms

A

All Capsules (as Amlodipine/Benazepril)
2.5/10
5/10, 5/20, 5/40
10/20, 10/40

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14
Q

Amlodipine + Benazepril mechanism

A

Amlodipine: CCB, inhibits influx of calcium ions across slow channels in vascular smooth muscle and cardiac muscle. decreases PVR, dilates coronary arteries, inhibits coronary spasms
Benazepril: ACE-I, decreases plasma angiotensin II, which leads to decreased aldosterone secretion. decreases peripheral arterial resistance

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15
Q

Amlodipine + Benazepril metabolism and excretion

A

both metabolized in liver

amlodipine excreted as inactive metabolites in urine

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16
Q

Amlodipine + Benazepril drug interactions

A

Indomethacin: decreases therapeutic effects of Amlodipine + Benazepril
Capsaicin: increases incidence of coughing
use with caution when given with K-sparing diuretics and K supplements
lithium toxicity may occur
amlodipine may increase plasma levels of simvastatin

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17
Q

Amlodipine + Benazepril CI/precautions

A

CI: second and third trimesters of pregnancy
Caution: renal or hepatic impairment, collagen vascular disease (agranulocytosis) or aortic stenosis, and patients undergoing surgery or anesthesia
report signs of facial swelling, difficulty breathing, infection
Rare: increase in angina or MI on initiation of therapy
Caution in HF patients
Max dose of simvastatin with amlodipine is 20mg daily

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18
Q

Amlodipine + Benazepril Pregnancy category

A

D

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19
Q

Amlodipine + Benazepril ADRs

A

cough, headache, dizziness, edema, ANGIOEDEMA, nausea, flushing, fatigue, abdominal pain

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20
Q

Amlodipine + Benazepril patient education

A

without regard to meal
do not discontinue without consultation
avoid nonprescription cough, cold, and allergy meds unless consulted
avoid salt substitutes containing potassium
report signs of facial swelling, difficulty breathing, or infection

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21
Q

Amlodipine + Valsartan brand name

A

Exforge

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22
Q

Amlodipine + Valsartan indication/dosage

A

treatment of HTN in patients not adequately controlled by monotherapy or as initial therapy in patients likely to need multiple medications: start at 5/160 daily, titrate to max dose of 10/320 daily

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23
Q

Amlodipine + Valsartan mechanism

A

Amlodipine: CCB: inhibits influx of calcium ions across slow channels in vascular smooth muscle and cardiac muscle. causes decrease in PVR, dilation of coronary arteries, and inhibition of coronary spasm
Valsartan: ARB, blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to AT1 receptor

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24
Q

Amlodipine + Valsartan metabolism and excretion

A

Amlodipine is metabolized in lever and excreted in urine as inactive metabolites
Valsartan is eliminated as unchanged drug in both feces (83%) and urine (13%)

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25
Amlodipine + Valsartan drug interactions
NSAIDS (inc COX-2 inhibitors) may decrease valsartan effects and increase risk of renal function deterioration amlodipine may increase adverse effects of simvastatin
26
Amlodipine + Valsartan CI/precautions
amlodipine: rare increased risk of angina or MI when initiating therapy. Caution in HF patients. discontinue in pregnancy caution in volume or salt-depleted patients (excessive hypotension) hepatic or renal dysfunction max dose of simvastatin used with amlodipine is 20mg/day
27
Amlodipine + Valsartan Pregnancy category
D. Valsartan has been shown to be excreted in milk of lactating rats, do not use in nursing mothers
28
Amlodipine + Valsartan ADR's
peripheral edema, nasopharyngitis, URTI's, dizziness
29
Amlodipine + Valsartan patient education
without regard to meals do not take OTC cough/cold meds without consulting do not dtop abruptly discontinue in pregnancy dizziness may occur in first few days, report if persistent
30
Atenolol brand name
Tenormin
31
Atenolol indication/dosage
HTN: 50mg daily initially, alone or with diuretic. Use 50-100mg/day for maintenance Angina pectoris: 50-200mg daily. start at 50mg and titrate after 7 days
32
Atenolol mechanism
B-blocker, relatively cardioselective for B1 1) decreased HR and CO 2) decreased systolic and diastolic BP 3) inhibition of isoproterenol tachycardia 4) decreased reflex orthostatic tachycardia
33
Atenolol excretion
unchanged drug excreted in urine
34
Atenolol drug interactions
``` may decrease effects of CLONIDINE NSAIDs may decrease effects toxic effects increased with VERAPAMIL increases toxic effects of lidocaine use with prazosin may increase Ortho Hypo Ampicillin may decrease effects ```
35
Atenolol CI/precautions
CI: sinus bradycardia, heart block >1st degree, cardiogenic shock, overt cardiac failure caution: bronchial asthma, HF, DM, hyperthyroidism, and impaired renal function
36
Atenolol pregnancy category
D | increased risk of neonatal hypoglycemia and bradycardia in pregnancy and nursing
37
Atenolol ADRs
dizziness, fatigue, drowsiness, nausea, bradycardia, hypotension
38
Atenolol patient education
take with food caution while operating machinery or when mental awareness is required avoid abrupt withdrawal from therapy DM: be aware that this agent may mask hypoglycemic symptoms
39
Benazepril brand name
Lotensin
40
Benazepril indication/dosage
HTN: initially 10mg daily, maintenance dose is 20-80mg in 1-2 doses when used with diuretic: start with 5mg daily, or temporary discontinuation of diuretic cut first recommendationin half for renal impairment: 5mg initially, max 40mg/day
41
Benazepril mechanism
ACE-I may increase serum potassium results in decreased peripheral arterial resistance
42
Benazepril metabolism and excretion
metabolized to benazeprilat (active) in liver | excreted through urine
43
Benazepril drug interactions
DO NOT USE WITH ALISKIREN indomethacin may decrease therapeutic effects Capsaicin may increase incidence of coughing caution when given with K-sparing diuretics or K supplements lithium toxicity when used together hypoglycemia may occur when used with sulfonylureas
44
Benazepril CI/precautions
CI: ALISKIREN caution: pregnant/nursing women, impaired renal function, collagen vascular disease, or aortic stenosis, and patients undergoing surgery or anesthesia Rare angioedema and neutropenia report signs of facial swelling, difficulty breathing, or infection
45
Benazepril pregnancy category
D
46
Benazepril ADR's
cough, headache, dizziness, ANGIOEDEMA, fatigue, nausea
47
Benazepril patient education
do not discontinue abruptly avoid nonprescription cough, cold, allergy meds without consultation avoid salt substitutes containing potassium stay hydrated!!! report facial swelling, difficulty breathing, or infection
48
Bisoprolol + HCTZ brand name
Ziac
49
Bisoprolol + HCTZ indication/dosage
HTN: iniate at 1 2.5/6.25mg tablet daily. Titrate in 14 day intervals, with max dose of 2 10/6.25mg tablets usual dose is 1 tablet daily in morning
50
Bisoprolol + HCTZ discontinuation
titrate dosage down over 2 week period while closely observing patient to discontinue medication
51
mechanism
Bisoprolol: B-blocker, B1 selective without significant membrane stabilizine or ISA cardioselective at normal doses, becomes less selective (B2) at higher doses causes decrease CO, inhibition of renin release by kidneys, inhibition of tonic sympathetic outflow from vasomotor centers in brain, or combination of all HCTZ: inhibits reabsorption of Na and Cl in distal tubule
52
Bisoprolol + HCTZ drug interactions
other antihypertensive agents may potentiate actions of this agent caution with clonidine, verapamil, and diltiazem may increase therapeutic and toxic effects of lithium HCTZ absorption may be impaired by cholestyramine or colestipol both digoxin and B-blockers slow atrioventricular conduction and decrease heart rate, increased risk of bradycardia
53
Bisoprolol + HCTZ CI/precautions
CI: cardiogenic shock, overt cardiac failure, second or third degree AV block, marked sinus bradycardia, or anuria caution: compensated cardiac failure, PVD, bronchospastic pulmonary disease, DM, impaired renal or hepatic function, and during anesthesia measure serum electrolytes during therapy
54
Bisoprolol + HCTZ pregnancy category
C
55
Bisoprolol + HCTZ ADRs
fatigue, headache, dizziness, and diarrhea
56
Bisoprolol + HCTZ patient education
``` may be taken with food do not stop abruptly may mask hypoglycemic symptoms may cause dizziness, operate with caution usually given in AM due to diuresis avoid excessive sun exposure ```
57
Carvedilol brand name
Coreg (CR)
58
Carvedilol indication/dosage
essential HTN: start at 6.25mg BID, increasing to 12.5mg BID after 7-14 days with SBP 1h after dose as guide Mild-moderate HF in combination with digitalis, diuretics, and ACE-I, to reduce progression: start at 3.125mg BID LVEF
59
Carvedilol mechanism
nonselective B-blocker with a1 blocking activity 1) reduces cardiac output 2) reduces exercise- and/or isoproterenol-induced tachycardia 3) reduces reflex orthostatic tachycardia CHF: shown to reduce systemic blood pressure, pulmonary artery pressure, PCWP, SVR, and HR while increasing SV
60
Carvedilol drug interactions
rifampin decreases plasma levels cimetidine increases SS AUC but not Cmax Quinidine, fluoxetine, paroxetine, and propafenone may increase plasma levels use with reserpine, clonidine, digoxin, or MAO-Is may produce significant hypotension or bradycardia diltiazem or verapamil may cause conduction disturbances may increase digoxin plasma levels use with 2C9 inhibitors may exacerbate bradycardia
61
Carvedilol CI/precautions
CI: NYHA class IV HF requiring IV inotropic therapy, bronchial asthma or related bronchospastic conditions, second- or third-degree AV block, sick sinus syndrome, cardiogenic shock, or severe bradycardia caution:hepatic impairment, PVD (aggravate symptoms), DM (mask hypoglycemia) and thyrotoxicosis (mask hyperthyroidism) discontinue at first sign of hepatic dysfunction (pruritis, dark urine, anorexia, jaundice, RUQ pain/tenderness, unexpected flu-like symptoms Caution during anesthesia (bradycardia
62
Carvedilol pregnancy category
C
63
Carvedilol ADRs
CHF: dizziness, diarrhea, bradycardia, hypotension, hyperglycemia, visual abnormalities Same occur in HTN treatment, but at same rate as placebo
64
Carvedilol patient education
take with food to decrease ortho hypo decreased lacrimation in contact lense wearers do not discontinue without consultation, must taper may cause drowsiness avoid nonprescription cough, cold, allergy meds unless discussed with pharmacist/physician

3. Cardiovascular agents (HTN, angina, arrhythmia) (3 decks)

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