ACE-I / ARBs

Question 1

What does ACE I stand for?

Answer 1

angiotensin
converting
enzyme
inhibitor

Question 2

regardless of effects on BP, what do ACE-I do?

Answer 2

1) decrease progression of heart failure
2) decrease progression of diabetic renal failure

regardless of BP they protect heart and kidney

Question 3

ACE I end in what?

Answer 3

“-pril”

Question 4

Describe the RAA system

Answer 4

Hypotension or decreased blood flow –> renin secretion –> angiotensin I secreted by kidney –> angiotensin I to angiotensin II by ACE –> AGII

Question 5

What are the 3 results of AG–II?

Answer 5

potent vasoconstrictor

stimulates secretion of aldosterone by adrenal glands

stimulates cardiac and vascular smooth muscle proliferation (cardiac remodeling, not good)

Question 6

what does aldosterone do

Answer 6

LOVES Na HATES K

causes Na/H2O retention, K excretion

Question 7

What is another effect of AG-II?

Answer 7

inhibition of Kinase II– this enzyme degrades bradykinin (a naturally occurring vasodilator which also increases prostaglandin production)

Question 8

What are the two ion effects of ACE-I?

Answer 8

Hyperkalemia

Hyponatremia

Question 9

What are the 3 adverse effects of ACE-I?

Answer 9

• Dry hacking cough (bradykinin increase is pulmonary irritant)
• Hyperkalemia
• Angioedema (swelling of tongue and throat)

Question 10

Angioedema is present with administration of what 2 drug classes?

Answer 10

1) NSAIDS

2) ACE-I

Question 11

Use caution in administering ACE-I in patients with what?

Answer 11

renal artery stenosis - decreased blood flow to the kidneys will vasoconstrict efferent arteriole and decrease renal/GFR pressure

Question 12

What are the 3 symptoms of hyperkalemia? Treat how?

Answer 12

1) Muscle cramps
2) tremors
3) Asystole

Treat- HCO3-, insulin in D5W, calcium chloride, K+ wasting diuretic

Question 13

T OR F

All pregnant females should avoid ACE-I, especially 1st trimester

Answer 13

FALSE, true but especially 3rd trimester

Question 14

Captopril-

Unique adverse effects?
How is it eliminated?

Answer 14

hypotension & bradycardia

renal elimination, so monitor CrCl

Question 15

What is a normal Cr clearance?

Answer 15

100-125 ml/min, worry when

Question 16

Enalapril-

why unique?

Answer 16

prodrug, activated by the body to enalaprilat

ONLY ACE-I available IV

Question 17

What determines which ACE-I to use?

Answer 17

Formularies (contracts)

Question 18

What does ARB stand for?

Answer 18

Angiotensin II Receptor Blocker

Question 19

What do ARBs end in?

Answer 19

“-sartan”

Question 20

How is ARB similar / different from ACE-I?

Answer 20

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

Question 21

Are ARBs at least as effective as ACE-I from cardiac and renal stand point?

Answer 21

yes, ARBS may even decrease cardiac modeling but EXPENSIVE!!!!

Question 22

Give an example of an ARB

Answer 22

Losartan

Question 23

What is an adverse effect of ARB?

Answer 23

decrease AGII so dilates efferent arteriole, which leads to renal dysfunction

Question 24

What is Entresto

Answer 24

Neprilysin + Valsartan

inhibits the enzyme that breaks down vasoactive peptides

Inhibits the peptides that make you pee & vasodilator to decrease BP & blood volume

Question 25

What are the 3 kinds of cough medicine?

Answer 25

Benzozonate
Codeine
Dextromethorphan

Question 26

NEVER MIX ACE-I AND WHAT?

Answer 26

aspirin

Question 27

Cr Clearance equation

Answer 27

( 140 - age) (weight kg) / (72*serum Cr)

multiply the answer by 0.85 if female