RAA System Drugs
Why would you give a patient Losartin instead of Captopril?
angiotensin receptor blockers are given instead of ACE-Is because the patient can not tolerate the adverse effects of ACE-I (normally dry cough)
NOTE: ARBs can also cause angioedema
What are the indications, adverse effects, contraindications, and interactions for all three CCBs?
AE: hypotension
Contraindicated: depressed cardiac function
Drug/drug interactions: combined effects with diuretics, vasodilators, and other antihypertensives; intensifies effects of beta blockers
What are the two alpha drugs we are studying and what classes are they?
Clonidine - alpha 2 agonist
Prazozin - alpha 1 adrenergic blocker
What's the difference between selective and nonselective Beta Blockers?
selective only blocks B1
nonselective blocks B1 and B2 (bronchoconstriction)
What drug do you give in a hypertensive crisis?
nitroprusside
What is the ACE-I drug we are studying and what are some notable adverse effects that accompany it?
Captopril - dry cough, 1st dose orthostatic hypotension (worse when taking other antihypertensives), rash, angioedema
What interactions do we need to look for when taking Verapamil?
verapamil interacts with grapefruit, beta blockers (may cause heart failure, bradycardia, AV block), carbamazepine, and digoxin
What is clonidine indicated for?
severe cancer pain, management of DHD, withdrawal from substances
What are the effects of cardioselective beta blockers and which drugs are cardioselective?
slows SA node firing and decreases cardiac contractility
metoprolol, atenolol, esmolol
What organs are we monitoring when a patient has a history of hypertension?
heart, brain, kidneys, retinas
What are adverse effects of Aliskerin and what does it interact with?
AE: diarrhea, hypotension, hyperkalemia
interacts with high fat foods (decreases absorption)
What's the main difference between Diltiazem and Verapamil?
diltiazem does not cause constipation
What is prazozin mainly indicated for?
dysuria associated with prostatic hypertrophy
What are the effects of alpha and beta blockers and which drugs are they?
vasodilation, decreased HR, decreased contractility
carvedilol, labetalol
What are modifiable factors to educate your patient on with a history of HTN?
achieve ideal body weight, no smoking, manage glucose and lipids, moderate physical activity 90-150 minutes a week, alcohol moderation
What is the mechanism of action of eplerenone, what drug is it paired with, and what are the indications for it?
decreases blood volume by blocking aldosterone receptors in the kidney
it is paired with spironolactone
indicated for heart failure, PMS, polycystic ovarian syndrome, and acne in young women
What are the adverse effects of nifedipine and what does it interact with?
AE: reflex tachycardia (BBs help), peripheral edema (diuretics help)
Interactions: grapefruit
When should you give the first dose of prazozin and why?
HS because it causes orthostatic hypotension
angina, tachydysrhythmias, heart failure, MI, reflex tachycardia associated with vasodilators
What are adverse effects of nitroprusside?
excessive hypotension, bradycardia, tachycardia, ECG changes, cyanoid poisoning
What are contraindicated for all RAA system drugs and what do all RAA system drugs interact with?
Interactions: may cause profound hypotension when combined with diuretics, vasodilators, and other antihypertensives; increase lithium levels!
What are the possible cardiac adverse effects when taking verapamil?
widened QRS, prolonged QT, and bradycardia
What's the difference between the MoA of clonidine and prazozin?
clonidine works centrally to decrease stimulation of the SNS, leading to a decrease in BP and HR; clonidine also works peripheral, causing vasodilation
prazozin works in relaxing smooth muscles in veins and arteries leading to vasodilation
In general, what are adverse effects associated with beta blockers?
bradycardia, decreased CO, AV blocks
specifically beta 2 blockage causes - bronchoconstriction, inhibition of gluconeogenesis, and failure to produce symptoms associated with hypoglycemia (check BG!!)
how do you administer nitroprusside?
dedicated IV line, infuse with a pump (no drip), continuous BP and HR monitoring, protect IV tubing from light, discard after 24 hours, discard if solution is any other color other than light brown