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Unformatted text preview: chances of slow onset of heart failure.
– Improves perfusion of cardiac muscle. • Being used to reduce diabetic nephropathy
– relaxes efferent arteriole lowering glomerular
pressure and presumably damage Non-Autonomic Inhibitors Smooth Muscle
• Angiotensin receptor antagonists –
• losartan (Cozaar®), valsartan (Diavan®), olmesartan (Benicar®) – Mechanism of action - Blocks Angiotensin II Receptor
• Prevents angiotensin II from constricting smooth muscle
• Prevents stimulating adrenal cortex for aldosterone release. – Therapeutic Use:
• Only recommended for hypertension control (not CHF, etc.) – Adverse Effects:
• Essentially same as ACE inhibitors except no persistent cough.
– Rash, proteinuria, headache, myalgia, dyspepsia, diarrhea
– Contraindicated in pregnancy:
» 2nd and 3rd trimester death or injury to fetus
– Less effective in black patients Non-Autonomic Inhibitors Smooth Muscle
• Aldosterone receptor antagonists –
• eplerenone (Inspra®), spironolactone (Aldactone®) – Mechanism of action - Blocks Aldosterone Receptor
• In renal epithelial cells (especially distal tubule)
• In non-epithelial cells of heart, blood vessels, brain – Therapeutic Use:
• Hypertension control
• CHF (refer back to CHF alternatives in notes) – Adverse Effects:
• Few so far
– Rare liver enzyme increases
– Rare kidney marker increases (BUN, creatinine, uric acid) • Cautions: monitor potassium levels for hyperkalemia Non-Autonomic Inhibitors Smooth Muscle
Calcium channel blockers
verapamil, diltiazem, felodipine, ismadipine, nicardipine, nifedipine • All cause vasodilation
• Usually a reflex tachycardia also occurs
• Direct action on blocking heart still makes these
useful to treat atrial tachycardias.
– Therapeutic Uses:
• Supraventricular tachycardia, angina
• Better choice for black patients (along with diuretics.) – Adverse Effects:
• Peripheral edema, dizziness, fatigue, flushing
• Constipation, nausea, diarrhea – Contraindicated in CHF (weakens contraction).
***Note: Compare and Contrast with ACE Inhibitors*** Modifying Circulating Volume
• Use thiazide type (eg. chlorothiazide)
• Useful in combinat...
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This document was uploaded on 02/07/2014.
- Spring '14