ACE Inhibitors & ARBs

Question 1

ACE ending

Answer 1

pril
- benazepril, lisinopril, ramipril

Question 2

ARBs ending

Answer 2

sartan
- Irbesartan, losartan, olmesartan, valsartan

Question 3

general mechanism to RAAS

Answer 3

angiotensinogen (Renin) angiotensin 1 (ACE), angiotensin 2

Question 4

what does angiotensin 2 cause

Answer 4

myocardial hypertrophy
increase thrist
increase SNS
increased constriction
aldosterone
- increased NA absorption which leads to water retention
- vascular fibrosis

Question 5

what is RAAS used for

Answer 5

to maintain CO (increase HR, contractility, BP, volume) this is good for short term like trauma but bad for long term like left ventricle ischemia

Question 6

how do ACEI work

Answer 6

inhibiting ACE so blocking the conversion of angiotensin 1 to angiotensin 2

Question 7

what is Bradykinin

Answer 7

vasodilator which is the opposite of angiotensin 2

Question 8

how do ACEI impact bradykinin

Answer 8

when ACE is functioning it degrades bradykinin but when we have an ACEI we get a build up of bradykinin

Question 9

why is the buildup of Bradykinin important

Answer 9

explains the cough and angioedema and also dilates vessels which will decrease blood pressure

Question 10

how do ARBS work

Answer 10

block the angiotensin 2 receptors, there is no harm in having increased angiotensin 2 molecules but ARBS block where the angiotensin 2 molecules work at so we do not get any negative effects

Question 11

target dosing

Answer 11

special predetermined does for diseases that do not have a value or symptom driving the treatment, like heart failure

Question 12

main side effects of ACEI and ARBS and what differes

Answer 12

hypotension, dizziness, renal dysnfunction, hyperkalemia
ACEI only: cough and angioedema

Question 13

how do ACEI and ARBS affect GFR

Answer 13

it normally slightly decreases it which is why it is good for diabetic nephropathy but if you have risk factors like volume depleted, vascoconstricting drugs, or renal vascular disease this can cause your GFR to drop into developing acute renal dysfunction

Question 14

drug interactions

Answer 14

NSAIDS: the chronic use of NSAIDS and ACEI/ARBS can lead to acute renal failure, this is because NSAIDS decrease the pressure by constricting afferent, and ACEI dilates the efferent which lowers the glomerular pressure and the use of these together with extremely decrease the pressure in the glomerulus

Question 15

what individuals might be at risk for hyperkalemia

Answer 15

the use of salt substitutes or potassium supplements which can be seen in patients who have renal failure or heart failure

Question 16

ACEI are useful for what patients

Answer 16

hypertension, diabetes, diabetic nephropathy, post MI, CAD risk

Question 17

what HF patients should get ACEI, all patients with an EF of

Answer 17

<40%

Question 18

hypotension is more common with

Answer 18

hyponatermia

Question 19

if you have angioedema in the oropharynx

Answer 19

this is a medical emergency and that patient should never be put on a ACEI again

Question 20

why do we get an increase in potassium

Answer 20

aldosterone isn’t stimulated so we hold onto potassium

Question 21

when should we avoid in pregnancy

Answer 21

2nd half: fetal hypotension

Question 22

what other drug is a interaction

Answer 22

cyclosporine

Question 23

you may prefer what ARB for patients with gout

Answer 23

losartan

Question 24

ARBS

Answer 24

Irbesartan
Losartan
Olmesartan
Valsartan

Question 25

ACEI

Answer 25

ramipril
lisinopril
benazepril