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50 Cards in this Set

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Brand name, classification, unique features:

Capoten
Captopril, ACE inhibitor

Requires 2-3 doses per day
Infrequently causes agranulocytosis or neutropenia
Brand name, classification, unique features:

Lisinopril
Prinivil

ACEI
Brand name, classification, unique features:

Enalapril
Vasotec

ACEI -

Few side effects, comp to placebo
Brand name, classification, uses:

Ramipril
Altace

ACEI + risk reduction (MI, stroke,death)from CVD in high-risk groups
Brand name, classification, uses:

quinapril
Accupril

ACEI - htn, HF
ACE inhibitors - uses (4)
HTN (esp high-renin)

Heart failure (with dig & diuretics)

HTN with diabetic neuropathy (doesn't affect glucose levels, bradykinin increases insulin sensitivity)

MI - enhance reperfusion
ACE inhibitors -- contraindications
Pregnancy (fetal death/inj 2nd and 3rd trimester)

Lactation -- use caution, detected in milk

Bilateral renal artery stenosis
ACE inhibitors - adverse effects
First dose hypotension (pronounced)
Cough (most frequent)
dizziness, proteinuria, rash, tachycardia, headache, angioedema
ACE inhibitors -- drug interactions
Inc antihypertensive effect with diuretics & sympathetic blockers

Hyperkalemia with K-sparing diuretics

NSAIDs decreases effect
ACE inhibitors are typically less effective in which racial group?
African Americans
Name 4 ACEIs
capoten (Captopril)
ramipril (Altace)
quinapril (Accupril)
enalapril (Vasotec)
MOA of Angiotensin II Receptor Antagonists (ARBs)
Blocks angiotensin II receptors in vascular muscle preventing vasoconstriction and aldosterone secretion
ARBs -- side effects
Hypotension
Dizziness
Hyperkalemia
Indications for ARBs
HTN
DM with proteinuria

Have advantages of ACEIs without the cough
Contraindications for ARBs
Pregnancy (fetal death in 2nd & 3rd trimesters)

Lactation
Brand name, classification, and unique features:

irbesartan
Avapro - ARB (angiotensin II receptor antagonist)
Brand name, classification, and unique features:

losartan
Cozaar -- ARB
Brand name, classification, and unique features:

valsartan
Diovan - ARB

Usual ARB indications + HF & post-MI with L vent damage/dysfunction
ARBs -- drug interactions
Phenobarbital reduces levels
3 physiologic mechanisms for blood pressure regulation
Sympathetic nervous system
Vascular volume
Vascular tone
Indications for peripherally acting alpha adrenergic antagonists
HTN
HTN with HF

Urinary outflow obstruction in BPH
MOA of alpha adrenergic antagonists
Direct dilation of peripheral arteries and veins
Brand name, classification, and unique features:

terazosin
Hytrin

alpha adrenergic antagonists
Brand name, classification, and unique features:

doxazosin
Cardura

alpha adernergic antagonists
Alpha adrenergic antagonists -- adverse effects
1st dose hypotension (sudden and severe)

Edema, dry mouth, congestion, h/a, sexual dysfx, lethargy
Alpha adrenergic antagonists

Use in preg/lactation
Preg C

Lactation: Safety not established
Alpha adrenergic antagonists

Drug interactions
Phenobarb shortens 1/2 life

Agents that dec intestinal motility can inc systemic absorption

Inc hypotension with ETOH, silfenadil, antihtn drugs, nitrates
Alpha adrenergic antagonists --precaution re first dose
Profound hypotension -- pts lying and observed for 2 hrs p first dose
MOA for calcium channel blockers (CCBs)
Blocks entry of calcium into the smooth muscles of blood vessel walls
5 actions of CCBs
1) inotropic force (dec myocardial contractility)
2) slowed vent contractions
3) coronary artery dilation
4) peripheral artery dilation
5) dec peripheral resistance
Brand name, classification, and unique features:

diltiazem
Cardizem, CCB

Reduce in renal dysfx
CYP 450
Increases propanolol levels
Brand name, classification, and unique features:

nifedipine XR
Procardia XR

No longer used as single agent due to toxicity
Inc. effects of oral anticoagulants
Brand name, classification, and unique features:

felodipine
Plendil, CCB

Slow onset (2-5 hrs)
Inc dig levels
Brand name, classification, and unique features:

Amlodipine
Norvasc, CCB

Slowest onset & longest half-life
Name 4 CCBs
amlodipine (Norvasc)
diltiazem (Cardizem)
felodipine (Plendil)
Nifedipine (Procardia)
Calcium channel blockers --
Adverse effects
Peripheral edema (avoid in HF)
Difference between DHP and non-DHP CCBs
DHPs don't affect the cardiac conduction system (so aren't used for arrhythmias)
List 2 non-DHP CCBs
Verapamil (Calan)
Diltiazem (Cardizem)

Can be used for arrhythmias
Beta blockers decrease the _________ _________ by decreasing the ___________, _______________, and ___________ _________ of the heart.
Cardiac output

rate
contractility
conduction velocity
Name 2 beta-1 selective beta blockers
Metoprolol (Lopressor)
atenolol (Tenormin)
Name 2 non-selective beta blockers
Timolol
Propanolol
What is the advantage of cardioselective beta blockers?
They work on beta 1 receptors with less activity on beta 2 receptors, do decreased side effects such as gluconeogenesis and bronchoconstriction
What is intrinsic sympathomimetic activity (ISA)?
Some beta blockers act as weak agonists at some adrenergic receptors -- may have less bronchoconstriction and less rebound hypertension
Brand name, classification, and unique features:

Atenolol
Tenormin, beta-blocker (selective)

Good starting therapy for mild-mod htn
Once daily dosing
Few side effects
Brand name, classification, and unique features:

Metaprolol
Lopressor, selective Beta blocker

Shorter half-life
Levels may be inc by verapamil, cimetidine, OCPs
Brand name, classification, and unique features:

propanolol
Inderal - nonselective Beta blocker

Transient htn d/t B2 receptor antagonism (B2s dilate lg arteries)
Bronchospasm is a side effect
Abrupt discontinuation can cause rebound htn and tachycardia
Brand name, classification, and unique features:

labetalol
Transdate, mixed alpha and beta antagonist

Contraindicated in asthma or bradycardia
Beta blockers - contraindications
Asthma
Heart failure
General info re thiazide diuretics
Usual first choice
Good for women w/ osteoporosis because of Ca+ sparing
Inhibits sodium reabsorption in the distal tubule
Sodium and potassium wasting
Hypokalemia is major problem
Brand name, classification, and unique features:

Hydrochlorothiazide
Hydrodiuril, thiazide diuretic

1st agent for HTN, chronic edema, idiopathic hypercalcuria
Contraindicated in pregnancy