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89 Cards in this Set

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what type of drugs' MOA inhibits calcium entry through voltage dependent channels?
CCB
what type of muscles do CCB's work on?
1.smooth muscle by decrease in muscle contraction
2.Cardiac Muscle (decreases depolarization/reduces myocardial contraction)
3.Cardiac conduction system (inhibition of pacemaker potential and slows AV cond.)
if a patient has an arrhytmia, what type of CCB will they be on usually (80% of the time)
Nondihydropyridines
Non-D.H.P's because they control heart rate
what are the clinical indications for CCB's?
HTN, effort induced angina, arrythmias, esophageal spasm
what are some side effects for CCB's?
HA, palpitations, flushing, peripheral edema (non-DHP's), constipation
what is the classification/dose of Diltiazem?
non-DHP CCB.
IR: 30/60/90mg q8 hrs.
SR: 120/240/320/480mg q24 hrs
which dihyropyridine is given to a patient c acute hemorragic stroke and is only effective within 8 hrs of event?
Nisoldipine. 10mg. q6 hrs
what is the class/dose of verapamil?
non-DHP CCB.
IR: 40/80mg q8
SR: 80/160/240/320mg q24
what is the class/dose of Amiodipine?
(norvasc) DHP CCB.
5-10mg QD.
what is the class/dose of felodipine?
DHP CCB.
5/10mg QD.
what is the class/dose for Nicerdipine?
DHP. CCB. for HTN crisis.
30/60mg QD.
IV: 90mg
what is the class/dose for Nisoldipine?
DHP. CCB. (hem.stroke)
10mg. q6
what is the class/dose for Nifedipine?
10mg PRN
SR/XL: 30/60/90mg q24
(procardia)
what is the MOA for ACE inhibitors?
they act to block the conversion of angio I to angio II which leads to a decrease in TPR (arteriolar dilation) and causes veno dilation. also inhibits the breakdown of BRADYKININ.
if your patient is on an ACE inhibitor, and you are monitoring serum levels of K, at what point would you cease the meds due to hyperkalemia
once the serum levels are 2-3 times higher than the baseline levels
what is the class/dose of Ramipril?
ACE I~ altace
2.5/5/10mg QD
what is the class/dose of Enalapril?
ACE I~ vasotek
2.5/5/10/20mg QD-BID
IV: 1.25mg
what is the class/dose of Lisinopril?
ACE I~ Prinivil/Zestril
2.5/5/10/20mg QD-BID
what is the class/dose of Benazepril?
ACE I~ Lotensin
5/10/20/40mg QD-BID
what is the class/dose of Quinapril?
ACE I~ Acupril
2.5/5/10 QD-BID
what is the class/dose of Trandolapril?
ACE I~ Mavik
now used in conjunction c Varapomil
what is the class/dose of Captopril?
ACE I~ Capoten
6.25/12.5/25/50 TID.
what are the clinical indications for ACE Inhibitors?
HTN, proteinuria, CHF, MI, Diabetic Nephropathy
what are some side effects of ACE Inhibitors?
hyperkalemia, increased Scr, cough, taste disturbances, angioedema, hypotension
what are some contraindications of ACE Inhibitors?
bilateral renal stenosis, acute renal failure, pregnancy
what is the MOA of Angiotensin Receptor Blockers?
they block angiotensin II, which leads to decrease in afterload and preload. No FX on bradykinin.
what are some clinical indications of ARB's?
HTN, proteinuria, CHF, MI, diabetic nephropathy
what are some side effects of ARB's?
hyperkalemia, increased Scr, angioedema, hypotension
what are some contraindications of ARB's?
bilateral renal stenosis, acute renal failure, pregnancy
what is the class/dose of Losartan?
ARB. Cozaar
25-100mg. QD.
what is the class/dose of Valsartan?
ARB. Diovan
40/80/120mg QD.
what is the class/dose of Candesartan?
ARB. Atacan
6/8/12/24/32mg QD.
what is the class/dose for Irbesartan?
ARB. Avapro
75/150/300mg QD.
what is the MOA for Alpha 1 Receptor Blockers?
they dilate both resistance and capacitance vessels, reducing TPR and improve venous return. Always give 1st dose at NIGHT
why are Alpha 1 receptor blockers good for male p with BPH?
because there are alpha 1 receptors in the prostate
what are the clinical indications for an Alpha 1 receptor blocker?
HTN, BPH
what are the contraindications of an alpha 1 receptor blocker?
decreased heart rate
what is the class/dose of Prazosin?
Alpha 1 Receptor Blocker
minipress
2-30mg BID
what is the class/dose of Doxazosin?
alpha 1 blockers
cardura
1-16mg QD
what is the class/dose of Terazosin?
alpha 1 blocker
Hytrin
1-20mg QD
what are the MOA of alpha 2 agonists?
firing of the sympathetic nerve decreases, which decreases the amount of norepinephrine found at the nerve terminals
when are alpha 2 agonists usually brought "on board"
as an add on therapy, 3rd or 4th line
what are some side effects of alpha2 agonists?
dry mouth, drowsiness, sedation, hypotension
what is the class/dose of Clonidine?
alpha 2 antag
.2-1.2mg PO BID
what is the class/dose of
Methyldopa?
alpha 2 antag
125-500mg PO BID.
good for pregnancy.
according to the JNC 7, which type of diuretics should be used for patients with uncomplicated HTN?
thiazide-type diuretics
according to the JNC 7, persons older than 50 years with a systolic BP of more than _______ is a much more impt. CVD risk than diastolic?
140 mm of Hg
according to the JNC 7 report, what is the ultimate public health goal of antihypertensive therapy?
the reduction of cardiovascular and renal morbidity and mortality.
According to the JNC 7 report, what is the most common form of target-organ damage associated with HTN?
Ischemic heart disease
The JNC 7 report states that for patients with acute coronary syndromes, HTN should be treated initially with which meds?
B-Blockers and ACE inhibitors
what type of disease state would you use CCB's for?
arrhythmias
MOA of CCB's
decrease depolarization and reduce contractility
NON-Dhp's are used to treat?
80% of the time: rate control
if you have a NPO patient c an arrhytmia and you dont want to use the extended release products what is the alternative?
Nifedipine 10mg PRN
what would you start patient on IV for rate control CCB?
Diltaizem 30mg q8.
you can start overlap with PO formula
what do DHP CCB typically treat?
HTN.
especially SYSTOLIC BP.
dose/indications for Amlodipine?
CCB: dhp
5mg QD
you have a patient who is post op due to a hypertensive crisis. what would you want to give IV?
Nicardipine 90mg IV
this CCB is used for p in acute hemorragic stroke, patient cannot swallow. but this must be given within 8 hours of the stroke?
Nisoldipine 10mg q 6 hours
what are some indications for CCB's?
HTN
effort induced angina
arrythmias
esophageal spasm
if a patient is having esophageal spasm, what is a great drug to give?
CCB: nifedipine 10mg gel tab
what is a major/main side effect of non-DHP's?
constipation.
add stool softner or change to DHP.
MOA of ACE I's?
venodilation.
blocks ACE. therefore bradykinin is not broken down.
what is a great drug for patient with HTN+ DM?
altace 2.5mg QD
what is the only IV formula CCB?
enalopril
1.25mg IV
what does JNC VII say to combine mavock with now?
verapomil
patients presents with HTN and proteinuria. what is the drug of choice?
ACE inhibitors. they work on the renin aldosterone system. if we protect the kidneys by having more vasokilation at the kidney we are going to decrease the amount of protein being excreted.
what drug must be on board in both CHF and post MI
ace inhibitors
what are some side effects of ace inhibitors?
hyperkalemia, increased Scr.
cough, andioedema
which patients cannot get ace inhibitors or ARB's?
patients with:
bi-lateral renal stenosis
acute renal failure
pregnancy
MOA of ARB's
block angiotenisn II from going to the receptors.
slight decrease in BP.
Decrease afterload/preload esp CHF patients
give an example of an ARB
losartan (cozaar) 25mg QD
what is the drug of choice to use for a male patient with BPH and HTN?
Alpha 1 Receptor BLocker: minipress. (prazosin) 2mg BID.
where do you find most Alpha 1 receptors?
in the heart
when is the best time to take alpha 1 blockers?
at night. they cause orthostatic HTN
MOA of alpha 1 receptor blockers?
dilate resistance and capacitance and TPR.
improve venous return
MOA of alpha 2 agonists?
firing of sympathetic nerves.
works on catecholamines.
add on therapy
what is drug of choice for a pregnant female with HTN?
methyldopa 125mg BID
two side effects of methyldopa
xerostomia, drowsiness
what is the first line agent for p with DM + HTN?
ACE inhib
if patient with DM + HTN has a contraindication to an ACE inhibitor, what is your alternative drug of choice?
CCB
if patient with DM + HTN is on CCB due to a contraindication of ACE/ARB, which CCB would be best?
a DHP. best for HTN.
ex)almodipine 5mg QD.
what is your first line tx for a patient with HTN + heart failure?
ACE inhib and ARB.
due to LV dysfunction, and to prevent the EF from decreasing even more.
what is your diuretic of choice for a patient with CHF?
Loop Diuretic. the strongest. LASIX 40mg
what do we worry about with patients on an ACE INHIBITOR and a DIURETIC?
hypotention.
Post MI patient should be on what drugs (standard minimun)
beta blocker; non ISA
and ACE or ARB. (for cardiac remodeling)
give two examples of ISA bb?
pindolol, acebutolol
if patient has a SECOND or THIRD degree heart block what drugs do you avoid?
BB, CCB
what drugs do you avoid with pregnancy for HTN?
ACE INHIB, ARB's