Diuretics and Antihypertensives

Question 1

Beta Blockers decrease blood pressure by

Answer 1

decrease cardiac output and inhibits the release of renin which decreases production of angiotensin II and aldosterone secretion

Question 2

Example of selective BB

Answer 2

Metoprolol, atenolol

Question 3

Which type of BB can NOT be used for asthma

Answer 3

nonselective BB

Question 4

BB on DOC for?

Answer 4

previous MI, supraventricular tachyarrythmias, stable ischemic heart disease, chronic HF

Question 5

Never give BB to?

Answer 5

those with asthma, 2nd degree heart block, 3rd degree heart block, diabetes or severe PAOD

Question 6

ADEs of BB

Answer 6

 Common SE—lower BP and bradycardia [the person
 Lipid Altercations—non-cardioselective BB will decrease HDL [good cholesterol] and increase the trigs
 Fatigue, insomnia and sexual dysfunction can be seen in non-cardioselective BB

Question 7

What happens if you abruptly stop a BB?

Answer 7

cause severe HTN, and even angina, acute MI and even sudden death [in those with ischemic heart disease]; taper these drugs over a few weeks when stopping them—even if they are being given for headache

Question 8

ACE inhibitors MOA

Answer 8

reduce PVR without increasing CO, HR or contractibility; ACEI block ACE—which converts angiotensin I to angiotensin II

 ACEIs also prevents the breakdown of bradykinin, which increases NO and prostacyclin from the vessels
 NO and prostacyclin are potent vasodilators of the arterioles and veins
 By reducing levels of angiotensin II, aldosterone levels are decreased, as is Na+
 ACEI reduce cardiac preload and afterload—important reason we use these drugs in folks with CAD

Question 9

ACE inhibitors recommended for?

Answer 9

high BP in those with DM, CKD, MI, HF, high risk of CAD and those with proteinuria

Question 10

Examples of ACE

Answer 10

captopril
enalapril
lisinopril

Question 11

What does chronic use of ACEIs do?

Answer 11

keep BP low, cause LVH to regress and prevent ventricular remodeling in those who have had and MI or those with HF

Question 12

ACEI are first line in?

Answer 12

HF, high BP, CKD and those at risk for CAD

Question 13

Pharmacokinetics of ACEI

Answer 13

 Oral bioavailable as drug or
 All but Captopril and Lisinopril undergo hepatic conversion to active metabolites—so these 2 are preferred in those with live compromise
 Fisinopril is only ACEI not renally eliminated—so no dose adjustments with this drug in those with CKD
 Enalapril is available IV

Question 14

ADES and serious ADEs of ACEI

Answer 14

ADEs:
Cough [more frequent in women]
 Seen in 10%, thought to be from increased bradykinin and substance P
Elevation of serum creatinine up 30% from baseline [this is acceptable]
Low BP Dysguesia

Serious ADEs:
 Skin rash
 Angioedema—thought to be from elevated bradykinin levels
 Monitor serum creatinine
 These drugs cause body to hold K+, so monitor K+ and about K+ supplements, potassium sparing diuretics and salt substitutes
 ACEI induce fetal malformations—cannot be used by pregnant woman

Question 15

Angiotensin II Receptor Blockers (ARBs)

Answer 15

 Prototype drug is Losartan
 These drugs block the AT1 receptor, decreasing activation of AT1 receptors by
angiotensin II
 Their effects are much like the ACEIs
 ARBs do not increase bradykinin levels—so can be used in those who cough on an ACEI or those who have developed angioedema on an ACEI
 1st line agents for DM, HF, CKD
 ADEs are similar to ACEIs [except the cough and angioedema]
 CANNOT be used with an ACEI
 Teratogenic in pregnant women

Question 16

Renin Inhibitors

Answer 16

 Prototype drug is Aliskeren—Tekturna
 This drug inhibits renin and acts earlier in the RAAS system than ACEIs or ARBs
 Aliskeren cannot be given with an ACEI or an ARB
 Can cause diarrhea in high doses—can cause cough and angioedema, but less often than ACEIs
Contraindicated in pregnancy
Metabolized by CYP34A—many drug-drug interactions