Unit 4-Heart Failure/Inotropic agents Flashcards
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Drug class
ACE inhibitor
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Mechanism
Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Uses
1st-line for CHF; inhibit LV remodeling post-MI
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Side effects
Dry cough, angioedema, hyperkalemia, hypotension
Short-acting; contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Drug class
Angiotensin Receptor Blocker (ARB)
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Mechanism
Blocks type 1 angiotensin II receptors (stimulates vascular smooth muscle contraction, dilates arteries and veins, promotes renal excretion of Na and water, inhibits cardiac & vascular remodeling)
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Uses
Used in place of an ACEI when cough is an issue
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Side effects
Angioedema, hyperkalemia, hypotension
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Drug class
β-blockers
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Mechanism
Blocks high circulating levels of catecholamines
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Uses
Dramatically decreases mortality in CHF patients
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Side effects
Should be started at very low dose and slowly ratchet up; do not stop suddenly
Diuretics
Mechanism
Decrease volume and preload
Diuretics
Uses
Improve arterial distensibility; reduce preload
Diuretics
Side effects
Volume contraction, electrolyte depletion; causes neurohormonal activation
Contraindication in hypovolemic patients