ACEi and ARBs Flashcards
What drugs have a -kiren ending?
Renin inhibitors
What drugs have a -Prils ending?
ACE inhibitors
What drugs have a -sartans ending?
ARBs (angiotensin receptor blockers)
What are the actions of ACEi?
- Dec BP, reduce Ang II constrictors
- Dec BV so reduction in aldosterone
- Dec sympathetic activation
- Inc Bradykinin (prevents metabolism)
- Dec generation ROS
- Dec glomerular filtration rate
- Dec hypertension remodelling
What does bradykinin do?
- stimulates dilation of blood vessels
What is ROS why is a decrease beneficial?
Reactive oxygen species
- diminishes oxidative stress related injuries
What are the major ACE inhibitors?
Captopril Enalapril Lisinopril Ramipril Perindopril Trandolapril
What is the benefit of slower onset ACEi’s and which ACE are longer onset?
longer = Captopril and enalapril
benefits of slower onset = longer duration so one pill daily and less rashes or taste disturbance
What major factor will effect what is first line in patients with heart failure?
Whether ejection fraction is preserved or not
What is first line in Heart failure with reduced ejection fraction?
ACEi and Beta blocker or aldosterone antagonist
ARB if intolerant to ACEi
What are possible second line treatments if HF symptoms remain?
One of these:
- Replace ACEi with sacubitril valsartan
- add ivabradine
- add hydralazine and nitrate
- use digoxin (symptomatic relief if have a sinus rhythm)
What is the most common side effect of ACEi?
Dry cough (may want to change to ARB)
What are the adverse effects of ACEi?
- Acute renal failure
- Hypotension (first dose)
- Hyperkalaemia
- Teratogenicity (abnormalities in foetus)
- skin rash
- Taste disturbance
What are the drug interactions of ACEi?
- with Diuretics dec Na
- potassium sparing diuretics inc risk of hyperkalaemia
- hypotensive agents inc hypotension
- NSAIDs reduce renal BF and inc risk of renal impairment
When are ACEi contraindicated?
- avoid in renovascular disease
- severe aortic stenosis
- start at low does in HF
What needs to be monitored in patients taking ACEi?
- Potassium if taking potassium sparing diuretic
- monitor BP and renal function in patients with HF
In patients with heart failure without reduced ejection fraction what other treatments should be tried before medication?
1) first treat comorbidities e.g. hypertension, atrial fibrillation, ischaemic heart disease or diabetes
2) personalised exercise based cardiac rehabilitation
3) start on first line medication treatment
What are the most common ARBs?
- Losartans
- Irbesartan
- Valsartan
- Candesartan
What are the actions of ARBs?
- antagonise effects of Ang II at AT1 receptors
- have no effect on metabolism of bradykinin
- can promote AT2 receptor signalling
How do actions of ACEi and ARBs differ?
- all angiotensin is stopped in ARBs as acts at receptor whereas in ACEi some Ang still made in non-ACE pathways
When are ARBs contraindicated?
- similar to ACEi
- bilateral renal artery stenosis
- aortic stenosis
- pregnancy
- must monitor renal function in unilateral disease, renal impairment or atherosclerosis
What are the adverse effects of ARBs?
- better tolerated than ACEi usually
- 1st dose hypotension
- acute renal failure
- hyperkalaemia
- angio-oedema
What is the new drug class which acts similarly to ACEi/ARBs?
ARNIs (dual NEP enzyme/angiotensin receptor inhibitors
