ACE inhibitors and ARB's Flashcards
What is the function of the angiotensin converting enzyme (ACE)?
The angiotensin converting enzyme catalyses the conversion of angiotensin 1 to angiotensin 2 and also breaks down bradykinin.
What are some of the major advances in cardiovascular medicine alongside ACE inhibitors?
ACE inhibitors were one of the major advances in cardiovascular medicine, along with beta blockers, calcium channel blockers, and statins.
Which ACE inhibitors are commonly used and for what conditions?
Captopril is used for heart failure.
Ramipril is used for hypertension and is typically the 1st or 2nd line of treatment.
Enalapril is used prophylactically in ischaemic heart disease.
Where do ACE inhibitors originate from?
The root of ACE inhibitors comes from the Brazilian pit viper, whose venom is highly toxic.
What are some common side effects of ACE inhibitors?
Common side effects include a persistent dry cough (due to increased bradykinin levels), angioedema (which occurs in about 1% of recipients), and increased vascular permeability. These side effects are particularly more common in women and people of African descent.
How do ACE inhibitors help in treating heart failure and hypertension?
ACE inhibitors help by reducing both systolic and diastolic blood pressure, which is beneficial in the treatment of heart failure and hypertension.
What population differences are observed in the response to ACE inhibitors?
People of African descent may not respond as effectively to ACE inhibitors. Specific polymorphisms in genes have been identified that impact responses to these medications.
What is the role of Angiotensin 2 in the body?
Angiotensin 2 increases stroke volume, heart rate, and total peripheral resistance. It contracts blood vessels, enhances sodium reabsorption, and triggers aldosterone release.
What are Angiotensin Receptor Blockers (ARBs), and what do they do?
Angiotensin Receptor Blockers (ARBs), also known as ‘sartans,’ reduce the effects of angiotensin 2, which can be therapeutically beneficial. They block angiotensin 1 receptors, which mediate most cardiovascular effects of angiotensin 2.
What are some examples of Angiotensin Receptor Blockers and their uses?
Losartan is used for heart failure.
Candesartan is used for hypertension and can be the 1st or 2nd line of treatment.
Irbesartan is used prophylactically in ischaemic heart disease.
What are the side effects of Angiotensin Receptor Blockers compared to ACE inhibitors?
Angiotensin Receptor Blockers are generally better tolerated than ACE inhibitors because they do not impact bradykinin. However, they can cause hyperkalaemia and renal failure due to reduced aldosterone levels, which result in potassium retention.
How do Angiotensin Receptor Blockers compare in efficacy to ACE inhibitors?
Angiotensin Receptor Blockers are somewhat more effective in reducing blood pressure, but their overall impact on disease management is similar to ACE inhibitors. They are generally better tolerated, though.
What are the potential risks associated with ACE inhibitors and Angiotensin Receptor Blockers?
Both ACE inhibitors and Angiotensin Receptor Blockers carry risks of hyperkalaemia and renal failure due to reduced aldosterone production, which leads to potassium retention.
What causes the persistent dry cough associated with ACE inhibitors?
The persistent dry cough is caused by increased levels of bradykinin, which sensitizes the airways.
How do Angiotensin Receptor Blockers (ARBs) impact bradykinin compared to ACE inhibitors?
Angiotensin Receptor Blockers do not affect bradykinin levels, unlike ACE inhibitors, which lead to increased bradykinin and contribute to side effects like dry cough.
