ACE, ARB'S, CCB, antiarrhythmics Flashcards
(35 cards)
Renin- angiotensin-aldosterone system (RAAS) in hypertension
angiotensinogen uses renin to convert to angiotensin 1
angiotensin 1 uses ACE to convert to angiotensin 2
Angiotensin 2 increases aldosterone, sodium and water retention, thirst, systematic nervous system
AND causes vasoconstriction, vascular fibrosis, and myocardial hypertrophy.
ACE inhibitors are most commonly used for
Hypertension which is high risk for CAD
Relaxes arteries and allows blood flow
ACE inhibitors indications
patients with diabetes, diabetic nephropathy, post MI, or high CAD risk/hypertension
ALL patients with ejection fraction less then or equal to 40%
ACE inhibitors dosing considerations
start low and go slow until target dose
benefits not seen right away
hypotension more common with hyponatremia
ACE inhibitors side effects
hypotension and dizziness (orthostatic hypotension)
cough and angioedema (swelling around mouth)
renal dysfunction
hyperkalemia
ACE inhibitors side effects (renal dysfunction)
decrease in GRF not usual but less then 20%
highest risk of ARF: volume depleted, renal vascular disease, vasoconstricting drugs
ACE inhibitors side effects (hyperkalemia)
usual increase in less then 1mEq/L
Baseline for SCr more then 1.6mg/dl = greatest risk for increase potassium.
ACE inhibitors warnings
avoid in pregnancy
do not use with bilateral renal artery stenosis (major risk for ARF)
ACE inhibitors interactions
potassium supplements
NSAID’s (especially with diuretics and dehydration)
cyclosporine
ACE inhibitors TOP 200 list
147 & 150 benazepril
4 & 51 lisinopril
201 ramipril
ACE inhibitors end with
pril
Angiotensin 2 receptors antagonist (ARB’s)
most similar to ACE inhibitors with less cough and angioedema
same side effects
similar but not superior efficacy with HF
ARB’s indications
treats hypertension, congestive heart failure, and diabetic nephropathy
ARB’s dosing considerations
start low and go slow until target dose
benefits not seen right away
hypotension more common with hyponatremia
ARB’s side effects
hypotension and dizziness (orthostatic hypotension)
cough and angioedema (swelling around mouth)
renal dysfunction
hyperkalemia
ARB’s warning
avoid in pregnancy
do not use with bilateral renal artery stenosis (major risk for ARF)
ARBS TOP 200 list
Lrbestartan
losartan
olmesartan
telmisartan
valsartan
neprilsyin inhibitor indications
treatment of chronic heart failure.
superior to ACE inhibitors
higher risk of hypotension and angioedma then ACE inhibitors
Lower risk of cough and renal dysfunction
neprilysin inhibitor TOP 200
Sacubitril and valsartan
aldosterone antagonist indications
Treatment of chronic HF hypertension, chronic kidney disease associated with DM and hyperaldosteronism
anti-aldosterone actions, potassium-sparing diuretic effects (hypotension, hyperkalemia, gynecomastia)
aldosterone antagonists TOP 200
Spironolactone
Eplernone
calcium channel blockers indications
inhibit transmembrane influx of calcium (act at SA/SV node and or vascular smooth muscle, vasodilation and or decreased heart rate)
CCB TOP 200
Diltiazem and verapamil (negative inotropic and chronotropic effects)
dihydropyridines (no effects on conduction in vivo)
CCB Top 200 (dihydropyridines)
Amlodpine
nifedipine
