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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

Bradykinin promotes

vasorelaxation in vascular smooth muscle