ACE Inhibitors and Cardiovascular Effects
41 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

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

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Summary of Drugs for CVS - part 1 PDF

    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.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser