Sketchy Pharm: ACE inhibitors, ARBs, Aliskiren

Question 1

Renin is produced, stored, and released from _____________.

Answer 1

the juxtaglomerular apparatus

Question 2

Explain the action of angiotensin II on GFR.

Answer 2

It causes the efferent arteriole to constrict, which preserves GFR. This is important because in low-volume states, the kidneys might not have the pressure needed to filter the blood.

(Think of the guy with two tense red suspenders sipping coffee from the Grounds Filter Rate machine.)

Question 3

Angiotensin II acts on the ____________ to directly stimulate increased sodium reabsorption.

Answer 3

PCT

Think of the guy watching the Pro Cart Track TV eating salty peanuts.

Question 4

ACE inhibitors and angiotensin-receptor blockers can cause a temporary increase in creatinine. Why?

Answer 4

Because they temporarily decrease GFR; think, if angiotensin increases GFR by constricting the efferent arteriole, then ACE inhibitors decrease GFR by dilating the efferent arteriole.

Question 5

ACE inhibitors can cause ________________ because of the sudden decrease in vasoconstriction.

Answer 5

hypotension

Question 6

ACE inhibitors reduce mortality in those with _____________.

Answer 6

MI and heart failure

Think of the guardian angel flying above the couple.

Question 7

Beta-blockers and ACE inhibitors decrease the ______________ after MIs.

Answer 7

undesired remodeling

Question 8

Patients with hypertension and _______________ should be given an ACE inhibitor.

Answer 8

albuminuria (think of the ALBUM in the Diasweeties Shop with high pressure pipes)

Question 9

In what situations would you not use an ACE inhibitor?

Answer 9

Pregnancy (think of the tarantula on the jacket of the woman being escorted out)

C1 esterase deficiency (a hereditary condition of angioedema in which people lack the enzyme that inhibits the complement pathway; think of the girl with the C-shaped lip ring)

NSAID use

Bilateral renal artery stenosis (the two purses with red straps)

Question 10

Watch out in using ACE inhibitors and ARBs in those with _______-kalemia.

Answer 10

hyper (as both cause this by counteracting the sodium-potassium exchanger in the collecting duct)

Question 11

What is the mechanism of aliskiren?

Answer 11

It is a direct renin inhibitor, thus preventing the conversion of angiotensinogen to angiotensin I.