Chapter 4 CV and hematology drugs - vasodilators

Question 1

captopril
lisinopril
enalapril
remipril
benazepril
fosinopril
moxeipril
trandolapril
perindopril

ace inhibitors

Answer 1

• inhibits angiotensin converting enzyme (ACE) in lungs
• l/t reduced synthesis of vasoconstrictor, angiotensin II
• suppressing aldosterone => natriuresis
• potentiates other vasodilators (bradykinin, prostagladins)

indication
* HTN
* high renin HTN
* HTN patients w/ diabetic neuropathy d/c glucose levels not affected
* HF used with diuretics and digitalis
* MI —- enhance heart reperfusion

effects
* all: 1st dose hypotension
* dizziness
* proteinuria
* rash
* tachycardia
* headache
* cough

Captopril — causes agranulocytosis or neutropenia — 2-3 doses/day

interactions
* watch out for diuretics, sympathetic blockers
* increased serum K+ with potassium sparing diuretics
* decreased antihypertensive effects w/ indomethacin (nsaid)

used in conjunction with thaizide diuretic
immediate cessation indicated upon signs of potential angioedema (swelling of face, lips, eyelids, or difficulty breathing of swallowing)

Question 2

losartan (cozaar)
valsartan
irbesartan (avapro)
candesartan (atacand)
telmlsartan (micardis)
eprosartan (teveten)
olmesartan (benicar)
azilsartan (edarbi)

angiotensin II antagonists

Answer 2

• antagonist at angiotensin II receptor of vascular muscle

indication
HTN

effects
* hypotension, dizziness

contraindication
* pregnancy

interaction
* phenobarbital reduce level of losartan and metabolites

Question 3

epierenone (inspra)

aldosterone receptor antagonists

Answer 3

• blocks binding of aldosterone to mineralcorticoid receptor

indication:
* HTN
* CHF post MI

effects
* hyperkalemia
* nephrotoxicity

contraindication
* serum K+ > 5.5 meq/l
* creatinine clearance < 30 cc/min

interaction
* ketoconazole, itraconazole

Question 4

hydralyzine (apresoline)

direct vasodilators

Answer 4

• relaxes arterioles (not veins) independent of sympathetic interactions
• decreases BP l/t reflex tacycardia and increase cardiac output
• directly increases renal blood

indication
* mod HTN
* may be used in pregnant women who are hypertensive

effects
* reflex tachycardia
* palpitations
* fluid retention
* systemic lupus erythematosis-like syndrome (SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.)
* chronic therapy can l/t peripheral neuritis (d/t interference with vitamin B6 metabolism in neural tissue)

PO/IV/IM

contraindicated:
* patients with ishcemic heart disease

interactions
* potentiates other antihypertensives
* reduces vasoconstriction by sympathomimetic drugs

BETA BLOCKERS used concomitantly to reduce reflex tachycardia
Diuretics also used to adjunctively to reduce sodium and water retention

Question 5

monoxidil (loniten)

direct vasodilator

Answer 5

• relaxes arterioles (not veins) independent of sympathetic interactions
• decreases BP l/t reflex tacycardia and increase cardiac output
• directly increases renal blood

indication
* HTN not controlled by other drugs
* male pattern baldness!

effects
* cardiac muscle lesions
* pulmonary damage
* hirsutism
* reflex tachycardia
* palpitations
* fluid retention
* systemic lupus erythematosis-like syndrome (SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.)
* chronic therapy can l/t peripheral neuritis (d/t interference with vitamin B6 metabolism in neural tissue)

contraindication
* pt w/ ischemic heart disease

interaction
* profound orthostaic HTN in combination with guanethidine (antihypertensive)

Question 6

isoxsuprine (vasodilan)

direct vasodilator

Answer 6

skeletal muscle vasodilator

indication
* peripheral or cerebral vascular insufficiency

effects
* dizziness
* hypotension
* tachycardia
* GI distress

d/c if rash develops

Question 7

papverine (pavabid)

direct vasodilator

Answer 7

• smooth muscle dilator
• no specific mech

indication
* peripheral, cerebral and myocardial (with arrhythmias) ischemia

effects
* tachycardia sedation
* GI distress
* chronic hepatitis

bid

MAY inhibit levodopa

Question 8

nitrorusside (nipride)

direct vasodilator

Answer 8

• convert to nitric oxide => inducing cGMP
• cGMP stimulates phosphorylation/dephosphorylation cascade
• relaxes smooth muscle by dephosphorylating myosin

indication
* continuous IV infusion in hypertensive crisis

effects
* severe hypotension
* cyanide toxicity
* hepatotoxicity

full effect within 2 minutes and rapid loss of effect when infusion is d/c’d

dramatic changes iwth minimal infusion rate changes

Question 8

epoprostenal (flonan)

direct vasodilator

Answer 8

• pulmonary and systemic arterial vasodilation
• decerased platelet aggregation

indication
* primary pulmonary HTN

effects
* flushing
* headache,
* GI distress
* hypotension
* jaw pain

continuous IV requires pump for home use

contraindication
left ventricle CHF

Question 9

fenoldpam (corlopam)

Answer 9

• dopamine agonist (d1 selective)

indication
* HTN emergencies

effects:
* dose-related fall in BP
* inc in HR

IV continous infusion (5 min)

ICU ONLY