CCB, ACE-I, ARBs Flashcards Preview

Pharmacology > CCB, ACE-I, ARBs > Flashcards

Flashcards in CCB, ACE-I, ARBs Deck (47):
1

Different types of CCBs have different effects on

cardiac muscles

2

What leads to muscle contraction

Ca released from the sarcoplasmic reticulum

3

Extracellular Ca is required for contraction of what types of tissue

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

4

CCBs are used for

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

5

3 classes of CCBs

dihydropyridines, phenylalkylamines and benzothiazepines or nondihydropyridines

6

Drugs of CCBs dihydropyridines

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

7

Effects of DHPs

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

8

Exception that most DHPs cause reflex tachycardia

amlodipine (norvasc), has a slower onset of action

9

Exception that most DHPs do not depress cardiac function

nifedipine (procardia)

10

Amlodipine (Norvasc) highlights (5)

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

11

Nifedipine (procardia, adalat) (4)

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

12

Nicardipine (Cardene)

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

13

Drugs to avoid taking with grapefruit juice

Nicardipine (cardene) and Nifedipine (procardia, adalat)

14

Clevidipine (cleviprex) (4)

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

15

only approved for HTN, older, not used much

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

16

The phenylakylamine drug

verapamil (calan, isoptin, verelan)

17

verapamil (calan, isoptin, verelan) MOA

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

18

Verapamil (calan, isoptin, verelan) use

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

19

verapamil (calan, isoptin, verelan) Highlights

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

20

The benzothiazepine drug

diltiazem (cardizem, cartia, taztia, tiazac)

21

diltiazem (cardizem, cartia, taztia, tiazac)

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

22

DOC for atrial fib and atrial flutter

diltiazem (cardizem, cartia, taztia, tiazac)

23

Main effect of DHPs

is on vasculature

24

Main effect of non-DHPs

is inhibitory effect on HR and contraction in addition to vasodilation

25

RAAS activated by

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

26

Effects of Angiotensin II that are associated with rapid vasoconstriction

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

27

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

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

28

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

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

29

Cardiac remodeling

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

30

ACE-I drug names

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

31

clinical uses of ACE-I

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

32

ACE-I drug overall info

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

33

Exception of all ACE-I given orally

Enalapril (vasotec) also available IV

34

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

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

35

exception that all ACE-I are eliminated via renal excretion

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

36

ADRs of ACE-I

hypotension, chronic cough, hyperkalemia, angioedema

37

Contraindications of ACE-I

pregnancy category X, and renal artery stenosis

38

ARBs clinical uses

HTN, CHF, diabetic nephropathy

39

Overall info of ARBs

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

40

ARB drug names

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

41

ADR of ARB

hypotension, hyperkalemia

42

Contraindications of ARB

renal artery stenosis, pregnancy category X

43

Direct renin inhibitor drug

aliskiren (tekturna)

44

Use of aliskiren (tekturna)

HTN, AMI

45

Aliskiren (Tekturna) highlights

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

46

ADR and contraindication of Aliskiren (Tekturna)

hyperkalemia, hypotension, pregnancy category D

47

Important to keep in mind with using multiple RAAS meds

using many will increase ADRs