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8/3/2019 Lecture 2 Drugs
1/2
8/3/2019 Lecture 2 Drugs
2/2
AE
Monitoring Reassess dose if K+ >5.5 mEq/L (remove
other agents that K+
Caution: renal artery
Stenosis
MONITOR: K+ lvls, SrCr
Reassess dose if K+ >
5.5 mEq/L (remove
other agents that
K+
Caution: renal artery
Stenosis
Safety If symptoms worsen,stop titration and
return to last
tolerated dose
--patients may
become more
symptomatic for
weeks 4-12 before
improvement
Reasons to stop
titration:
hypoperfusion,hypotension,
symptomatic
bradycardia,
bradycardia at reat,
orthostatsis,
Specific Trials ACE vs ARB studies:Val-HeFT trial (ACEi+ valsartan or placebo)
no mortality benefit with ACE/ARB combo
CHARM (ACEi+ Candesartan or placebo)
CV effects
ELITE (losartan vs. captopril)-losartan was better tolerated and had fewer
d/c
ACEi only:
SOLVD (enalapril vs. placebo)
mortality & hospitalizations
HOPE (ramapril vs. placebo)
rate HR