ACE Inhibitors:
- -PRILs
- AngII vasoconstriction & aldosterone
- Awos: ¯ AngII = ¯ BP (ie afterload); ¯ in fluid also = ¯ afterload
- Aldosterone: fluid and ¯ potassium
- Therefore, ACEIs à vasodilation, ¯ fluid, potassium
- Most prominent use for ACEIs is Rx of HTN and HF
- Major side effects: cough, headache, dizziness, abdominal pain, confusion, renal failure, impotence
Drugs Used in Heart Failure
A) Remove Cause; B) Treat Symptoms
- ¯ workload à ACEIs
- other vasodilators: combination of hydralazine & isosorbide dinitrate
- Nitroprusside used in Rx of acute HF b/c ¯ pre and afterload w no effect on contractility
- Beta blockers:
- ¯ fluid à Diuretics
HF is assoc w retention of Na and water (first line of attack is to reduce sodium)
- contractility à digitalis
45 Osteoporosis
· Objective: prevent bone loss & Rx established osteoporosis
· Defn osteoporosis: “loss of bone mass”
· Diet & exercise play major role in maintenance of bone mass
· BCE,Serms, Oth: bisphosphonates, calcitonin, estrogens, selective estrogen receptor modulators, other
Estrogens: Ca retention; retard bone loss. Used to prevent bone loss after menopause. (Can not mass following bone loss).
Calcitonin: Inhibits osteoclastic activity; some analgesic activity (may be used in fractures); administered nasally or subQ
Bisphosphonates: (-DRONATEs); eg alendronate, clodronate; Improve bone mass in established osteoporosis (inhibit osteoclastic activity and ¯ bone turnover/resorption); Not well absorbed from GI (esp when food is present); Also used in Paget’s Dz;
SERMs: Raloxifene: estrogen agonist on bone, but estrogen antagonist on breast and uterus. Like estrogens, can risk of thromboembolism; Approved for prevention of postmenopausal osteoporosis (like estrogen).
Other: Vit-D & Calcium, Fluoride; Ca supplementation reduces loss, but does not mass once lost. Vit-D: deficiency can occur in elderly women confined indoors. Fluoride: rebuilds bone, but high doses produces brittle bone.