8/3/2019 Lecture 2 Drugs

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8/3/2019 Lecture 2 Drugs

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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