6
Which medication acts on angiotensin from renin which is excreted from the kidneys?
Loop diuretics --> Thiazide diuretics
Which medication acts directly on angiotensin II?
Angiotensin II receptor blockers (ARBs) (-sartan)
Which medication acts on angiotensin I and angiotensin converting enzyme in the lungs and other tissue?
ACE inhibitors (EX: Lisinopril)
Which medication blocks angiotensin II from vasoconstriction, increasing aldosterone release, increasing retention of salt and water and vascular remodeling and hypertrophy?
K+ sparing diuretics (EX: spironolactone)
What medication ends in -pril?
ACE inhibitors
- Potential adverse effect from taking ACE inhibitors or Angiotensin II receptor blockers (ARBs)
- Life threatening condition
- Swelling (rapid onset) under the skin from fluid accummulating at face, lips, throat, tongue, eyelids, genitalia, etc.
- Treated emergently w/glucocorticoid (steroid) and an antihistamine (H1 agonist)
- Newer drugs showing faster resolution: Icatibant
Angioedema ***
Action: decreased vascular resistance by limiting production of angiotensin II (which is a powerful vasoconstrictor that elevates BP); ultimately decrease afterload (and preload) -- lowers SBP (and DBP)
- NOT AS EFFECTIVE IN AFRICAN AMERICAN POPULATION
Use: HTN; Chronic CHF (as maintenance med) and renal failure, MI
Effects on exercise: improves exercise tolerance (increase force of heart contraction) and decreases peripheral resistance (decreases BP)
PT considerations: orthostatic risk; can be symptomatic; dry cough; angioedema
ACE inhibitors (end in -pril)
Which medication ends in -sartan
Angiotensin II receptor blockers (ARBs)
Which medication ends in -pine?
Calcium channel blockers
Action: blocks angiotensin II receptor from being bound, so it cannot activate vasoconstriction to cause increased BP
Use: HTN, HF, post-MI
Effect on exercise: improves exercise tolerance (increased force of heart contraction) and decreases peripheral resistance (decreased BP)
PT considerations: orthostatic risk; can be symptomatic; cough
Angiotensin II receptor blockers (end in -sartan)
Action: relax smooth muscles in arteries to decrease afterload (resistance) and contractility
- Known as dihydropyridines (type of CCBs)
Primary use: HTN (good for African American), angina (stable), Raynaud's
Effects of exercise: decrease MVO2 demand by decreasing SBP
PT considerations: may improve an individuals tolerance for activity; dizziness; lightheadedness
Calcium channel blockers
Action: inhibits catecholamine stimulus (SNS) by decreasing contractility effort and ultimately MVO2 demand; also class II antiarrhythmic
Use: Post-MI, (atrial) arrhythmias, HTN (w/other meds)
Effects of exercise: blunts HR response with exercise; minimal increase or blunted BP response; increased exercise tolerance and increased aerobic capacity
PT considerations: individuals will have lower resting and submax HR (bradycardia in some); hypotension risk
Beta blockers
For patients on this medication, their resting HR may be in the 60's and with exercise their HR may go up to only 90 when they are at a 16 on the RPE scale.
So we use RPE to grade exercise instead of HR **
Beta-blockers
Known as "Non-DHPs"
EX: Verapamil, Cardizem for A fib, heart block, Prinzmetal angina.
Class IV anti-arrhythmic ** --> Calcium channel blockers
Which medication ends in -olol?
Beta-blockers
- Multi-therapy management to address lifestyle risks:
- high cholesterol
- smoking
- Meds to help prevent future cardiovascular event
- decrease contractile effort
- Maintain and control HR
- Assist conduction timing
- Prevent arrhythmias
Post myocardial ischemia/infarct
- Aspirin
- Decrease platelet aggregation
- Statin
- Reduce further cholesterol formation
- Beta blocker
- decrease HR and contractility effort
- Calcium channel blocker
- decrease afterload resistance and contractility effort
- Antiarrhythmic agent (possibly)
- suppress ectopic beats/prolong APs
Post MI: additional agents (for discharge)
Action: generalized vasodilation of peripheral blood vessels (veins)
Primary use: ACS, AMI [spray, SL, paste, IV]; or for HTN, h/o angina [long-acting oral, patch]
Effects of exercise: increased exercise tolerance before onset of angina pain and/or decreased ischemic EKG changes; fast acting decreased cardiac preload
PT considerations: can lower BP/orthostatic response; patients on nitro prn should have them bring it with them to PT just in case; rebound headaches after taking them
Nitrates
Which medications end in -statins?
Cholesterol-lowering agents
Action: Potent intravenous vasodilator (both arterial and venous dilation)
Use: Hypertensive crisis, in acute CHF, pulmonary edema
Effects on exercise: decreased afterload and preload pressures within 1-2 minutes
PT considerations: constant BP monitoring!!! Limit activity to ROM in bed
Effects: can cause severe hypotension; N/V; cramps; H/A; CO2 retention
- IV only drugs, dilating arteries and veins
- Used in hypertensive crisis (180-120)
- Will hit system in 5 seconds, BP will drop in 1 min
Sodium nitroprusside (Nipride) ***
- HMG co-A reductase inhibitors
- Risk of increased liver enzymes
- bile acid resins
- GI distress
- Nicotinic acid
- risk: increased BG; flushing
- Fibric acid derivatives
- dyspepsia potential
PT considerations: potential for (bilateral) myalgia (pain/cramping); myositis; rhabdomyolysis
Monitor: cholesterol panel; CPK
Cholesterol-lowering agents
What are class I antiarrhythmic medications that prolong AP/suppress ventricular contraction?
Na+ channel blockers/AV blockers
(Lidocaine, adenosine)
What are class II and class IV for antiarrhythmics?
II: beta-blockers/block ventricular contractility
IV: Ca+ channel blockers (non-DHP)
What is class III medications for antiarrhythmics that prolong AP?
K+ channel blockers
- Human monoclonal antibodies
- Bind to and inhibit circulating PCSK9 from binding to the low density lipoprotein
- This permits LDL to recycle back to the liver cell surface and more LDL-R available to clear LDL from the blood.. thus decrease LDL levels
- Use if statin intolerant; expensive but for familial hypercholesterolemia
- For patients with familial hypercholesterolemia, ASCVD or high risk for (age 12+) and LDL > 100 despite on max total statins
Newer cholesterol agents --> PCSK9 inhibitors