Vasoactive Dialators

Question 1

Biological Effects of Angiotensin II

Answer 1

Volume Expansion: decrease Natriuresis & increase H2O Reabsorption
due to increased Aldosterone and Vasopressin
Direct Vasoconstriction, release of vasoconstrictors
Increased Sympathetic Tone
Cell Proliferation, Migration and Hypertrophy

Question 2

Vascular effects of ACE-I and ARB

Answer 2

Vasorelaxation
Decrease in arterial resistance
Progressive reduction in BP 
Reverse hypertrophy
Augment vascular distensibility
Decrease oxidative stress
Improved endothelial function
Antiplatelet effect (ACE-I greater)
Stabilize Plaques
Neutrophils and mononuclear cells
proliferation

Question 3

Cardiac Effects of ACE-I and ARB

Answer 3

Decreased preload and afterload
No change, or an increase, in cardiac output
Reverse hypertrophy

Question 4

Renal Effects of ACE-I and ARB

Answer 4

Renoprotective
Decreased proteinuria
Increased renal blood flow
Decreased kaliuresis that may result in HYPERKALEMIA
Preferential dilation of efferent arterioles,
which reduces intraglomerular pressure

Question 5

Other Effects of ACE-I and ARB

Answer 5

decrease Pulmonary vascular resistance
decrease Pulmonary capillary wedge pressure (preload)
Decreased sympathetic outflow
Decreased aldosterone production 
Improved insulin sensitivity

Question 6

Clinical Uses of ACE Inhibitors

Answer 6

General clinical uses: Hypertension, Heart Failure;
Post MI and left ventricular dysfunction, diabetic nephropathy, proteinuria
Acute MI
Acute MI; MI and stroke prophylaxis, and reduction of cardiovascular mortality in high risk patients

Question 7

Clinical Uses of ARBs

Answer 7

HF
Diabetic Nephropathy, Proteinuria
HTN with LVH (to reduce stroke), Diabetic Nephropathy, Proteinuria
Left ventricular failure or left ventricular dysfunction post-MI, HF

Question 8

Treatment of Systolic-Diastolic Hypertension without Other Compelling Indications

Answer 8

ACE-I and ARB

Question 9

Treatment of Isolated Systolic Hypertension without Other Compelling Indications

Answer 9

ARB (hasn’t been tested in ACE-Is)

Question 10

When are ACE-I and ARB first-line therapy for hypertension?

Answer 10

Ischemic Heart Disease
Recent STEMI or non-STEMI
Left Ventricular Systolic Dysfunction
With Cerebrovascular Disease
Left Ventricular Hypertrophy 
Non-Diabetic Chronic Kidney Disease
Caution with arterial stenosis
Diabetes
Metabolic syndrome

Question 11

What are the preferred antihypertensive combinations?

Answer 11

ACE I or ARB + Thiazide

ACE I or ARB + DHP CCB

Question 12

Renin Inhibitor

Answer 12

Aliskiren

Question 13

Angiotensin-Converting Enzyme Inhibitors

Answer 13

Captopril
Benazepril
Enalapril
Lisinopril
Quinapril
Ramipril

Question 14

Angiotensin Receptor Blockers

Answer 14

Candesartan
Irbesartan
Losartan
Valsartan

Question 15

ET Receptor Antagonist

Answer 15

Bosentan

Question 16

Vasopressin Receptor Antagonist

Answer 16

Conivaptan

Question 17

Synthetic BNP Analog

Answer 17

Nesiritide

Question 18

ACEI: Adverse Effects

Answer 18

Dry cough,

angioedema, hypotension, hyperkalemia.

Question 19

ACEI: Contraindications

Answer 19

Renal artery stenosis, K+ sparing diuretics, ARB, NSAIDs

Question 20

ACE-I and ARB aren’t good for ___________ in the kidney

Answer 20

Renal artery stenosis

Question 21

Aliskiren clinical use

Answer 21

Hypertension

Question 22

Aliskiren Side effects/Adverse reactions

Answer 22

Pregnancy category D

Angioedema, cough, diarrhea, dizziness, headache, hyperkalemia, hypotension

Question 23

Effects of Endothelin

Answer 23

blood vessels: Vasoconstriction (direct effect)
Mitogenesis 
Heart: Positive inotropic and chronotropic effects
Mitogenesis
kidneys: Vasoconstriction
Decreased glomerular filtration rate
Sodium and water excretion
Mitogenesis

Question 24

Bosentan clinical use

Answer 24

Pulmonary hypertension

Question 25

Bosentan side effects

Answer 25

Potential liver injury*, decrease in hemoglobin and hematocrit, not used in pregnant women

Question 26

Bosentan mech of action

Answer 26

Inhibition of endothelin receptors produces a decrease in pulmonary vascular resistance

Question 27

Conivaptan promotes

Answer 27

loss of water and vasodialation

Question 28

Conivaptan clinical use

Answer 28

Hyponatremia

Question 29

Conivaptan Side effects/Adverse Reactions

Answer 29

Thirst, headache, hypokalemia, vomiting, pollakiuria, peripheral edema, diarrhea, polyuria, phlebitis; pregnancy class C

Question 30

Bradykinin promotes

Answer 30

vasorelaxation in vascular smooth muscle

Question 31

Physiological Actions of Bradykinin

Answer 31

blood vessels: Relaxation of arterial smooth muscle Constriction of venous smooth muscle Increased capillary permeability increase Efflux of fluids from blood vessels to tissue lungs: Bronchoconstriction

Question 32

Physiological Actions of BNP

Answer 32

Direct relaxation of vascular smooth muscle decrease Pulmonary capillary wedge pressure (preload) decrease Endothelin 1 gene expression kidney: Increased natriuresis and diuresis Decrease renin secretion

Question 33

Nesiritide route of administration

Answer 33

IV or bolus injection/2 min

Question 34

Nesiritide Clinical Use

Answer 34

Acutely decompensated congestive heart failure

Question 35

Nesiritide Side effects/Adverse Reactions

Answer 35

Hypotension, tachycardia, Headache, abdominal pain, insomnia, dizziness, anxiety, nausea, vomiting; pregnancy class C