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PC 707 MODULE 4 CARDIAC
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PC 707 MODULE 4 CARDIAC
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PC 707 MODULE 4 CARDIACFirst line agents for HTN - Answers- Diuretics, Calcium Channel Blockers, & ACE
inhibitors or ARBs.
MOA of Thiazide diuretics - Answers- Increase urinary excretion of sodium & chloride in
equal amounts
Inhibit sodium & chloride reabsorption in the distal tubule
Deplete sodium and potassium & decrease excretion of calcium & uric acid
Indications for Thiazide Diuretics - Answers- HTN
Edema
Pearls for Thiazide Diuretics - Answers- Great as add-on agent for HTN as it can
potentiate effectiveness of the initial drug
Can be useful for women with osteoporosis and HTN because of the calcium-sparing
effects
MOA of ACEI - Answers- Angiotensin II is a potent vasoconstrictor, so by inhibiting it,
less constriction occurs
S/E of ACEI - Answers- Cough
Hyperkalemia
Renal function deterioation
Angiodema
abdominal pain
*Women & African-Americans have increased risk of developing angioedema
Indications for ACEI - Answers- HTN
Post-MI
HF
Pearls for ACEI - Answers- Drug of choice for HTN & DM
Protective in chronic mild kidney disease
*Renal protective early on but later on in DM & renal disease may be harmful
Do not combine ACEI with?? - Answers- ARBs
What should be monitored with ACEI? - Answers- Renal function-
*baseline
*1-2 wks after initiation
*periodically thereafter
Potassium levels
S/E of Thiazide Diuretics - Answers- Hyperglycemia (careful with DM), may alter
glycemic control
,Hyperuricemia (careful with gout)
Hypertriglyceridemia & hypercholesteremia (monitor lipids)
Hypokalemia (can increase risk for cardiac arrhythmias)
Hyponatremia
Contraindications of Thiazide Diuretics - Answers- Contains sulfa (careful with certain
sulfa drugs depending on allergy history; sulfonamide-derived drugs)
Significant renal impairment
Pre-existing hypokalemia
MOA of ARBs - Answers- Blocks the vasoconstricting and aldosterone-secreting effects
of angiotensin II by selectively blocking the binding of angiotensin II to the angiotensin II
receptor found in many tissues (less binding results in less constricting)
S/E of ARBs - Answers- Hyperkalemia
Angioedema
Renal function deterioation
Indications for ARBs - Answers- HTN
HF
Pearls for ARBs - Answers- If intolerant of ACEI try ARBs
Helpful for pt w/ HTN & DM
Cautious & monitor w/ kidney disease
Do not give if bilateral renal stenosis
Monitor renal function and potassium levels
*DO not combine w/ ACEI
MOA of Calcium Channel Blockers (CCBs) - Answers- Inhibit the movement of calcium
ions across the cell membrane.
This results in depression of mechanical contraction of myocardial and smooth muscle
and depression of impulse formation & conduction velocity.
The result is muscle relaxation & vasodilation.
CCB classifications - Answers- Dihydropyridine (DHPs)
Non-Dihydropyridine (non-DHPs)
DHPs - Answers- 1st gen- Nifedipine
2nd gen- Isradipine
Nicardipine
Felodipine
3rd gen- Amlodipine
non-DHPs - Answers- Phenilakylamines- Verapamil
Benzothiazepines- Diliazem
, DHP MOA & indication - Answers- Act predominantly in the periphery causing arterial
vasodilation. Because of their high vascular selectivity, these drugs are primarily used to
reduce systemic vascular resistance and arterial pressure and are therefore commonly
used to treat hypertension.
non-DHP MOA & Indication - Answers- Act predominantly centrally to decrease heart
rate (chronotropy) and contractility (inotropy). These drugs have a very important role in
treating angina (by reducing myocardial oxygen demand and reversing coronary
vasospasm) and in managing arrhythmias. (e.g., Cardizem (Diltiazepam) & Verapamil
(Calan)).
S/E of CCBs - Answers- Heart block or bradycardia (depresses cardiac muscles and AV
node)
Reflex tachycardia (risk with dihydropyridines)
Ankle edema (considered benign, due to vasodilation)
Headaches (due to vasodilation)
Mood changes
Contraindications of CCBs - Answers- 2nd and 3rd degree heart blocks
Severe bradycardia (non-DHPs)
CCBs can worsen??? - Answers- HF
Indications for CCBs - Answers- HTN
Angina
A-fib (rate control)
PSVT & SVT
Pearls for CCBs - Answers- Calcium channel blockers (non-DHPs) can lead to
worsening HF in patients with cardiac dysfunction
Work particularly well in treating HTN in African Americans
MOA of Loop Diuretics - Answers- Inhibit the sodium-potassium-chloride pump of the
kidneys at the loop of Henle and inhibit the reabsorption of sodium and chloride
Has greater diuretic effect than thiazides
Indications for Loop Diuretics - Answers- HTN
Edema
HF
S/E for Loop Diuretics - Answers- Fluid/Electrolyte Loss
Hypokalemia (increases risk of arrhythmias)
Hyponatremia
Hypomagnesemia
Contraindications for Loop Diuretics - Answers- Anuria
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