NR565 Week 3 & 4 Study Guide
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
o Monitor potassium levels
•
• o Nitrates and peripheral vasodilators nitrates work on veins and reduce preload,
hydralazine is a vasodilator
• o Anti-lipidemics
• o Diuretics treat symptoms of congestions, help the body get rid of excess fluid,
reduce symptoms that result in excess fluids like shortness of breath doing
this it reduces heart failure (aldosterone inhibitors)
• Also know:
• o ACEIs & ARBs benefits in other conditionsHTN, HEART FAILURE,
SLOWING RENAL DISEASE , CARDIOVASCULAR DISEASE AS
WELL
• o Dosing schedules
• o Management of ACEI side effects
• o Therapeutic monitoring for cardiac glycosides and antiarrhythmics
• Chapter 28: Chronic Stable Angina & Low Risk Unstable Angina
Differentiate between myocardial oxygen supply & demand Angina: Ischemia
caused by the imbalance between myocardial oxygen supply (MOS) and
myocardial oxygen demand (MOD) produces pain referred to as angina.
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
o Monitor potassium levels
•
• o Nitrates and peripheral vasodilators nitrates work on veins and reduce preload,
hydralazine is a vasodilator
• o Anti-lipidemics
• o Diuretics treat symptoms of congestions, help the body get rid of excess fluid,
reduce symptoms that result in excess fluids like shortness of breath doing
this it reduces heart failure (aldosterone inhibitors)
• Also know:
• o ACEIs & ARBs benefits in other conditionsHTN, HEART FAILURE,
SLOWING RENAL DISEASE , CARDIOVASCULAR DISEASE AS
WELL
• o Dosing schedules
• o Management of ACEI side effects
• o Therapeutic monitoring for cardiac glycosides and antiarrhythmics
• Chapter 28: Chronic Stable Angina & Low Risk Unstable Angina
Differentiate between myocardial oxygen supply & demand Angina: Ischemia
caused by the imbalance between myocardial oxygen supply (MOS) and
myocardial oxygen demand (MOD) produces pain referred to as angina.
