ACE-inhibitors and ARBs Flashcards
How are ACE inhibitors beneficial to people with CHF?
improves symptoms by decreasing afterload and preload and blunting the RAAS system.
How are ACE-i beneficial to people with asymptomatic LV dysfunction (
They slow the progression to clinical heart failure. reduce the number of hospitalizations
Do ACE-i decrease mortality?
yes
How do they benefit patients with DM?
Protective to the kidneys (independent to BP)
How does blocking the production of AT II affect the body?
- vasodilates
- decreases aldosterone secretion –> decrease Na and water retention
- slow smooth muscle proliferation in the heart (remodeling)
what other effect do ACE-i have?
also inhibit Kinase II
- this increases the amount of bradykinin (vasodilators)
- also increases the amount of PGs (vasodilators)
Name two ACE-i.
Captopril and Enalapril.
In what patients should you adjust the dose of ACE-i?
renal insufficiency – make dose adjustments when CrCl lowers. You should monitor their SrCr and BUN as well.
What electrolyte should you monitor when giving ACE-i?
K (probably due to the decreased aldosterone)
Which ACE-i is a prodrug?
Enalapril (active is enalaprilat)
What is the only IV ACE-i?
Enalaprilat
What is the formula for CrCl?
mls per min = [(140-age) x Kg] / [72 x SrCr] …multiply it by 0.85 if the patients is female.
Name 5 AE’s related to ACE-i.
- Dry hacking cough
- Hyperkalemia
- Angioedema
- Decreased renal/GRF pressure with RAS
- Teratogenic effects on fetus
Why do you get a dry hacking cough with ACE-i? What can you do for these patients?
increased bradykinin
Do NOT give antitussives (dextromethorpan, codeine, tessalon pearls).
Can try ASA.
Explain why you shouldn’t prescribe ACE-i to those with renal artery stenosis?
The kidneys response to stenosis is to activate the RAS system. If ATII cannot be produced, then this system will fail and the kidney will suffer from decreased renal perfusion.
