Plasma protein into angiotensin angiotensin helps

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Unformatted text preview: postural hypotension - SNS still functional+++ – Contraindications • Angina or coronary artery disease (tachycardia) • Hypersensitive reaction to drug • May develop rheumatism and blood diseases – Skin rash, anemia indicate drug should be discontinued Renin-Angiotensin-Aldosterone Renin-Angiotensin-Aldosterone (RAA System) • Low BP (detected in afferent arteriole) releases Renin • Renin is an enzyme – Converts angiotensinogen (plasma protein) – Into angiotensin • Angiotensin helps increase BP in 2 ways – Potent vasoconstrictor – Aldosterone from adrenal cortex • Aldosterone increases sodium reabsorption from distal convoluted tubule (increasing extracellular volume including plasma) Non-Autonomic Inhibitors Smooth Muscle Non-Autonomic • Angiotensin Converting Enzyme (ACE) Inhibitors: – captopril (Capoten®), enalapril (Vasotec®), lisinopril (Prinivil®), benazepril (Lotensin®), fosinopril (Monopril®), ramipril (Altace®), quinapril (Accupril®), moexipril (Univasc®), trandolapril (Diavan®) – Mechanism: Inhibits ACE – less vasoconstriction and less aldosterone secretion so less fluid retention. Non-Autonomic Inhibitors Smooth Muscle Non-Autonomic Angiotensin Converting Enzyme (ACE) Inhibitors: – Mechanism: Inhibits ACE – less vasoconstriction and less aldosterone secretion so less fluid retention. – Adverse Effects: • Less concern about severe effects – Fatal bone marrow depression and renal damage occur chiefly in patients with renal disease. • 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 – Especially effective with a small dose of hydrochlorothiazide. – Other uses are significant ACE Inhibitors recommended ACE for other therapeutic uses • Often the first drug given for CHF – Digitalis and diuretics are often prescribed as well. – Less likely to cause potassium depletion and cardiac arrhythmias. – More likely to cause first dose hypotension and dizziness, decreased renal function and severe persistent cough. • Has been recommended post MI to decrease...
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