19. Adrenergic & Angiotensin Block in CHF

Question 1

What is the difference in SE btw an ACE-inhibitor and an ARB?

Answer 1

all the same except with ARBs, no cough and less angioedema

Question 2

What are the ACE inhibitors’ side effects?

Answer 2

1. cough (dry, nonproductive) 2. hyperkalemia 3. angioedema 4. renal problems 5. neutropenia 6. hypotension

Question 3

ACE is an enzyme produced in the ____.

Answer 3

lungs

Question 4

How is the RAAS stimulated?

Answer 4

1. hypovolemia 2. low NaCL

Question 5

Hydralazine is a _____.

Answer 5

vasodilator

Question 5

ACE inhibitors end in -_____.

Answer 5

opril

Question 6

Name the 2 vasodilators that are most commonly used.

Answer 6

1. hydralazine 2. isosorbide

Question 7

What is stage B HFrEF?

Answer 7

heart structure problem w/o symptoms

Question 8

ACE inhibitors block both ____ and ____.

Answer 8

angiotensin conversion to angiotensin-II AND bradykinin conversion to its inactive fragments

Question 8

What does angiotensin II do?

Answer 8

1. vasoconstriction 2. increased sympathetic output 3. increased aldosterone production and Na+ reab 4. increased ADH release 5. increased thirst

Question 10

The ARBs end in -_____.

Answer 10

sartan

Question 11

What is stage C HFrEF?

Answer 11

structural disease w/ symptoms

Question 12

ARBs mainly have an effect on the ____ receptor.

Answer 12

AT1

Question 14

What is your target creatinine clearance level?

Answer 14

< 30

Question 15

What does digoxin do?

Answer 15

increases CO and SV

Question 16

Angiotensinogen is a zymogen produced in the ____.

Answer 16

liver

Question 17

High bradykinin causes?

Answer 17

a cough, remodeling of the LV, and vasodilates

Question 18

If your pt is stage C HFrEF and is black, add ____ in addition to the beta blocker and ACEI/ARB.

Answer 18

hydralazine and isosorbide

Question 19

Bradykininogen is a zymogen produced in the ____.

Answer 19

liver

Question 20

What is stage D HFrEF?

Answer 20

refractory - hospitalized pts

Question 21

Why do African Americans need a vasodilator, too?

Answer 21

1. they get HFrEF at an earlier age 2. their HFrEF is more advanced 3. they have a higher rate of mortality and hospitalizations 4. they have more TGF-beta (increased fibrosis) 5. they have increased vasothelin 6. sometimes they’re NO synthetase deficient 7. the RAAS is decreased