ACE Inhibitors/ARBs

Question 1

Outline the RAS

Answer 1

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

Question 2

What electrolyte imbalance are ace inhibitors commonly associated with?

Answer 2

Hyperkalemia (inhibit sodium retention and potassium excretion)

Question 3

What harmful effect of angiotensin II can ace inhibitors help to prevent?

Answer 3

Remodeling of cardiac and vascular smooth muscle

Question 4

What is kinase II and what effect do ace inhibitors have on it?

Answer 4

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)

Question 5

List four adverse effects of ace inhibitors

Answer 5

Dry hacking cough, hyperkalemia, angioedema, renal dysfunction in patients with renal artery stenosis

Question 6

Why do ace inhibitors cause a dry hacking cough, and how is it treated?

Answer 6

Result of increased bradykinin in the lungs, potentially treated with aspirin but NOT responsive to any cough suppressants

Question 7

What medications other than ace inhibitors commonly cause angioedema?

Answer 7

NSAIDS (overload of bradykinin)

Question 8

Which trimester of pregnancy is especially important to avoid ace inhibitors?

Answer 8

Third trimester

Question 9

What was the first ace inhibitor?

Answer 9

Captopril

Question 10

What four uses do ACE inhibitors have?

Answer 10

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)

Question 11

How many times a day is captopril taken?

Answer 11

Three

Question 12

What creatinine clearance suggests necessity for dose adjustment when taking captopril?

Answer 12

CrCl less than 50 mL/minute

Question 13

What is a normal creatinine clearance?

Answer 13

100 to 125 mL per minute

Question 14

What labs must be monitored closely when patients take captopril?

Answer 14

Serum creatinine, BUN, potassium

Question 15

Which ace inhibitor is a prodrug?

Answer 15

Enalapril

Question 16

Name the only ace inhibitor to come in IV dosage form

Answer 16

Enalapril

Question 17

List potential adverse effects of ARB’s

Answer 17

Hyperkalemia

do not cause cough because do not inhibit kinase

Question 18

How do ARB’s work?

Answer 18

Block angiotensin II receptors to prevent binding

Question 19

What is the major use of Neprilysin?

Answer 19

Treatment of CHF (when coformulated with valsartan)

Question 20

How does Neprilysin in combination with valsartan work?

Answer 20

Inhibits enzymes that breakdown vasoactive peptides
(when the heart stretches, peptides make you pee and cause vasodilation. More peptides available = more fluid excretion.)