Name one benefit of vitamin C

It helps with the absorption of other vitamins

Vitamin C and Fruit

Nutrition, Metabolism, and Body Temperature Regulation. Nutrient is a substance that promotes normal growth, maintenance, and repair. Major nutrients are carbohydrates, lipids, and proteins. Other nutrients include vitamins and minerals (and technically speaking, water).Complex carbohydrates (starches) are found in bread, cereal, flour, pasta, nuts, and potatoes .Simple carbohydrates (sugars) are found in soft drinks, candy, fruit, and ice cream.Glucose is the molecule ultimately used by body cells to make ATP.Neurons and RBCs rely almost entirely upon glucose to supply their energy needs.Excess glucose is converted to glycogen or fat and stored .The most abundant dietary lipids, triglycerides, are found in both animal and plant foods.Essential fatty acids – linoleic and linolenic acid, found in most vegetables, must be ingested. Dietary fats help the body to absorb vitamins, a major energy fuel of hepatocytes and skeletal muscle, and a component of myelin sheaths and all cell membranes. Lipids functions in smooth muscle contraction, control of blood pressure and inflammation. Cholesterol stabilizes membranes and is a precursor of bile salts and steroid hormones. The dietary requirements for lipids are higher for infants and children than for adults. The American Heart Association suggests that fats should represent less than 30% of one’s total caloric intake, saturated fats should be limited to 10% or less of one’s total fat intake, and daily cholesterol intake should not exceed 200 mg. Complete proteins that meet all the body’s amino acid needs are found in eggs, milk, milk products, meat, and fish.Incomplete proteins are found in legumes, nuts, seeds, grains, and vegetables. Essential amino acids are the building blocks for nonessential amino acids. Protein supply for nonprotein nitrogen-containing substances. Daily intake should be approximately 0.8g/kg of body weight. All amino acids needed must be present at the same time for protein synthesis to occur. Protein will be used as fuel if there is insufficient carbohydrate or fat available. The rate of protein synthesis equals the rate of breakdown and loss. Anabolic hormones accelerate protein synthesis. Vitamins are organic compounds needed for growth and good health. They are crucial in helping the body use nutrients and often function as coenzymes. Only vitamins D, K, and B are synthesized in the body; all others must be ingested. Water-soluble vitamins (B-complex and C) are absorbed in the gastrointestinal tract . Vitamin B12 additionally requires gastric intrinsic factor to be absorbed. Fat-soluble vitamins (A, D, E, and K) bind to ingested lipids and are absorbed with their digestion products. Vitamins A, C, and E also act in an antioxidant cascade. There are seven minerals are required in moderate amounts . These are calcium, phosphorus, potassium, sulfur, sodium, chloride, and magnesium. Dozens are required in trace amounts. Minerals work with nutrients to ensure proper body functioning. Calcium, phosphorus, and magnesium salts harden bone.

Nutrition Notes Nutrition- study of how your body uses food Process by which body uses nutrients How you look and feel Resist diseases and illness How you perform physically and mentally Nutrients: substances in food your body needs to grow, repair and supply energy to your body cells 6 Classes of Nutrients 1.Carbohydrates: 1 gram= 4 calories 2. Protein: 1 gram- 4 calories 3. Fats: 1 gram= 9 calories 4.Water 5. Vitamins 6. Minerals Calorie: measurement of energy in food Metabolism: Rate at which body burns energy(calories) Hunger: physical drive to eat Appetite: pshycological desire for food What influences your food choices: Foods you like Health Reasons Family and Culture Time & Money Advertising Emotions Friends Social Media: Modeling Nutrients Carbohydrates: your body’s main source of energy sugars/starches in food 45%-65% of diet #1 source of energy Simple: sugars converted to glucose= energy (fruits, dairy, honey, some manufactured foods) Complex: sugars linked together (starches) (grains, bread, pasta, beans, vegetables) Fiber: tough, indigestible carbohydrates Cleans our digestive system Prevents some types of cancer Prevents heart disease (fruits, vegetables, whole grains,nuts) 2. Protein: growth and repair of body tissues Made up of chemicals called “amino acids” Basic building material of all body cells (muscles, bones, skin, internal organs) Secondary source of energy protein(hemoglobin) attaches to oxygen in blood Functions as hormones regulating body functions 10-15% of diet *Body uses 20 Amino Acids found in food ( body produces 11 and 9 must come from diet) Essential amino acids: 9 amino acids body doesn't produce Complete Amino Acids: foods that contain all 9 essential amino acids ( animal products) Incomplete Amino Acids: food products that do not contain all 9 essential amino acids. Fats 15-25% of diet Secondary source of energy Blood clotting Controlling inflammation Maintains healthy skin/hair absorb /transport fat soluble vitamins Regulates body temperature Types of Fat Unsaturated: “good” fat Liquid at room temperature Can help fight heart disease (veg oil, nuts) Saturated: “bad” fat Solid at room temp Clogs arteries Causes strokes, heart attack, diabetes (animal products, meat, dairy) Cholesterol: waxy like fat substance found in meat products HDL: good type of cholesterol Body creates(liver) Creates cell wall, hormones, and vit D LDL: bad cholesterol- found in foods (clogs arteries) 4. Trans Fat: “one of the worst type of fats” Formed by a process called “hydrogenation”: adding Hydrogen molecules to unsaturated fats to make it more solid and resistant to chemical change. Vitamins A vitamin is a chemical compound that is needed in small amounts for the human body to work correctly. Vitamins are classified as either fat soluble (vitamins A, D, E and K) or water soluble (vitamins B and C). This difference between the two groups is very important. It determines how each vitamin acts within the body. The fat soluble vitamins are soluble in lipids (fats). Fat soluble vitamins can be stored in our body Water soluble vitamins must be taken every day Human body produces some amounts of Vitamin D & K

Orchard / fruit trees Importance of fruit trees • Fruit trees are important for the following uses: They are a source of food, they produce fruits Some are used for making medicines Others provide shade and can also act as wind breakers. Those with beautiful flowers are very decorative. They contain vitamins which means they have nutritional value. Classification of fruit trees • Fruit trees are classified as indigenous and exotic. Indigenous fruit trees • are those that natural grow in a country. • They take longer to grow. • Examples of indigenous fruit trees are: English name Shona Name Snot apple Water berry Red ivory Fig Monkey orange Wild custard apple Mobola fruit Exotic fruit trees • These are trees that were brought from other countries. • They are commercially grown in orchards. • Common exotic fruit trees include: • Exotic fruit trees grow faster than indigenous. Ornamental horticulture • It deals with the growing of decorative plants. • Decorative plants are collectively called ornamental plants. • They include trees, shrubs, flowers and lawn grasses. Importance of ornamental plants They beautify the environment. Flowers often produce a pleasing fragrance. Flowers attract insects like bees that are responsible for pollination. Plants produce oxygen that we need for breathing. • Some are used for making medicines. • Lawn grasses prevent soil erosion. • Plants provide shelter for birds and insects. Classification of ornamental plants • There are four classes of ornamental plants. Trees Shrubs Flowers Lawn Trees: • Ornamental trees are very useful as decorative plants. • This is because most of these trees produce beautiful flowers and some are ever green. • Examples of decorative trees include flamboyant, jacaranda, pines, Cyprus. Shrubs: • A shrub is a woody plant with many branches but smaller than a tree. • Some of them are ornamentals because they produce beautiful flowers. • Others can be cut into decorative shapes. • The golden duranta is good example because it can be cut into nice shapes. • The bougainvillea is another example of a decorative plant because: It can act as a climbing plant. It produces decorative flowers. It can also be cut into any shape using a hedge shear. Flowers: • Flowers have the following functions: They are used for decorations at weddings, hotels and parties. They are used as an expression of love and appreciation such as valentine’s day and get well soon messages. They are useful in bee farming called apiculture as they are a source of nectar used for making honey. Flowers produce a pleasant fragrance used in the production of soaps and scents for perfumes, deodorant and lotions. Lawn: • A lawn is an area of grass that is kept cut short and is usually part of someone's garden or backyard, or part of a park. • Some lawn grasses grown in Zimbabwe are Durban, kikuyu, couch and buffalo lawn. • They prevent soil erosion. • They also provide a comfortable outdoor resting place. Forestry Importance of trees • Trees are important to us and animals. • The Forestry Commission is responsible for taking care of trees in Zimbabwe. • Trees are also important to the environment because: They are a source of fuel in the form of firewood. They are used for making most of the furniture we use. Most medicines come from both exotic and indigenous trees, for example pine trees and gum trees are used for making cough medicines. Trees provide browsing animals like the kudu and giraffe with food. Fruits from both exotic and indigenous fruit trees are a rich source of vitamins Trees give out oxygen which we need for breathing. Trees provide timber that can be used for roofing. • Trees are grouped according to where they come from. • The groups are indigenous and exotic. 1 . Indigenous trees : • These are local trees that have always been grown in their country. Shona name English name Mutohwe Snot apple Mususu Yellow wood Mubvamaropa Blood wood Muuyu Baobab Muonde Fig tree Musasa msasa Characteristics of indigenous trees  take longer to mature  Do not produce straight poles  Grow on their own  Hard wood 2 .Exotic trees : • These are trees that have been brought from another country to be grown in Zimbabwe. Characteristics of exotic trees  They are brought in a country from another country. Grow very fast.  Have soft woods  Usually grow straight  Usually grown in orchards and plantations Common exotic trees in Zimbabwe are: Gum trees Pine trees Wattle Cyprus Date palm Mango Apple pawpaw Causes of plant damage • plant damage is when cultivated crops are kept from normal growth that leads to reduced yields. • plant damage is caused by both living and non living things. • Some of the common causes of crop damage are: (a)Pests • These are living organisms that cause physical damage to crops. • Examples of pests are weevils, army worm, aphids, cutworms and locusts. (b) Diseases • Plant diseases are caused by living organisms called pathogens. • These pathogens infest the plant and take away nutrients. • Fruit rot and bacteria spot are some of the examples of plant diseases. (c) Weeds • these are plant which grow where they are not wanted. • For example if black jack grows in a groundnut field, it is a weed. • Weeds compete for nutrients with cultivated plants. (d) Very high temperatures • High temperatures may cause crops to wither. • High temperatures may also lead to lightning and fires. • This can burn up crops. ( e) Frost • Frost damages crops in winter. • Tomatoes, potatoes, and beans are easily damaged by frost. (f) Drought • drought is when there is no rainfall in a season where it supposed to be raining. • It is one of the most serious forms of crop damage. • Plants wither and die if there is no rainfall. ( g) Animals • Wild animals like baboons often eat maize crops before they mature. • Birds also are a problem to crops like sorghum. Signs of plant damage • There are various signs that show plant damage. • Some can be corrected but some lead to total loss. • Some signs of plant damage include: Lodged plants Flowers and small fruits blown to the ground Dull leaf color Wilted plants Stunted growth

Foods from the Americas Tomatoes Tomatoes are native to Mexico and Central America, and the Aztecs grew them back in the eighth century. In the sixteenth century, Spanish explorers introduced tomatoes to Spain, and the tomato’s popularity spread quickly through Europe. The French, Germans, and Italians absolutely loved them. But the British thought they were poisonous at first. In the nineteenth century, a British diplomat introduced tomatoes to the Middle East, and now Egypt is among the world’s top tomato producers. Read about the foods from the Americas. Then try out the recipes. Avocado The Aztecs also cultivated the avocado (they called it ahuactl). The avocado is an oily fruit, rich in vitamins A, B, and C. The fruit does not get ripe on the tree. People need to pick it from the tree before it develops its flavor and full maturity. Sailors used to call avocados “seaman’s butter,” because the fruit lasts for a long time, and it was good for sea voyages. Chocolate Chocolate (chocolatl in the Aztec language) was the treasured drink of the Aztecs. When the Spaniard Hernán Cortés arrived in Mexico in 1519, the Aztecs gave him chocolate as part of a royal welcome. It is said that the Aztec Emperor, Moctezuma, used to drink 50 cups of chocolate a day out of a gold cup. The Spanish introduced chocolate to Europe. However, it was only in the nineteenth century that Henri Nestlé, in Switzerland, created the first bar of chocolate. Nowadays, very few people can resist the sweet food—once only for kings

Based on the text "Eating colours every day," here is a set of multiple-choice questions using "Wh-" question words (Who, What, Where, When, Why) to test comprehension: Comprehension Quiz: Eating Colours 1. What does the phrase "eating colours" actually mean? A) Eating food with artificial food coloring. B) Choosing a variety of colorful fruits and vegetables. C) Painting your food before you eat it. D) Only eating your favorite color of food. 2. Why should we eat different colours every day? A) To make the plate look pretty for photos. B) Because colorful food tastes sweeter. C) To get different vitamins and minerals that help us stay healthy. D) Because it is easier to cook colorful food. 3. When can you try to include many colours in your diet? A) Only on the weekends. B) Once a month. C) Only for dinner. D) Throughout the day in all your meals. 4. What is a specific benefit mentioned for our bodies when we eat these foods? A) They help us run faster than a car. B) They help our bodies grow, stay strong, and fight illness. C) They change our eye color. D) They help us sleep for 12 hours. 5. Which of these is an example of a "purple" food mentioned for dessert? A) Red peppers B) Dates C) Purple grapes D) Carrot soup 6. What "Wh-" category does the carrot soup fall into for the suggested daily menu? A) What you eat for breakfast. B) What you eat for lunch. C) What you eat for dessert. D) What you eat for a midnight snack.

1. The following are ingredients in preparing pumping solution, EXCEPT; a. 5 kgs ham leg c. 1 cup saturated salt solution b. one tablespoon sugar d. 2 drops maplein 2. What is the value in grams of 6.4% refined salt if the amount of pork meat is 1 kilogram? a. 64 grams c. 640 grams b. 6.4 kilograms d. 6,400 grams 3. What is the main purpose of curing meat? a. To tenderize it c. To add color to it b. To prevent spoilage d. To increase its weight 4. What is the advantage of using pumping pickle over cover pickle and dry cure mixtures? a. It reduces the curing time. b. It enhances the flavor. c. It controls the concentration of salt. d. All of the above 5. What is the function of phosphate in curing solutions? a. It increases the water-holding capacity of the meat. b. It inhibits the growth of bacteria. c. It prevents oxidation of fat. d. It improves the texture of the meat. 6. What is the function of carrageenan in curing solutions? a. It acts as a thickener. b. It acts as a binder. c. It acts as a stabilizer. d. All of the above 7. In coloring salted eggs, how many teaspoons of vinegar must be added? a. 1 teaspoon b. 2 teaspoons c. 3 teaspoons d. 4 teaspoons 8. The following are factors that must be considered in packaging eggs. a. quality maintenance b. packaging design c. type of transport d. cost 9. In type 3 packaging material for eggs, what type of materials can these be made? a. burlap b. plastic c. paper board d. polystyrene 10. How many hours must be needed to bake the ham in an oven? a. 5 hours b. 3 hours c. 4 hours d. 2 hours 11. What is the ideal temperature of a smoke fish when storing it at home inside a refrigerator? a. 30℃ b. 38 ℃ c. 100 ℃ d. 50 ℃ 12. The following are ingredients for curing meat EXCEPT a. salt b. sugar c. vinegar d. cooking oil 13. What is the maximum period for commercial salted duck eggs? a. 18 days b. 21 days c. 14 days d. 30 days 14. What type of curing method is needed when fatty fish such as herring is being used? a. pickle curing b. dry curing c. cover pickle curing d. Pumping pickle curing 15. In making a pork ham, how many quarts of water must be needed to bring it to a boil? a. 2 quarts b. 3 quarts c. 4 quarts d. 5 quarts 16. In making a homemade skinless pork longganisa, what is the percentage of pork fats and lean meat? a. 20% fats, 80% lean meat b. 30% fats, 70% lean meat c. 40% fats, 60 lean meat d. 50% fats, 50% lean meat 17. It is a systematic procedure of producing a record for reference A. output C. documentation B. production report D. input 18. Anything produced, especially through a process, a product, a yield. A. documentation C. output B. input D. production report 19. It is the process of capturing data or translating information to a recording format. A. documentation C. production report B. reporting D. output 20. What is the value in grams of 6.4% refined salt if the amount of pork meat is 1 kilogram? a. 64 grams c. 640 grams b. 6.4 kilograms d. 6,400 grams 21. What is the difference between pumping pickle and cover pickle? a. Pumping pickle is injected into the meat, while cover pickle is poured over it. b. Pumping pickle is made with vinegar, while cover pickle is made with water. c. Pumping pickle is used for whole cuts of meat, while cover pickle is used for sliced meat. d. Pumping pickle is a dry mixture, while cover pickle is a liquid solution. 22. What is the main ingredient of dry cure mixtures? a. Sugar b. Salt c. Spices d. Phosphate 23. What is the function of vitamin C powder in curing solutions? a. It acts as an antioxidant. b. It enhances the color of the meat. c. It accelerates the curing reaction. d. All of the above 24. What is the ideal temperature for storing cured meat? a. Below 0°C b. Between 0°C and 4°C c. Between 4°C and 10°C d. Above 10°C 25. The following are advantages of packaging shell eggs EXCEPT. a. It protects against micro-organisms such as bacteria b. It prevents the loss of moisture. c. It protects the eggs from possible crushing while being handled, stored, or transported. d. It prolong the shelf life of the eggs. 26. How many pieces of eggs can be filled in a type 2 packaging materials, filler tray? a. 36 b. 12 c. 30 d. 24 27. How many hours must be needed in smoking ham? a. 10 to 19 hours b. 5 to 9 hours c. 15 to 24 hours d. 20 to 29 hours 28. It is a food packaging method that removes all air from a food-filled, plastic film package before sealing it. a. smoking b. drying c. vacuum packing d. weighing 29. Which is NOT TRUE about packaging a smoked fish? a. Sort cooled smoked fish according to size b. Pack or transfer smoked fish in bulk packaging materials by arranging the fish head and tail in any position. c. When the packaging material is nearly full, weigh the whole pack to check the product weight attained. d. Close or seal the packs. 30. The following nutrients can be found in an egg, EXCEPT. a. vitamins b. minerals c. omega 3 d. amino acids

Vitamin C, Vitamin K and Fluoride

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

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