ACE Inhibitors And ARBs

Question 1

T or F
ACE inhibitors only inhibit formation of angiotensin II

Answer 1

False
Also block the breakdown of bradykinin (a vasodilator) and block the breakdown of substance P

Question 2

General action mechanism of ACE inhibitors
1-
2-
3-
4-

Answer 2

1-vasodilation(inhibition of formation of angiotensin II and metabolism of bradykinin)
2-blocking the effect of angitensin II on sympathetic release of norepi
3-promote Na and water excretion by blocking aldosterone release
4- inhibit cardiac and vascular remodeling

Question 3

Therapeutic uses
1-
2-
3-

Answer 3

Heart failure
Hypertension
Post myocardial infarct

Question 4

T or false
The difference between ACE inhibitor drugs is that they have different duration of action and half life

Answer 4

True

Question 5

Effects on heart failure
1-
2-
3-
4-
5-

Answer 5

1- reduced afterload which enhances ventricular volume and improves ejection fraction
2- reduced preload which decrease pulmonary and systemic congestion and edema
3- reduced sympathetic activation
4- decreased myocardium oxygen demand by decreasing afterload and preload
5-prevents heart remodeling ( hypertrophy) caused by angiotensin II

Question 6

ACE inhibitors may be classified to —- groups according to their —— of their active moiety
Captopril have ——- group
Fosinopril is the only drug that have —— group
Majority contain —— group

Answer 6

3
Chemical structure
Sulfhydryl
Phosphinyl
Carboxyl

Question 7

T or F
Captopril and enalapril are prodrugs

Answer 7

False
Captopril isn’t

Question 8

T or F
Majority of ACE inhibitors are prodrugs

Answer 8

T

Question 9

T or F
ACE inhibitors are cleared prodominately by liver

Answer 9

False
Kidney

Question 10

Majority of ACE inhibitors have ——– oral bioavailability

Answer 10

High because they are administered as prodrugs

Question 11

T or F
Dose reduction is not essential in case of renal dysfunction because ACEI are mostly excreted in bile

Answer 11

False
Dose reduction is important laanu bytla3u bl pipi :(

Question 12

T or F
Enalapril was the first agent developed

Answer 12

Falseeee
Captoooo

Question 13

Enalapril and most ACEIs are ——

Answer 13

Esterified by plasma esterases to become active (enalaprilat)

Question 14

Side effects of ACE inhibitors
1-
2-
3-
4-
5-
6-

Answer 14

1-dry cough (10-20%) because of elevated bradykinin
2-hypotension
3-angioedema (life threatening airway swelling and obstruction)
4-hyperkalemia (aldosterone reduction)
5-dizziness headache drowsiness diarrhea
6-dysguesia

Question 15

Sulhydryl related effects (captopril)
1-
2-
3-

Answer 15

Neutropenia
Rash
Nephrotic range proteinuria

Question 16

AngII cause vasocontriction of —– and —- arterioles which maintain GF
ACE inhibitor cause vasodilation of —– arteriole which lead to —– GF

Answer 16

Afferent and efferent
Efferent
Decreased

Question 17

Contraindications
1-
2-

Answer 17

Pregnancyyy byaamel birth defects
Stenosis of both arteries supplying kindey

Question 18

Drug interaction
1-
2-

Answer 18

1-potassium supplements, potassium sparing diuretics or other drugs that increase pirassium levels will cause severe and toxic hyperkalemia when administered with ace imhibitors
2-NSAIDs may reduce the effect of ACEIs

Question 19

ARBs mode of action

Answer 19

Block angII receptors typeI (ATI) on blood vessels and other tissues such as heart

Question 20

T or F
ATI are coupled to Gs protein

Answer 20

False
Gq IP3 transduction pathway

Question 21

T or F
ARBs and ACEIs have similar effects and are used for the same indications

Answer 21

True

Question 22

List the names of drugs included and half lives of each

Answer 22

Candesartan (atacand)
Irbesartan (aprovel) 11-15 hr
Telmisartan (micardis) 24 hr
Valsartan (diovan) 6 hr
Losartan (cozaar) 6-9 hr

Question 23

T or F
All ARBs are well absorbed after oral administration

Answer 23

True

Question 24

Actions of ARBs

Answer 24

Similar to ACEIs

Question 25

ARBs adverse effects:
1-
2-
3-
4-

Answer 25

1- hyperkalemia
2-impairment of renal function if bilaretal renal artery stenosis
3-rare dizziness
4- headache diarrhea abnormal taste rash

Question 26

ARBs contraindications:
1-
2-

Answer 26

1- pregos
2- bilateral renal artery stenosis with ARBs may lead to renal failure

Question 27

T or F
ARBs increase bradykinin levels so they cause dry cough and angioedema like ACEIs

Answer 27

Falseeeee
Ma bezedu l bradykinin
So ma byaamlu dry cough and angioedema