EXAM #2: CV PHARM VI Flashcards
(70 cards)
What is the mechanism of action of the ACE inhibitors?
Block of Angiotensin Converting Enzyme (ACE) to reduce the amount of circulating Angiotensin II
Note that this also inhibits the breaksdown Bradykinin, which leads to vasodilation
What is the role of ACE inhibitors in antihypertensive therapy?
- 1st line or add-on for uncomplicated HTN
- 1st line therapy for comorbidities
Effects are enhanced by combining with diuretic*
How are ACE inhibitors cleared? What are the clinical implications?
Cleared by the kidney; thus, reduce dose in patients with kidney failure
What is the effect of elevated plasma renin activity in ACEI therapy?
Can cause hyper-responsiveness b/c:
- Renin converts angiotensinogen to ANG I
- Individuals are accostomed to having high ANG I levels that are NOT going to be converted to ANG II
What patients will have a high plasma renin activity?
Patients in heart failure and those with Na+ depletion
When are ACEIs contraindicated?
1) Pregnancy
2) Bilateral renal artery stenosis
3) Angioedema
What are the situations with potentially favorable effects of ACEIs?
1) Patients with low-normal K+ b/c these drugs INCREASE plasma K+
2) Prediabetes
3) Albuminuria
What are the situations with potentially unfavorable effects of ACEIs?
1) High-normal K+
2) Hyperkalemia
3) Volume depletion
ACEIs will cause vasodilation in patients with volume depletion and lead to HYPOTENSION*
What are the adverse effects of ACEIs?
1) Hypotension
2) Cough
3) Angioedema
4) Increased plasma K+
5) Acute renal failure
6) Fetopathic potential
7) Skin rash
What causes coughing in ACEI therapy? What can you consider as an alternative therapy?
Bradykinin
—> ARBs
What patient is a “good responder” to ACEI?
Young/ middle aged Caucasians
What patient population is labled as “bad responders” to ACEIs?
Elderly African Americans
Remember from the ED, increased angioedema in African Americans*
List the ACEIs. List the ARBs. How do you tell the difference?
Lisinopril
Captopril
Fosinopril
Losartan
Valsartan
Candesartan
Remember:
- pril= ACEI
- artan= ARB
What is the mechanism of action of the Angiotensin Receptor 1 Blockers?
Antagonize Angiotensin II Receptors, Type-I, which block ANG II from binding to the adrenal gland
Note that ANG II concentrations will either stay the same or increase with these drugs
What is the role of Angiotensin Receptor I blockers in antihypertensive therapy?
Alternative for patients with intolerance to ACE inhibitors
Think of as an alternative for elderly African American patients
When should you consider ARBs as first-line therapy?
1) DM
2) CKD
3) CAD
4) LV-Dysfunction
But NOT CVA
When is ARB use contraindicated?
1) Pregnancy
2) Bilateral renal artery stenosis
What patient populations have favorable and unfavorable responses to ARBs?
Same as ACEIs.
Favorable:
- Low-normal K+
- Pre-DM
Unfavorable:
- Hyperkalemia
- Volume depletion
What is the mechanism of action of the DHP Ca++ blockers for HTN?
Recall that these are the Ca++ channel blockers with a 10:1 vasodilatory effect compared to the NDPH
Note that this vasodiatory effect will induce reflex tachycardia, especially in the first week of use
What is the role of DHP Ca++ blockers for HTN?
- First line or add-on therapy for uncomplicated HTN
- Add-on for DM and CAD
When should DHP Ca++ blockers be avoided?
Left ventricular dysfunction
List the DHP Ca++ blockers that are used as anti-hypertensive drugs.
Nifedipine
Amlodipine
Felodipine
What are the situations that are favorable for DHP Ca++ blockers?
1) Reynaud Syndrome
2) Elderly patients with isolated systolic HTN
3) Cyclosporine-induced HTN
What are the situations that are unfavorable for DHP Ca++ blockers?
1) Peripheral edema b/c one of the side effects is peripheral edema
2) High normal rate–>Tachycardia
