Cardiovascular pharmacology VII Flashcards
what are the ACE inhibitor agents?
- captopril
- lisinopril
- fosinopril
what is the mechanism of action for the ACE inhibitors?
- decreases amount of circulating angiotensin II
2. bradykinin concentration builds up (vasodilation)
the ACEI effect may be very potent in which populations?
patients with high plasma renin levels
- heart failure
- sodium depleted patients
ACEIs should be avoided in which population?
pregnant women
ACEIs have potentially favorable effects in which population?
prediabetes
what are the potentially unfavorable effects of ACEIs?
- hyperkalemia
2. volume depression
what are the adverse effects of ACEIs?
- hypotension
2. coughing
what are the angiotensin I blockers?
- losartan
- valsartan
- candesartan
what is the mechanism of action for the angiotensin I blockers?
block binding of angiotensin II to AT1 receptor
what is the role of calcium channel blockers for hypertension?
add on therapy for diabetes and coronary artery disease
which calcium channel blocker class has more of a vascular action?
dihydropyridine (10:1 action compared to NDHP)
what are the calcium channel blocker drugs for hypertension?
- nifedipine
- amlodipine
- felodipine
calcium channel blockers used for hypertension should be avoided in which population?
LV dysfunction
what are the favorable effects of calcium channel blockers for hypertension?
elderly patients with isolated systolic HTN
what are the unfavorable effects of calcium channel blockers for HTN?
high-normal HR or tachycardia
what is the role of NDHP calcium channel blockers in HTN?
alternative to beta blockers in coronary artery disease - block decreased cardiac contraction
what are the indications for NDHP calcium channel blockers for HTN?
- migraine
- arrhythmias
- high-normal HR or tachycardia
what is the role of thiazide diuretics for HTN?
- uncomplicated HTN
- LV dysfunction (first line)
- previous ischemic stroke (first line)
- patients with osteoporosis (increases calcium reuptake)
what are the adverse effects of using thiazide drugs for HTN?
- gout
- hyponatremia
- hypokalemia
what are the indications for beta blockers for HTN?
- coronary artery disease
2. LV dysfunction
what are the indications for aldosterone blockers for HTN?
- add on for resistant HTN
2. add on for coronary artery disease and LV dysfunction
what are the favorable effects of aldosterone blockers for HTN?
- low-normal potassium
2. chronic kidney disease
what are the adverse effects of aldosterone blockers for HTN?
high-normal potassium
what is the role of a1 receptor blockers in HTN (prazosin, doxazosin, terazosin)?
- very effective especially with diuretic
2. added benefits of lowered LDL, TG, and total cholesterol
a-methyldopa (a2 agonist) is good for what condition?
- gestational hypertension
2. chronic hypertension in pregnancy
what is the MOA of hydralazine?
- arterial vasodilator
- decreases IP3 induced calcium release from smooth muscle SR - decreased contraction
- opens calcium activated potassium channels in smooth muscle - relaxation
- relaxes arterioles
what is the role of hydralazine in HTN?
- resistant HTN add on
- severe chronic kidney disease
- gestational HTN
what are the adverse effects of hydralazine?
- drug induced lupus (long use)
- compensatory tachycardia and sodium retention
should be used in combination with diuretic and beta blocker or NDHP CCB
what is the MOA of minoxidil?
- arterial vasodilator - direct
2. potassium channel opener - relaxes arteriolar VSMCs
what is the role of minoxidil in HTN?
- only used for severe refractory HTN
2. used in combination with beta blockers and diuretics
what is the MOA of sodium nitroprusside?
- arterial vasodilator
- donates NO - cGMP mediated calcium sequestration
- decreases preload and afterload
sodium nitroprusside is good for what condition?
acute MI
what is the MOA of aliskiren?
- direct renin inhibitor
2. binds directly to catalytic site of renin - prevents cleavage of angiotensinogen to generate angiotensin I
what is the contraindication for aliskiren?
pregnancy
what is the MOA of reserpine?
- rauwolfia alkaloid
- blocks transport of NE into storage vesicles
- depletes NE from sympathetic nerve endings
- decreases sympathetic tone, PVR, BP
- depletes catecholamines in brain and myocardium - sedation, depression, decreased CO
what is the role of reserpine in HTN?
combination with a thiazide diuretic
what is the preferred thiazide agent for resistant HTN?
chlorthalidone
what is idea behind renal sympathetic denervation in treating resistant HTN?
decrease sympathetic outflow to kidney to ultimately decrease renin output
