Flashcards in Angiotensin and Adrenergic Antagonist: PHarmacology Deck (57)
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1
Vicious cycle of HFrEF (cycle 1)
1) Myocardial disease
2) decr SV/Cardiac output
3) arteriolar vasoconstriction
4) incr systemic vascular resistance
5) incr afterload
2
Vicious cycle of HFrEF (cycle 2)
1) Myocaridal disease
2) decr SV/CO
3) incr NaCl and H2O retention --> incr renin angiotensin/aldosterone --> incr arterial vasoconstriction
4) incr blood volume --> peripheral edema
5) incr LV preload
3
Hydralazine action
Direct arterial vasodilation (decr afterload)
4
Side effects of hydralazine
drug induced SLE
5
isosorbide dinitrate
NO vasodilator = venous vasodilation
(decr preload)
6
Side effects of isosorbide dinitrate
hypotension
headache
dizziness
7
side effects of combined hydralazine and isosorbide dintrate
headache
8
which is better used, ACE inhibitor or hydralazine ISDN combo
ACE inhibitor
9
when do you specifically use hydralazine ISDN combo
in african ameicans with NYHA 3-4 HFrEF in combo with beta blocker, ACE inhibitor, and a aldosterone antagonist
OR in HFrEF when can't take ACE inhibitor or ARB
10
why do african americans have lots of problems with HF?
1) TGFB = incr type 1 and type 2 collagen --> incr fibrosis
2) incr endothelin (vasoconstrictor)
3) decr renin angiotensin system
4) decr in NO (vasodilator)
11
how do ACE inhibitors function?
1) angiotensinogen (zymogen produced in liver)
2) renin (produce in kidney in response to low BP/Na) convert angiotensinogen to angiotensin 1
3) ACE (produce in lungs) convert angiotensin 1 to 2
12
how is bradykinin produced
1) bradykninogen (produced in liver)
2) kallikrenin convert bradykininogen to bradykinin
3) kinase II (ACE II) convert bradykinin to inactive filaments
13
why does high bradykinin lead to cough
bradykinin = pulmonary irritant
potent vasodilator
14
Effect of angiotensin II in vascular smooth muscle
incr arteriolar constriction
incr arterial blood pressure
15
Effect of angiotensin II in CNS and PNS?
facilitate sympathetic activity
incr CO
incr arterial blood pressure
16
Effect of angiotensin II in adrneal cortex
incr aldosterone secretion
incr Na reabsoprtion
incr arterial blood pressure
17
Effect of angiotensin II in kidney tubules
incr Na reabsorption
incr arterial blood pressure
18
Effect of angiotensin II in kidney arterioles
change GFR
incr filtration fraction
incr Na+ and H2O retention
incr arterial blood pressure
19
Effect of angiotensin II in brain
incr ADH
incr thirst
incr H2O absorption/ingestion
incr arterial blood pressure
20
ACE inhibitors names
captopril
enalapril
lisinopril
21
dosing of captopril
shortest half life = 3x /day
22
dosing of enalapril
BID
23
dosing of lisinopril
longest half life
once daily
24
Side effects of ACE inhibitors
1) cough
2) hyperkalemia
3) angioedema
4) renal dysfunction
5) neutropenia
6) hypotension
25
Drug interactions with ACE inhibitors
1) lithium
2) NSAIDs (incr serum Na affecting afterload and preload)
3) Salt substitute
4) loop diuretics
5) K+ sparing diuretics
26
Contraindications of ACE inhibitors
pregnancy
bilat renal artery stenosis
renal failure
angioedema
hyperklaemia
CAUTION WITH ELDERLY
27
When is ACE inhibitor good?
Good for NYHA good for class 2-4 (more sick)
and starts right away
also can reduce risk of HF
28
Is ACE inhibitors dose dependent?
NO SIGNIFICANCE
29
what is the angiotensin escape?
aldosterone continues to incr even though you are blocking angiotensin
30
