Mmc Mhs Pharmacology - Cardiovascular Pharm Ii

Front 1

ACE Inhibitors

Back 1

1) Captopril


2) Enalapril


3) Lisinopril

Front 2

Angiotensin II Receptor Blockers (ARBs)

Back 2

1) Losartan


2) Valsartan


3) Telmisartan

Front 3

Renin Inhibitors

Back 3

Aliskiren

Front 4

ACE Inhibitors – Mechanism of Action

Back 4

1) Block angiotensin converting enzyme (ACE), resulting in decreased ANG II formation


2) Decrease systemic vascular resistance (arteriolar and venous); promote natriuresis


3) Prevents bradykinin degradation

Front 5

Side effects of ACE Inhibitors

Back 5

1) Dry cough, rash, fever altered taste


2) Angioedema

3) Hyperkalemia

4) Hypotension

NOTE: Contraindicated in pregnancy


NOTE: Contraindicated in pregnancy

Front 6

Therapeutic use of ACE Inhibitors

Back 6

1) Recommended for treatment of hypertension when first line agents are contraindicated or ineffective

2) First line treatment for patients with hypertension with chronic renal disease

3) Recommended treatment after MI

Front 7

ARBs – Mechanism of action

Back 7

1) Competitive antagonists of angiotensin type 1 (AT1) receptor


2) Do not interfere with bradykinin degradation

3) Produce arteriolar and venous dilation, block aldosterone secretion and decrease salt and water retention

Front 8

Clinical Uses of Nonpeptide ARBs

Back 8

Hypertension (used as an alternative to ACE inhibitors)

Front 9

Side effects of ARBs

Back 9

1) Similar to those seen with ACE inhibitors

2) Lower incidence of cough

3) Contraindicated in pregnancy

Front 10

Aliskiren – Mechanism of Action

Back 10

1) Inhibits action of renin, which results in decreased ANG I, ANG II, and aldosterone levels


2) Does not interfere with bradykinin degradation

Front 11

Clinical Uses of Aliskiren

Back 11

Hypertension

1) Lowers blood pressure as effectively as ACE inhibitors, ARBs and thiazides

2) Can be combined with other antihypertensive drugs

Front 12

Hydralazine – Mechanism of Action

Back 12

1) Release of nitric oxide from endothelial cells


2) Relaxes smooth muscle (more effective on arteries and arterioles)

3) Decreases peripheral resistance and induces reflex tachycardia

Front 13

Clinical Uses of Hydralazine

Back 13

1) Used to treat moderately severe hypertension

2) Given in combination with beta blockers and a diuretic

3) Acceptable treatment for pregnancy-induced hypertension

Front 14

Side effects of Hydralazine

Back 14

1) Headache

2) Tachycardia
3) Nausea
4) Sweating and flushing
5) Arrhythmia
6) Precipitation of angina

Front 15

Minoxidil– Mechanism of action

Back 15

1) Opens potassium channels, resulting in hyperpolarization of smooth muscle


2) Promotes arteriolar vasodilation (does not affect venules)

Front 16

Clinical Uses of Minoxidil

Back 16

1) Severe hypertension that is refractory to other drugs

2) Severe reflex tachycardia may require co-administration of a beta blocker and a loop diuretic

2) Baldness (topical application)

Front 17

Side effects of Minoxidil

Back 17

Hypertrichosis (body hair)

Front 18

Sodium Nitroprusside – Mechanism of Action

Back 18

1) Stimulates release of nitric oxide and increases cGMP


2) Decreases total peripheral resistance by dilation of arterioles and venules

Front 19

Clinical Uses of Sodium Nitroprusside

Back 19

1) Hypertensive emergencies (given iv to cause prompt vasodilation)

2) Will also induce reflex tachycardia

Front 20

Side Effects of Sodium Nitroprusside

Back 20

1) Excessive hypotension



2) Cyanide toxicity

Front 21

Beta Blockers –Mechanism of Action

Back 21

1) Acts primarily on the heart


2) Inhibits beta adrenergic receptors


3) Decreases heart rate, cardiac force and pressure

4) Also reduce renin release


4) Increases heart size and injection time

Front 22

Clinical Uses of Beta Blockers

Back 22

Used to treat a subset of hypertensive patients

1) More effective in African Americans

2) More effective in young compared to elderly patients

3) Used to treat patients with concomitant diseases (angina, congestive heart failure, previous MI, supraventricular tachyarrhythmias)

Front 23

Side effects of Beta Blockers

Back 23

1) Bradycardia

2) CNS effects (fatigue, lethargy, insomnia, hallucinations)

3) Hypotension

4) Decreased libido and sexual dysfunction

5) Alterations in serum lipid patterns (decreased HDL and increased plasma triglycerides)

6) Use cautiously in patients with asthma

Front 24

Calcium Channel Blockers – Mechanism of Action

Back 24

Blocks L–type calcium channels in heart and blood vessels; results in decreased intracellular calcium

Front 25

Clinical Uses of Calcium Channel Blockers

Back 25

1) Used to treat hypertension in patients who have asthma, diabetes or angina

2) Do not usually require addition of a diuretic since they have an intrinsic natriuretic effect

Front 26

Side Effects of Calcium Channel Blockers

Back 26

1) Constipation

2) Dizziness

3) Headaches

4) Hypotension

5) Fatigue

Front 27

alpha Adrenoreceptor Blockers

(Prazosin)

Back 27

- Relax arterial and venous smooth muscle, resulting in decreased peripheral resistance and lower arterial blood pressure

- Used to treat mild to moderate hypertension (seldom used as monotherapy)

Front 28

Clonidine - Mechanism of Action

Back 28

-Agonist at alpha2 adrenoreceptors

-Decreases central adrenergic outflow

Front 29

Clonidine -

Therapeutic Uses

Back 29

- Used to treat hypertension in patients who have not responded adequately to two or more drugs

- Can be used to treat hypertension complicated by renal disease

Front 30

Clonidine -

Adverse Effects

Back 30

1) Sedation

2) Dry mouth

3) Constipation

4) Rebound hypertension can occur following abrupt withdrawal of drug

Front 31

Alpha-methyldopa - mechanism of action

Back 31

- Converted to methylnorepinephrine, which actives alpha2 adrenoreceptors

- Decreases central adrenergic outflow

- Reduces total peripheral resistance and blood pressure

- No effect on heart or blood flow to the kidney

Front 32

Alpha-methyldopa - Therapeutic Uses

Back 32

- Used to treat hypertensive patients with renal insufficiency

- Used to treat pregnant hypertensive patients

Front 33

Alpha-methyldopa - Adverse Effects

Back 33

- Sedation

- Drowsiness

Front 34

Labetalol

Back 34

- Alpha and beta adrenergic receptor blocker

- Given as an iv bolus or infusion in hypertensive emergencies

Front 35

Fenoldopam

Back 35

- Peripheral dopamine-1 receptor agonist

- Given as an iv infusion to treat all hyptensive emergencies (including patients with renal insufficiency)

- Contraindicated in patients with glaucoma

Front 36

Diuretics

Back 36

- Used as first line therapy for hypertension

- Low dose diuretic therapy effective in preventing stroke, MI and congestive heart failure

- Superior to beta blockers for treating hypertension in older adults

Front 37

Thiazide Diuretics

(Hydrochlorothiazide) - Mechanism of action

Back 37

Lower blood pressure by increasing sodium and water excretion

Front 38

Thiazide Diuretics - Therapeutic Uses

Back 38

- Used to treat hypertension in African Americans and in the elderly

- Often used as part of combination therapy with beta blockers, ACE inhibitors, ARBs)

Front 39

Thiazide Diuretics - Adverse Effects

Back 39

- Hypokalemia

- Hyperuricemia

- Hypomagnesemia

- Gout attacks

Front 40

Loop Diuretics

(Furosemide)

Back 40

- Selectively inhibit NaCl reabsorption in the kidney

- Reduce blood pressure by reducing blood volume

- Decrease renal vascular resistance and increase renal blood flow

Front 41

Potassium Sparing Diuretics

(Amiloride)

Back 41

- Inhibit epithelial sodium transport; resulting in decreased sodium retention

- Reduce blood pressure by reducing blood volume

- Reduces K+ loss in the urine