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Hypotension: Signs and Symptoms Dizziness, Lightheadedness, Fainting, Confusion Hypotension: Prevention "start low and go slow", monitor Angina definition chest pain All antihypertensives can cause hypotension (BP < 90) or bradycardia (HR < 60) Bradycardia: Signs and Symptoms Dizziness, Lightheadedness, Fainting, Fatigue, Blurred Vision Bradycardia: Prevention "Start low and go slow", monitor 2 Tyes of Ca++ Channel Blockers (CCB) Dihydropyridines (DHP) Non-dihydropyridines (non-DHP) Dihydropyridine Mechanism Block Ca++ in vascular smooth muscle, Affect BP Non-DHP Mechanism Block Ca++ in cardiac cells, Affect HR DHP naming tip End in "-pine" DHP Indication HTN Non-DHP Indications HTN, angina, and arrhythmias 2 generic non-DHPs Verapamil Diltiazem Atrial Fibrillation Erratic signals from the atria, SA node fires too rapidly, quivering instead of contracting, trouble pumping efficiently (blood can clot) How do CCBs affect Atrial Fibrillation? Slow down the rate CCB Adverse Effects Edema, Constipation, Flushing, Headache How to monitor edema? daily weighings to check for water retention Which CCB is most frequently prescribed to control HR? non-DHPs Amlodipine (Norvasc) Drug Interactions Conivaptan (vassopressin antagonist), Pimozide (antipsychotic) Amlodipine/Benazepril (Lotrel) Drug Interactions Conivaptan (vassopressin antagonist), Pimozide (antipsychotic) Diltiazem (Cardizem, Cartia, Tiazac) Drug Interactions Conivaptan (vassopressive antagonist), Pimozide (antipsychotic), Tolvaptan (vassopressin antagonist) Felodipine (Plendil) Drug Interactions Conivaptan (vassopressive antagonist), Pimozide (antipsychotic) Nifedipine (Procardia, Nifedical XL, Adalet CC) Drug Interactions Conivaptan (vassopressive antagonist), Pimozide (antipsychotic) Verapamil (Isoptin, Calan, Verelen) Drug Interactions Conivaptan (vassopressive antagonist), Disopyramide (antiarrhythmic), Dofetilide (antiarrhythmic), Pimozide (antipsychotic), Silodosin (alpha 1 blocker), Topotecan (antineoplastic agent) Nitroglycerin (Nitrostat, Nitroquick) Mechanism Vasodialtor Nitroglycerin (Nitrostat, Nitroquick) Indications Acute angina treatment Nitroglycerin (Nitrostat, Nitroquick) forms sublingual tablet, patch, or injection How many tablets of NTG can a patient take before reporting to the ER? 3 Nitroglycerin (Nitrostat, Nitroquick) Dosing PRN, Still having chest pain take another (up to 3) Nitroglycerin (Nitrostat, Nitroquick) Adverse Effects Headache (50%), Dizziness, Hypotension Nitroglycerin (Nitrostat, Nitroquick) Storage Away from light, air, moisture, Tightly sealed glass bottle (easy open), Be aware of expiration date, Should taste bitter & produce tingling Isosorbide mononitrate (Imdur) Mechanism Vasodilator Isosorbide mononitrate (Imdur) Indications angina prevention Isosorbide mononitrate (Imdur) forms tablet Isosorbide mononitrate (Imdur) Dosing Scheduled, 30 - 120 mg/day Isosorbide mononitrate (Imdur) Adverse Effects Headache, Dizziness Take aspirin or tylenol for headache prevention Which drugs cause hyperkalemia? ACEIs, ARBs, K+ Sparing diuretics Which drugs cause sensitivity to sunlight? loop diuretics and thiazides Which drugs end in "-artan"? ARBs Which drugs should not be discontinued abruptly? beta-blockers and clinidine What is the first-line drug for HTN? thiazides Which drugs have a contraindicated history of angioedema? ACEIs