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Cardio Drugs 3

Advanced Pharm for Nursing Practice 3

QuestionAnswer
Meds used for erectile dysfunction are also used for pulm HTN Meds used for erectile dysfunction are also used for pulm HTN
What is the trade name of the vasodilator sildenafil when used for Erectile Dysfunction? Pulmonary HTN? sildenafil is Viagra for erectile dysfunction & Revatio for pulmonary HTN
Vasodilators/Erectile dysfunction generic drugs end with? Vasodilators/Erectile dysfunction generic drugs end with –AFIL
What’s the use of tadalafil (Cialis)? Cialis is an erectile dysfunction drug that has also been approved for tx of pullm arterial HTN
What are SE/ADR of –AFIL vasodilator/erectile dysfunction drugs? HA, flushing, nasal congestion, abnormal vision (blue-green vision); WARNING: LOSS OF VISION
What’s a contraindication for vasodilators/erectile dysfunction drugs? contraindicated with Nitrates
What are the 2 groups of CCBs and what are their prototypes? the 2 Ca+ channel blocker groups are dihydropyridine [nifedipine (Procardia)] and non-dihydropyridine [verapamil]
Verapamil is what type of drug? It has the greatest affect on what? And the least effect on what? Verapamil is a non-dihydropyridine Ca+ channel blocker; it has the greatest affect on heart and the least affect on bld vessels
Diltiazem* is what type of drug? It has the greatest affect on what? And the least affect on what? Diltiazem is a non-dihydropyridine Ca+ channel blocker; it has EQUAL affect on the heart and bld vessels
What is Nifedipine (Procardia)? nifedipine the prototype dihydropyridine Ca+ channel blocker and it has LITTLE effect on the heart and its greatest affect on bld vessels
How does verapamil work? verapamil decr contractility (inotropic contraction strength)
How does diltiazem* work? diltiazem slows conduction through the AV node
Which CCB has the greatest effect on the heart? verapamil has the greatest affect on the heart
Which CCB has the greatest effect on the blood vessels? nifedipine has the greatest affect on bld vessels
What is relationship between Ca+ channel blockers and action potential? leakage of Ca+ causes action potential, and when it reaches Na+ potential, there’s a spike causing action potential to go down the neuron. Blocking Ca+ channels slows the heart bc of the blocked Ca+ leakage
How do Ca+ channel blockers work? CCBs block channels in cardiac and smooth muscle (CALCIUM IS NECESSARY TO ACTIVATE CONTRACTION OF ACTIN AND MYOSIN)
How does Calcium work in contraction? Calcium removes the “blindfolds” of troponin & calmodulin, activating myosin contraction
How do CCBs work in the heart? In the smooth muscles? CCBs slow the SA node, blocking AV conduction; this more so decreases contractility (how strong it beats) more so than how fast it beats; smooth muscle is relaxed by CCBs, this lowers BP bc of vasodilation
What are indications for CCBs? indications for CCBs are supraventricular tachyarrythmias, Verapamil can be given IV or PO; all CCBs are useful for coronary artery vasospasm and angina; amlodipine (Norvasc) is drug most commonly used to treat primary HTN & vasospastic angina
Which CCB would a pt prefer between nifedipine (Procardia) vs amlodipine (Norvasc)? Why? a pt would prefer amlodipine over nifedipine because amlodipine is a 1x/day drug, but nifedipine must be taken 3x./day
What are drug interactions with Verapamil? verapamil is a cardiac depressant & can cause additive cardiac depression /c other depressants; ex: Digoxin and verapamil both slow the heart; beta-blockers and verapamil slow the heart and decr contractility
Can verapamil be added to anti-arrythmics? yes, verapamil can be added to anti-arrythmic drugs
Verapamil and diltiazem of the CCB group are specifically in the what group? What types of enzymes are they? verapamil and diltiazem are of the dihyropyridine group, they are ENZYME INHIBITORS (toxicity with other drugs more likely)
What is the relationship between grapefruit, CCBs, and cytochrome 3A4? grapefruit is an enzyme inhibitor; grapefruit interferes /c cytochrome 3A4, this would cause drugs that ordinarily have a low bioavailability will now have increased concentrations
Why is amlodipine (Norvasc) such a popular drug? Amlodipine is so popular because of its high bioavailability; it’s not affected by 1st pass effect or grapefruit juice
What are SE/ADR of CCBs? verapamil causes bradycardia & constipation; dihydropyridines (like nifedipine) can cause reflex tachycardia bc of extreme decr in BP [rembr. sinus/carotid stimulation]; other SE of nifedipine are: lower bld pressure, dizziness, peripheral edema, & HA
Why can you get reflex tachycardia with nifedipine? nifedipine, which is a dihydropyridine will lower BP bc of its function has a CCB, & often /c XS decr of BP, reflex tachycardia is triggered; in this case, bld vessels are what’s affected most, NOT t/ heart (so heart keeps vasoconstricting)
Which CCB has the least negative side effects? Diltiazem
How does the juxtaglomerular apparatus work in the kidneys?? When the juxtaglomerular apparatus senses a decr in the amount of bld and Na+ going through it, it will release RENIN; renin acts on the protein ANGIOTENSINOGEN (that floats around in the bld and causes the stimulation & release of ANGIOTENSIN).
How does angiotensin converting enzyme convert angiotensinogen to angiotensin? ANGIOTENSIN is a potent vasoconstrictor. ANGIOTENSIN acts on the adrenal medulla to cause release of ALDOSTERONE which is a potent Na+ RETENTION SUBSTANCE. ANGIOTENSIN is formed from angiotensinogen by ANGIOTENSIN CONVERTING ENZYME
How does Angiotensin converting enzyme inhibitors work? angiotensin converting enzyme inhibitors prevent the conversion of angiotensin from angiotensinogen
What is the ACEI prototype? Captopril (Capoten)
What do ACEI generic drugs end in? ACEI generic drugs end in –PRIL
How do angiotensin converting enzyme inhibitors work? ACEIs inhibit angiotensin converting enzyme; it decreases the availability of angiotensin II, resulting in VASODILATION & DECR ALDOSTERONE RELEASE
What does angiotensin do to blood vessels? angiotensin is a powerful vasoconstrictor
What is bradykinin? bradykinin is a vasodilator mostly found in the lungs
What is the relationship between ACEIs and bradykinin? ACEI inhibit the metabolism of bradykinin, enhancing vasodilation
What are the actions of ACEIs? ACEIs enhance vasdodilation through inhibition of metabolism of bradykinin; may activate prostaglandins; may reverse cardiac hypertrophy, primarily by blocking effect of aldosterone; may cause a mild naturesis (diuresis of much Na+), & prevent loss of K+
What’s the indications for ACEIs? tx of HTN (step 1 drug); coronary artery dz (step 1); heart failure (step 1); nephropathy treatment
Even though Captopril is the prototype for ACEIs, what is the 1 ACEI drug and why?
What’s a negative and annoying side effect of ACEIs that often causes a change in what med? ACEIs cause a cough (bc of the bradykinin irritating the lungs); the only way to stop the cough is to change to an angiotensin receptor blocker
What are general SE/ADR of ACEIs? skin rash and dysgeusia (bad taste) (more common w/ Captopril), cough; 1st dose hypotension (start lowest dose at night in bed and titrate up); this is only a prob for hypovolemic pts
What are contraindications/cautions of ACEIs? pregnancy cat D., very rarely cause angioedema with face and tongue swelling. STOP ACEIs IMMEDIATELY & GIVE EPINEPHRINE AND change do diff drug; renal artery stenosis can occur if you dilate that artery and stop the blood flow to the kidney
What are ACEIs interactions? NSAIDS interfere /c prostaglandins; Lithium bc ACEI change Na+ availability & Na+ availability can change Lithium toxicity; K+supplments bc ACEIs cause hypokalemia; diuretics cause hypovolemia
When would you put a pt on an angiotensin receptor blocker? you’d put a pt on an angiotensin receptor blocker if they began coughing from the ACEIs; ARBs are an alternative (that may be better)
What is the prototype for angiotensin receptor blockers? the ARB prototype is LOSARTAN* (Cozaar)
What do generic ARB’s end with? generic ARBs end with –SARTAN
The SARTAN sisters Are Real B’s [ARBs] The SARTAN sisters Are Real B’s [ARBs]
What is most commonly prescribed Angiotensin Receptor Blocker? VALSARTAN is the most commonly prescribed angiotensin receptor blocker
How do angiotensin receptor blockers work? angiotensin receptor blockers selectively block angiotensin I receptor sites in the adrenal medulla & prevent the release of aldosterone.
What are the indications for Angiotensin Receptor blocker? ARBs are indicated #1 for HTN and heart failure, & also to tyr and prevent diabetic nephropathy
What are contraindications/warnings about angiotensin receptor blockers? angiotensin receptor blockers are pregnancy category D (just like ACEIs); renal failure, and hypovolemia
Created by: Fukanwa