ACE inhibitors, ARBs & Digoxin

Question 0

Actions of angiotensin 2

Answer 0

Inc aldosterone
Inc sym tone (inc NA)
Inc Ca
Inc thirst
Inc ADH
Inc baroreceptor reflex
Inc BP

Question 1

Hypertension

Answer 1

140/90 mmHg

Question 2

What type of inhibitor is an ACEi?

Answer 2

Competitive inhibitors of the enzyme

Question 3

ACEi contraindications

Answer 3

Pregnancy (AT2 has a role in vascular developement in foetus)
Renal art stenosis

Question 4

ACEi ADRs

Answer 4

Hypotension (particularly postural)
Dry persistent cough (blocks bradykinin degradation in lungs)
Facial angioedema
Hyperkalaemia

Question 5

What receptor do ARBs block?

Answer 5

The AT1 - angiotensin TWO receptor

Question 6

ARBs ADRs

Answer 6

Hypotension
Occasional dry persistent cough (not as frequent as ACEi)
Angioedema (v rare)
Hyperkalaemia

Question 7

ARB contraindications

Answer 7

Pregnancy
RAS
Previous insensitivity to ACEi

Question 8

What dies Digoxin treat?

Answer 8

CHF (congestive heart failure)
Cardiac Arythmias (AF & atrial flutter)

Question 9

What is Digoxin?

Answer 9

A cardiac glycoside

• CHF
• atrial fibrillation
• atrial flutter

Question 10

Action of Digoxin

Answer 10

Inhibits Na/K ATPase

Switches ion flux in Na/Ca exchanger

• Na gets spat out instead
• Ca enters instead- more contraction - positive ionotropic effect

Question 11

Digoxin ADRs :(

Answer 11

Narrow therapeutic index :(
Nausea & vomiting
CNS disturbances, hallucinations 
Bi geminal cardiac arythmias 
Hyperkalaemia

Question 12

Digoxin contraindications

Answer 12

Renal impairment (D builds up)
AV heart block