Therapeutic use only recommended for hypertension

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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 Non-Autonomic • 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 Non-Autonomic • 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 – Diarrhea – Rare liver enzyme increases – Rare kidney marker increases (BUN, creatinine, uric acid) • Cautions: monitor potassium levels for hyperkalemia Non-Autonomic Inhibitors Smooth Muscle Non-Autonomic 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: • Hypertension • 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 Modifying • Diuretics • Use thiazide type (eg. chlorothiazide) • Useful in combinat...
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This document was uploaded on 02/07/2014.

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