Cardiovascular Drugs: Antihypertensives Flashcards
LIst drug classes that can be used to decrease preload
diuretics
nitroglycerin
RAAS drugs
sodium nitroprusside
PDE inhibitor
List drug classes that can be used to decrease afterload
hydralazine
RAAS drugs
dihydropyridines
minoxidil
sodium nitroprusside
list drug classes that can be used to decrease contractility
B1 antagonists
calcium channel blockers
list drug classes that can be used to increase contractility
digoxin
B1 agonists (dobutamine)
dopamine
PDE inhibitor
list drug classes that can be used to regulate (decrease) heart rate
B1 antagonists
calcium channel blockers
Are diuretics used for hypertension?
yes
Explain the RAAS
angiotensinogen produced in liver
renin produced in kidneys
renin catalyzes angiotensinogen –> ang2
ACE (high concentration in lungs) catalyzes ang1 –> ang2
ang2 = ADH secretion, vasoconstriction, aldosterone increase (Na+/water retention)
Mechanism of action of ACE inhibitors
inhibit ACE, thus inhibit ang2 formation.
–> vasodilation, decreased aldosterone, decreased CV remodeling
aldosterone results in:
Na+/H2O retention
CV remodeling
list some ACE inhibitors
lisinopril
enalopril
captopril
benazepril
route of administration of ACE inhibitors
PO except enalopril (IV)
Major adverse effects of ACE inhibitors
**dry cough
**angioedema (rare)
first dose hypotension
hyperkalemia
are ACE inhibitors approved for use during pregnancy
no
How do ARBs (angiotensin II receptor blockers) work?
block the effects of ang2 at the receptor
What are the major differences between ACE inhibitors and ARBs?
ARBs don’t result in as much cough/angioedema risk
ARBs don’t result in as much aldosterone suppression (lower hyperK+ risk)
ARBs may not prevent cardiovascular remodeling as well
How do direct renin inhibitors work?
inhibit the release of renin and thus block the entire RAAS
What is the first line RAAS drug in prevention of cardiac morbidity and mortality?
ACE inhibitors
List a direct renin inhibitor
aliskiren
List some ARBs
losartan
valsartan
cadesartan
How do the aldosterone antagonists work?
block the effects of aldosterone = K+ retention, Na+/H2O excretion
List some aldosterone antagonists
spironolactone
eplerenone
Adverse effects of aldosterone antagonists?
hyperK+
endocrine effects with spironolactone
What are the cardiac outcomes of beta 1 antagonism
decreased HR
decreased contractility
decreased AV node conduction
What does B1 agonism do in the kidney
stimulate renin release (RAAS activation)
What do calcium channel blockers do in the heart?
same as B1 blockers
decreased HR
decreased AV node conduction
decreased contractility
What do calcium channel blockers do in the vasculature?
vasodilation
Which class of calcium channel blockers work only in the vasculature?
Dihydropyridines
What is the difference between dihydropyridines and nondihydropyridines?
Nondihydropyridines block calcium channels in the heart and vasculature; dihydropyridines block calcium channels in the vasculature only
What do you expect to HR & BP after dihydropyridine administration?
decrease BP
reflex tachycardia
what do you expect to happen to HR & BP after nondihydropyridine administration?
decrease BP
decrease HR
list some dihydropyridines
nifedepine
amlodipine
nicardipine
nimodipine
list some nondihydropyridines
verapamil
diltiazem
What is the effect of arteriole vasodilation
decreased afterload
= increased cardiac output, increased tissue perfusion
what is the effect of venous vasodilation?
decreased preload
= decreased ventricular filling & contractility = decreased cardiac output & decreased tissue perfusion
Does venous or arteriole vasodilation result in more orthostatic hypotension?
venous
(more pooling in the very large capacitance vessels)
Does venous or arteriole vasodilation result in more reflex tachycardia?
Arteriole
(baroreceptors are located in the arteries)
What does hydralazine result in?
Direct arteriole vasodilation
reflex tachycardia
long term use = fluid retention
What vasodilator works the FASTEST?
sodium nitroprusside
Does sodium nitroprusside dilate the veins or the arteries?
both
What is the maximum length of time recommended for sodium nitroprusside infusion?
3 days
Do the organic nitrates result in more venous or more arteriole vasodilation?
venous
List some organic nitrates
nitroglycerin
isosorbide mononitrate
isosorbide dinitrate
What is the active substance of the organic nitrates?
nitric oxide (NO)
What is the route of administration of nitroglycerin?
IV (continuous infusion d/t short half life)
sublingual
buccal
transdermal
PO
What is the route of administration of isosorbides?
PO
What is the route of administration of sodium nitroprusside?
IV (continuous infusion d/t short half life)
Points of patient education when administering nitroglycerin transdermal?
Show how to measure out the dose
Ensure 8+hrs/day “drug free” (to avoid tolerance development)
- usually at night when angina isn’t provoked
