ACE/ARB/DIURETICS

Question 1

Renin Inhibitor: Aliskiren

Answer 1

Direct inhibitor of renin and decreases formation of angiotensin 1 from angiotensinogen

HTN

NO USE IN PREGNANCY OR LACTATION

Question 2

Lisinopril

Answer 2

most commonly used
T1/2 life: 12 hours
NOT A PRODRUG

Question 3

Enalapril

Answer 3

prodrug hydrolyzed to
active enalaprilat

Question 4

Captopril

Answer 4

Thiol-containing
NOT A PRODRUG
T1/2: 3 hrs

Indication: supine hypertension, orthostaTIc hypotension

side effects: rash, neutropenia, agranulocytosis

Question 5

Fosinopril

Answer 5

phosphonate-containing
PRODRUG

Question 6

Indications

Answer 6

first line monotherapy for HTN, heart failure

Question 7

Advantages

Answer 7

Beneficial in HF, CKD, DM, ischemic heart disease

Question 8

Disadvantages

Answer 8

not useful in African American

Question 9

Side effects

Answer 9

cough, angioedema

hyperkalemia due to increase in bradykinin

DO NOT USE IN PREGNANCY OR BREASTFEEDING

avoid NSAIDS as that may reduce effectiveness

Question 10

ARB’S

Answer 10

Block angiotensin 2 receptor with much higher affinity for AT1 vs AT2

Question 11

Potency of products

Answer 11

candesartan=olmesartan>irbesartan=eprosartan>telmisartan=valsartan=losartan

Question 12

ARB structure

Answer 12

imidazole ring, phenyl ring, and either tetrazole or carboxylic acid

Question 13

Indications

Answer 13

first line monotherapy in hypertension (cannot tolerate ACE-I)

Question 14

Advantages

Answer 14

not associated with dry cough

beneficial in CKD, DM, and ischemic heart disease

beneficial in reducing uric acid and be used especially with people with gout

Question 15

Disadvantages

Answer 15

not useful in AA

Question 16

Side effects

Answer 16

hypotension, hyperkalemia, angioedema, reduction in GFR

DO NOT USE IN PREGNANCY OR LACTATION

Question 17

Aldosterone receptor antagonist

Answer 17

block reabsorption of sodium in the bloodstream reducing BP

Chronic HF, HTN, aldosteronism

not monotherapy for HTN but can help reduce hypokalemia

SE: hyperkalemia, gynostemia, impotence

DO NOT USE IN PREGNANCY OR LACTATION

Question 18

Thiazides (Chlorthalidone)

Answer 18

blocking the Na Cl cotransporter in DCT

Initially reduces blood volume and CO by diuretic effect

long term lowers peripheral resistance due to decreased muscle sensitivity

first line monotherapy for HTN

Effective in AA

Not drug of choice in diabetes, hyperlipidemia, gout

SE: hypokalemia, hyperuricemia, metabolic acidosis, hypercalcemia, hyperlipidemia, hyperglycemia