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Nsg 6005Week 7 Test STUDY GUIDEChapter 161.ACEI/ ARBs-drug of choice for pt who are younger and white and patients with DM, HF, MI,CAD, heart failure with or without left ventricular dysfunction notas effective forBlack patients-Bradykin in ACEI causes cough/ ARBS don’t cause cough-Improve insulin sensitivity / Helps prevent diabetic neuropathy or slow itsprogression-Excreted in kidneys-Absolute contraindications bilateralrenal artery stenosis, pregnancy, angioedema-Catopril- take on empty stomach-Losartan- take without regard to food-Enalapril, quinapril and ramipril- can cause photosensitivity reactions-Losartan levels are lowered by inhibitors of p450 (cyp450) 3a4, and 2cp(ex.Cimetidine) --AllARBs- interact withantacids,NSAIDS, allopurinol, rifampin, fluconazole,cimetidine, digoxin probenecid-ADR:angioedema, renal dysfunction-Dose reduce ACEI if serum CR greater than 2.5 / DC if neutrophil count is <1,000-Check CR, WBC, and POTASSIUM levels2.CALCIUM CHANNEL BLOCKERS-Indications: HTN, angina, tachyarrhythmias-Avoid in heart failure / EF <40%-Block calcium from entering the cell-Dihydropyridines- cause peripheral edema (nifedipine, nicardipine, amlodipine)-Interact with CYP 3A4-Antihypertensive effects may be decreased with use of NSAIDS-Digoxin levels may be increased-Verapamil may be decreased with use of VIT d and calcium / also use with statinHMG-Co-A reductase inhibitor serum levels may be increased-Avoid grapefruit juice/ high fat meals-All CCB’s- interact with H2 blockers-Diltiazem (Cardizem)-don’t take with high fat or high carb meal-Migraine prophylaxis- verapamil is most common-Raynauds- type 2 CCBs- nifedipine drug of choice3.HYPERTENSION-ACEI, ARBS, DIURETICS4.POST MI
-Beta Blockers5.Classes of Drugs-1A,1B,1C: what do they have in common:: treatVentricular arrhythmias& they areSodium channel blockers-IA & IIIwhat do they have in common : they bothblockK channels-Which class prolongs action potential :Class III and 1A-APD- ACTION POTENTIAL DURATION6.Cardiac glycosides-Digoxin most common-Treatment of heart failure-Highly selective inhibitors of sodium potassium adenosine triphosphate (ATPase) “sodium pump”-Taking digoxin with food, fiber or after meals results in slower absorptionDrug ClassCellular Mechanism of ActionPrototype DrugsIaNa channel blockers that↑ APD/alsoblock K channels ,↑QRS/QTMost atrial and ventricular arrhythmiasQuinidine,Procainamide,DisopyramideQuinidine- only for tx malariaIbNa channel blockers that slightly↓ APD,↓ QTVentricularVTach and prevent VFib after DCcardioversionLidocaine, Mexiletine, PhenytoinIcNa channel blockers that don't changeAPD,↑ QRSSupraventricular arrhythmia/ ventricularPropafenone, FlecainideIIβ-blockers- increases threshold potential ,prolongs ERPPropranolol, Atenolol, Esmolol,MetoprololIIIProlong APD(K Channel Blockers)Supraventricular tachyarrhythmia’sAmiodarone,♥Dronedarone,Sotalol, Ibutilide, BretyliumSotalolinteractswithpseudoephedrine, phenylephrineIV