The Cardiovascular System (20):
● Drug therapy hypertension:
o RAAS Suppressants (4) Hypertension (HTN), Heart Failure, Diabetic Nephropathy,
left ventricular dysfunction following myocardial infarction (MI)
▪ ACE inhibitors- captopril (Capoten)
● Expected Pharmacologic Action: Blocks production of angiotensin
II, Vasodilation (arteriolar), Urinary excretion of sodium and
water, Urinary retention of potassium
● Side and Adverse Effects:
o Severe hypotension following first dose
o Dry, nonproductive cough due to increase in bradykinin
(decrease breakdown of bradykinin)
o Angioedema (swelling of mouth, throat due to inhibition of
kinase II)
o Rash and report of metallic taste in mouth
o Hyperkalemia (high potassium)
o Neutropenia (low WBC – white blood cell count –
neutrophils)
● Administration:
o Available for oral use only.
o Must be taken two to three times daily for HTN; three
times daily for heart failure.
o Give captopril one (1) hour before meals for adequate
absorption.
▪ ARBs- losartan (Cozaar)
● Expected Pharmacologic action: Antihypertensive, blocks
angiotensin II, Vasodilation (arteriolar), Urinary excretion of
sodium and water, Urinary retention of potassium
o *Very similar like ACE Inhibitors – ARBs are less able to
protect against acute CV events (MI) 2nd choice
o * ARBs do not cause hyperkalemia or cough
● Side Effects:
o Angioedema (occurs less than with ACE inhibitors; but
still a potential risk)
o Headache (HA), insomnia
o Severe hypotension may occur with overdose or in
volume depletion (low circulating blood volume
● Administration: oral administration only. Take w/ or w/o food
▪ Aldosterone antagonists- eplerenone (Inspra)
● Expected pharm effect: Blocks aldosterone receptors. Urinary
excretion of sodium and water. Urinary retention of potassium.
● Side and Adverse Effects: Hyperkalemia →Due to the potassium
sparing effects. (Hyperkalemia : > potassium: irregular heart rate,
muscle cramps, progressive weakness, hyperactive bowel sounds,
and diarrhea)
● Administration: oral use only; give along/combine with other
antihypertensive drugs. Maximum effect may take 4 weeks.
▪ Direct renin inhibitors- aliskiren (Tekturna)
● Expected Pharmacologic action: Binds with renin: inhibits
activation of angiotensin I, Vasodilator (arteriolar), Urinary
excretion of sodium and water, Urinary retention of potassium
● Side and Adverse Effects:
o Hyperkalemia
o Cough or angioedema (swelling of mouth, throat); Less
cough than ACE Inhibitors
o Diarrhea, abdominal pain: more likely in high doses
● Administration: oral use only; Give at a consistent tie daily relative
to meals. 2 week until full effect. Monitor hypotension.
● Make sure patients who are using a salt substitute read the label
because most salt substitute potassium for sodium; the drug
excretion of potassium, using a salt substitute that contains
potassium can be dangerous
o Calcium channel blockers- nifedipine (Adalat, Procardia)
▪ Expected Pharmacologic actio...
