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What are the cautioned (not CI) situations for ARB and ACEI use?
K sparing diuretics, K supplements and Bilateral renal stenosis
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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
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What is the MOA for CCBs?
Block inward movement of Ca through L-type Ca Channels across the cell membrane, causing smooth muscle relaxation
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Which are the non-Dihydropyridine CCBs?
Verapamil and Diltiazem
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Should you use long acting or short acting CCBs for HTN?
Long acting
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Which CCBs are cardioselective?
Non-Dihydropyridines = Verapamil and Diltiazem
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Which CCBs are Vasoselective?
Dihydropyridines; ending in –dipine
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Are 1st generation or second generation Vasoselective CCBs used more for HTN, why?
2nd generation, due to less rebound tachycardia
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What are the first generation Vasoselective CCBs?
Nifedipine, Nicardipine, and Isradipine
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What are the second generation Vasoselective CCBs?
Felodipine, Amlodipine, and Nisoldipine
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Are Cardioselective or Vasoselective CCBs used more for HTN?
Vasoselactive
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Peripheral edema occurs more with Dihydropyridines or Non-dihydropyridines?
Dihydropyridines
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What are the adverse effects of Dihydropyridines?
- Peripheral edema
- Reflex tachycardia
- Gingival hyperplasia
- Headache
- Dizziness
- Flushing
- Orthostatic hypotension
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What are the adverse effect sof Non-Duihydropyridines?
- Peripheral edema
- Orthostatic hypotension
- Bradycardia
- Constipation (mostly verapamil)
- AV Conduction disturbances
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If your patient has fluid retention on a Dihydropyridine, what should you do?
Add and ACEI (Do not add a Loop)
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With what CCBs should you not use BB in combo, why?
Non-dihydropyridines (both cause bradycardia)
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What groups do CCBs work the best in?
- African Americans, IHD and Elderly
- Raynaud’s syndrome
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What populations should you use CCBs with caution in?
- CHF (sans felodipine and amlodipine)
- GERD
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A heart rate of _____ is contraindicated in patients taking Dihydropyridines, because it indicates Heart block or severe LV dysfunction.
60
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What should you monitor for patients on CCBs?
HR, BP and adverse effects
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Which CCB should you worry about DDIs with due to CYP3A4 inhibition?
Verapamil (>Diltiazem) = caution with Digoxin, Simvastatin, GF juice
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What is the MOA for BB?
- ↓ HR, ↓ CO, ↑ TPR
- by ↓ SV (which ↓ CO → ↓ BP) and ↓ renin
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Which BBs have vasodilatory properties and by what mechanism?
Labetolol and Carvedilol (alpha-blockers) and Nebivolol (NO activity)
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Which BBs are Non-selective and of those, which are ISA + and which are ISA –?
- ISA (-): Nadolol, Propranolol and Timolol
- ISA (+): Pindolol and Pentbutolol
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Which BBs are B1 Selective and of those, which are ISA + and which are ISA –?
- ISA (-):Atenolol, Metoprolol, Betaxolol, Bisoprolol, Nebivolol
- ISA (+): Acebutolol
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Which BBs are Lipophilic?
Propranolol, Pentbutolol, Nebivolol and Carvedilol
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Which BBs are Hydrophilic?
Nadolol, Bispropolol and Atenolol
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What are BBs CI in?
Atrial-ventricular 2nd or 3rd degree heart block
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What groups should you always choose Selective BBs for?
Asthma, COPD, PVD, Diabetes
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Which BBs are useful for CHF patients?
carvedilol, bisoprolol, and metoprolol succinate
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