EPCC Pharmacology PDF

1 CARDIOVASCULAR SYSTEM MEDS: Renin-Angiotensin-Aldosterone System (RAAS) Angiotensin Converting Enzyme Inhibitor pg 505 Angiotensin Receptor Blockers (ARBs) pg. 510 (ACE Inhibitor) syllable is – ipril syllable is - artan Mechanism --reduces levels of angiotensin II—dilates blood vessels --blocks ac...

1 CARDIOVASCULAR SYSTEM MEDS: Renin-Angiotensin-Aldosterone System (RAAS) Angiotensin Converting Enzyme Inhibitor pg 505 Angiotensin Receptor Blockers (ARBs) pg. 510 (ACE Inhibitor) syllable is – ipril syllable is - artan Mechanism --reduces levels of angiotensin II—dilates blood vessels --blocks access to receptors in blood vessels, --increases levels of bradykinins—also dilates blood adrenal, and other tissues. of Action vessels, but also causes cough and angioedema --similar effects as the ACE inhibitors, but does not --most are oral, can be given w/ food, once or twice a inhibit Kinase II, so cough and angioedema are less day. Excreted by kidney. common Hypertension Therapeutic Hypertension—safe for asthma patients (c.f. beta blockers), proved to also decrease risk of CV mortality --Slows retinopathy Uses HF & MI HF & MI Nephropathy—so decrease in ESRD Diabetic nephropathy Prevents MI, stroke and death in pt. with CV risk Prevents MI, stroke, and death in pt. with CV risk --First dose hypotension—especially if on diuretic, so Generally well tolerated. Adverse need to lower initial dose or stop diuretics 2- 3 days Dizziness, muscle cramps or weakness, heartburn, Effects --Cough—dry irritating nonproductive, due to Kinase II diarrhea, sensitivity to touch. --Hyperkalemia—rare unless taking K --Renal failure—if have renal condition --Angioedema—can be fatal, increased capillary permeability Specific Drugs captopril—used for high BP, HF, and nephropathy enalapril –used for high BP, HF lisinopril—used for high BP, HF, MI. Active component Diuretics; Other antihypertensive drugs Drug Interactions Drugs that increase K levels; Lithium NSAID Comments Category D (BBW) Causes rebound hypertension if stopped abruptly losartan – used for high BP, stroke prevention & diabetic nephropathy olmesartan—used for high BP only valsartan—used for high BP, HF, MI Not as much an issue Especially used for patients with diabetes Category C in first trimester, and then Category D in second and third trimester Direct Renin Inhibitors pg 515 aliskirin --Only one in this class, oral med --Inhibits the conversion of angiotensinogen into angiotensin I, so suppresses the entire RAAS. --No proof that it is any better than the others. --Used for hypertension --Cough, angioedema and hyperkalemia is less. Aldosterone Antagonists Eplerenone pg. 581 Selective aldosterone receptor blocker, so fewer side effects than spironolactone (diuretic). Used for hypertension and HF. Hyperkalemia