ANGIOTENSIN II RECEPTOR BLOCKERS

Prepared by: Marie Joy Alteza Ma. Cristina Bragais Roxanne De Vera Mark Vincent Flores

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM

LOW BP

RENIN (from kidneys)

RENIN converts ANGIOTENSINOGEN (from liver) to ANGIOTENSIN I

a.) Causes smooth muscles in blood vessels to constrict

ANGIOTENSIN II has 2 effects:

An enzyme, ANGIOTENSIN CONVERTING ENZYME (ACE), converts ANGIOTENSIN I to ANGIOTENSIN II

b.) Acts on the ADRENAL CORTEX to increase ALDOSTERONE secretion

ALDOSTERONE

Causes retention of SODIUM and WATER

the effects of ANGIOTENSIN II (a and b) Increase the blood pressure

Increase in BLOOD VOLUME

ANGIOTENSIN II RECEPTOR BLOCKERS

Are medications that block the action of angiotensin II, permitting the blood vessels to relax and dilate lowering the blood pressure. They have effects similar to an ACE inhibitor which is why they are often used when an ACE inhibitor cannot be tolerated by patients.

Mechanism of Action
The final active messenger of the reninangiotensin pathway is angiotensin II. Angiotensin II binds to AT1 receptors to cause vasoconstriction and fluid retention, both of which lead to an increase in blood pressure. The angiotensin II receptor blockers lower blood pressure by blocking the AT1 receptors.

The ABRs include the following drugs:

Candesartan (Atacand) is used alone or as part of combination therapy to treat hypertension. Usual Dosage: 16-32 mg/d PO Eprosartan (Teveten) is used alone or as part of combination therapy to treat hypertension in adults. Usual Dosage: 400-800 mg/d PO

 Valsartan (Diovan) can be used alone or as part of combination therapy for hypertension and for the treatment of heart failure in patients who are intolerant to ACE inhibitors. Usual Dosage: 80-320 mg/d PO

 Losartan (Cozaar) can be used alone or as part of combination therapy for hypertension, as well as for treatment of diabetic neuropathy with an elevated serum creatinine and proteinuria in patients with hypertension and type 2 diabetes.

 Irbesartan (Avapro) is used on monotherapy in the treatment of hypertension but can be combined with other antihypertensive if needed. It is also used to slow the progression of kidney disease in patients with hypertension and type 2 diabetes.

INDICATION
Hypertension Congestive Heart Failure (CHF) Atrial fibrillation Diabetic Neuropathy

ADVERSE EFFECTS
Headache Dizziness Syncope Weakness Hypotension Diarrhea Abdominal pain Nausea Dry mouth Rash Dry skin Alopecia

SERIOUS SIDE EFFECTS

Liver failure Renal failure Angiodema decrease in white blood cells and swelling of tissues

DRUG INTERACTIONS
Lithium - Increase SE of Lithium. Rifampin - Reduces blood levels of Losartan Fluconazole - Decreases the effect of Losartan Phenobarbital - Decreases serum levels.

CONTRAINDICATIONS

Allergy Pregnancy Lactation

CAUTIONS

Hepatic and Renal dysfunction Hypovolemia

NURSING RESPONSIBILITIES
Encourage the patient to implement lifestyle changes, including wt.loss, smoking cessation, decrease alcohol and salt in the diet and increase exercise. Administer without regard to meals; give with food. Ensure that the female patient is not pregnant before beginning therapy and suggest the use of barrier contraceptives while she is taking this drug. Find an alternative method of feeding the baby if the patient is nursing. Monitor the patient carefully in any situation that might lead to a drop in fluid volume. Provide comfort measure Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.