Mechanisms Indications and Side Effects

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Angiotensin converting enzyme inhibitors: Block conversion of angiotensin I to II in lungs and vascular endothelium, reduced peripheral vascular resistance (PVR), lower blood pressure; indications — hypertension; side effects: reduced bradykinin breakdown in lungs, causing angioedema and cough. Management of toxicity: Epinephrine, Hj-blockers, steroids.

Angiotensin receptor blockers: Decrease formation of angiotensin II at vascular receptor sites; indications — hypertension; side effects: few, bradykinin metabolism unaffected, no angio-edema and cough so common with ACE inhibitor therapy.

All: Produce vascular smooth muscle relaxation with peripheral vasodilation and triggering of baroreceptor-mediated tachycardia; main uses — hypertension.

Management of toxicity: Fluids, a-pressors. Hydralazine: Same indications, and lupus syndrome possible as a side effect, as with procaineamide.

Minoxidil: Same indications, and hair growth. Diazoxide: Same, and immediate increase in glucose in management of insulin and oral hypoglycemic overdoses.

Sodium nitroprusside: Vasodilation via nitric oxide mechanism; cyanide (CN) toxicity possible (Lilly CN kit — sodium nitrite first, then sodium thiosulfate).

Angiotensinogen I Renin

Angiotensin I

Angiotensin converting enzyme irs (ACEI)

Angiotensin converting enzyme irs (ACEI)

Inactived bradykinin

Angiotensin II Angiotensin

Angiotensin " receptor -P blockers (ARBs) *

Vasoconstriction

Aldosterone secretion

Peripheral vascular resistance

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