Flashcards in Vasoactive Dialators Deck (35)
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1
Biological Effects of Angiotensin II
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
2
Vascular effects of ACE-I and ARB
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
3
Cardiac Effects of ACE-I and ARB
Decreased preload and afterload
No change, or an increase, in cardiac output
Reverse hypertrophy
4
Renal Effects of ACE-I and ARB
Renoprotective
Decreased proteinuria
Increased renal blood flow
Decreased kaliuresis that may result in HYPERKALEMIA
Preferential dilation of efferent arterioles,
which reduces intraglomerular pressure
5
Other Effects of ACE-I and ARB
decrease Pulmonary vascular resistance
decrease Pulmonary capillary wedge pressure (preload)
Decreased sympathetic outflow
Decreased aldosterone production
Improved insulin sensitivity
6
Clinical Uses of ACE Inhibitors
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
7
Clinical Uses of ARBs
HF
Diabetic Nephropathy, Proteinuria
HTN with LVH (to reduce stroke), Diabetic Nephropathy, Proteinuria
Left ventricular failure or left ventricular dysfunction post-MI, HF
8
Treatment of Systolic-Diastolic Hypertension without Other Compelling Indications
ACE-I and ARB
9
Treatment of Isolated Systolic Hypertension without Other Compelling Indications
ARB (hasn't been tested in ACE-Is)
10
When are ACE-I and ARB first-line therapy for hypertension?
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
11
What are the preferred antihypertensive combinations?
ACE I or ARB + Thiazide
ACE I or ARB + DHP CCB
12
Renin Inhibitor
Aliskiren
13
Angiotensin-Converting Enzyme Inhibitors
Captopril
Benazepril
Enalapril
Lisinopril
Quinapril
Ramipril
14
Angiotensin Receptor Blockers
Candesartan
Irbesartan
Losartan
Valsartan
15
ET Receptor Antagonist
Bosentan
16
Vasopressin Receptor Antagonist
Conivaptan
17
Synthetic BNP Analog
Nesiritide
18
ACEI: Adverse Effects
Dry cough,
angioedema, hypotension, hyperkalemia.
19
ACEI: Contraindications
Renal artery stenosis, K+ sparing diuretics, ARB, NSAIDs
20
ACE-I and ARB aren't good for ___________ in the kidney
Renal artery stenosis
21
Aliskiren clinical use
Hypertension
22
Aliskiren Side effects/Adverse reactions
Pregnancy category D
Angioedema, cough, diarrhea, dizziness, headache, hyperkalemia, hypotension
23
Effects of Endothelin
blood vessels: Vasoconstriction (direct effect)
Mitogenesis
Heart: Positive inotropic and chronotropic effects
Mitogenesis
kidneys: Vasoconstriction
Decreased glomerular filtration rate
Sodium and water excretion
Mitogenesis
24
Bosentan clinical use
Pulmonary hypertension
25
Bosentan side effects
Potential liver injury*, decrease in hemoglobin and hematocrit, not used in pregnant women
26
Bosentan mech of action
Inhibition of endothelin receptors produces a decrease in pulmonary vascular resistance
27
Conivaptan promotes
loss of water and vasodialation
28
Conivaptan clinical use
Hyponatremia
29
Conivaptan Side effects/Adverse Reactions
Thirst, headache, hypokalemia, vomiting, pollakiuria, peripheral edema, diarrhea, polyuria, phlebitis; pregnancy class C
30
