CCB, ACE-I, ARBs

Question 1

Different types of CCBs have different effects on

Answer 1

cardiac muscles

Question 2

What leads to muscle contraction

Answer 2

Ca released from the sarcoplasmic reticulum

Question 3

Extracellular Ca is required for contraction of what types of tissue

Answer 3

cardiac and smooth muscle, not skeletal muscle, the manner in which it occurs is different

Question 4

CCBs are used for

Answer 4

angina pectoris, arrhythmias, HTN, some for Raynaud’s syndrome and migraines

Question 5

3 classes of CCBs

Answer 5

dihydropyridines, phenylalkylamines and benzothiazepines or nondihydropyridines

Question 6

Drugs of CCBs dihydropyridines

Answer 6

Nifedipine (Procardia), Felodipine (Plendil), Isradipine (DynaCirc), nisoldipine (sular), Nicardipine (cardene) Amlodipine (norvasc), Clevidipine (Cleviprex)

Question 7

Effects of DHPs

Answer 7

decrease in peripheral vascular resistance, dilate arteries not veins, decrease afterload, little direct* effect on HR and intropy, reduce demand

Question 8

Exception that most DHPs cause reflex tachycardia

Answer 8

amlodipine (norvasc), has a slower onset of action

Question 9

Exception that most DHPs do not depress cardiac function

Answer 9

nifedipine (procardia)

Question 10

Amlodipine (Norvasc) highlights (5)

Answer 10

only available PO, slower onset, used for HTN and angina, most commonly used, ADR is peripheral edema in lower extremities

Question 11

Nifedipine (procardia, adalat) (4)

Answer 11

immediate release and XL, used for HTN, angina and PAH, Raynaud’s, do not take grapefruit, ADR: reflex tachy*, peripheral edema, etc

Question 12

Nicardipine (Cardene)

Answer 12

available PO and IV, HTN and acute stroke, quick onset, no grapefruit juice, reflex tachy etc

Question 13

Drugs to avoid taking with grapefruit juice

Answer 13

Nicardipine (cardene) and Nifedipine (procardia, adalat)

Question 14

Clevidipine (cleviprex) (4)

Answer 14

newest, only available IV, has to be given in lipid form so can cause hypertriglyceridemia, acute HTN,

Question 15

only approved for HTN, older, not used much

Answer 15

isradipine (DynaCirc), felodipine (plendil), nisoldipine (sular)

Question 16

The phenylakylamine drug

Answer 16

verapamil (calan, isoptin, verelan)

Question 17

verapamil (calan, isoptin, verelan) MOA

Answer 17

less potent dilator than DHPs, slows conduction through SA and AV nodes, decrease HR and inotropy

Question 18

Verapamil (calan, isoptin, verelan) use

Answer 18

arrhythmias, angina and HTN but better options for these last two

Question 19

verapamil (calan, isoptin, verelan) Highlights

Answer 19

quick onset, causes constipation, do not use for CHF and certain arrythmias

Question 20

The benzothiazepine drug

Answer 20

diltiazem (cardizem, cartia, taztia, tiazac)

Question 21

diltiazem (cardizem, cartia, taztia, tiazac)

Answer 21

based on frequency of CCB, initial reflex tachy, used for HTN, arrhythmias, angina, slows conduction of SA and AV, do not use in CHF

Question 22

DOC for atrial fib and atrial flutter

Answer 22

diltiazem (cardizem, cartia, taztia, tiazac)

Question 23

Main effect of DHPs

Answer 23

is on vasculature

Question 24

Main effect of non-DHPs

Answer 24

is inhibitory effect on HR and contraction in addition to vasodilation

Question 25

RAAS activated by

Answer 25

Na reabsorption at macula densa, BP sensors in pre-glomerular vessels, B receptor activation in kidney

Question 26

Effects of Angiotensin II that are associated with rapid vasoconstriction

Answer 26

Direct vasoconstriction, enhanced action of peripheral norepi, increased sympathetic discharge, release of epi from adrenal gland

Question 27

Effects of Angiotensin II that are associated with a slower pressor response

Answer 27

direct effects to increase Na reabsorption in proximal tubule, synthesis and release of aldosterone causing retention of Na and water, renal vasoconstriction

Question 28

Effects of Angiotensin II that are associated with vascular and cardiac hypertrophy and remodeling

Answer 28

increase in preload, afterload and vascular wall tension, increase expression of oncogenes

Question 29

Cardiac remodeling

Answer 29

process where cardiac and vascular muscle become thicker, more fibrotic, and results in decreased efficiency of contraction, major factor of CHF

Question 30

ACE-I drug names

Answer 30

Enalapril (vasotec), lisinopril (zestril), ramipril (altace), benazepril (Lotensin), quinapril (lotensin), captopril (capoten), fosinopril (Monopril), moexipril (univasc), perindopril (aceon), trandolapril (mavik)

Question 31

clinical uses of ACE-I

Answer 31

HTN (first line), CHF, CAD, diabetic nephropathy

Question 32

ACE-I drug overall info

Answer 32

Often seen in combo with other drugs, no huge advantage of one drug over other, old, inexpensive, invaluable for preventing cardiac remodeling

Question 33

Exception of all ACE-I given orally

Answer 33

Enalapril (vasotec) also available IV

Question 34

Exception that all ACE-I have long half life for once daily

Answer 34

Captopril (capoten) has a 3 hr half life, give 3 times a day

Question 35

exception that all ACE-I are eliminated via renal excretion

Answer 35

Moexipril (univasc) is excreted hepatically, and fosinopril (monopril) is excreted hepatically and urinary

Question 36

ADRs of ACE-I

Answer 36

hypotension, chronic cough, hyperkalemia, angioedema

Question 37

Contraindications of ACE-I

Answer 37

pregnancy category X, and renal artery stenosis

Question 38

ARBs clinical uses

Answer 38

HTN, CHF, diabetic nephropathy

Question 39

Overall info of ARBs

Answer 39

go to drug if pt can't tolerate ACE-I, many available as combo, only available PO, use cautiously in severe renal impairment

Question 40

ARB drug names

Answer 40

Losartan (Cozaar), valsartan (Diovan), olmesartan (Benicar), irbesartan (Avapro), candesartan (Atacand), Telmisartan (Micardis), Azilsartan (Edarbi)

Question 41

ADR of ARB

Answer 41

hypotension, hyperkalemia

Question 42

Contraindications of ARB

Answer 42

renal artery stenosis, pregnancy category X

Question 43

Direct renin inhibitor drug

Answer 43

aliskiren (tekturna)

Question 44

Use of aliskiren (tekturna)

Answer 44

HTN, AMI

Question 45

Aliskiren (Tekturna) highlights

Answer 45

never use as monotherapy, available in combo, newest option, expensive,

Question 46

ADR and contraindication of Aliskiren (Tekturna)

Answer 46

hyperkalemia, hypotension, pregnancy category D

Question 47

Important to keep in mind with using multiple RAAS meds

Answer 47

using many will increase ADRs