CH 31: ACEI & ARBs Flashcards
What are ACE inhibitors?
what are they used for? what do they do?
- = first-line agents in treatment of HTN and HF
- block conversion of angiotenin I to angiotensin II (occurs in lungs)
- results in decr in BP + HR
- decrease in aldosterone secretion reduces blood volume
- breaks down bradykinin (similar to histamine)
Drugs affecting renin-angiotensin-aldosterone system
How to decide which drug to use for HTN?
primary vs secondary htn treatment
primary: due to genetics, treatment = hydrochlorothiazide
secondary - drug of choice = ACE for kidney protection / heart if CVS problems
Indications for ACE inhbitoris?
Drugs affecting renin-angiotensin-aldosterone system
- slows progression of HF
- lower mortality of recent acute MI
- prophylaxis for adverse cardiac events
- prevent or delay progression of renal disease and retinopathy of diabetics
ACE inhibitors - serious AEs & contraindications?
Drugs affecting renin-angiotensin-aldosterone system
- contraindicated in hyperkalemia
- caution when using ACEI with K+ sparing diuretics (don’t give with spironolactone)
- watch K+ levels
- angioedema most serious –> rapid swelling of throat, face, larynx, tongue that can lead to airway obstruction
- all have black box warning regarding risk for major congenital defects, esp 2nd & 3rd trimester
Lisinopril: therapeutic effects + uses
ACE inhibitor/ antiHTN
- HF
- HTN
- acute MI
What is the prototype drug for ACEI?
therapeutic classification & pharmacological classification?
lisinopril (Prinivil, Zestril)
therapeutic classification: antihypertensive
pharmacologic classification: ACEI
Lisinopril: mechanism of action?
ACEI/ antiHTN
- binds to and inhibits action of ACE
- decr in serum angiotensin II reduces aldosterone, which results in less sodium and water retetion
Lisinopril - what are the AEs?
ACEI/ antiHTN
- cough
- headache
- dizziness
- orthostatic hypotension
Lisinopril: what are the serious AEs?
ACEI/antiHTN
- angioedema
- agranulocytosis (abnormal bld levels)
- hepatotoxicity
Lisinopril - contraindications?
ACEI/antiHTN
- pregnancy - category D
- angioedema
- hyperkalemia
- serious renal impairment
lisinopril - any nursing considerations?
KNOW THIS!!!
ACEI/anti-HTN
- check renal labs and K+ levels for hyperkalemia
- monitor BP before administration and 30min to 1 hour after
lisinopril - drug interactions?
- decreased antiHTN activity and worsened renal disease (NSAIDs –> GI + GFR = kidneys)
- synergistic hypotensive action (diuretics + other hypotensives)
- hyperkalemia (K+ supplements, potassium-sparing diuretics)
- pregnancy category C (1st trimester), category D (2nd & 3rd)
lisinopril - treatment of overdose?
- normal saline or vasopressor
- hemodialysis
Angiotensin II receptor blockers (ARBs) - what are they used for? how do they work?
- act by inhibiting AT1 receptor and are used for HTN + HF
- block angiotensin II form activating their target receptors in smooth muscle
- cause vasodilation, reduce PR, decr BP
- prevent aldosterone secretion
- promote excretion of Na+ & h2o by kidneys
what are the indications for ARBs? contraindications?
- same as ACEI
- HTN, HF
- some approved to treat MI and prophylaxis of CVA
- unlike ARBs, don’t cause cough
- angioedema less common than ARBs
What is the prototype drug for ARBs?
therapeutic & pharmacologic classification?
prototype = losartan (Cozaar)
therapeutic classification: antiHTN
pharmacologic: angiotensin II receptor blocker
losartan - what are the therapeutic effects/uses?
ARBs
- HTN
- CVA prophylaxis
- prevention of diabetic neuropathy
- off-label use for HF
losartan - what is the mechanism of action?
- selectively blocks angiotensin AT1 receptors, resulting in decreased BP
- blockade prevents cardiac remodelling and deterioration of renal function in pts with diabetes (protects heart & kidneys)
losartan - any drug interactions?
- decr antiHTN activity w/ NSAIDs
- additive hypotensive action w/ diuretics & other hypotensives
- hyperkalemia –> K+ supplements, potassium-sparing diuretics
- additive hypotensive effect (alcohol)
