RAAS Drugs, Vasodilators, and Anti-Hypertensives

ACE Inhibitors

MOA

• Suppressing formation of angiotensin 2

  • dilates blood vessels

  • reduces blood volume

• vasodilation

Generic Names

• Lisinopril

• Captopril

• Enalapril

Uses

• HTN

• MI

• HF/LV dysfunction

• Nephropathy

• Prevent a cardiovascular event

Adverse effects

• cough

• angioedema

• first-dose hypertension

• hyperkalemia

• renal failure

• fetal injury

Drug Interactions

• diuretics

• other HTN medications

• potassium raising medications

• Lithium

• NSAIDS

ARBs

MOA

• blocks the actions of angiotensin 2 (blocks access to receptors)

  • dilation of arterials and veins

  • increase rental excretion

Generic Names

• Losartan

• Valsartan

Uses

• HTN, HF< Diabetic Nephropathy, MI

• prevention of CV event

• patients who cannot tolerate ACEs

Adverse effects

• angioedema

• fetal harm

• renal failure

Drug interactions

• other antihypertensives

Aliskiren

Direct Renin Inhibitor

MOA

• act on renin to inhibit conversion of angiotensin into angiotensin 1

• suppress the entire RAAS

Use

• HTN

Adverse Effects

• GI effects (diarrhea, abdominal pain, indigestion, fetal harm)

Drug Interactions

• Atorvastatin

• Ketoconazole

• Irbesartan

• Furosemide

Spironolactone

Aldosterone Antagonists

MOA

• blockade of aldosterone

• retention of potassium and increased excretion of sodium and water

• reduced blood volume

• reduced BP

Uses

• HTN

• HF

Adverse Effects

• hyperkalemia

• endocrine effects

• fetal harm

Drug interactions

• Drugs that raise potassium

• ACEI, ARBs, direct renin inhibitors

Hydralazine

Vasodilator

MOA

• selective dilation of arterioles

  • little effects on veins

  • reduction in peripheral resistance and arterial BP

  • Increased HR and myocardial contractility

Absorption

• readily absorbed after PO admin within 45 minutes

• parenteral within 10 minutes

Metabolism

• inactivated by acetylation

Uses

• essential HTN

• HTN crisis

• HF

Adverse effects

• reflex tachycardia

• increased blood volume

• lupus like syndrome

• Headache, dizziness, weakness, and fatigue

Drug Interactions

• beta blocks and diuretics

• other HTN medications

Minoxidil

Vasodilators

MOA

• selective dilation of arterioles

• increased HR and myocardial contractility (reflex)

Absorption

• rapid and complete PO administration

• Max effect in 2-3 hours

Metabolism

• extensive

Uses

• severe HTN

Adverse effects

• reflex tachycardia

• sodium and water retention

• hypertrichosis

• pericardial effusion

Drug interactions

• should be used with beta blockers and diuretics