Hypertension Medications
How to choose CCB for your patient
As a clinical pharmacist, there’s often confusion about how to choose a calcium channel blocker (CCB) due to the laundry list of products and uses. Think of dihydropyridine CCBs (amlodipine, nifedipine, etc) as more potent vasodilators, but they can bump up heart rate. NONdihydropyridines (diltiazem, verapamil) slow heart rate. Preferred choice…
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Side Effects
Kidney problems when CLARITHROmycin is combined with CCBs
As a clinical pharmacist, you will get alerts about kidney problems when clarithromycin is combined with a calcium channel blocker (amlodipine, etc). Do your part... Clarithromycin is a strong 3A4 inhibitor that can slow the metabolism of calcium channel blockers and increase their levels. This can lead to hypotension , edema, bradycardia an…
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Hypertension
How to treat MILD hypertension
As a cardiovascular pharmacist, you will hear debate about when to start drugs in patients with MILD hypertension, systolic blood pressure (BP) 140 to 159 mmHg or diastolic 90 to 99 mmHg. The latest analysis questions whether BP drugs benefit stage 1 or mild hypertension. It suggests that only one cardiovascular (CV) event is prevented for ever…
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Side Effects
How to handle drug-induced edema
Questions come up about how to handle drug-induced edema. Peripheral edema often prompts clinicians to jump straight to a workup for thromboembolism or heart, renal, or hepatic failure. But first look for medications that can cause it... Dihydropyridine calcium channel blockers ( amlodipine, etc ) cause dose-dep…
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Side Effects
How to treat peripheral edema due to dihydropyridine calcium channel blockers
One of the most ADVERSE EFFECT caused by calcium channel blockers (CCD), dihydropyridine (e.g., amlodipine, etc) is peripheral edema. It's dose-dependent. Incidence of peripheral edema may be > 80% with high doses. Major cause of CCB nonadherence. Mechanism is thought to be arteriolar dilatation. The resulting pressure gradient between arteriole and venule ca…
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Nephrology and Urology
Risk of acute kidney injury when adding NSAID to diuretic plus ACEI or ARB
As a clinical pharmacist, you'll hear more about the risk of acute kidney injury when adding an NSAID to a diuretic plus an ACEI or ARB . Combining all three agents creates a "triple whammy" to impair kidney function and sometimes the kidneys can't compensate. This is especially true in patients at risk due to age over 65, chronic kidney disease, o…
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Loop Diuretics
Overview of HEART FAILURE treatment
Overview ㅡ Heart failure typically classified by New York Heart Association (NYHA) I-IV functional classification or American College of Cardiology Foundation/American Heart Association (ACCF/AHA) A-D staging ( see table 1 ) . Heart failure with reduced ejection fraction (HFrEF) or systolic heart failure results in decreased heart pump function (left ventricular ejec…
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Hypertension
Be ready to manage patients with very high blood pressure
What should you do when patients report a very high blood pressure (BP) reading on a home monitor or pharmacy? Don't automatically refer to the emergency department (ED) for a blood pressure above 180/120 mmHg. Advise promptly rechecking BP, and ensure proper technique, sit quietly for 5 minutes, appropriate cuff size, feet on the floor, etc. And shift the foc…
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Myocardial Infarction
Angiotensin II receptor blockers (ARBs)
Therapeutic actions ㅡ ARBs selectively block the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland. This action blocks the vasoconstriction effect of the renin-angiotensin system as well as the release of aldosterone leading to decreased BP; may block vessel remodeling that occurs in hypertension and contribu…
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