Ore Adaramola

Pharmacology
Critical Thinking Assignment
July 11 2010

1. The renin-angiotensin-aldsoterone system (RAAS) plays an important role in regulating

BP, blood volume, & fluid & electrolyte balance. . Review the actions of angiotensin II
& aldosterone.
When the body detects a drop on BP or blood volume the RAAS system releases
angiotensin II and aldosterone and this increases the BP increases through vasoconstriction and
retention of H2O.

2. How is the BP regulated by the RAAS?

When the BP drops the RAAS system releases angiotensin which raises the BP
by vasoconstriction.

3. What are angiotensin-converting enzyme inhibitors (ACEI) used to treat?

ACE treats HTN, heart failure, MI, diabetic neurophaphy.
 Lisinopril,
 Enalapril,
 Captopril

4. What is the major differences in adverse effects with ACEI & ARB’s?
ACE’s has involvement of Kinase II and this action produces the adverse reaction
of cough and hyperkalema. Whereas ARB’s do not act on Kinase two so they do not
produce that sideeffect.

5. Aldosterone antagonist block receptors for aldosterone. List the therapeutic uses &
adverse effects of spironolactone (Aldactone) & eplerenone (Inspra).
Aldosterone antagonist blockreceptors are used for HTN & HF.
Eplerenone can be used in pts with HF to improve sx, reduce hospitalizations and prolong
life. Adverse affects are hyperkalemia secondary to K retention.

6. Diltiazem (Cardizem) acts on vascular smooth muscle & the heart. It has the same
direct effects as verapamil. List the direct effects?

Direct effects are:

1) Blocked at the peripheral arterioles causes dilation, and thereby decreases arterial
pressure
 2) Blocked at arteries and arterioles of the heart increases coronary perfusion
3)Blocked at the SA node decreases HR.
4) Blocked at the AV node decreases AV nodal conduction.
5) Blocked in the myocardium decreases force of contraction.

7. List the adverse effects of diltiazem. Of these, which is a reason that a heart failure
patient may not be able to tolerate this medication?
Dizziness, headaches, flushing and edema, it should be used with caution in pts with CF,
because it can cause fluid retention (edema), which can be especially dangerous in people with
CHF.

8. The medication group of vasodilators provide what therapeutic effects?

Vasodilators produce a selective effects, some agents produce dilation of
arterioles, others dilation of veins and others dilation of veins and arterioles. Hydralize
silates the arterioles, NTG dilates the veins, and Sodium Niropresside dilates both arteries
and veins.

9. Why is it important to understand about the difference in arteriole versus venous

dilation?
drugs that act on the arterioles and dilates cause a decrease in cardiac afterload, by
decreasing afterload, arteriolar dilation decreases cardiac work while causing cardiac
output and tissue perfusion to increase. Drugs that dilate veins reduce the force, which
blood is returned to the heart, which reduces ventricular filling. The reduction of
ventricular filling decreases cardiac preload.

10. Review and differentiate the administration, therapeutic uses & adverse effects of
hydralazine & sodium nitroprusside.
Nitroprusside is the fastest HTN agent available, used in hypertensive emergencies,
causes dilation of veins and arterioles, given by IV infusion. Side effects are:
hypotension, cyanide poisoning and thiocyonide toxicity. A main Side effect that occurs
with Hydralozine SLE.

11. Why is nitroprusside the drug of choice for a hypertensive emergency?

Because is the fastest antihypertensive agent available.

12. List the potential consequences of HTN.

 MI,
 stroke
 kidney failure
 angina pectoralis.

13. List the 5 different ways that antihypertensive medications can lower BP.
 decrease blood volume,
 decrease arterial resistance,
  decrease myocardium contractility & suppressing reflex of tachycardia,
 preventing aldosterone mediate retention of Na and H2O,
 promotes dilation of arterioles.

14. When a pt has a new diagnosis of HF which medication are usually started first?
Diuretics

15. Why might a HF patient be on a combination of isosorbide & hydralazine?

The combination represents an alternative when ACE and ARBs can’t be used.
Isosorbide dilates veins and hydralazine dilates arterioles.

16. List the 2 fundamental causes of a dysrhythmias

Disturbances of impulse formation and the disturbances of impulse conduction.

17. What is the antidote for heparin overdose?

Protamine sulfate is the antidote.

18. Why are patient usually weaned off of nitroglycerin?

If Nitroglycerin is withdrawn abruptly vasoconstriction spasm may happen.