19. Adrenergic & Angiotensin Block in CHF Flashcards
What is the difference in SE btw an ACE-inhibitor and an ARB?
all the same except with ARBs, no cough and less angioedema
What are the ACE inhibitors’ side effects?
- cough (dry, nonproductive) 2. hyperkalemia 3. angioedema 4. renal problems 5. neutropenia 6. hypotension
ACE is an enzyme produced in the ____.
lungs
How is the RAAS stimulated?
- hypovolemia 2. low NaCL
Hydralazine is a _____.
vasodilator
ACE inhibitors end in -_____.
opril
Name the 2 vasodilators that are most commonly used.
- hydralazine 2. isosorbide
What is stage B HFrEF?
heart structure problem w/o symptoms
ACE inhibitors block both ____ and ____.
angiotensin conversion to angiotensin-II AND bradykinin conversion to its inactive fragments
What does angiotensin II do?
- vasoconstriction 2. increased sympathetic output 3. increased aldosterone production and Na+ reab 4. increased ADH release 5. increased thirst
The ARBs end in -_____.
sartan
What is stage C HFrEF?
structural disease w/ symptoms
ARBs mainly have an effect on the ____ receptor.
AT1
What is your target creatinine clearance level?
< 30
What does digoxin do?
increases CO and SV
Angiotensinogen is a zymogen produced in the ____.
liver
High bradykinin causes?
a cough, remodeling of the LV, and vasodilates
If your pt is stage C HFrEF and is black, add ____ in addition to the beta blocker and ACEI/ARB.
hydralazine and isosorbide
Bradykininogen is a zymogen produced in the ____.
liver
What is stage D HFrEF?
refractory - hospitalized pts
Why do African Americans need a vasodilator, too?
- 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
