ACE Inhibitors/ARBs Flashcards
Outline the RAS
Hypotension – renin secretion – angiotensin I secretion – angiotensin I conversion to angiotensin II by ACE – angiotensin II vasoconstricts and stimulates aldosterone secretion – aldosterone causes sodium retention and potassium excretion
What electrolyte imbalance are ace inhibitors commonly associated with?
Hyperkalemia (inhibit sodium retention and potassium excretion)
What harmful effect of angiotensin II can ace inhibitors help to prevent?
Remodeling of cardiac and vascular smooth muscle
What is kinase II and what effect do ace inhibitors have on it?
Kinase II is an enzyme responsible for degradation of Bradykinin, a vasodilator that amplifies production of prostaglandins that also vasodilate
Ace inhibitors inhibit kinase II (less kinase II = more bradykinin = more vasodilation)
List four adverse effects of ace inhibitors
Dry hacking cough, hyperkalemia, angioedema, renal dysfunction in patients with renal artery stenosis
Why do ace inhibitors cause a dry hacking cough, and how is it treated?
Result of increased bradykinin in the lungs, potentially treated with aspirin but NOT responsive to any cough suppressants
What medications other than ace inhibitors commonly cause angioedema?
NSAIDS (overload of bradykinin)
Which trimester of pregnancy is especially important to avoid ace inhibitors?
Third trimester
What was the first ace inhibitor?
Captopril
What four uses do ACE inhibitors have?
Long term CHF symptom treatments, delay in progression of asymptomatic LV dysfunction, survival benefit for patients with NYHA II- IV (heart failure), renal protection in patients with diabetes (independent of effects on blood pressure)
How many times a day is captopril taken?
Three
What creatinine clearance suggests necessity for dose adjustment when taking captopril?
CrCl less than 50 mL/minute
What is a normal creatinine clearance?
100 to 125 mL per minute
What labs must be monitored closely when patients take captopril?
Serum creatinine, BUN, potassium
Which ace inhibitor is a prodrug?
Enalapril
Name the only ace inhibitor to come in IV dosage form
Enalapril
List potential adverse effects of ARB’s
Hyperkalemia
do not cause cough because do not inhibit kinase
How do ARB’s work?
Block angiotensin II receptors to prevent binding
What is the major use of Neprilysin?
Treatment of CHF (when coformulated with valsartan)
How does Neprilysin in combination with valsartan work?
Inhibits enzymes that breakdown vasoactive peptides
(when the heart stretches, peptides make you pee and cause vasodilation. More peptides available = more fluid excretion.)
