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54 Cards in this Set
- Front
- Back
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Angiotensin I (from the liver) travels in the blood stream to the lungs where the
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metabolic cells of the alveoli use angiotensin-converting enzyme (ACE) (IN THE LUNGS) to convert angiotensin I to angiotensin II
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antihypertensive drugs
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ACE inhibitors
angiotensin II receptor blockers (ARB's) calcium channel blockers vasodilators diuretic agents renin inhibitors |
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Beta blocker
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leads to a decrease in heart rate and strength of contraction as well as vasodilation
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Angiotensin-converting enzyme inhibitor
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blocks the conversion of angiotensin I to angiotensin II
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Calcium channel blocker
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relaxes muscle contraction or other autonomic blockers
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Angiotensin II receptor blocker
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blocks the effects of angiotensin on the blood vessel
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Diuretic
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decreases serum sodium levels and blood volume
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Angiotensin- converting enzyme (ACE) inhibitors
all oral |
Lisinopril
captopril moexipril enalaprilat PRIL AND ENALAPRILAT IV enalapril- advantage of parenteral use |
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ACE inhibitors
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act in the lungs to prevent ACE from converting angiotensin I to angiotensin II
a powerful vasoconstrictor and stimulator of aldosterone release |
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ACE with digoxin or diuretic
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CHF and left ventricular dysfunction
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Contraindications
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impaired renal function
heart failure salt/volume depletion barrier contraceptive no preggers no breast milk to baby |
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Adverse effects
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CNS; syncope, dizziness, headache
Derm: alopecia, rash Cough CV: tachycardia, heart failure, arrhythmias, hypotension Liver damage Renal damage: proteinuria renal failure GI: constipation, GI upset GU: loss of libido |
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Quinapril
ramipril trandolapril |
fairly well tolerated and not as many adverse effects
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Benazepril
enalapril fosinopril |
unrelated cough
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Capropril
moexipril perindopril and lisinopril |
-fatal pancytopenia, cough, GI disress,BMS,tachycardia
-GI, skin, cough, cardiac arrhythmias, fatal myocardial infarction pancytopenia -fatl pancytopenia, airway obstruction |
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Drug-Drug
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hypersensitivity-allopurinol
NSAID- decreased hypertensive effect |
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Drug-Food
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Food decreases absorption
take one-two hours before a meal on an empty stomach |
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Angiotensin II receptor blockers
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bind with the angiotensin II receptors in vascular smooth muscle and in the adrenal cortex to block vasoconstriction and the release of aldosterone
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ARB
intolerant to ACE inhibitors slow progression of renal disease in pts with hypertension and Diab 2 absorbed metabolize in the liver by the cytochrome P450 |
Candesartan
irbesartan losartan telmisartan valsartan |
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Contraindications
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hepatic dysfunction
renal dysfunction hypovolemia pregnancy barrier contraceptive |
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Adverse Effects
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headache
dizziness syncope GI dry mouth Upper RTI sympt cough rash-dry skin-alopecia various cancers |
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Drug-Drug
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-Decreased serum levels and loss of effectiveness
phenobarbital indomethacin rifamycin -Decrease in anticipated antihypertensive effects -ketoconazole -fluconazole -diltiazem |
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Calcium Channel Blockers
immediate release sustained release |
decrease blood pressure, cardiac workload, and myocardial oxygen consumption
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Immediate release and sustained release
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amlodipine
felodipine isradipine nicardipine |
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only safe if given as sustained release or extended release
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diltiazem
nifedipine nisoldipine verapamil |
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Clevidipine and Nicardipine
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only available in IV form for short-term management of hypertension when an oral calcium channel blocker cannot be used
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CCB
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metabolized in the liver
excreted in the urine |
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Contraindications
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heart block or sick sinus syndrome
renal dysfunction hepatic dysfunction |
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Adverse Effects
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dizziness
light headed headache fatige nausea hepatic injury hypotension bradycardia peripheral edema heart block skin flushing rash |
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drug-drug
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increase in serum levels and toxicity of cyclosporine if taken with diltiazem
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Drug-Food
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Do NOT take with grapefruit juice- concentration of calcium channel blockers increase, sometimes to toxic levels
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Vasodialtors
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severe hypertension or hypertensive emergencies
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Vasodilators
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hydralazine
monoxidil nitroprusside |
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rapidly absorbed and widely distributed
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Nitroprusside-IV
Hydralazine-po, IV, IM Minoxidil-PO only |
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Contraindications
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cerebral insufficiency
peripheral vascular disease CAD heart failure tachycardia pregnancy no breast milk to baby |
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Minoxidil
dizziness anxiety ha reflex tachycardia heart failure chest pain edema skin rash unusual hair growth |
Nitroprusside
cyanide toxicity ha vomiting dizziness ataxia LOC imperceptible pulse absent reflex dilated pupils distant heart sound shallow breathing |
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Diuretics
mild hypertension |
increase excretion of sodium and water from the kidney
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thiazide and thiazide like diuretics
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bendroflumethiazide, chorothiazide, hydrochlorothiazide, methyclothiazide
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Potassium sparing diuretics
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amiloride, spironolactone, triamterene
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Renin inhibitor
Aliskiren (Tekturna) |
inhibits renin-decreased plasma renin activity and inhibiting the conversion of angiotensinogen to angiotensin I
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aldosterone not released may cause hyperkalemia
combined with furosemide may loose diuretic effect |
angioedema with respiratory involvement
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Sympathetic Nervous system blockers
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drugs that block the effects of the sympathetic nervous system are useful in blocking many of the compensatory effects of the sympathetic nervous system
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Beta- blockers
block vasoconstriction decrease heart rate decrease cardiac muscle contraction increase blood flow to kidney-decrease renin |
monotherapy in step 2 treatment
many adverse effects atenolol metoprolol nadolol propranolol timolol |
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alpha and beta blockers
block all receptors of sympathetic nervous system fatigue loss of libido GI and GU upset |
carvedilol
guanabenz labetalol |
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Alpha adrenergic blockers
episodes of pheochromocytoma-rare tumor of adrenal gland tissue-too much epi and norepi |
inhibit the postsynaptic alpha1-adrenergic receptors
decreasing sympathetic tone in the vasculature and causing vasodilation which leads to a lowering of bp |
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also block presynaptic alpha2-receptors preventing the feedback control of norepinephrine
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result is increase in the reflex tachycardia that occurs when blood pressure decreases
phenoxybenzamine phentolamine |
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Alpha1 blockers
treat hypertension |
block the postsynaptic alpha1 receptor sites
decreases vascular tone and promotes vasodilation leading to a fall in blood pressure |
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do not block presynaptic alpha 2 receptor sites therefore the reflex tachycardia that accompanies a fall in blood pressure does not occur
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doxasozin
prazosin terazosin |
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Alpha 2 agonists
stimulate alpha 2 receptors in the CNS to inhibit the CV centers leading to a decrease in sympathetic outflow from the CNS and a resultant drop in BP |
CNS adverse effects-GI- cardiac dysrhythmias
clonidine guanfacine methyldopa |
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Sympathetic adrenergic agonists or vasopressors
-sympathomimetic drug |
first choice for treating severe hypotension or shock
dobutamine dopamine ephedrine epinephrine isoproterenol norepinephrine phenylephrine |
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increased bp
increased blood volume increased strength of cardiac muscle contractions |
decreased GI activity-nausea constipation
increased respiratory rate change in bp ha-peripheral blood flow with numbness tingling gangrene |
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Alpha specific adrenergic agent
midodrine orthostatic hypotension |
activates alpha receptors in arteries and veins to produce an increase in vascular tone and an increase in bp
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Contraindicated in the presence of supine hypertension, cad, pheochromocytoma, acute renal disease, urinary retention, thyrotoxicosis, renal and hepatic impairment
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aE
piloerection, chills , rash, hypertension, bradycardia , dizziness, vision changes, vertigo ha, urination issues |
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drug-drug
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increased effects and toxicity of cardiac glycosides, beta blockers, alpha-adrenergic agents, and corticosteroids
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