ACE inhibitors and ARB

Question 1

ACE inhibitors example and mechanism

Answer 1

captopril

• reduce formation fo AngII
• reduce vasoconstriction, fluid retention and ventricular remodelling (improve survival)

Question 2

ARBs example and mechanism

Answer 2

valsartan

• reduce action of AngII by blocking AT1R
• reduce fluid retention, vasoconstriction and ventricular remodelling (improve survival)

Question 3

Why is ARB better?

Answer 3

• more complete blockade of RAAS (formation via other pathway)
• will not block Type 2 receptor which leads to vasodilation

Question 4

Adverse effect of ACE inhibitors and ARB

Answer 4

• hypotension
• AKI
• fetal hypotension and renal failure and malformation (contraindicated in pregnancy)
• hyperkalemia (do not use with K sparing)
• dry cough and angioedema (bradykinin)

Question 5

Use of ACE inhibitors and ARB

Answer 5

• heart failure
• hypertension
• odema (less effective than loop)

Question 6

Limitations of both ACE inhibitors and ARB

Answer 6

• prevent the negative feedback on the renin secretion

- alternative mechanism for aldosterone production

Question 7

Direct renin inhibitors example and mechanism

Answer 7

Aliskiren

- reduce fluid retention, vasoconstriction and ventricular remodelling

Question 8

Adverse effect of direct renin inhibitors

Answer 8

• fetal hypotension, renal failure and malformation
• hyperkalemia
• Acute renal failure

Question 9

Aldosterone antagonist

Answer 9

same as K sparing (eplerenone and spironolactone)
reduce Na+ reabsorption and K+ dumping
reduce ventricular remodelling