NR566 Week 3 Study Outline
,NR566 Week 3 Study Outline
Many questions are written to assess your clinical application of
the material from the textbook, in real-world scenarios.
Chapter 16: Drugs Affecting the Cardiovascular & Renal
Systems
• Know the pharmacodynamics, pharmacotherapeutics clinical
use, drug interactions and adverse drug reactions for:
o o Angiotensin converting enzyme inhibitors (ACEI): pregnancy D
Benazopril Captopril Enalapril Fosinopril Lisinopril Moexipril
o vasodilators
o Not as effective for African-American patients
o When combined with a diuretic, race no longer an issue
o Adverse drug reactions (ADRs): dry cough (bradykinin- mediated), hypotension, loss
of taste, angioedema, blood dyscrasias, teratogenicity, hyperkalemia, acute renal
failure, cholestatic jaundice, pancreatitis, rash
•
o o Angiotensin receptor blockers (ARBs) pregnancy D
Pharmacokinetics
o Losartan: CYP 2C9
o Extensive first-pass metabolism resulting in 33% bioavailability
o Inducers: rifampin, barbituates
o Inhibitors: lovastatin, SMZ/TMP, fluconazole, fluvastatin, fluvoxamine, sertraline
o
Angiotensin II Receptor Blockers SARTANS : losartan, esporsartan,
olmesartan, telmisartan, valsartan, candesartan, irbesartan
, o Like ACEI orthostasis with dose changes
•
o o Calcium channel blockers (CCB)nifedipine cat safe and
Functionally act as vasodilators, lowering calcium (Ca++) influx into smooth muscles
o Two major classes
o Type I – Non-dihydropyridines: affect conduction through the atrioventricular (AV)
node and have negative chronotropic effects
o Why it is used in treating supraventricular tachycardia
o Diltiazem (Cardizem), verapamil (Calan)
o Type II – Dihydropyridines: do not affect conduction through the AV node
o Nifedipine (Procardia), amlopidine (Norvasc), felodipine (Plendil)
• amlodipine cat C, methyldopa very safe
o Cardiac glycosides and antiarrhythmics
Digoxin
o Well-absorbed orally
o NOT extensively metabolized, excreted unchanged by kidneys Half-life is 36 to 48 hours
o In the absence of oral or intravenous loading, steady state is achieved in four half-
lives or 1 week
o Reduced clearance of digoxin with drug interaction
o Quinidine, amiodarone, verapamil, diltiazem
o ADRs
o Gastrointestinal (GI) most common: anorexia, nausea/vomiting, diarrhea
o Central nervous system: fatigue, disorientation, depression, hallucinations,
visual disturbances – yellow vision and green halos around lights
o Toxicity: atrial arrhythmias/tachycardia in children
o Cardiac: bradycardia, premature ventricular contractions, junctional and AV
block arrhythmias, and bigeminy
o Avoid using in patients with normal left ventricular systolic function
o Monitoring
o Diagnosis of toxicity is based on both clinical and laboratory data
o Toxicity commonly occurs with serum levels greater than 2 ng/mL
,NR566 Week 3 Study Outline
Many questions are written to assess your clinical application of
the material from the textbook, in real-world scenarios.
Chapter 16: Drugs Affecting the Cardiovascular & Renal
Systems
• Know the pharmacodynamics, pharmacotherapeutics clinical
use, drug interactions and adverse drug reactions for:
o o Angiotensin converting enzyme inhibitors (ACEI): pregnancy D
Benazopril Captopril Enalapril Fosinopril Lisinopril Moexipril
o vasodilators
o Not as effective for African-American patients
o When combined with a diuretic, race no longer an issue
o Adverse drug reactions (ADRs): dry cough (bradykinin- mediated), hypotension, loss
of taste, angioedema, blood dyscrasias, teratogenicity, hyperkalemia, acute renal
failure, cholestatic jaundice, pancreatitis, rash
•
o o Angiotensin receptor blockers (ARBs) pregnancy D
Pharmacokinetics
o Losartan: CYP 2C9
o Extensive first-pass metabolism resulting in 33% bioavailability
o Inducers: rifampin, barbituates
o Inhibitors: lovastatin, SMZ/TMP, fluconazole, fluvastatin, fluvoxamine, sertraline
o
Angiotensin II Receptor Blockers SARTANS : losartan, esporsartan,
olmesartan, telmisartan, valsartan, candesartan, irbesartan
, o Like ACEI orthostasis with dose changes
•
o o Calcium channel blockers (CCB)nifedipine cat safe and
Functionally act as vasodilators, lowering calcium (Ca++) influx into smooth muscles
o Two major classes
o Type I – Non-dihydropyridines: affect conduction through the atrioventricular (AV)
node and have negative chronotropic effects
o Why it is used in treating supraventricular tachycardia
o Diltiazem (Cardizem), verapamil (Calan)
o Type II – Dihydropyridines: do not affect conduction through the AV node
o Nifedipine (Procardia), amlopidine (Norvasc), felodipine (Plendil)
• amlodipine cat C, methyldopa very safe
o Cardiac glycosides and antiarrhythmics
Digoxin
o Well-absorbed orally
o NOT extensively metabolized, excreted unchanged by kidneys Half-life is 36 to 48 hours
o In the absence of oral or intravenous loading, steady state is achieved in four half-
lives or 1 week
o Reduced clearance of digoxin with drug interaction
o Quinidine, amiodarone, verapamil, diltiazem
o ADRs
o Gastrointestinal (GI) most common: anorexia, nausea/vomiting, diarrhea
o Central nervous system: fatigue, disorientation, depression, hallucinations,
visual disturbances – yellow vision and green halos around lights
o Toxicity: atrial arrhythmias/tachycardia in children
o Cardiac: bradycardia, premature ventricular contractions, junctional and AV
block arrhythmias, and bigeminy
o Avoid using in patients with normal left ventricular systolic function
o Monitoring
o Diagnosis of toxicity is based on both clinical and laboratory data
o Toxicity commonly occurs with serum levels greater than 2 ng/mL
