Diuretic, ACE Inhibitors and Angiotensin II receptor blockers (Week 3) Flashcards
Commonly used anticoagulants
- Warfarin
- Heparin (Unfractionated
- Low molecular weight heparins (Tinzaparin, Enoxaparin, Dalteparin)
- Apixaban
Classifications of Diuretic Drugs
- Carbonic anhydrase inhibitors
- Loop Diuretics
- Osmotic Diuretics
- Potassium-sparing diuretics
- Thiazide and Thiazide-like diuretics
Action of Loop Diuretics
Act primarily on the thick ascending limb of the loop of Henle, blocking chloride and sodium resorption…..
Movement of Loop Diuretics
Absorption:
Distribution:
Metabolism: Kidneys
Excretion: Urine
Common Adverse Effects of Loop Diuretics
CNS: Dizziness, headache, tinnitus, blurred vision
GI: Nausea, vomiting, diarrhea
Hemat: Agranulocytosis, thrombocytopenia, neutropenia
Metabolic: hypokalemia, hyperglycemia, hyperuricemia, hyponatremia, hypochloremia, hypocalcemia, hypomagnesemia, metabolic alkalosis in severe cases
Indications of Loop Diuretics
Manage edema associated with heart failure and kidney or liver disease, to manage hypertension, and to increase the kidney increase of calcium in patients with hypercalcemia. May also be indicated with heart failure from diastole dysfunction.
Action of Loop Diuretics
Act primarily on the thick ascending limb of the loop of Henle, blocking chloride and sodium resorption…..
Contraindications of Loop Diuretics
- Known drug allergy
- hepatic coma
- severe electrolyte loss
Interactions of Loop Diuretics
Loop diuretics have neurotoxic and nephrotoxic properties and produce additive effects when given in combination with other drugs with similar toxicities.
- Aminoglycosides
- Vancomycin
- Corticosteroids
- Digoxin
- Lithium Carbonate
- NSAIDs
Administration of Loop Diuretics
Dosage varies with drug and age of pt.
Mannitol - IV
Furosemide - IM, IV, PO
Examples of Thiazide Diuretics
- acetazolamide
- methazolamide
Movement of Thiazide Diuretics
Absorption:
Distribution:
Metabolism:
Excretion: Kidneys
Action of Thiazide Diuretics
- Site if action is at the convoluted tubule, where it inhibits the resorption of sodium, potassium, and chloride.
- Results in osmotic water loss.
- Cause direct relaxation of the arterioles, which reduces afterload
Contraindications of Thiazide Diuretics
- Known drug allergy
- Hyponatremia
- Hypokalemia
- Severe Kidney or Liver Dysfunction
- Adrenal Gland insufficiency
- Cirrhosis
Adverse Effects of Thiazide Diuretics
CNS: Dizziness, headache, blurred vision
GI: Anorexia, nausea, vomiting, diarrhea
GU: Erectile dysfunction
Hemat: Jaundice, leukopenia, agranulocytosis
Integumentary: Urticaria, Photosensitivity
Metabolic: Hypokalemia, glycosuria, hyperglycemia, hyperuricemia, hypochloremic alkalosis
Management of OD in Thiazide Diuretics
An overdose can lead to an electrolyte imbalance resulting from hypokalemia. Treatment includes electrolyte replacement.
Symptoms of OD of Thiazide Diuretics
- anorexia
- nausea
- lethargy
- muscle weakness
- mental confusion
- hypotension
Interactions of Thiazide Diuretics
- corticosteroids, antagonism
- diazoxide, additive (hypokalemia)
- digoxin, incr. digoxin toxicity
- oral hypoglycemics
- excessive consumption of licorice, hypokalemia
- Lithium, decreased clearance (incr. lithium toxicity)
- NSAIDs, inhibition of kidney prostaglandins (decr. diuretic activity.
Indications of Thiazide Diuretics
Treatment of:
- edema of various origins
- idiopathic hypercalciuria
- diabetes insipidus
- Heart failure due to diastolic dysfunction
Administration
PO varies by age
Examples of Potassium-Sparing Diuretics
- spironolactone
- amiloride
- eplerenone
- triamterene (only in combination with hydrochlorothiazide)
Movement of Potassium-Sparing Diuretics
Absorption:
Distribution:
Metabolism:
Excretion:
Action of Potassium-Sparing Diuretics
- Acts in the collecting ducts and distal convoluted tubules
- Interferes with sodium-potassium exchange
- Blocks the resorption of sodium and water induced by aldosterone
- Relatively weak and usually used adjunctive to thiazide as it counteracts its adverse effect of potassium loss
Contraindications of Potassium-Sparing Diuretics
- Known drug allergies
- Hyperkalemia
- Severe kidney failure
- Anuria
- Triamterene for liver failure
Common Adverse Effects of Potassium-Sparing Diuretics
CNS: Dizziness, headache
GI: Cramps, nausea, vomiting, diarrhea
Other: Urinary frequency, weakness, hyperkalemia
Interactions of Potassium-Sparing Diuretics
- Lithium, incr. lithium toxicity
- ACE inhibitors, hyperkalemia
- Potassium supplements, hyperkalemia
- NSAIDs, inhibit kidney prostaglandins, diminished diuretic response
Indications of Potassium-Sparing Diuretics
Spironolactone and triamterene - hyperaldosteronism - hypertension - potassium loss from potassium wasting Spironolactone - preventing remodeling in HF
Examples of Angiotensin II Receptor Blockers
- losartan
- eprosartan mesylate
- valsartan
- irbesartan
- candesartan cilexetil
Action of Angiotensin II Receptor Blockers
ARBs block the binding of angiotensin II to type 1 angiotensin II receptors. These receptors are thought to play a role in raising BP.
Movement of Angiotensin II Receptor Blockers
Absorption:
Distribution:
Metabolism:
Excretion:
Contraindications of Angiotensin II Receptor Blockers
- Drug allergy
- Pregnancy
- Lactation
- Use cautiously in older adults and patients with kidney dysfunction
- Assess BP before and during treatment
Most Common Adverse Effects of Angiotensin II Receptor Blockers
- Upper Respiratory Infections
- Headache
Interactions of Angiotensin II Receptor Blockers
- NSAIDs, decreased antihypertensive
- Lithium, Incr. lithium concentrations
- Phenobarbital, Increases metabolism
- Potassium Supplements and potassium-sparing diuretics, additive potassium-increasing affects
Management of Toxicity and OD of Angiotensin II Receptor Blockers
Manifests as hypotension, tachycardia, and sometimes bradycardia.
Treatment is symptomatic and supportive. Includes IV fluids to expand blood volume.
Indications of Angiotensin II Receptor Blockers
Treatment of Heart Failure and Hypertension
Examples of Angiotensin-Converting Enzyme (ACE) Inhibitors
- Benazepril hydrochloride
- Captopril
- Cilazapril
- Enalapril sodium
- Fosinopril sodium
- Lisinopril
- perinopril erbumine
- quinapril
- ramipril
- trandolapril
Movement of Angiotensin-Converting Enzyme (ACE) Inhibitors
Absorption:
Distribution:
Metabolism:
Excretion:
Action of Angiotensin-Converting Enzyme (ACE) Inhibitors
Inhibit angiotensin-converting enzyme, which converts angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and induces aldosterone secretion by adrenal glands. Aldosterone stimulates water and sodium resorption, which raises BP. By inhibiting these processes, BP is lowered.
Contraindications of Angiotensin-Converting Enzyme (ACE) Inhibitors
- Drug allergy esp. with hx of angioedema rx
- Baseline of potassium of 5 mmol/L
Adverse Effects of Angiotensin-Converting Enzyme (ACE) Inhibitors
- fatigue, dizziness, mood changes, headaches
- dry non-productive cough
- first dose hypotension
- loss of taste, hyperkalemia, rash, anemia, neutropenia, thrombocytosis, agranulocytosis
- in severe HF, kidney failure can occur
- monitor potassium levels
- inflammation of submucosal tissues, can progress to anaphylaxis
- angioedema
Toxicity and OD Management of Angiotensin-Converting Enzyme (ACE) Inhibitors
- Manifests as hypotension
- Treatment is symptomatic and supportive. Includes IV fluids to expand blood volume.
- Hemodialysis is effective for the removal of captopril and lisinopril
Interactions of Angiotensin-Converting Enzyme (ACE) Inhibitors
- NSAIDs can reduce antihypertensive effect
- Other antihypertensives can have a hypotensive effect
- Lithium, can cause lithium toxicity
- Potassium supplements and potassium-sparing drugs can cause hyperkalemia
Indications of Angiotensin-Converting Enzyme (ACE) Inhibitors
- Heart Failure
- HTN with pt that has HF
- stops the progression of left ventricular hypertrophy
- Prevents the progression of diabetic nephropathy
