Week 4 AntiHypertensives & Vasodilators

Question 1

Describe the Renin-Angiotensin-Aldosterone Pathway

Answer 1

Hypovolemia/Hyponatremia/Decreased SNS Tone–>
Juxtaglomerular Cells release–> Renin–>
Converts Angiotensinogen to Angiotensin 1–>
Lungs release–> ACE–>
Converts Angiotensin 1 to Angiotensin 2–>
Activation of Aldosterone Secretion & AT1 Receptors–>
Causes: Vasoconstriction, Salt & Water Retention, Cardiac remodeling, SNS Activation, Vasopressin (ADH) secretion

Question 2

ACE Inhibitor names end in ______.
Mechanism of Action
Common Side Effects of ACE Inhibitors

Answer 2

• pril
• Inhibits ACE preventing the conversion of Angiotensin 1 into Angiotensin 2
• Angioedema (d/t Bradykinin), Cough, Hyperkalemia
• *Should be AVOIDED in PREGNANCY**

Question 3

Should ACE Inhibitors & NSAIDs be given together?

Answer 3

NO!

Question 4

Which ACE Inhibitor can be given IV?

Answer 4

Enalopril

Question 5

ARB names end in ______.

Mechanism of Action

Answer 5

• sartan
• Block Angiotensin 2 from binding to Angiotensin 1 Receptors preventing vasoconstriction, SNS activation, & Cardiac Remodeling
• *Should be AVOIDED in PREGNANCY-causes fetal morbidity**

Question 6

Name the Dihydropyridine Ca2+ Channel Blockers.

Do these work more on the blood vessels or heart?

Answer 6

Nifedipine, Amlodipine, Nicardipine, Clevidipine, Nimodipine

Work more on the blood vessels (vascular smooth muscle)-Vasodilation

Question 7

Name the Non-Dihydropyridine Ca2+ Channel Blockers.

Do these work more on the blood vessels or heart?

Answer 7

Verapamil & Diltiazem

Work more on the heart-Negative inotropic & Chronotropic activity (L-type Ca2+ Channels)

Question 8

When is Nifedipine used?

Answer 8

Printz Metal Angina

Question 9

TRUE/FALSE Volatiles have Ca2+ Channel Antagonist effects similar to Ca2+ Channel Blockers.

Answer 9

TRUE, use caution when using together!

Question 10

TRUE/FALSE Ca2+ Channel Blockers do NOT potentiate the effects of NMBs.

Answer 10

FALSE, they potentiate the effects of both Depolarizing & Non-Depolarizing NMBs causing reversal impairment

Question 11

Which Ca2+ Channel Blocker has Local Anesthetic properties?

Answer 11

Verapamil

Question 12

What happens when Dantrolene is used in a patient on a Ca2+ Channel Blocker?

Answer 12

May Result in Hyperkalemia & Cardiac Collapse

Question 13

Name 2 NitroVasodilating Drugs

What is the Mechanism of Action?

Answer 13

Sodium Nitroprusside & Nitroglycerin
MOA: Donates Nitric Oxide (NO) through the vascular endothelium–> activates guanylate cyclase–>
converts to GTP–>then converts to cGMP–>
DIRECT VASODILATION (smooth muscle relaxation)

Question 14

Hydralazine
Mechanism of Action
Dose

Answer 14

Direct Arteriole relaxation by activating guanylate cyclase

Dose: 2.5-10mg IV (Start SMALL! Unpredictable!)