Chapter 16: Drugs Affecting the Cardiovascular and Renal Systems ACEIs, ARBs and Direct Renin Inhibitors: Act on the RAA system to reduce pressure by decreasing sodium and water retention, decreasing vasoconstriction, and increasing vasodilation. ACEI: PRILs • MOAs: Improve oxygenation to heart muscle and decrease inappropriate remodeling of the heart muscle after MI or with HF. Decrease production of ATII and Aldosterone. • Indications: Hypertension. Young, white, DM, MI, or HF. AA=increased angioedema. • Absolute contraindications: Bilateral renal artery stenosis, angioedema, pregnancy • Precautions: impaired renal function, hypovolemic and hyponatremic states. Hyperkalemia, hepatic impairments • Monitoring: BP, weight, fluid status, renal function, potassium, WBC for neutropenia. • Adverse drug reactions: Angioedema. Hypotension (dizzy, HA, fatigue). Dry hacking cough within first week of therapy. Rash, photosensitivity. • Drug interactions: Diuretics should be stopped for 2-3 days before starting meds. Increase doses in 1-2 weeks intervals. NSAIDS interact. No salt substitutes. ARBSs: ARTANs • MOAs: Block ATII receptor. Do not affect cardiac output and do not produce tachycardia. • Indications: Hypertension. Young, white, DM, MI, or HF. AA=increased angioedema. • Absolute contraindications: Bilateral renal artery stenosis, angioedema, pregnancy • Precautions: Impaired renal function, hypovolemic, hyponatremic states. Hyperkalemia, hepatic impairments • Monitoring: BP, weight, fluid status, renal function, potassium, • Adverse drug reactions: Hypotension (dizzy, HA, fatigue). • Drug interactions: Losartan lowered by P450. NSAIDS interact. No salt substitutes. DRI: Aliskiren. • MOAs: Directly impact renin levels with ATI and ATII reductions. • Indications: Hypertension. Young, white, DM, MI, or HF. AA=increased angioedema. • Absolute contraindications: Bilateral renal artery stenosis, angioedema, pregnancy • Precautions: Impaired renal function, hypovolemic and hyponatremic states, hyperkalemia, hepatic impairments. • Monitoring: BP, weight, fluid status, renal function, potassium, • Adverse drug reactions: Angioedema. Hypotension (dizzy, HA, fatigue). Sometimes produce cough. • Drug interactions: CYP3A4. NSAIDS interact. No salt substitutes. CCBs: • MOA: Block the L-type calcium channel. Relax arterial smooth muscle=reduces afterload, with limited effect on preload. Reduces contractility (Neg inotrope) Decrease in SA-AV node conduction.