ACE-I / ARBs Flashcards
What does ACE I stand for?
angiotensin
converting
enzyme
inhibitor
regardless of effects on BP, what do ACE-I do?
1) decrease progression of heart failure
2) decrease progression of diabetic renal failure
regardless of BP they protect heart and kidney
ACE I end in what?
“-pril”
Describe the RAA system
Hypotension or decreased blood flow –> renin secretion –> angiotensin I secreted by kidney –> angiotensin I to angiotensin II by ACE –> AGII
What are the 3 results of AG–II?
potent vasoconstrictor
stimulates secretion of aldosterone by adrenal glands
stimulates cardiac and vascular smooth muscle proliferation (cardiac remodeling, not good)
what does aldosterone do
LOVES Na HATES K
causes Na/H2O retention, K excretion
What is another effect of AG-II?
inhibition of Kinase II– this enzyme degrades bradykinin (a naturally occurring vasodilator which also increases prostaglandin production)
What are the two ion effects of ACE-I?
Hyperkalemia
Hyponatremia
What are the 3 adverse effects of ACE-I?
- Dry hacking cough (bradykinin increase is pulmonary irritant)
- Hyperkalemia
- Angioedema (swelling of tongue and throat)
Angioedema is present with administration of what 2 drug classes?
1) NSAIDS
2) ACE-I
Use caution in administering ACE-I in patients with what?
renal artery stenosis - decreased blood flow to the kidneys will vasoconstrict efferent arteriole and decrease renal/GFR pressure
What are the 3 symptoms of hyperkalemia? Treat how?
1) Muscle cramps
2) tremors
3) Asystole
Treat- HCO3-, insulin in D5W, calcium chloride, K+ wasting diuretic
T OR F
All pregnant females should avoid ACE-I, especially 1st trimester
FALSE, true but especially 3rd trimester
Captopril-
Unique adverse effects?
How is it eliminated?
hypotension & bradycardia
renal elimination, so monitor CrCl
What is a normal Cr clearance?
100-125 ml/min, worry when
Enalapril-
why unique?
prodrug, activated by the body to enalaprilat
ONLY ACE-I available IV
What determines which ACE-I to use?
Formularies (contracts)
What does ARB stand for?
Angiotensin II Receptor Blocker
What do ARBs end in?
“-sartan”
How is ARB similar / different from ACE-I?
AG-II can not bind, so no aldosterone is released. Hyperkalemia still results, but no dry cough from increased bradykinin or angioedema from the bradykinin sensitivity
Are ARBs at least as effective as ACE-I from cardiac and renal stand point?
yes, ARBS may even decrease cardiac modeling but EXPENSIVE!!!!
Give an example of an ARB
Losartan
What is an adverse effect of ARB?
decrease AGII so dilates efferent arteriole, which leads to renal dysfunction
What is Entresto
Neprilysin + Valsartan
inhibits the enzyme that breaks down vasoactive peptides
Inhibits the peptides that make you pee & vasodilator to decrease BP & blood volume
