ACE Inhibitors & ARBs Flashcards
ACE stands for
Angiotension converting enzyme
ACEI’s
ACE inhibitor, stops ACE from converting Angiotensin I into Angiotensin II then to Aldosterone
Aldosterone
Increases Na+ and water retention which raises BP
Increased thirst, SNS activity, vasoconstriction, and myocardial hypertrophy
ACE and bradykinin
ACE inhibits bradykinin (vasodilator)
ACEI’s and bradykinin
ACEI’s allows bradykinin to vasodilate
Angiotensin
vasoconstrictor
Bradykinin
vasodilator
ACEI’s cause bradykinin to increase or decrease
INCREASE
Too much bradykinin in some people cause what
Cough and angioedema
ACEI’s suffix
-pril
African Americans
ACEI’s and ARB’s are less significant in them
- they have lack of nitric oxide (vasodilator) which is the opposite of angiotensin II
ACEI’s are given to patients with
HTN
diabetes, diabetic neuropathy, post-MI, high CAD risk
Target dosing
Dosing to a number
- may not be able to get to the target dose if they are already on many drugs
ACEI’s side effects
Hypotension & dizziness
Cough & angioedema
renal dysfunction
hyperkalemia
Angioedema
Emergency, swelling of mouth and throat
- Should never get another ACE inhibitor if angioedema occurs
Renal dysfunction
ACEI’s cause GFR to decrease a bit, isn’t usually harmful, good in diabetes
- SOME people can be a bigger decrease in GFR causing acute renal failure (dehydrated patients, they are on other vasoconstricting drugs, renovascular disease, on diuretics)
Hyperkalemia
ACEI’s tend to increase K+ levels, small increase
- SOME people it can be a bigger increase
ACEI’s do what to glomerulus
Dilates efferent arteriole
Decreases pressure in glomerulus
Decreases filtration
A.T. 2 does what to glomerulus
Constricts efferent arteriole
Do not use ACEI’s when
In pregnancy (fetal hypotension)
With bilateral renal artery stenosis
ACEI’s interactions
K+ supplements, ACEI’s increase K+ which increases hyperkalemia
NSAIDS (pain relievers), alter BF in glomerulus by decreasing afferent BF so filtration decreases dramatically. High risk to cause renal failure
Cyclosporine (anti rejection drug), can cause kidney dysfunction & hyperkalemia
ARB’s stand for
Angiotensin II Receptor Blockers
ARB’s do not change what in the blood
The amount of A.T. 2
- A.T. 2 cannot act on its receptor
ARB’s difference in side effects from ACEI’s
lack of cough & angioedema
What doesn’t build up in the blood with ARB’s?
Bradykinin, since ACE is still able to inhibit bradykinin
ARB’s suffix
-sartan
