Therapeutics - HTN 2

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  1. What are the cautioned (not CI) situations for ARB and ACEI use?
    K sparing diuretics, K supplements and Bilateral renal stenosis
  2. What should you monitor in patients on ARBs and ACEIs?
    • BP
    • renal function (BUN, SCr)
    • (SCr may increase transiently but should normalize in ~ 2 weeks)
    • Electrolytes (Na, K, etc.)
    • Adverse effects
    • What is the MOA of Aliskiren/Tekturna?
    • Direct Renin inhibitor
  3. What is the MOA for CCBs?
    Block inward movement of Ca through L-type Ca Channels across the cell membrane, causing smooth muscle relaxation
  4. Which are the non-Dihydropyridine CCBs?
    Verapamil and Diltiazem
  5. Should you use long acting or short acting CCBs for HTN?
    Long acting
  6. Which CCBs are cardioselective?
    Non-Dihydropyridines = Verapamil and Diltiazem
  7. Which CCBs are Vasoselective?
    Dihydropyridines; ending in –dipine
  8. Are 1st generation or second generation Vasoselective CCBs used more for HTN, why?
    2nd generation, due to less rebound tachycardia
  9. What are the first generation Vasoselective CCBs?
    Nifedipine, Nicardipine, and Isradipine
  10. What are the second generation Vasoselective CCBs?
    Felodipine, Amlodipine, and Nisoldipine
  11. Are Cardioselective or Vasoselective CCBs used more for HTN?
  12. Peripheral edema occurs more with Dihydropyridines or Non-dihydropyridines?
  13. What are the adverse effects of Dihydropyridines?
    • Peripheral edema
    • Reflex tachycardia
    • Gingival hyperplasia
    • Headache
    • Dizziness
    • Flushing
    • Orthostatic hypotension
  14. What are the adverse effect sof Non-Duihydropyridines?
    • Peripheral edema
    • Orthostatic hypotension
    • Bradycardia
    • Constipation (mostly verapamil)
    • AV Conduction disturbances
  15. If your patient has fluid retention on a Dihydropyridine, what should you do?
    Add and ACEI (Do not add a Loop)
  16. With what CCBs should you not use BB in combo, why?
    Non-dihydropyridines (both cause bradycardia)
  17. What groups do CCBs work the best in?
    • African Americans, IHD and Elderly
    • Raynaud’s syndrome
  18. What populations should you use CCBs with caution in?
    • CHF (sans felodipine and amlodipine)
    • GERD
  19. A heart rate of _____ is contraindicated in patients taking Dihydropyridines, because it indicates Heart block or severe LV dysfunction.
  20. What should you monitor for patients on CCBs?
    HR, BP and adverse effects
  21. Which CCB should you worry about DDIs with due to CYP3A4 inhibition?
    Verapamil (>Diltiazem) = caution with Digoxin, Simvastatin, GF juice
  22. What is the MOA for BB?
    • ↓ HR, ↓ CO, ↑ TPR
    • by ↓ SV (which ↓ CO → ↓ BP) and ↓ renin
  23. Which BBs have vasodilatory properties and by what mechanism?
    Labetolol and Carvedilol (alpha-blockers) and Nebivolol (NO activity)
  24. Which BBs are Non-selective and of those, which are ISA + and which are ISA –?
    • ISA (-): Nadolol, Propranolol and Timolol
    • ISA (+): Pindolol and Pentbutolol
  25. Which BBs are B1 Selective and of those, which are ISA + and which are ISA –?
    • ISA (-):Atenolol, Metoprolol, Betaxolol, Bisoprolol, Nebivolol
    • ISA (+): Acebutolol
  26. Which BBs are Lipophilic?
    Propranolol, Pentbutolol, Nebivolol and Carvedilol
  27. Which BBs are Hydrophilic?
    Nadolol, Bispropolol and Atenolol
  28. What are BBs CI in?
    Atrial-ventricular 2nd or 3rd degree heart block
  29. What groups should you always choose Selective BBs for?
    Asthma, COPD, PVD, Diabetes
  30. Which BBs are useful for CHF patients?
    carvedilol, bisoprolol, and metoprolol succinate
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Therapeutics - HTN 2
Therapeutics - HTN 2
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