Hypertension medications that affect the RAAS system - Pharmacology - Cardiovascular | @LevelUpRN

Summary

This educational video script focuses on cardiovascular medications, particularly those for hypertension and angina. It reviews the renin-angiotensin-aldosterone system (RAAS) and introduces various classes of medications that target different parts of this system. Key drugs discussed include aliskiren, ACE inhibitors like captopril and lisinopril, angiotensin II receptor blockers like losartan and valsartan, and aldosterone antagonists like eplerenone. The script highlights their mechanisms of action, side effects, and the importance of blood pressure monitoring during therapy.

Takeaways

• 💊 The video discusses cardiovascular medications, focusing on those used for hypertension and angina.
• 🔍 A review of the Renin-Angiotensin-Aldosterone System (RAAS) is provided as a foundation for understanding the medications.
• 👉 Aliskiren, a direct renin inhibitor, is highlighted for its role in treating hypertension by inhibiting the conversion of angiotensinogen to angiotensin I.
• 🚫 Aliskiren carries a black box warning due to fetal toxicity and can cause hypotension, angioedema, and GI upset.
• 🌟 ACE inhibitors, such as captopril and lisinopril, are used for hypertension, heart failure, myocardial infarction, and diabetic nephropathy.
• 📉 ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, leading to vasodilation.
• 🤒 Key side effects of ACE inhibitors include hypotension, angioedema, cough, and elevated potassium levels.
• 💧 Angiotensin II receptor blockers, like losartan and valsartan, are used to treat hypertension and diabetic nephropathy by blocking angiotensin II effects.
• 😵 Side effects of angiotensin II receptor blockers include hypotension, dizziness, and GI upset, with a black box warning for fetal toxicity.
• 🛡️ Aldosterone antagonists, such as eplerenone, are used for hypertension and heart failure post-MI by blocking mineral corticoid receptors.

Q & A

What is the primary function of the renin-angiotensin-aldosterone system (RAAS)?

The RAAS system is involved in regulating blood pressure and fluid balance in the body. Renin activates angiotensinogen into angiotensin I, which is then converted into angiotensin II by ACE. Angiotensin II causes vasoconstriction, promotes the reabsorption of water and sodium at the kidneys, and stimulates the release of aldosterone, which further enhances sodium and water reabsorption.

How does the medication aliskiren work within the RAAS system?

Aliskiren is a direct renin inhibitor that acts by inhibiting renin, preventing the conversion of angiotensinogen into angiotensin I. This action at the top of the RAAS system helps to lower blood pressure.

What are the potential side effects of aliskiren?

Side effects of aliskiren include hypotension, angioedema, and gastrointestinal upset. It also carries a black box warning due to fetal toxicity.

Which class of medications are ACE inhibitors, and how do they work?

ACE inhibitors, such as captopril and lisinopril, work by blocking the conversion of angiotensin I into angiotensin II, leading to vasodilation and a reduction in blood pressure.

What are the key side effects associated with ACE inhibitors?

Key side effects of ACE inhibitors include hypotension, angioedema, cough, and elevated potassium levels. They also carry a black box warning for fetal toxicity.

How can one remember which medications are ACE inhibitors?

ACE inhibitors often end in '-pril', which can be remembered with the mnemonic that drawing an 'ace' in cards gives you a 'thrill'.

What is the role of angiotensin II receptor blockers in hypertension treatment?

Angiotensin II receptor blockers, such as losartan and valsartan, treat hypertension by blocking the effects of angiotensin II, resulting in vasodilation.

What are the common side effects of angiotensin II receptor blockers?

Common side effects include hypotension, dizziness, and gastrointestinal upset. These medications also carry a black box warning for fetal toxicity.

How can one remember the side effects of angiotensin II receptor blockers?

The side effects can be remembered as they relate to the mnemonic 'Satan', which is associated with the '-sartan' ending of these medications, and include hypotension, dizziness, and GI upset.

What is the function of eplerenone, and how does it work within the RAAS system?

Eplerenone is an aldosterone antagonist used for hypertension and heart failure after a myocardial infarction. It blocks mineral corticoid receptors, inhibiting the effects of aldosterone and reducing sodium and water reabsorption.

What are the side effects of eplerenone, and why is potassium level monitoring important?

Side effects of eplerenone include hyperkalemia and dizziness. Monitoring potassium levels is crucial due to the risk of elevated potassium, a significant side effect of this medication.

What advice is given to patients taking medications that can cause hypotension?

Patients should be advised to change positions slowly to avoid symptoms of hypotension, such as dizziness upon standing quickly.

Outlines

00:00

💊 Introduction to Cardiovascular Medications

The paragraph introduces the topic of cardiovascular medications, specifically focusing on those used for hypertension and angina. It sets the stage for a detailed discussion by first reviewing the renin-angiotensin-aldosterone system (RAAS), which is crucial for understanding how these medications work. The paragraph explains how renin activates angiotensinogen into angiotensin I, and how ACE converts it into angiotensin II, which is responsible for vasoconstriction, sodium and water reabsorption, and aldosterone release. The first medication discussed is a direct renin inhibitor, aliskiren, which is used to treat hypertension by inhibiting the activation of angiotensinogen. The side effects of aliskiren include hypotension, angioedema, and GI upset, with a black box warning due to fetal toxicity. The importance of monitoring blood pressure during therapy is emphasized.

05:06

🌡️ Medications Affecting the RAAS System

This paragraph delves into various medications that act on different parts of the renin-angiotensin-aldosterone system to treat hypertension and related conditions. It starts with ACE inhibitors, such as captopril and lisinopril, which block the conversion of angiotensin I to angiotensin II, leading to vasodilation. The side effects include hypotension, angioedema, cough, and elevated potassium levels, with a black box warning for fetal toxicity. The paragraph also covers angiotensin II receptor blockers, exemplified by losartan and valsartan, which work by blocking the effects of angiotensin II. Their side effects are hypotension, dizziness, and GI upset, also carrying a black box warning for fetal toxicity. Lastly, the paragraph discusses aldosterone antagonists, specifically eplerenone, used for hypertension and heart failure post-MI. It works by blocking mineral corticoid receptors, leading to decreased sodium and water reabsorption. The key side effect is hyperkalemia, and it's crucial to monitor both blood pressure and potassium levels during therapy.

Keywords

💡Cardiovascular Medications

Cardiovascular medications are drugs that affect the heart and blood vessels. They are used to treat various conditions such as hypertension, angina, and heart failure. In the video, the speaker begins a series on these medications, focusing on those used for hypertension and angina, which are critical for managing blood pressure and heart health.

💡Hypertension

Hypertension, commonly known as high blood pressure, is a medical condition where the force of the blood against the artery walls is consistently too high. It is a focus of the video as many of the medications discussed are used to treat this condition, aiming to reduce the risk of heart disease and stroke.

💡Angina

Angina is a type of chest pain that occurs when the heart muscle doesn't get enough oxygen-rich blood. It is a symptom of an underlying heart condition and is mentioned in the video as another indication for the use of certain cardiovascular medications.

💡Renin-Angiotensin-Aldosterone System (RAAS)

The RAAS system is a hormone system that regulates blood pressure and fluid balance. In the video, the speaker reviews this system as a foundation for understanding how various medications work, as many of them target different parts of this system to manage hypertension.

💡Aliskiren

Aliskiren is a direct renin inhibitor used to treat hypertension. It is highlighted in the video as a medication that acts at the beginning of the RAAS system, inhibiting the conversion of angiotensinogen to angiotensin I, thus helping to control blood pressure.

💡ACE Inhibitors

ACE inhibitors are a class of drugs that block the conversion of angiotensin I to angiotensin II, leading to vasodilation and lower blood pressure. Examples given in the video include captopril and lisinopril, which are used to treat hypertension and other conditions like heart failure.

💡Angiotensin II Receptor Blockers

Angiotensin II receptor blockers, or ARBs, are medications that block the effects of angiotensin II, resulting in vasodilation. The video mentions losartan and valsartan as examples, which are used to treat hypertension and diabetic nephropathy.

💡Aldosterone Antagonist

An aldosterone antagonist is a medication that blocks the action of aldosterone, leading to reduced reabsorption of sodium and water in the kidneys. Eplerenone is the example given in the video, used for hypertension and heart failure post-MI.

💡Hypotension

Hypotension, or low blood pressure, is a potential side effect of many cardiovascular medications, as discussed in the video. Medications that are used to treat hypertension can sometimes lower blood pressure too much, leading to this side effect.

💡Angioedema

Angioedema is a side effect mentioned in the video that can occur with certain cardiovascular medications. It is a condition where the deep layers of the skin and mucous membranes below the skin swell rapidly, and it is associated with the use of ACE inhibitors and ARBs.

💡Fetal Toxicity

Fetal toxicity refers to the harmful effects that certain medications can have on a developing fetus if taken during pregnancy. The video emphasizes this as a significant concern with some cardiovascular medications, warranting a black box warning.

Highlights

Introduction to cardiovascular medications and their categorization.

Emphasis on the importance of understanding the renin-angiotensin-aldosterone system (RAAS).

Description of renin's role in activating angiotensinogen into angiotensin I.

Function of ACE in converting angiotensin I into angiotensin II.

Effects of angiotensin II on vasoconstriction, water and sodium reabsorption, and aldosterone release.

Overview of medications acting on different parts of the RAAS system.

Aliskiren as a direct renin inhibitor used to treat hypertension.

Mnemonic for remembering aliskiren's action on angiotensinogen.

Side effects of aliskiren including hypotension, angioedema, and GI upset.

Black box warning for aliskiren due to fetal toxicity.

Importance of monitoring blood pressure during aliskiren therapy.

ACE inhibitors like captopril and lisinopril, used for hypertension, heart failure, and diabetic nephropathy.

Mnemonic for ACE inhibitors ending in '-pril' to aid memory.

Key side effects of ACE inhibitors: hypotension, angioedema, cough, and elevated potassium.

Fetal toxicity and black box warning associated with ACE inhibitors.

Instructions for patients on ACE inhibitors to change positions slowly to prevent hypotension.

Angiotensin II receptor blockers like losartan and valsartan, used for hypertension and diabetic nephropathy.

Mnemonic for side effects of angiotensin II blockers: hypotension, dizziness, and GI upset.

Fetal toxicity and the importance of monitoring blood pressure with angiotensin II blockers.

Aldosterone antagonist eplerenone, used for hypertension and heart failure post-MI.

Mnemonic for eplerenone's action on aldosterone and its memory aid.

Key side effects of eplerenone: hyperkalemia and dizziness.

Importance of monitoring potassium levels in patients on eplerenone.

Anticipatory teaser for the next video discussing additional hypertension medications.

Transcripts

Alright.

So starting in this video, we are going to be talking about cardiovascular medications.

There are a lot to know in this category, but we're going to break it off into chunks

to help make it more manageable.

If you are following along with cards, I'm on card 11, and we're going to start off with

medications that are used for hypertension or angina.

So before we get into our first batch of medications, let's do a review of the renin-angiotensin-aldosterone

system or RAAS system.

So renin is released by the kidneys in response to a decrease in renal blood flow or low blood

pressure.

Then, renin activates angiotensinogen into angiotensin I.

Then, ACE, which is angiotensin converting enzyme, converts angiotensin I into angiotensin

II.

And then, angiotensin II does a number of things.

The first thing it does is it causes vasoconstriction of the blood vessels.

It also causes water and sodium to be reabsorbed at the kidneys.

And then, finally, it causes the release of aldosterone from the adrenal cortex, which,

in turn, also causes reabsorption of water and sodium at the kidneys so these medications

that I'm about to go over, they will act on different parts of this renin-angiotensin-aldosterone

system.

So the first medication we're going to talk about that is used to treat hypertension is

a direct renin inhibitor, and the medication that's important to know in this class is

aliskiren, and it's used to treat hypertension.

It acts by inhibiting renin, which is at the top of our RAAS system, which prevents angiotensinogen

from being activated into angiotensin I.

So the way I remember this medication-- if you look at the word aliskiren, it kind of

looks like Alice and Karen.

So Alice and Karen gang up on Angie, right, so Angie being angiotensinogen, to stop it.

So side effects with aliskiren include hypotension as well as angioedema and GI upset.

This medication also carries a black box warning because of fetal toxicity.

It's going to be really important to monitor the patient's blood pressure during therapy.

And, again, like I shared in my introduction video to this whole series, for a lot of these

medications, you could kind of figure out what one of the key side effects is going

to be just by its mode of action so this medication is used to treat hypertension, so if it does

its job too well, we're going to end up with hypotension, which is a side effect for this

medication.

Now, let's talk about ACE inhibitors.

ACE inhibitors include medications such as captopril and lisinopril.

They will all end in that -pril, which kind of looks like thrill, so if you're playing

cards and you draw an ace, then you get a thrill.

So that kind of helps you to remember that medications that end in that -pril are ACE

inhibitors.

So ACE inhibitors can be used for hypertension as well as heart failure, a myocardial infarction,

and diabetic nephropathy.

They work by blocking the conversion of angiotensin I into angiotensin II, which results in vasodilation.

They do have some key side effects.

So hypotension is going to be a key side effect.

Again, if our medication is doing its job too well-- it's being used for hypertension.

If it works too well, we're going to end up with hypotension.

So hypotension is a key side effect.

Other really important side effects to know include angioedema, cough, and elevated potassium.

So those all start with A, C, E. So A for angioedema C for cough, and E for elevated

potassium.

And so that's how you can remember those key side effects in addition to hypotension.

Other side effects.

This drug is toxic for fetuses, so it does carry a black box warning, and you would not

want to use this during pregnancy.

And then it's important to monitor blood pressure during therapy, and you want to teach your

patient to change positions slowly because of that hypotension side effect.

So when a patient has hypotension, and if they get up too quickly, they may be going

right back down.

So you want them to kind of sit up on the side of the bed and dangle their feet for

a little while before just popping out of bed.

So hopefully, that's helpful.

Now, let's talk about angiotensin II receptor blockers.

So medications that fall within this class include losartan and valsartan.

These medications will all end in that -sartan, which kind of looks like Satan, and if you

saw Satan, it would probably make your blood pressure drop, make you feel dizzy, and make

your stomach hurt, which are key side effects with this class of medication.

So angiotensin II blockers are used to treat hypertension as well as diabetic nephropathy.

They work by blocking the effects of angiotensin II which results in vasodilation.

So key side effects, you can probably guess what one of them's going to be.

It's hypotension.

In addition, it's dizziness and GI upset.

It also carries a black box warning because of fetal toxicity.

And again, when your patient is on this medication, you're going to want to monitor their blood

pressure carefully.

And also, teach them to change their positions slowly because of that hypotension.

Okay.

So the last medication that works within that RAAS system is an aldosterone antagonist.

So the medication in this class that I would be familiar with is eplerenone.

And it is used for hypertension as well as heart failure after an MI.

It works by blocking mineral corticoid receptors which inhibits the effect of aldosterone and

results in reabsorption of sodium and water.

So the way I remember this medication is that eplerenone does an epic job of blocking aldosterone.

So the E-P at the beginning of eplerenone kind of reminds me of epic.

And again, the end of it is that -one.

So eplerenone does an epic job of blocking aldosterone.

Side effects include hyperkalemia, very important side effect to know with this medication,

as well as dizziness.

So when a patient is taking this medication, you want to make sure you're monitoring their

blood pressure during therapy.

But also monitoring their potassium levels because of that side effect of hyperkalemia.

Alright.

In my next video, we're going to talk about more medications that are used to treat hypertension.

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