Drugs Used for Heart Failure and Hypertension Flashcards
The functioning unit of the kidney is the
nephron
the door into the kidney is
afferent arteriole
The rotary—
the glomerulus (a capillary plexus) where filtration takes place
the door out of the kidney
the efferent arteriole
MI can lead to
heart failure
heart failure does not mean
coronary heart disease
At any given moment, the kidney is
“sensing” the pressure and volume of blood flow throughout the body
efferent arteriole
will increase pressure in capillary so stuff can be pushed out of tubules
toxins in kidneys go out vessels through
the loop of Henle out through urine , along this pathway things get absorbed or pushed out
if excess fluid then makes the heart
work harder so increasing preload, so overwhelming heart pumps by excessive fluid
With low volume or low BP, the kidney will release
Renin** from a small area (juxtaglomerulus apparatus) just inside the afferent arteriole
Renin (the messenger)→
(liver) angiotensin 1→angiotensin 2→ via Angiotensin Counting Enzyme (ACE)
Angiotensin 2 triggers the release of
“AL” (Aldoesterone) from the adrenal cortex causing sodium and water retention
Angiotensin 2 tells every vessel to
vasoconstrict so increases bp to the kidney
What does angiotensin 2 “tense”
“Tenses” your “angios”— vasocontricts
What does angiotensin 2 trigger the release of
“AL”—aldosterone (from the adrenal cortex to save Na+ & H2O
Wheredoes angiotensin 2 increase inflammation
in the arteries
What does angiotensin 2 increase with tissues
Increases tissue resistance to insulin; so doesn’t let it do what it needs to do w/ blood glucose
What factors do angiotensin 2 have
Prothrombotic - clot producing factor; Potent growth factor
Drugs that influence the RAA (Renin Angiotensin Aldosterone) system
1.Direct renin inhibitor (DRI) 2.ACE inhibitor 3. Angiotensin Receptor Blockers (ARBs) 4. Drugs that block aldosterone
Direct renin inhibitor (DRI)
aliskiren (Tekturna); tells JGA to shut off renin production
ACE inhibitors
captopril (Capoten); typically end with prill
Angiotensin Receptor Blockers (ARBs)
block angiotensin at the tissue receptor: losartan (Cozaar), valsartan (Diovan); similar to ACE inhibitors
Drugs that block aldosterone
spironolactone (Aldactone)
“Prils”
ACE inhibitors (Derived from venom of Brazilian pit viper); Captopril (Capoten), Enalapril (Vasotec), Benazepril (Lotensin)
ACE Inhibitors Function:
anti-hypertensive, to treat CHF, anti-inflammatory, anti-thrombotic, hypoglycemic, decrease growth of tissue “remodeling”
ACE Inhibitors as Anti-hypertensive agents via
vasodilation and inhibition of aldosterone (Na+ and H20 diuresis)
ACE Inhibitors treat CHF why?
CHF is a hyperreninemic state (low volume/low pressure as the heart is not pumping effectively)—increased renin—angiotensin—aldosterone—the PRILS stop the vicious cycle
ACE Inhibitors provide a ________ effect
a Hypoglycemic effect (be careful when starting ACE inhibitors in diabetics on anti-glycemic drugs) - diabetes have poor circulation and swinging blood glucose levels so over time have damage to vessels
ACE Inhibitors Decrease growth of tissues or “remodeling”
not good when talking about heart; angie 2 remodels heart and disrupts conduction, it reshapes left ventricle and increases growth of tissues, leads to dysrythmia
if pt on ACE then pt will
go to the bathroom more
if the ACE inhibitor is blocking the absorption of Na and H2O
then will excrete them
In your heart after a myocardial infarction–
angiotensin 2 remodels and enlarges the myocardium and disrupts the conduction system…
In your heart with chronic heart failure–
remodeling increases the risk of ventricular dysrhythmias
Angiotensin increases
vascular fibrosis resulting in hypertension
Angiotensin vasoconstricts & increases
inflammation in arteries
Angiotensin increases intraglomerular blood pressure resulting in
intraglomerular hypertension leading to CKD (chronic kidney disease)
“Angie” is a _____________ girl…
bad
ACE inhibitors are used: To decrease the risk of
of 1st and 2nd myocardial infarctions in high-risk patients due to anti-inflammatory effects
ACE inhibitors are used:for prevention of
strokes, diabetic nephropathy, and diabetic retinopathy
ACE inhibitors are used: to decrease
insulin resistance and reduce the risk of progression to type 2 diabetes
ACE inhibitors are used for Prevention of diabetic nephropathy by
destroying vessels in the nephron
ACE inhibitors are used for Prevention of diabetic retinopathy by
destroying vessels in the retina
side effects of ACE inhibitors
hypotension, hyperkalemia, hypoglycemia, cough, angiodema
hyperkalemia and ACE inhibitors
excreting sodium and water and retaining potassium; the higher the K the less the heart contracts, so k can stop the heart
never give _____ through an IV push
Potassium
hypoglycemia and ACE inhibitors
especially when the patient is already on hypoglycemic drugs
cough with ACE inhibitors
dry, hacking cough
angioedema
lip and tongue swelling most common- almost like an allergic reaction
What is the mechanism of the ACE inhibitor-induced angioedema?
Angiotensin Converting Enzyme normally breaks down bradykinin, a potent vasodilator
ACE inhibitors inhibit the breakdown of bradykinin resulting in
The accumulation of bradykinin with 2 effects: 1) vasodilation 2) increased permeability
