ACE Inhibitors and ARB's

Question 1

What are ACE inhibitors used to treat?

Answer 1

Used to treat heart failure and high blood pressure.

Question 2

How is RAAS regulated?

Answer 2

Regulated by renal blood flow.

Question 3

What are the 3 main hormones involved in RAAS?

Answer 3

Renin
Aldosterone
Angiotensin II

Question 4

Where is ACE found?

Answer 4

Renal Endothelium
Lungs
Capillary Endothelium

Question 5

What is the purpose of renin?

Answer 5

This is a hormone released by the liver and converts angiotensinogen in to angiotensin I.

Question 6

What is the purpose of ACE?

Answer 6

This converts angiotensin I into angiotensin II.

Question 7

What is the purpose of Angiotensin II?

Answer 7

This acts on AT1 receptors to allow vasoconstriction.

Question 8

How does angiotensin II influence the release of aldosterone?

Answer 8

Angiotensin II acts on the adrenal cortex and encourages aldosterone to be released.

Question 9

What is the purpose of aldosterone?

Answer 9

This stimulates Na+ and water reabsorption to occur.

Question 10

What are the indications for ACE inhibitors?

Answer 10

Heart failure
Hypertension 
Post myocardial infarction
Diabetic Nephropathy
Diabetic Retinopathy

Question 11

What is diabetic nephropathy?

Answer 11

This is a diabetic disease which comes about with kidney damage due to the kidney leaking protein out.

Question 12

What is diabetic retinopathy?

Answer 12

Blood vessel in the eye BURSTS. Causes the leakage of blood and therefore, there is a LOSS of vision.

Question 13

What is post myocardial infarction?

Answer 13

This complete blockage due to atherosclerosis.

Question 14

The prognosis of heart failure worsens when:

Answer 14

High dosage of diuretics
Low BP
Low sodium
Severe symptoms

Question 15

Name some symptoms of heart failure?

Answer 15

Coughing 
Pulmonary Oedema
Pleural effusion 
Ascites 
Congestion 
Tiredness 
Dyspnea

Question 16

What is ascites?

Answer 16

This is swelling in the abdomen and is the fluid build - up in the lungs.

Question 17

What is congestion?

Answer 17

This blockage of the blood vessels in the heart due to weakness in NOT being able to pump it out.

Question 18

What is pleural effusion?

Answer 18

Build - up of fluid in the lungs (water in the pleural membrane space).

Question 19

What is dyspnea?

Answer 19

This is shortness of breath.

Question 20

What are the 2 main forms of treatment used for chronic heart failure management?

Answer 20

Digoxin

Diuretics

Question 21

What is digoxin?

Answer 21

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.

Question 22

What are diuretics?

Answer 22

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.

Question 23

What is the mode of action of ACE inhibitors?

Answer 23

They block the ACE enzyme and thus, reduce the levels of angiotensin II

Question 24

What do ACE inhibitors do?

Answer 24

They lower blood pressure by reducing angiotensin II levels and thus, allow the blood vessels to relax and widen (VASODILATION).

Question 25

What is a side effect of using an ACE inhibitor?

Answer 25

Dry Cough due to an increase in bradykinin

Question 26

What is the most common example of an ACE inhibitor?

Answer 26

Captopril. | This is very short acting and thus, has to be given x3 a day.

Question 27

What are the side effects of using ACE inhibitors?

Answer 27

``` Dizziness Hypotension Rash Dry Cough Angioedema Neuropathy Hyperkalaemia ```

Question 28

What is neuropathy?

Answer 28

This is LOSS of nerve function -> Leads to pins and needles.

Question 29

What is angioedema?

Answer 29

Swelling of LOWER layer of the skin and the tissue under the skin + mucous membranes.

Question 30

What is hyperkalaemia?

Answer 30

This is a HIGH level of plasma potassium and thus, is very dangerous. There are NO symptoms and is very dangerous.

Question 31

What are the contraindications of using ACE inhibitors?

Answer 31

``` Renal artery steroids. Pregnancy + Breast Feeding Peripheral Vascular Disease Low BP NSAIDS ```

Question 32

Why is it dangerous to give ACE inhibitors to pregnant women?

Answer 32

This can cause fetal damage = Disrupts kidney formation // deafness // body can die.

Question 33

In terms of evidence based ACE inhibitors, which study is famous?

Answer 33

CONSENSUS.

Question 34

What was the CONSENSUS study about?

Answer 34

They studied Enalapril = This is used for severe congestive heart failure.

Question 35

What was the outcome of the CONSENSUS study?

Answer 35

Reduces mortality and improvs symptoms.

Question 36

What is the second line of medicine for chronic heart failure?

Answer 36

ARB's = Angiotensin II Receptor Blockers.

Question 37

What is the purpose of ARB's?

Answer 37

This is used to treat hypertension and diabetic neuropathy -> Mostly used for the treatment of congestive heart failure.

Question 38

What do ARB's do?

Answer 38

They modulate the renin - angiotensin system.

Question 39

What is the mode of action for ARB's?

Answer 39

They block angiotensin II receptors and thus, prevent Angiotensin II from binding to Angiotensin II receptors on the muscles surrounding the blood vessels.

Question 40

What are the mostly commonly used ARB's?

Answer 40

Losartan Candesartan Irbesartan

Question 41

What are the indications of ARB's?

Answer 41

Hypertension Heart Failure Albuminuria Left Ventricle Hypertrophy

Question 42

What is Albuminuria?

Answer 42

This is leakage of albumin protein into the urine = This is an early sign of kidney disease.

Question 43

What are the side effects of using ARB's?

Answer 43

``` Dizziness Fatigue Hypotension Hyperkalaemia Muscle // Bone pain ```

Question 44

What are the contraindications of using ARB's?

Answer 44

Renal Artery Stenosis Pregnancy and Breast Feeding Ace Inhibitors Cardiovascular system issues.