ACE
This drug blocks enzyme that converts angiotensin 1 to angiotensin 2 as well as inhibits the release of bradykinin.
captopril, lisinopril, benzapril
these drugs block the action of angiotensin II at various receptor sites and prevents the effects of vasoconstriction and aldosterone secretion
losartan, valsartan, candasartan
What are the two categories and what are the Very Nice Drugs?
dihydropyridines and non dihydropyridines
Verapamil (non)
Nifedipine (d)
Diltiazem (non)
selective: metoprolol, esmolol, atenolol
Non selective: propanolol, timolol
Types of adjuvant meds?
Antiadrenergic
Alpha-1 receptor blockers: prazosin (Minipress)
Alpha-2 receptor agonists: clonidine (Catapres)
RAAS
Direct renin inhibitors: aliskiren (Tekturna)
Aldosterone antagonist
Direct vasodilators
nitroprusside (Nitropress)
Hydralazine (Hydra-Zide, BiDil)
Main uses for ace?
HTN, DM, prevent/reverse heart remodeling with HF, post MI
uses for these drugs
HF, MI, post MI, HTN
Which calcium channel blocker is mostly used for african americans? And is it a dihydropyridine or a non?
amoldipine; di!
Action of beta blockers?
Blocks epinephrine and norepinephrine at beta-adrenergic receptors
Decrease HR
Decrease contraction
think: beta BLOCK
this medication is an alpha 1 blocker; used for htn; and has something called a first dose phenomenon meaning OH, palpitation, dizziness happens after first dose; we must take this at bedtime. it can also cause edema, reflex tachycardia, blurred vision or urinary incontinence
prazosin
cough, angioedema, pregnancy contraindication, taste change, orthostatic hypo, protects kidneys, renal artery stenosis contra, increases potassium, lowers bp/leukopenia
What are the advantages for this drug?
angioedema is rare, doesnt cause a cough
Side effects of dihydropyridines? why is that different than the non?
edema, flushing, reflex tachycardia
because with these drugs there is more effect on vasodilation and less effect on the heart
BBW for beta blockers?
Abrupt discontinuation caused exacerbation of angina, dysrhythmias, and MIs with patients who had CAD
this drug directly relaxes smooth muscle in blood vessels = dilation and decreased peripheral vascular resistance. it is most effective in managing a hypertensive emergency
its given iv and needs continous monitoring, Converts to thiocyanate in liver: can have cyanide toxicity (coma, dilated pupils, pink color) check lab levels
nitroprusside
what are the nursing consideration? name at least two
monitor labs and electrolytes, consult provider if cough becomes bothersome, avoid salt substitutes and with K+ or K+ rich foods
Nursing considerations?
Do not take with ACEs
Non dihydropyridines SE?
bradycardia, rare side effects include heart block arrythmias, HF,
what are the signs and symptoms of an OD?
Bradycardia, heart block, hypotension, Mental status change
This direct-acting vasodilator relaxes smooth muscle in arteries, reducing afterload and lowering blood pressure. It may cause reflex tachycardia, fluid retention, and a lupus-like syndrome with long-term use. (double points if you get this one)
hydralazine
BBW for captopril
T or F; the symptoms of this drug are similar to that of ACE
T
Why do we have to educate patients on possible food/drug interactions with these drugs?
CYP3A4 inducers: St. John's Wort
Decreases effectiveness
CYP3A4 inhibitors: grapefruit juice
Increases plasma concentration
what does beta block stand for? its a pneumonic <3 good luck
bradycardia, exacerbate hf, taper off, asthma and copd use with caution, blood glucose masking, lowers bp, orthostatic hypo, circulation may be impaired, know s&s of OD
this alpha 2 agonist can be used orally to treat adhd, patch for htn, or epidural for pain managmenet in cancer
this other a2 agonist can be used in hypertensive crisis through IV
s/s: cns depression, bradycardia, rebound htn whe stopped abruptly, n/v
first one: clonidine
2nd: methyldopa