Week 6: Hypertensive Meds- Renin/Angiotensin Inhibitors & Calcium Blockers

Renin-angiotensin plays a role in

fluid balance of body, this system malfunctions in HTN

6 steps of renin angiotensin system

1)BP falls and renin is released

2)Angiotensinogen is produced by liver

3)renin contacts angiotensinogen, converts to angiotensin I

4)A1 is transformed to A2 by ACE

5)A2 is a strong vasoconstrictor and stimulates aldosterone

6)aldosterone increases sodium resorption and water resorption to maintain plasma

what are the 3 drugs considered renin-angiotensin system inhibitors

ACE inhibitors, angiotensin II blockers (ARB), renin inhibitors

ace inhibitors function

inhibit enzyme that convers Angiotensin 1to angiotensin 2, reduces BP with little effect on cardiac

adverse effects of ACE inhibitors

dry cough, allergic reaction, renal failure

what do ace inhibitors end in

-pril

Angiotensin II receptor blockers (ARBS) function

inhibit angiotensin 2 from binding to receptors on vascular tissue, blocks formation of angiotensin II

adverse effects of ARBs

angioedema, dizziness, dry cough (less than ACE), hyperkalemia

ending of ARBs

-tan

direct renin inhibitors function

prevent renin from converting angiotensinogen to angiotensin I (decrease the precursor for angiotensin II and aldosterone)

adverse effects of direct renin inhibitor

dry cough, angioedema, avoided in those with kidney/blood disease

role of calcium channel blockers

calcium plays role in activating contractile smooth muscle, blocks calciums entry

what was calcium channel blockers originally used to treat

angina pectoris, certain arrythmias

2 types of calcium channel blocker agents

dihydropyridine agents and nondihydropyridine agents

dihydropyridine agents function

block calcium entry into vascular smooth muscle and cause vasodilation

dihydropyridine agents specific use

treat HTN

nondihydropyridine agents function

greater effect on calcium influx on myocardial cells, decrease HR and myocardial contraction

nondihydropyridine agents specific use

arrythmias

adverse effects of calcium channel blockers

avoid systemic heat, edema in LE, OH, abnormal HR, headache, metabolic side effects

calcium channel blockers are a good choice for

htn related kindey disease

less side effects of calcium channel blockers if

long acting or sustained release formulations

drug selection with uncomplicated stage 1 HTN

thiazide diuretic, Ca channel blocker or RAS inhibitor

drug selection for those with uncomplicated stage II HTN

2 first line drugs combined (thiazide diuretic or Ca channel blocker combined with RAS inhibitor)

nonpharm treatment of HTN can be used in what 2 stages

good for elevated and stage I HTN

nonpharm treatment options

diet mods, decrease alcohol and tobacco, decrease body weight, regular exercise, weight loss, stress management

primary side effect across all agents is

hypotension and OH

rehab concers

exercise can cause vasodilation so avoid it since they are taking meds that already do it, response to exercise is blunted