ACEi

Question 1

Name the ACE inhibitors

Answer 1

• *-PRIL**
• *CAPTO/**pril
• *ENALA/**pril
• *RAMI/**pril
• *LISINO/**pril

Question 2

ACE inhibitors MOA

Answer 2

inhibit ACE ⇒ATI is not converted to ATII

→ counteracts ATII effects

• dilate efferent arteriole → decrease GFR
• ​decrease Aldosterone Release →decrease Na+ reabsorption (natiuresis)
• ​decrease pressor effects of ATII
  (“floppy red suspenders”)

Question 3

ACE inhibitors are used to treat …

Answer 3

-1st line treatment for CHF
(“failing heart balloon”)

-used in myocardial infarction
(“mandolina player playin dem Broken heart strings”)

-1st line agents used for HTN
(“High pressure candy pipes”)

-slow the progression of diabetic nephropathy
(“Diasweeties Candy shop”)

• ACEi reduce Mortality
  (“Angel above le cross”)

Question 4

which patients should be started on ACEi therapy ?

Answer 4

-patients with albuminuria and BP > 130/80
(“albums in diasweeties candy shop”)

Question 5

what side effects might ACEi cause ?

Answer 5

-can cause significant hypotension and syncope in patients with high renin levels (in heart failure)
(“fainting poker player with floppy red suspenders”)

-can cause hyperkalemia due to decreased aldosterone levels
(“raised banana daquiri”)

-dry cough due to an increase of bradykinin
(“coughing dealer”)

-ACE increases the risk of fetal hypotension
(“Tarantula on mama’s back”)

Question 6

when are ACEi contraindicated and why ?

Answer 6

• ACE inhibitors are contraindicated inhereditary angioedema ( to C1 esterase deficiency) due to increased Bradykynin activity .
• ACE inhibitors are contraindicated in bilateral renal artery stenosis due to further decrease in GFR
• use of ACEi can precipitate acute renal failure charachterized by persistent increase in creatinine levels-azotemia

Question 7

which drugs should be avoided during ACEi therapy ?

Answer 7

NSAIDs should be avoided since they inhibit the actions of prostaglandins and bradykynin , causing vasoconstriction of afferent arteriole→GFR decrease

• can precipitate acute kidney injury

Question 8

in case of Hereditary angioedema , which drugs can replace ACEi therapy ? why ?

Answer 8

ARBs can be used as a replacement therapy since they don’t affect bradykynin serum levels

Question 9

Name the ARBs

Answer 9

-SARTAN (chair says “SoRry TAkeN”)

LO/ sartan
CANDE/ sartan
VAL/ sartan

Question 10

MOA OF ARBs

Answer 10

Angiotensin II receptor blockers

Question 11

Possible side effects of ARBs

Answer 11

- Hyperkalemia (“banana daquiri on taken chair”)

Question 12

Name a drug which can directly inhibit renin

Answer 12

Aliskiren

(“high limit-high risk slots”)

Question 13

name a possible side effect of Aliskiren ?

Answer 13

Hyperkalemia
(“slot machine showing 3 bananas”)