ACE Inhibitors and ARB's Flashcards
What are ACE inhibitors used to treat?
Used to treat heart failure and high blood pressure.
How is RAAS regulated?
Regulated by renal blood flow.
What are the 3 main hormones involved in RAAS?
Renin
Aldosterone
Angiotensin II
Where is ACE found?
Renal Endothelium
Lungs
Capillary Endothelium
What is the purpose of renin?
This is a hormone released by the liver and converts angiotensinogen in to angiotensin I.
What is the purpose of ACE?
This converts angiotensin I into angiotensin II.
What is the purpose of Angiotensin II?
This acts on AT1 receptors to allow vasoconstriction.
How does angiotensin II influence the release of aldosterone?
Angiotensin II acts on the adrenal cortex and encourages aldosterone to be released.
What is the purpose of aldosterone?
This stimulates Na+ and water reabsorption to occur.
What are the indications for ACE inhibitors?
Heart failure Hypertension Post myocardial infarction Diabetic Nephropathy Diabetic Retinopathy
What is diabetic nephropathy?
This is a diabetic disease which comes about with kidney damage due to the kidney leaking protein out.
What is diabetic retinopathy?
Blood vessel in the eye BURSTS. Causes the leakage of blood and therefore, there is a LOSS of vision.
What is post myocardial infarction?
This complete blockage due to atherosclerosis.
The prognosis of heart failure worsens when:
High dosage of diuretics
Low BP
Low sodium
Severe symptoms
Name some symptoms of heart failure?
Coughing Pulmonary Oedema Pleural effusion Ascites Congestion Tiredness Dyspnea
What is ascites?
This is swelling in the abdomen and is the fluid build - up in the lungs.
What is congestion?
This blockage of the blood vessels in the heart due to weakness in NOT being able to pump it out.
What is pleural effusion?
Build - up of fluid in the lungs (water in the pleural membrane space).
What is dyspnea?
This is shortness of breath.
What are the 2 main forms of treatment used for chronic heart failure management?
Digoxin
Diuretics
What is digoxin?
This is an oral tablet which strengthens the heart muscle’s contractions and RESTORES a normal steady heart rhythm.
This can be prescribed for atrial fibrillation.
What are diuretics?
These are water pills which help the kidney to get rid of UNNEEDED salt and water.
This makes the pumping of the heart much easier.
What is the mode of action of ACE inhibitors?
They block the ACE enzyme and thus, reduce the levels of angiotensin II
What do ACE inhibitors do?
They lower blood pressure by reducing angiotensin II levels and thus, allow the blood vessels to relax and widen (VASODILATION).
What is a side effect of using an ACE inhibitor?
Dry Cough due to an increase in bradykinin
What is the most common example of an ACE inhibitor?
Captopril.
This is very short acting and thus, has to be given x3 a day.
What are the side effects of using ACE inhibitors?
Dizziness Hypotension Rash Dry Cough Angioedema Neuropathy Hyperkalaemia
What is neuropathy?
This is LOSS of nerve function -> Leads to pins and needles.
What is angioedema?
Swelling of LOWER layer of the skin and the tissue under the skin + mucous membranes.
What is hyperkalaemia?
This is a HIGH level of plasma potassium and thus, is very dangerous.
There are NO symptoms and is very dangerous.
What are the contraindications of using ACE inhibitors?
Renal artery steroids. Pregnancy + Breast Feeding Peripheral Vascular Disease Low BP NSAIDS
Why is it dangerous to give ACE inhibitors to pregnant women?
This can cause fetal damage = Disrupts kidney formation // deafness // body can die.
In terms of evidence based ACE inhibitors, which study is famous?
CONSENSUS.
What was the CONSENSUS study about?
They studied Enalapril = This is used for severe congestive heart failure.
What was the outcome of the CONSENSUS study?
Reduces mortality and improvs symptoms.
What is the second line of medicine for chronic heart failure?
ARB’s = Angiotensin II Receptor Blockers.
What is the purpose of ARB’s?
This is used to treat hypertension and diabetic neuropathy -> Mostly used for the treatment of congestive heart failure.
What do ARB’s do?
They modulate the renin - angiotensin system.
What is the mode of action for ARB’s?
They block angiotensin II receptors and thus, prevent Angiotensin II from binding to Angiotensin II receptors on the muscles surrounding the blood vessels.
What are the mostly commonly used ARB’s?
Losartan
Candesartan
Irbesartan
What are the indications of ARB’s?
Hypertension
Heart Failure
Albuminuria
Left Ventricle Hypertrophy
What is Albuminuria?
This is leakage of albumin protein into the urine = This is an early sign of kidney disease.
What are the side effects of using ARB’s?
Dizziness Fatigue Hypotension Hyperkalaemia Muscle // Bone pain
What are the contraindications of using ARB’s?
Renal Artery Stenosis
Pregnancy and Breast Feeding
Ace Inhibitors
Cardiovascular system issues.
