NR 566 Week 3 Study Guide 2020– Johns Hopkins University of Nursing (Question &Answer 96% correct)
NR566 Week 3 Study Outline
Chapter 16: Drugs
... [Show More] Affecting the Cardiovascular & Renal Systems Angiotensin converting enzyme inhibitors (ACEI or ACE Inhibitors)
o Drugs: benazepril, captopril, enalapril, fosinopril, lisinopril, and moexipril, perindopril, quinapril, ramipril, trandolapril
o Pharmacodynamics:
o MOA: Slows or inhibits the angiotensin converting enzyme which then decrease how much angiotensin II (AT II) is produced thus lowering BP
o Inhibit RAAS activity=decreased production of both angiotensin II and aldosterone
o Act on the RAAS system: decreases peripheral vascular resistance (decreased afterload)
o Indirectly reduce the secretion of aldosterone=decreased sodium and water retention, reducing extracellular fluid volume and preload
o Lower vascular resistance w/o decreasing cardiac output (CO) or GFR
o Do not affect CO=Do not produce reflex tachycardia
o Strong evidence for CV and cerebrovascular risk reduction, HF, and slowing of renal disease
o Improves oxygenation to heart muscle, decreases inappropriate remodeling of heart muscle after MI or with HF, and reduces affects of DM on the kidneys
o Also plays a role in the kinin-kallikrein-bradykinin system: ACEs facilitate the breakdown of bradykinin into inactive fragments thus reducing the actions of bradykinin (pain, extravascular smooth muscle contraction, increased vascular permeability, and increased leukocyte chemotaxis)
o Reno-protective for individuals with proteinuria but is not as protective in renal patients without proteinuria
Improve insulin sensitivity
Decrease proteinuria in those with CKD and help with BP control
In earliest signs of diabetic nephropathy (microalbuminuria) lisinopril is recommended
Lisinopril reduces the progression of this complication independent of BP control
Adding an ACE inhibitor to patients with known CKD commonly results in increate crt
The improvement in proteinuria happens despite this effect
Because of this, it is acceptable to have up to a 30% increase in crt with d/c of ACE inhibitor
Although crt increases acutely, GFR improved long term
d/c should only be considered for patients with progression and/or significant deterioration in renal function for patients with hyperkalemia
o Pharmacotherapeutics:
o Contraindications: bilateral renal artery stenosis, angioedema, and pregnancy
o Use with caution:
Impaired renal function especially in older adults, hypovolemic or hyponatremic states, hepatic impairment
o Contraindicated in hyperkalemia: reduced aldosterone may worsen the imbalance
Risk increased with patients with HF r/t reduced blood flow to kidneys
o Contraindicated in pregnancy r/t fetal renal abnormalities in the latter half of pregnancy and cardiac abnormalities in the first trimester
o Adverse drug reactions (ADRs):
o ADRs are usually transient, mild, and more common in longer acting agents
o ADRs increase with higher doses
o dry hacking cough, usually only last a week but is often cited as the reason for discontinuance
(bradykinin and substance P after the drug interrupts the RAAS: d/c drug and see if the patient improves)
More common in African Americans and Asian population
Class phenomenon: changing to a new generation ACE has been associated with less cough
o hypotension (dizziness, HA, fatigue, orthostatic hypotension)
o Tachyphylaxis frequently occurs with continued use [Show Less]