NR 566 Week 3 Study Guide {2020}

NR 566 Week 3 Study Guide {2020} – Chamberlain College of Nursing NR566 Week 3 Study Outline Chapter 16: Drugs 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 o loss of taste o Angioedema (serious)