Flashcards in GENERAL ACEI Deck (18)
All persons with BP over 120/80 should initiate?
Treatment threshold goals without DM and kidney disease?
Treatment threshold goals with DM or kidney disease?
First line therapy for HTN is? Unless?
Thiazide diuretic unless there is a compelling medication to reach goal
*most patients will require at least 2 medications to reach goal
What are compelling indications?
Heart Failure, MI, High CVD, DM, CKD, Stroke and isolated systolic hypertension.
Describe HTN urgency?
Diastolic pressure over 120 with evidence of progressive end organ damage. Goal is to decrease DBP to 100-105 within 24 hours.
*Progressive end organ damage can be noted by increased BUN/Creat. Don't want to decrease DBP too much because brain is dependent on higher pressure!
Describe HTN crisis?
Diastolic pressure over 120 with evidence of end organ FAILURE. Goal is to decrease DBP to 100-105. Using Nitroprusside, NTG or Labetalol.
Angiotension II is a potent vasoconstrictor responsible for what kind of constriction?
Arterial Smooth Muscle Constriction.
What does Angiotension II increase the secretion of?
What is the MOA of Angiotension II Converting Enzyme Inhibitors?
Block the conversion of Angiotension I to Angiotension II through the interaction with the zinc ion of angiotension converting enzyme therefore preventing conversion of angiotension I to II. Thus preventing vasoconstriction, sodium retention and SNS stimulation.
End result of ACEI that Vicki wants us to know?
Prevents Na resorption, vasoconstriction and the breakdown of bradykinin causes vasodilation which helps us with afterload but causes the cough.
Name some popular ACE Inhibitors?
Lisinopril (zestril, prinivil)
What important system does the ACEI block?
What three conditions are ACEI considered first line therapy for?
What kind of condition is DM is more effective? Why?
Diabetes. Delayed progression of renal disease.
The major difference among the ACEI class is?
Name some important things about ACEI.
They are potent, minimal side effects, good patient compliance. We don't want them to have the morning of and they always tank their BP on induction because they are DRY. Contraindicated in pregos (we don't want to decrease the blood volume). Be careful with ACEI and NSAIDS they both block bradykinin related vasodilation