MN553 ADVANCED PHARMACOLOGY
AND PHARMACOTHERAPEUTICS -
Cardiovascular & Hematopoietic
Systems
After serial BP measurements indicate a persistent 150 to 160 systolic in individuals
without other major deep vein risks - answer Medications are initiated after diet and
exercise. Target values below 140 systolic are not rigidly enforced if adherence to
medications and exercise have proven beneficial, especially in elders with hypotensive
episodes.
Targets of below 140 systolic remain for patients with diabetes mellitus (DM).
Emphasis on lifestyle changes continues after medications are started.
Treatment of Hypertension With Higher Cardiovascular (CV) Risk
Stage I: systolic blood pressure (SBP) 140 to 159/diastolic blood pressure (DBP) 90 to
99 - answer Diuretics: thiazide-type
May consider angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor
blocker (ARB), calcium channel blocker (CCB), or combination
Treatment of Hypertension with Higher Cardiovascular Risk
Stage II: SBP greater than or equal to 160/DBP greater than or equal to 100 - answer
Two-drug combination: thiazide-type and ACEI, ARB, beta blocker (BB), or CCB
Treatment of Hypertension with Higher Cardiovascular Risk
With compelling indications: heart failure (HF), DM, stroke, chronic kidney failure, point
of maximal impact - answer Diuretics, ACEI, ARB, BB, CCB as needed
Treatment: Heart Failure
Stage A - answer ACEIs are drug of choice.
ARBs are considered but more expensive.
Heart Failure
Stage B - answer ACEI in all patients, ARB for those who cannot tolerate an ACEI
BBs in most
Heart Failure
Stage C - answer ACEI and BBs (nonselective) in all patients Diuretics, digoxin
Spironolactone
Heart Failure
Stage D - answer Stage C treatments
Inotropes: dobutamine
Ventricular assist device, transplantation, hospice
ACEIs
, MN553 ADVANCED PHARMACOLOGY
AND PHARMACOTHERAPEUTICS -
Cardiovascular & Hematopoietic
Systems
Pharmacodynamics - answer Inhibition of angiotensin-converting enzyme (ACE)
activity results in decreased production of both angiotensin II (AT II) and aldosterone.
Can lower vascular resistance without decreasing cardiac output (CO) or glomerular
filtration rate (GFR).
Does not produce reflex tachycardia.
ACE:
Strong evidence for CV and cerebrovascular risk reduction, HF, and slowing renal
disease - answer Improves oxygenation to heart muscle, decreases inappropriate
remodeling of heart muscle after myocardial infarction (MI) or with heart failure, reduces
affects of diabetes on the kidneys
ACE: diabetes, hyperlipidemia - answer Improves insulin sensitivity, does not affect
glucose metabolism or raise serum lipid levels
ACE - answer Benazopril 5 mg if on diuretic; 10 mg if not on diuretic, 80 mg/day
Captopril 25 mg 2 to 3 x day 450 mg/day
Enalapril 2.5 mg twice daily if on diuretic; 5 mg twice daily if not on diuretic 40 mg/day
Fosinopril 10 mg daily 80 mg/day Lisinopril 10 mg daily 80 mg/day
Moexipril 7.5 mg prior to meal once/day 60 mg/day
ACEIs Who to use with, Who not to use with - answer Use with
Young Caucasian patients
Patients with angina: prevents formation of AT II and decreases pulmonary vascular
resistance by decreasing retention of sodium and water and reducing extracellular fluid
and preload Diabetic patients: prevents or slows nephropathy HF patients
Not as effective for African-American patients When combined with a diuretic, race no
longer an issue
However, African Americans and Asians have three to four times greater risk of
developing angioedema.
ACEIs Adverse Reactions - answer Adverse drug reactions (ADRs): dry cough
(bradykininmediated), hypotension, loss of taste, angioedema, blood dyscrasias,
teratogenicity, hyperkalemia, acute renal failure, cholestatic jaundice, pancreatitis, rash
Angiotensin II Receptor Blockers - answer Prevent binding of AT II to receptors in
kidney, brain, heart, and arterial walls
Inhibit the renin-angiotensin-aldosterone system (RAAS) and cause fall in peripheral
resistance Evidence supports use in kidney disease until late stage and heart failure,
but not renal protective like ACEI
AND PHARMACOTHERAPEUTICS -
Cardiovascular & Hematopoietic
Systems
After serial BP measurements indicate a persistent 150 to 160 systolic in individuals
without other major deep vein risks - answer Medications are initiated after diet and
exercise. Target values below 140 systolic are not rigidly enforced if adherence to
medications and exercise have proven beneficial, especially in elders with hypotensive
episodes.
Targets of below 140 systolic remain for patients with diabetes mellitus (DM).
Emphasis on lifestyle changes continues after medications are started.
Treatment of Hypertension With Higher Cardiovascular (CV) Risk
Stage I: systolic blood pressure (SBP) 140 to 159/diastolic blood pressure (DBP) 90 to
99 - answer Diuretics: thiazide-type
May consider angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor
blocker (ARB), calcium channel blocker (CCB), or combination
Treatment of Hypertension with Higher Cardiovascular Risk
Stage II: SBP greater than or equal to 160/DBP greater than or equal to 100 - answer
Two-drug combination: thiazide-type and ACEI, ARB, beta blocker (BB), or CCB
Treatment of Hypertension with Higher Cardiovascular Risk
With compelling indications: heart failure (HF), DM, stroke, chronic kidney failure, point
of maximal impact - answer Diuretics, ACEI, ARB, BB, CCB as needed
Treatment: Heart Failure
Stage A - answer ACEIs are drug of choice.
ARBs are considered but more expensive.
Heart Failure
Stage B - answer ACEI in all patients, ARB for those who cannot tolerate an ACEI
BBs in most
Heart Failure
Stage C - answer ACEI and BBs (nonselective) in all patients Diuretics, digoxin
Spironolactone
Heart Failure
Stage D - answer Stage C treatments
Inotropes: dobutamine
Ventricular assist device, transplantation, hospice
ACEIs
, MN553 ADVANCED PHARMACOLOGY
AND PHARMACOTHERAPEUTICS -
Cardiovascular & Hematopoietic
Systems
Pharmacodynamics - answer Inhibition of angiotensin-converting enzyme (ACE)
activity results in decreased production of both angiotensin II (AT II) and aldosterone.
Can lower vascular resistance without decreasing cardiac output (CO) or glomerular
filtration rate (GFR).
Does not produce reflex tachycardia.
ACE:
Strong evidence for CV and cerebrovascular risk reduction, HF, and slowing renal
disease - answer Improves oxygenation to heart muscle, decreases inappropriate
remodeling of heart muscle after myocardial infarction (MI) or with heart failure, reduces
affects of diabetes on the kidneys
ACE: diabetes, hyperlipidemia - answer Improves insulin sensitivity, does not affect
glucose metabolism or raise serum lipid levels
ACE - answer Benazopril 5 mg if on diuretic; 10 mg if not on diuretic, 80 mg/day
Captopril 25 mg 2 to 3 x day 450 mg/day
Enalapril 2.5 mg twice daily if on diuretic; 5 mg twice daily if not on diuretic 40 mg/day
Fosinopril 10 mg daily 80 mg/day Lisinopril 10 mg daily 80 mg/day
Moexipril 7.5 mg prior to meal once/day 60 mg/day
ACEIs Who to use with, Who not to use with - answer Use with
Young Caucasian patients
Patients with angina: prevents formation of AT II and decreases pulmonary vascular
resistance by decreasing retention of sodium and water and reducing extracellular fluid
and preload Diabetic patients: prevents or slows nephropathy HF patients
Not as effective for African-American patients When combined with a diuretic, race no
longer an issue
However, African Americans and Asians have three to four times greater risk of
developing angioedema.
ACEIs Adverse Reactions - answer Adverse drug reactions (ADRs): dry cough
(bradykininmediated), hypotension, loss of taste, angioedema, blood dyscrasias,
teratogenicity, hyperkalemia, acute renal failure, cholestatic jaundice, pancreatitis, rash
Angiotensin II Receptor Blockers - answer Prevent binding of AT II to receptors in
kidney, brain, heart, and arterial walls
Inhibit the renin-angiotensin-aldosterone system (RAAS) and cause fall in peripheral
resistance Evidence supports use in kidney disease until late stage and heart failure,
but not renal protective like ACEI
