Cardio Top 300 Week 2

Carvedilol brand

Coreg, Coreg CR

Carvedilol class

alpha/beta-adrenergic blocker

Carvedilol indications

HFrEF, HTN

Carvedilol dosages

HFrEF: 3.125 mg po bid, may titrate to 25 mg po bid for patients weighing ≤85 kg, 50 mg po bid for patients weighing >85 kg

HTN: 6.25 mg po bid; max 25 mg po bid; Extended-release capsule, 20 mg po daily in the morning, max 80 mg po daily

Carvedilol MOA

Selective α1- and nonselective β-adrenergic blocker that decreases AV nodal conduction in supraventricular tachycardias and blockade of catecholamine-induced dysarrhythmia

Carvedilol contraindications

Hypersensitivity, bronchial asthma, severe sinus bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe hepatic impairment

Carvedilol common ADRs

Cold extremities, dizziness, diarrhea, fatigue, hypotension, weight gain

Carvedilol rare but serious ADRs

Heart failure, hepatotoxicity, Stevens-Johnson syndrome

Carvedilol patient counseling points

Take with food or milk, report signs/symptoms of heart failure, bradyarrhythmias, bronchospasm, hypotension, syncope, or exacerbation of angina with initial dosing and dose changes, rebound HTN, may mask hypoglycemia

Diltiazem brand

Cardizem (CD), Cartia, Tiazac

Diltiazem class

Non-dihydropyridine CCB

Diltiazem indications

HTN, stable chronic angina, vasospastic angina

Diltiazem dosages

HTN: 60-120 mg (extended-release, 12 h) po bid, may titrate to 360 mg/d po; 120-240 mg (extended-release, 24 h) po daily, may titrate to 540 mg po daily

Stable, chronic angina, vasospastic angina: 30 mg (immediate-release) po qid, may titrate to 360 mg/d po; 120-180 mg (extended-release, 24 h) po daily, may titrate to 540 mg/d po

Diltiazem MOA

Calcium-channel-blocking drug that decreases HR, prolongs AV nodal conduction, and decreases arteriolar and coronary vascular tone. It also has negative inotropic properties

Diltiazem contraindications

Hypersensitivity, pulmonary congestion and acute MI, hypotension, 2nd- or 3rd-degree AV block, sick sinus syndrome

Diltiazem common ADRs

edema

Diltiazem rare but serious ADRs

Heart failure, heart block, hepatotoxicity, Stevens-Johnson syndrome, toxic epidermal necrolysis

Diltiazem counseling points

Report symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope, skin changes. Do not drink alcohol. Take at a consistent time of day

Isosorbide mononitrate brand

Imdur

Isosorbide mononitrate class

Long-acting nitrate, antianginal

Isosorbide mononitrate indication

Angina prophylaxis

Isosorbide mononitrate dosages

Extended release, initial, 30-60 mg po daily, may titrate to maintenance of 120-240 mg po daily; immediate release, 20 mg po bid separated 7 h apart to decrease tolerance development

Isosorbide mononitrate MOA

Converted to NO by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle.

Isosorbide mononitrate contraindications

Hypersensitivity to nitrates, concurrent use with PDE-5 Is, concurrent use with riociguat

Isosorbide mononitrate common ADRs

dizziness, headache

Isosorbide mononitrate rare but serious ADRs

Severe hypotension, syncope, increased intracranial pressure

Isosorbide mononitrate counseling points

Take on empty stomach with at least half a glass of water. This medication can cause headaches, lightheadedness, dizziness. Do not stop abruptly. Do not take with alcohol

Labetalol brand

Normodyne, Trandate

Labetalol class

alpha/beta-adrenergic blocker

Labetalol indications

HTN

Labetalol dosages

HTN: initial 100 mg po bid; may titrate in 100 mg increments po bid every 2-3 d to maintenance dose of 200-400 mg po bid, MAX dose 2400 mg daily

Labetalol MOA

Adrenergic receptor blocking drug that has selective α1- and nonselective β-adrenergic receptor blocking actions

Labetalol contraindications

Hypersensitivity; bronchial asthma or related bronchospastic condition; severe sinus bradycardia, 2nd- or 3rd-degree AV block; overt heart failure; cardiogenic shock, conditions associated with severe and prolonged hypotension, concurrent use of non-dihydropyridine calcium channel blockers

Labetalol common ADRs

Dizziness, nausea, orthostatic hypotension

Labetalol rare but serious ADRs

Hepatotoxicity, bronchospasm, heart block

Labetalol counseling points

Report signs of hypotension with dosing changes. Avoid alcohol. May cause dizziness, orthostatic hypotension, bronchospasm, slow HR, hepatotoxicity, syncope. May mask hypoglycemia. Do not abruptly stop, may cause rebound HTN

Metoprolol Succinate brand

Toprol-XL

Metoprolol succinate class

beta-adrenergic blocker, cardioselective

Metoprolol succinate indication

Angina, HFrEF, HTN, AMI

Metoprolol succinate dosages

Angina: 50 mg po bid or 100 mg extended-release po daily, may titrate at weekly intervals to max 400 mg total daily dose

HFrEF: NYHA class II, 25 mg extended-release po daily for 2 wk, may titrate to target of 200 mg/d; NYHA class III-IV, 12.5 mg extended-release po daily for 2 wk, may titrate to target of 200 mg/d

HTN: 25-100 mg po daily, may titrate to 100-400 mg once daily; Children >6 y of age, 1 mg/kg po daily, may titrate to max 2 mg/kg/d

AMI: 25-50 mg po daily, may titrate to max 200 mg/d as tolerated

Metoprolol succinate MOA

Extended release - cardioselective β-adrenergic blocker used in arrhythmias, HTN, angina pectoris, and heart failure. It is also effective in decreasing post-MI mortality

Metoprolol succinate black box warning

XL - ischemic heart disease with abrupt withdrawal

Metoprolol succinate contraindications

XL - hypersensitivity; severe bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome; decompensated heart failure; cardiogenic shock

Metoprolol succinate common ADRs

Dizziness, fatigue, hypotension

Metoprolol succinate rare but serious ADRs

Heart failure

Metoprolol succinate counseling points

May take without regard to food. Avoid alcohol and abrupt discontinuation. Report hypotension, HF, or exacerbation of angina. May mask hypoglycemia. May mix sprinkle capsule with soft food

Metoprolol tartrate brand

Lopressor

Metoprolol tartrate class

beta-adrenergic blocker, cardioselective

Metoprolol tartrate indications

HTN, AMI

Metoprolol tartrate dosages

HTN: 50 mg po bid, may titrate up to 400 mg po per day in 2-3 divided doses; 6 mg/kg/d, not to exceed 200 mg/d

AMI: 25-50 mg po q6h-q12h, convert to bid dosing over 2-3 d, MAX dose of 200 mg po daily

Metoprolol tartrate MOA

Cardioselective β-adrenergic blocker used in arrhythmias, HTN, angina pectoris, and heart failure. It is also effective in decreasing post-MI mortality

Metoprolol tartrate black box warnings

Ischemic heart disease with abrupt withdrawal

Metoprolol tartrate contraindications

Hypersensitivity; severe bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome; decompensated heart failure; cardiogenic shock

Metoprolol tartrate common ADRs

Dizziness, fatigue, hypotension

Metoprolol tartrate rare but serious ADRs

Heart failure

Metoprolol tartrate counseling points

Should be taken on an empty stomach. Avoid alcohol and abrupt discontinuation. Report hypotension, HF, or exacerbation of angina. May mask hypoglycemia.

Sacubitril/Valsartan brand

Entresto

Sacubitril/valsartan class

Neprilysin Inhibitor, Angiotensin 2 Receptor Antagonist

Sacubitril/valsartan indication

Heart failure (reduced or preserved EF)

Sacubitril/valsartan dosages

HF: 24mg/26mg po bid or 49mg/51mg po bid, may titrate to 97mg/103mg po bid

Sacubitril/valsartan MOA

Prodrug that inhibits neprilysin through the active metabolite LBQ657, leading to increased levels of peptides, including natriuretic peptides. selective, reversible, competitive antagonist of the angiotensin II receptor, which is responsible for the physiologic effects of angiotensin II, including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption.

Sacubitril/valsartan black box warning

Pregnancy

Sacubitril/valsartan contraindications

Hypersensitivity, history of angioedema, pregnancy, concomitant ACEIs, aliskiren

Sacubitril/valsartan common ADRs

Hypotension, hyperkalemia, increased SCr

Sacubitril/valsartan rare but serious ADRs

Rhabdomyolysis

Sacubitril/valsartan counseling points

May take without regard to food. Do not discontinue abruptly. May cause dizziness. Avoid NSAIDs

Nitroglycerin brand

Minitran, Nitro-Dur, Nitrostat

Nitroglycerin class

Nitrate, antianginal

Nitroglycerin indications

Angina prophylaxis, angina acute, chronic anal fissure

Ranolazine brand

Ranexa

Ranolazine class

Antianginal agent

Ranolazine indications

Chronic angina