Cardiovascular Medications Lecture

Overview

• Focus: Medications for hypertension and angina
• Organized into manageable chunks
• Starts with an overview of the Renin-Angiotensin-Aldosterone System (RAAS)

Renin-Angiotensin-Aldosterone System (RAAS)

• Renin: Released by kidneys (↓ renal blood flow/low BP) → activates angiotensinogen to angiotensin I
• ACE (Angiotensin-Converting Enzyme): Converts angiotensin I to angiotensin II
• Angiotensin II effects:
  • Vasoconstriction
  • Reabsorption of water and sodium at kidneys
  • Release of aldosterone (reabsorption of water and sodium)

Medications Targeting RAAS

Direct Renin Inhibitors

• Example: Aliskiren
• Action: Inhibits renin → prevents angiotensinogen from becoming angiotensin I
• Side Effects:
  • Hypotension
  • Angioedema
  • GI upset
  • Black Box Warning: Fetal toxicity
• Key Points:
  • Monitor BP during therapy
  • Side effects linked to mode of action (e.g., hypotension if too effective)

ACE Inhibitors

• Examples: Captopril, Lisinopril
• Action: Block conversion of angiotensin I to angiotensin II → vasodilation
• Uses: Hypertension, heart failure, myocardial infarction, diabetic nephropathy
• Side Effects:
  • Hypotension
  • Angioedema
  • Cough
  • Elevated potassium
  • Black Box Warning: Fetal toxicity
• Acronym for Side Effects: A.C.E. (Angioedema, Cough, Elevated potassium)
• Key Points:
  • Monitor BP and potassium levels
  • Teach patient to change position slowly to avoid dizziness

Angiotensin II Receptor Blockers (ARBs)

• Examples: Losartan, Valsartan
• Action: Block effects of angiotensin II → vasodilation
• Uses: Hypertension, diabetic nephropathy
• Side Effects:
  • Hypotension
  • Dizziness
  • GI upset
  • Black Box Warning: Fetal toxicity
• Key Points:
  • Monitor BP
  • Teach patient to change position slowly

Aldosterone Antagonists

• Example: Eplerenone
• Action: Block mineral corticoid receptors → inhibits aldosterone → reabsorption of sodium and water
• Uses: Hypertension, heart failure (post-MI)
• Side Effects:
  • Hyperkalemia
  • Dizziness
• Key Points:
  • Monitor BP and potassium levels during therapy

Summary

• Next video: Additional medications for hypertension
• Remember to monitor BP, potassium levels, and educate on side effects and safe practices

Reminder

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