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Pharmacodynamics > ACE Inhibitors and ARB's > Flashcards

ACE Inhibitors and ARB's Flashcards

1
Q

What are ACE inhibitors used to treat?

A

Used to treat heart failure and high blood pressure.

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2
Q

How is RAAS regulated?

A

Regulated by renal blood flow.

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3
Q

What are the 3 main hormones involved in RAAS?

A

Renin
Aldosterone
Angiotensin II

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4
Q

Where is ACE found?

A

Renal Endothelium
Lungs
Capillary Endothelium

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5
Q

What is the purpose of renin?

A

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

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6
Q

What is the purpose of ACE?

A

This converts angiotensin I into angiotensin II.

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7
Q

What is the purpose of Angiotensin II?

A

This acts on AT1 receptors to allow vasoconstriction.

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8
Q

How does angiotensin II influence the release of aldosterone?

A

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

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9
Q

What is the purpose of aldosterone?

A

This stimulates Na+ and water reabsorption to occur.

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10
Q

What are the indications for ACE inhibitors?

A 
Heart failure
Hypertension 
Post myocardial infarction
Diabetic Nephropathy
Diabetic Retinopathy
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11
Q

What is diabetic nephropathy?

A

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

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12
Q

What is diabetic retinopathy?

A

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

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13
Q

What is post myocardial infarction?

A

This complete blockage due to atherosclerosis.

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14
Q

The prognosis of heart failure worsens when:

A

High dosage of diuretics
Low BP
Low sodium
Severe symptoms

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15
Q

Name some symptoms of heart failure?

A 
Coughing 
Pulmonary Oedema
Pleural effusion 
Ascites 
Congestion 
Tiredness 
Dyspnea
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16
Q

What is ascites?

A

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

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17
Q

What is congestion?

A

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

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18
Q

What is pleural effusion?

A

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

19
Q

What is dyspnea?

A

This is shortness of breath.

20
Q

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

A

Digoxin

Diuretics

21
Q

What is digoxin?

A

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.

22
Q

What are diuretics?

A

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.

23
Q

What is the mode of action of ACE inhibitors?

A

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

24
Q

What do ACE inhibitors do?

A

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

25
Q

What is a side effect of using an ACE inhibitor?

A

Dry Cough due to an increase in bradykinin

26
Q

What is the most common example of an ACE inhibitor?

A

Captopril.

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

27
Q

What are the side effects of using ACE inhibitors?

A 
Dizziness 
Hypotension 
Rash 
Dry Cough
Angioedema 
Neuropathy 
Hyperkalaemia
28
Q

What is neuropathy?

A

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

29
Q

What is angioedema?

A

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

30
Q

What is hyperkalaemia?

A

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

31
Q

What are the contraindications of using ACE inhibitors?

A 
Renal artery steroids. 
Pregnancy + Breast Feeding 
Peripheral Vascular Disease 
Low BP
NSAIDS
32
Q

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

A

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

33
Q

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

A

CONSENSUS.

34
Q

What was the CONSENSUS study about?

A

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

35
Q

What was the outcome of the CONSENSUS study?

A

Reduces mortality and improvs symptoms.

36
Q

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

A

ARB’s = Angiotensin II Receptor Blockers.

37
Q

What is the purpose of ARB’s?

A

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

38
Q

What do ARB’s do?

A

They modulate the renin - angiotensin system.

39
Q

What is the mode of action for ARB’s?

A

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

40
Q

What are the mostly commonly used ARB’s?

A

Losartan
Candesartan
Irbesartan

41
Q

What are the indications of ARB’s?

A

Hypertension
Heart Failure
Albuminuria
Left Ventricle Hypertrophy

42
Q

What is Albuminuria?

A

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

43
Q

What are the side effects of using ARB’s?

A 
Dizziness 
Fatigue
Hypotension 
Hyperkalaemia 
Muscle // Bone pain
44
Q

What are the contraindications of using ARB’s?

A

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

Pharmacodynamics (21 decks)

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