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81 Cards in this Set
- Front
- Back
test
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test
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test 1
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test 2
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Diuretics
Thiazide - moa |
Inhibit Na/Cl transporter at distal tubules
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Diuretics
Thiazide - indication |
Most effect to reduce BP
-only use in CrCl>30 ml/min -good for AA (resistance to BB and ACEi) |
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Diuretics
Thiazide - precaution |
-HypoK
-Gout (increase Uric acid) -HyperCa (big concern CKD) |
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Diuretics
Thiazide -CI |
-Sulfa allergy
-ClCr < 30 ml/min |
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Diuretics
Thiazide - ADRs |
-HypoK, Mg
-Hyper (Ca, glycemia, lipid, uricemia) -Sexual dysfunction |
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Diuretics
Thiazide - dose Hydrochlorothiazide (HydroDiuril) |
12.5-50 mg (50) POQD
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Diuretics
LOOP - moa |
Block Na/K/Cl co-transporter in loop henle.
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Diuretics
LOOP - indication |
Pt with poor renal function (Cl<30 ml.min) and fluid overload
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Diuretics
LOOP - precaution |
HypoK
HypoCa |
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Diuretics
LOOP - ADR |
-Hypo (K, Mg, Ca)
-Hyper: (glycemia, lipid, uricemia) -Sexual dysfunction. -Ototoxicity |
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Diuretics
LOOP Furosemide (Lasix) dose Bumetanide (Bumex) Torsemide (Demadex) |
20-40 mg BID (160 ex fluid; 80 HTN)
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Diuretics: K-sparing
moa |
Inhibit Na channel in distal tubule and collecting duct.
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Diuretics: K-sparing
indication |
-Weak anti-HTN
-Good for hypoK with thiazide/loop. (K<4) |
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Diuretics:
K-sparing - ADR |
Hyper K
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Diuretics:
K-sparing: name brand/generic Amiloride Triamterence |
(Midamor)
(Dyrenium) |
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Diuretics:
Aldosterone Ant - moa |
Competitively block aldosterone at receptor site.
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Diuretics:
Aldosterone Ant - indication |
-Decent diuretic
-reduce morbidity and mortality (stage III and IV HF) and Post MI w. LVD |
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Diuretics:
Aldosterone Ant - CI |
-Eplerenone
men: Cr >2.0 mg/dl women: Cr>1.8 -Type II DM w proteinuria. -Spironolactone: Men: Cr> 2.5 mg/dl Women: Cr> 2.0 |
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Diuretics:
Aldosterone Ant - ADRs |
-Hyper K
-Gynecomastia (spironolactone) -HyperTG (epleronone) |
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Diuretics:
Aldosterone Ant: dose Eplerenone (Inspra) Spironolactone (Aldactone) |
50 mg QD-BID (100)
25-50 mg QD-BID (100) |
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Beta blocker - moa
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Antagonize β1 receptor on the heart.
(decrease HR decrease contractivity decrease in CO decrease BP) -antagonize β receptors in the kidney (decrease rennin RAAS and decrease Na and water retention. |
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Beta blocker- indication
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First line for compelling indication
-Post MI -Acute Coronary syndromes -High coronary artery disease risk -HF |
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Beta blocker - precaution
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-Asthma
-COPD -Diabetes -Peripheral artery disease *** Agents AVOID in Hepatic Failure 1. Metoprolol 2. Propanolol Renal failure: 1. Atenolol 2. Nadolol Most lipophillic (CNS: cross BBB. Use for GI disorder and sclerosis) 1. Propanolol Least lipophilic 1. Atenolol Good for HF: -metoprolol (ER), bisoprolol, carvedilol. |
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Beta blocker - CI
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Cardiogenic Shock (BP<90/50 or Hypotension)
-Decompensated Heart Failure (class IV heart failure) -2nd and 3rd degree AV block. Severe (Asthma and COPD) |
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Beta blocker - ADR
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-Brady cardia (HR<50 bpm)
-2nd and 3rd degree AV block. -Worsening class IV HF -Hypotension (BP<90/50) CNS: Dizziness (all BB) Depression and fatigue (propranolol: lipophilic agent) Endocrine: may increase cholesterol and glucose (rare) |
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Beta blocker name and dose:
CARDIO SELECTIVE Atenolol Bisoprolol Metoprolol Metoprolol ER NON-selective Propranolol Propranolol LA ISA (intrinsic sympathomimetic activity) DO NOT USE!!! |
cardio selective
(Tenormin) dose 25-100 mg QD (100) (Zebeta) 2.5-10 mg QD (10) (Lopressor) 25-100 BID (200) (Lopressor) 25-100 BID (200) (Toprol XL) 50-200 QD (200) non-selective (Inderal) 40-160 mg BID (320) (long acting) (Inderal LA, InnoPran XL) 80-160 QD (160) |
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ACEI - moa
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Inhibit the conversion of angiotensin I to angiotension II (potent vasoconstrictor)
-inhibit the breakdown of bradykinin and stimulate synthesis of PgE2 and prostacyclin (potent vasodilation) |
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ACEI - indication
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Thiazide is first line (for non-compelling),
ACEs: second line to diuretics in most HTN pt. Good for compelling indication: DM HF CKD Stable CAD Post MI Stroke (prevention) |
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ACEI - precaution
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Renal Insufficiency
(except fosinopril and ramipril) |
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ACEI - CI
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Bilateral renal artery stenosis
-pregnancy -HO angioedema -HO allergic rxn bee sting -HyperK |
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ACEI - ADRs
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-HyperK (due to reduce of aldosterone secretion)
-Dry Cough (due to bradykinin) -Angioedema (most in smoker and AA) -Increase SCr: (Due to decrease GFR) (continue : SCr is rise <35% from baseline or < 1 mg/dL) Consider use of fosinopril or ramipril Rare: neutropenia, and agranulocytosis. DDI***** Increase K 1. K supplements 2. K-sparing 3. Aldosterone ant 4. ARBs NSAID (nephrotoxicity) Lithium (increase lithium) |
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ACEI - name: dose
Benazepril Captopril Enalapril Fosinopril Lisinopril Ramipril |
(lotensin)
10-40 mg QD-BID (40) capoten) sulfa allergy 6.25-50 mg BID-TID (450) (Vasotec) 2.5-40 mg QD-BID (40) (Monopril) 10-40 mg QD (40) (Prinivil, Zestril) 10-40 mg QD (40) (Altace) (best to reduce morbidity and mortality due to CHD.) 2.5-10 mg QD-BID (20) |
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ARBs - moa
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Directly block the angiotensin II type 1 receptor.
-Leaves angiotensin II free to agonize type 2 receptor (beneficial effects) |
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ARBs - indication
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Use for pt intolerance to ACEIs (dry cough)
-Lowest incidence of side effects compare to other Anti-HTN agents. Good for: Type 2 DM with nephropathy (better than ACEs) HF HTN (equal to ACEs) Post MI (equal to Aces) |
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ARBs - precaution
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-angioedema (real life)
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ARBs - CI
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-Pregnancy
-HyperK -Bilateral renal artery Stenosis -angioedema.(exam only) |
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ARBs - ADRs
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-HyperK
-Angioedema -Renal Insufficiency -Orthostatic Hypotension DDIs: same ACEs Increase K 1. K supplements 2. K-sparing 3. Aldosterone ant 4. ARBs NSAID (nephrotoxicity) Lithium (increase lithium) |
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ARBs - name: dose
Candesartan Irbesartan Losartan Valsartan |
(Afacand)
4-32 mg QD-BID (32) (Avapro) 150-300 QD (300) (Cozaar) 25-100 QD-BID (100) (Diovan) 80-320 mg QD (320) |
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Hydrochlorothiazide
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(HydroDiuril)
12.5-50 mg (50) POQD diuretics |
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Furosemide
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(Lasix)
20-40 mg BID (160 ex fluid; 80 HTN) Loops |
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Amiloride (dose not need know)
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(Midamor)
K-sparing |
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Triamterene (dose not need know)
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(Dyrenium)
K-sparing |
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Eplerenone
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(Inspra)
50 mg QD-BID (100) Aldosterone ant. |
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Spironolactone
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(Aldactone)
25-50 mg QD-BID (100) Aldosterone ant. |
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Atenolol
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Tenormin
25-100 mg QD (100) BB cardioselective |
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Bisoprolol
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Zebeta
2.5-10 mg QD (10) BB cardioselective |
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Metoprolol
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Lopressor
25-100 BID (200) BB cardioselective |
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Metoprolol ER
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Toprol XL
50-200 QD (200) BB cardioselective |
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Propranolol
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Inderal
40-160 mg BID (320) BB nonselective |
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Propranolol (long acting)
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(Inderal LA, InnoPran XL)
80-160 QD (160) BB nonselective |
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Benazepril
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lotensin
10-40 mg QD-BID (40) ACEI |
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Captopril
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(capoten) sulfa allergy
6.25-50 mg BID-TID (450) ACEI |
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Enalapril
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Vasotec
2.5-40 mg QD-BID (40) ACEI |
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Fosinopril
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Monopril
10-40 mg QD (40) ACEI |
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Lisinopril
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(Prinivil, Zestril)
10-40 mg QD (40) ACEI |
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Ramipril
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(Altace) (best to reduce morbidity and mortality due to CHD.)
2.5-10 mg QD-BID (20) |
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Candesartan
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Afacand
4-32 mg QD-BID (32) ARBs |
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Irbesartan
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Avapro
150-300 QD (300) ARBs |
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Losartan
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Cozaar
25-100 QD-BID (100) ARBs |
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Valsartan
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Diovan
80-320 mg QD (320) ARBs |
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DHP-CCB - moa
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Block L-type calcium channels
-inhibit the Ca across cell membrane -leads to coronary and peripheral vasodilation |
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DHP-CCB - indication
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-Used as first line agents
-effective anti-HTN (esp in AA pop) -Use in certain compelling indications in addition to or in replacement of, other medications. (in high coronary artery disease risk, and diabetes) -DHP: very effective in older pt with isolated systolic HTN ( ISH) (use as add-on therapy to thiazide diuretic) |
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DHP-CCB - precaution
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DHP: may cause reflex tachycardia.
HF except for amlodipine ***Not to be used as monotherapy in CKD (causing increase proteinurea) |
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DHP-CCB - CI
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hypersensitivity
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DHP-CCB - ADRs
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Dizziness
Flushing Hypotension (reflect tachycardia) Headache Peripheral edema. Gingival hyperplasia GI complaints: (not much) Increase HR. (do not use immediate release nifedipine) DDI:*** 1. grapefruit juice (CYP 3A4 inh) may increase nifedipine |
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Amlodipine
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(Norvasc) (Can use amlodipine in HF pts.)
dhp-ccb |
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Felodipine
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(Plendil)
5-20 mg QD(20) dhp-ccb |
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Nifedipine long-acting
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Adalat CC, Procardia XL)
30-90 mg QD (180) dhp-ccb |
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DHP-CCB - moa
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Block L-type calcium channels
-inhibit the Ca across cell membrane -leads to coronary and peripheral vasodilation |
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DHP-CCB - indication
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-Used as first line agents
-effective anti-HTN (esp in AA pop) -Use in certain compelling indications in addition to or in replacement of, other medications. (in high coronary artery disease risk, and diabetes) -DHP: very effective in older pt with isolated systolic HTN ( ISH) (use as add-on therapy to thiazide diuretic) |
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DHP-CCB - precaution
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DHP: may cause reflex tachycardia.
HF except for amlodipine ***Not to be used as monotherapy in CKD (causing increase proteinurea |
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DHP-CCB - CI
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hypersensitivity
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DHP-CCB - ADRs
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Dizziness
Flushing Hypotension (reflect tachycardia) Headache Peripheral edema. Gingival hyperplasia GI complaints: (not much) Increase HR. (do not use immediate release nifedipine) DDI:*** 1. grapefruit juice (CYP 3A4 inh) may increase nifedipine |
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Amlodipine
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Norvasc (can use amlodipine in HF pts.)
25-100mg QD(10) dhp-ccb |
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Felodipine
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Plendil
5-20 mg QD(20) dhp-ccb |
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Nifedipine
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long-acting (Adalat CC, Procardia XL)
30-90 mg QD (180) |
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NDHP-CCB - moa
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Block L-type calcium channels
-inhibit the Ca across cell membrane -leads to decrease contractility of myocardium (negative inotropy) |
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NDHP-CCB - CI
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Bradycardia (HR<60 bpm)
Heart failure (all class of HF) 2nd and 3rd degree in atrioventricular block. |
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NDHP-CCB - ADRs
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-Bradycardia
-AV block -Heart failure exacerbation -GI (Anorexia, nausea, -constipation *more with Verapamil. -Hypotension *** diltiazem: more headache. -Peripheral edema (NOT COMMON) DDI*** 1. Verapamil and diltiazem (less) are CYP 3A4 inhibitors Increase-cyclosporine, digoxin, lovastatin, simvastatin. 2. Combi with BB: pronounced bradycardia. (NEVER START NDHP + BB at the same time) |