NR566 Week 3 Study Outline / STUDY GUIDE LATEST VERSION

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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 & R... enal 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  Extensive first-pass metabolism resulting in 33% bioavailability  Inducers: rifampin, barbituates  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  Why it is used in treating supraventricular tachycardia  Diltiazem (Cardizem), verapamil (Calan) o Type II – Dihydropyridines: do not affect conduction through the AV node  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  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 • [Show More]

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