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dohertys
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What to monitor when starting ACEI?
SCr, BUN, fluid balance and lytes x 1-2 wks of starting. If K> 5.6 or SCr > 30% rise over baseline consider stopping (unless related to volume loss)
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Contraindications to ACEI/ARB?
Bilateral renal artery stenosis (uni if 1 kidney), history of angioedema, pregnancy (teratogenic)
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ACEI are 1st line in which conditions?
HF, DM, Post MI, Uncomplicated HTN, LVH, Prior CVA/TIA, renal disease & ALL coronary artery disease patients
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Which group of patients do ACEI/ARB not work as well?
Black people - but still use for compelling indications (MI, HF, CKD)
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Some Side effects of ACEI?
K+ sparing, cough (10% - more with Asians), angioedema (0.5%), increased LFTs, low bp/fatigue/dizzy/headache
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Beta-blockers are 1st line for which conditions?
Stable angina, Post-MI, LVH ≤60yrs.
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Which groups are B-blockers not as good with?
Elderly - not unless post-MI/CHF/angina, Blacks - less effective
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Which B-blockers are cardio-selective? (4)
Acebutolol, Atenolol, Bisoprolol, Metoprolol
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Metoprolol's trade name?
Lopressor
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Bisoprolol's trade name?
Monocor
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Atenolol's trade name?
Tenormin
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Acebutolol's trade name?
Monitan
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Non-cardio-selective B-blockers? (5)
Nadolol, Pindolol, Propranolol, Sotalol, Timolol
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Special use of Propranolol (non-cardiac)
Tremor, and reduces bleeding from esophageal varices
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Non-selective Beta and alpha B-blockers? (2)
Carvedilol (COREG) and Labetalol (Trandate)
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Contraindications for beta-blockers?
Asthma, 2nd or 3rd degree heart block, PR > 0.24s, uncompensated HF, severe PAD, pheochromocytoma without alpha-blockade
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What is NORVASC?
Amlodipine - a Dihydropyridine (DHP) CCB
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What is ADALAT?
Nifedipine - a Dihydropyridine (DHP) CCB
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What is CARDIZEM?
Diltiazem - a non-DHP CCB - used for stable angina, HTN, coronary artery spasm
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What is DHP CCB action vs. Non-DHP?
DHP CCB - more peripheral vasodilation (deem), less effect on heart
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What is Non-DHP CCB action?
More negative chronotropic effect on heart, less vasodilation
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Which CCB's are bad for Wolff-Parkinson-White Syndrome?
Non-DHP CCB's (diatiazem and verapamil) b/c slow AV node conduction and allow current to reenter faster
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1st line Rx for uncomplicated HTN (no other compelling indications)
Thiazide diuretic (HCT or chlorthalidone) then B-blocker (≤60 yr), ACEI, Long acting CCB
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1st line Rx for isolated systolic HTN
Thiazide diuretic (HCT or chlorthalidone) or CCB (Long acting DHP)
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1st line Rx for DM WITH nephropathy (alb:Cr >2 in M, >2.8 in F or CKD)
ACEI or ARB (monitor SCr and K+) - but may need 3-4 drugs
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2nd line Rx for DM WITH Nephropathy if 1st drug can't control
Add 1+ of: Thiazide, Long acting-CCB
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1st line Rx in CAD
ACEI or ARB (except not in low risk pts)
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1st line Rx in stable angina
B-blocker, but strongly consider adding ACEI
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1st line Rx in prior MI
B-blocker + ACEI together
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