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ACE Inhibitors and Cardiovascular Effects
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ACE Inhibitors and Cardiovascular Effects

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Questions and Answers

What is the primary mechanism of action of organic nitrates?

  • Blockade of β1 receptors leading to vasorelaxation
  • Blockade of calcium channels leading to vasorelaxation
  • Generation of adrenaline leading to vasorelaxation
  • Generation of NO leading to vasorelaxation (correct)

    • What is the primary effect of β-blockers on cardiac oxygen demand?

  • Decrease cardiac contractility
  • Decrease cardiac oxygen demand (correct)
  • Increase cardiac oxygen demand
  • Increase cardiac output

    • What is the primary effect of Ca++ channel blockers on cardiac oxygen demand in classic angina?

  • Decrease cardiac oxygen demand (correct)
  • Increase cardiac output
  • Increase cardiac oxygen demand
  • Decrease cardiac contractility

    • What is the side effect of β-blockers that can worsen asthma?

    <p>Bronchospasm</p> Signup and view all the answers

    What is the primary effect of Ca++ channel blockers on cardiac oxygen supply in variant angina?

    <p>Increase cardiac oxygen supply</p> Signup and view all the answers

    What is the side effect of Ca++ channel blockers that is not responsive to diuretics?

    <p>Ankle edema</p> Signup and view all the answers

    What is the mechanism of action of organic nitrates that leads to increased oxygen supply?

    <p>Vasorelaxation</p> Signup and view all the answers

    What is the primary effect of β-blockers on cardiac output?

    <p>Decrease cardiac output</p> Signup and view all the answers

    What is the side effect of Ca++ channel blockers that can lead to poor left ventricular filling?

    <p>Decreased contractility</p> Signup and view all the answers

    What is the cardiovascular effect of organic nitrates that leads to decreased cardiac work?

    <p>Venodilation</p> Signup and view all the answers

    What is the definition of Angina Pectoris?

    <p>Sudden pain beneath the sternum, often radiating to the left shoulder and arm</p> Signup and view all the answers

    What is the primary cause of anginal pain?

    <p>Insufficient oxygen supply to the heart</p> Signup and view all the answers

    What is the most common underlying condition leading to anginal pain?

    <p>Atherosclerosis of the coronary arteries</p> Signup and view all the answers

    What is the primary action of anti-angina drugs?

    <p>Decreasing oxygen demand by the heart</p> Signup and view all the answers

    What is the role of arteriovenodilators in hypertensive emergencies?

    <p>Decreasing blood pressure</p> Signup and view all the answers

    What is the effect of insufficient oxygen supply to the heart?

    <p>Anginal pain</p> Signup and view all the answers

    What is the underlying pathology of atherosclerosis?

    <p>Narrowing of the coronary arteries</p> Signup and view all the answers

    What is the primary consequence of atherosclerosis of the coronary arteries?

    <p>Decreased oxygen supply to the heart</p> Signup and view all the answers

    What is the relationship between anginal pain and oxygen demand?

    <p>Anginal pain is caused by insufficient oxygen supply to meet oxygen demand</p> Signup and view all the answers

    Which of the following is NOT a type of direct vasodilator?

    <p>Beta blocker</p> Signup and view all the answers

    What is the primary mechanism of action of hydralazine?

    <p>Direct vasodilation</p> Signup and view all the answers

    Which of the following is an example of a venodilator?

    <p>Nitroglycerine I.V.</p> Signup and view all the answers

    What is the effect of diazoxide on blood vessels?

    <p>Vasodilation</p> Signup and view all the answers

    Which of the following is NOT a direct vasodilator?

    <p>Metoprolol</p> Signup and view all the answers

    What is the effect of direct vasodilators on blood vessels?

    <p>Relaxation and dilation</p> Signup and view all the answers

    Which of the following is an example of an arteriodilator?

    <p>Hydralazine</p> Signup and view all the answers

    What is the main mechanism of action of organic nitrates in the treatment of angina?

    <p>Vasorelaxation through generation of NO</p> Signup and view all the answers

    What is the primary cardiovascular effect of β-blockers in angina treatment?

    <p>Decrease in cardiac oxygen demand</p> Signup and view all the answers

    What is the side effect of β-blockers that can mask a hypoglycemic coma?

    <p>Bradycardia and hypoglycemic coma</p> Signup and view all the answers

    What is the effect of Ca++ channel blockers on cardiac oxygen supply in variant angina?

    <p>Increase in cardiac oxygen supply</p> Signup and view all the answers

    What is the common side effect of Ca++ channel blockers that is not responsive to diuretics?

    <p>Dizziness and ankle edema</p> Signup and view all the answers

    What is the cardiovascular effect of organic nitrates that leads to decreased cardiac work?

    <p>Increase in venous dilation</p> Signup and view all the answers

    What is the primary effect of β-blockers on cardiac output?

    <p>Decrease in cardiac output</p> Signup and view all the answers

    What is the side effect of Ca++ channel blockers that can lead to poor left ventricular filling?

    <p>Decrease in contractility</p> Signup and view all the answers

    What is the primary cardiovascular effect of Ca++ channel blockers in classic angina?

    <p>Decrease in cardiac oxygen demand</p> Signup and view all the answers

    What is the common side effect of β-blockers?

    <p>Dizziness and weakness</p> Signup and view all the answers

    What is the primary goal of treating heart disease with certain classes of drugs?

    <p>Improve survival and slow disease progression</p> Signup and view all the answers

    Which of the following classes of drugs is effective in treating heart disease?

    <p>ACE inhibitors, beta blockers, diuretics, and aldosterone antagonists</p> Signup and view all the answers

    What is the benefit of using ACE inhibitors in heart disease treatment?

    <p>Improve survival and slow disease progression</p> Signup and view all the answers

    Which of the following is NOT a benefit of using beta blockers in heart disease treatment?

    <p>Increase cardiac oxygen demand</p> Signup and view all the answers

    What is the role of diuretics in heart disease treatment?

    <p>Reduce blood pressure and alleviate fluid buildup</p> Signup and view all the answers

    Study Notes

    ACE Inhibitors

    • Decrease blood pressure by decreasing peripheral resistance without affecting cardiac output or heart rate
    • Do not cause reflex tachycardia, making them safe for patients with ischemic heart disease

    Diuretics

    • Thiazide diuretics: Hydrochlorothiazide
    • Loop diuretics: Frusemide
    • Potassium-sparing diuretics: Spironolactone, Triamterene

    Calcium Channel Blockers

    • Mechanism of action: block calcium channels
    • In the heart: decrease heart rate and contractility, thus decreasing cardiac output
    • In blood vessels: vasodilation, decreasing peripheral resistance
    • Examples: Non-Dihydropyridine (Diltiazem, Verapamil), selective to the heart

    Beta Blockers

    • Mechanism of action: act mainly by blocking β1 receptors, decreasing heart rate
    • Examples: Non-selective β-blockers (Propranolol, Carvedilol), selective β1-blockers (Atenolol, Bisoprolol)
    • Adverse effects: bradycardia, fatigue, cold extremities, erectile dysfunction, bronchospasm (especially non-selective)
    • Interactions: increased toxicity with other negative inotropic drugs (e.g., verapamil, lidocaine)

    Organic Nitrates

    • Mechanism of action: generation of NO leading to vasorelaxation
    • Cardiovascular effects: increase O2 supply, decrease cardiac work (decrease O2 demand) by vasodilation
    • Side effects: venodilation (postural hypotension, reflex tachycardia, dizziness, syncope), arteriodilation (throbbing headache, flushing), tolerance

    Beta Blockers (Cardiovascular Effects)

    • Reduce anginal pain by decreasing cardiac O2 demand through blockade of β1 receptors
    • Side effects: dizziness, weakness, headache, impotence, β2 blocking (bronchospasm, disturbance of blood glucose and lipid levels, masking hypoglycemic coma, bradycardia)

    Ca++ Channel Blockers (Angina)

    • In classic angina: reduce anginal pain by decreasing cardiac oxygen demand
    • Decrease heart rate and contractility
    • Decrease arterial pressure (afterload)
    • In variant angina: promote relaxation of coronary artery spasm, increasing cardiac O2 supply

    Ca++ Channel Blockers (Side Effects)

    • Arterial dilation: headache, flushing, dizziness, ankle edema (not responding to diuretics, especially nifedipine)
    • Decrease contractility: poor left ventricular filling
    • Heart block (especially with β-blockers and digoxin)

    Heart Failure

    • Definition: congestive heart failure

    Adverse Effects of ACE Inhibitors

    • Dry cough (5-30%)
    • Angioedema
    • Hyperkalemia
    • Teratogenic (not used in pregnancy)

    Diuretics

    • Mechanism of action: decrease blood volume, cardiac output, and blood pressure
    • Decrease blood pressure due to decreased cardiac output

    Beta Blockers

    • Mechanism of action: block β1 receptors, decreasing heart rate
    • Examples: non-selective β-blockers (Propranolol, Carvedilol), selective β1-blockers (Atenolol, Bisoprolol)
    • Adverse effects:
      • Bradycardia
      • Fatigue
      • Cold extremities
      • Erectile dysfunction
      • Bronchospasm (especially non-selective)

    Interactions of Beta Blockers

    • Increased toxicity with other -ve inotropic drugs (e.g., verapamil, lidocaine)

    Centrally Acting Adrenergic Drugs

    • α2-agonist (e.g., Clonidine) diminishes central adrenergic outflow
    • α-Methyldopa: another α2-agonist, valuable in treating pregnant hypertensive patients
    • Used in infusion in hypertensive emergencies

    Arteriovenodilators

    • Example: Sodium Nitroprusside

    Angina Pectoris

    • Definition: sudden pain beneath the sternum, often radiating to the left shoulder and arm
    • Causes: insufficient oxygen supply to meet oxygen demand, often due to atherosclerosis of coronary arteries

    Anti-Anginal Drugs

    • No specific examples provided

    Non-Pharmacological Management of Hypertension

    • Weight reduction is recommended to manage hypertension
    • A diet rich in fruits, vegetables, and low-fat dairy products with reduced saturated and total fat content is beneficial
    • Restricting daily dietary sodium intake is essential
    • Regular aerobic physical activity is recommended
    • Stopping alcohol consumption and quitting smoking are advised
    • Managing stress and controlling diabetes mellitus and atherosclerosis are important

    ACE Inhibitors and Angiotensin Receptor Blockers (ARBs)

    • ACE inhibitors: Enalapril, Ramipril, and Captopril
    • Angiotensin receptor blockers (ARBs): Losartan and Valsartan
    • These medications are eliminated primarily by the kidneys, so dosage adjustments are necessary in renal insufficiency cases

    Calcium Channel Blockers

    • Mechanism of action: blocking calcium channels
    • Effects on the heart: decreased heart rate and contractility, leading to decreased cardiac output
    • Effects on blood vessels: vasodilation, leading to decreased peripheral resistance
    • Examples: Diltiazem and Verapamil (non-dihydropyridine, more selective to the heart)

    Direct Vasodilators

    • Arteriodilators: Hydralazine, Minoxidil, and Diazoxide
    • Venodilators: Nitroglycerine (I.V.)

    Antihypertensive Drugs

    • ACEIs (Angiotensin-Converting Enzyme Inhibitors) decrease blood pressure by decreasing peripheral resistance without affecting cardiac output or heart rate.
    • They do not cause reflex tachycardia, making them safe for patients with ischemic heart disease.
    • Examples of ACEIs: Enalapril, Ramipril, and Captopril.
    • Examples of Angiotensin Receptor Blockers (ARBs): Losartan and Valsartan.

    Pharmacokinetics and Adverse Effects of ACEIs and ARBs

    • ACEIs and ARBs are eliminated primarily by the kidneys; therefore, the dose should be adjusted in renal insufficiency.
    • Adverse effects of ACEIs and ARBs include:
      • Dry cough (5-30%)
      • Angioedema
      • Hyperkalemia
      • Teratogenic effects (not used in pregnancy)

    Centrally Acting Adrenergic Drugs

    • α2-agonist Clonidine diminishes central adrenergic outflow, reducing blood pressure.
    • α-Methyldopa is another α2-agonist, specially valuable in treating pregnant hypertensive patients.

    Organic Nitrates

    • Organic nitrates, such as glyceryl trinitrate (nitroglycerin), generate NO, leading to vasorelaxation.
    • Cardiovascular effects:
      • Increase O2 supply and decrease cardiac work (decrease O2 demand) by vasodilation.
    • Side effects:
      • Venodilation → postural hypotension, reflex tachycardia, dizziness, and syncope.
      • Arteriodilation → throbbing headache and flushing.
      • Tolerance

    β-Blockers

    • Cardiovascular effects:
      • Reduce anginal pain by decreasing cardiac O2 demand.
      • Primarily through blockade of β1 receptors.
    • Side effects:
      • Most common: dizziness, weakness, headache, and impotence.
      • β2 blocking → bronchospasm (asthma), disturbs blood glucose and lipid levels.
      • Masks hypoglycemic coma and bradycardia.

    Ca++ Channel Blockers

    • In classic angina: Ca++ channel blockers reduce anginal pain by decreasing cardiac oxygen demand.
      • Decrease heart rate and contractility.
      • Decrease arterial pressure (afterload).
    • In variant angina: Ca++ channel blockers promote relaxation of coronary artery spasm, increasing cardiac O2 supply.
    • Side effects:
      • Arterial dilation → headache, flushing, dizziness, and ankle edema (not responsive to diuretics, especially nifedipine).
      • ↓ Contractility → poor left ventricular filling.
      • Heart block (especially with β-blockers and digoxin).

    Congestive Heart Failure

    • Definition: Congestive heart failure is a condition where the heart cannot pump enough blood to meet the body's needs.

    Hypertensive Crisis

    • Sudden and severe increase in blood pressure to 180/120 mm Hg or greater

    Diuretics

    • Mechanism of action: Diuretic action → decrease blood volume → decrease cardiac output → decrease blood pressure

    Classification of Diuretics

    • Thiazide diuretics: Hydrochlorothiazide
    • Loop diuretics: Frusemide
    • Potassium-sparing diuretics: Spironolactone, Triamterene

    Side Effects of Loop Diuretics

    • Hypocalcemia
    • Hyperuricemia
    • Hyperglycemia

    Effective Classes of Drugs for Hypertension

    • ACE inhibitors
    • β-adrenergic blocking agents
    • Diuretics
    • Aldosterone antagonists

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    Description

    This quiz covers the effects of ACE inhibitors on blood pressure, peripheral resistance, cardiac output, and heart rate, particularly in patients with ischemic heart disease.

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