ACEi and ARBs

Question 1

What is the main indication for ACEi?

Answer 1

Heart failure

hypertension

Question 2

What is the mechanism of action for ACEi?

Answer 2

It blocks the angiotensin converting enzyme responsible for converting inactive angiotensin I into vasoconstrictor angiotensin II.

(Reduces the levels of angiotensin II)

Question 3

State the 3 hormones involved in the RAAS?

Answer 3

Renin
Aldosterone
Angiotensin

Question 4

Explain the role of renin.

Answer 4

A hormone released by the juxtaglomerular apparatus.

It converts angiotensin into angiotensin I.

Question 5

What effect does angiotensin II have?

Answer 5

Acts on blood vessels stimulating vasoconstriction

Question 6

How does angiotensin II effect the release of aldosterone?

Answer 6

Angiotensin II acts on the adrenal gland to stimulate release of aldosterone.

Question 7

Explain the role of aldosterone.

Answer 7

Aldosterone acts on the kidney and stimulates reabsorption of salt and water

Question 8

What are the indications for ACEi use?

Answer 8

Heart failure
Hypertension
Post-myocardial infarction
Diabetic neuropathy ot retinopathy

Question 9

What is diabetic neuropathy?

Answer 9

Type of nerve damage as a result of diabetes, it most often damages nerves in the legs and feet

Question 10

What is diabetic retinopathy?

Answer 10

A complication of high blood sugar levels causing damage to the retina.

Question 11

What effect to ACE inhibitors have?

Answer 11

They inhibit angiotensin II levels and allow vasodilatation which lowers blood pressure

Question 12

What is the most common side effect of ACEi?

Answer 12

Dry cough

Question 13

State the most common used ACEi?

Answer 13

Captopril.
Short acting
give x3 a day

Question 14

What are ACEi called? (last syllable)

Answer 14

(-pril)

Question 15

Side effects of ACEi are:

Answer 15

Dizziness 
Hypotension 
Rash 
Dry cough 
Hyperkaleamia

Question 16

What are the contraindications of ACEi?

Answer 16

Renal artery stenosis
Pregnancy & breastfeeding
Low BP 
High dose diuretics 
Age > 70yrs

Question 17

What are some symptoms of heart failure?

Answer 17

Shortness of breath
Fatigue and weakness
Oedema
Persistent cough to wheezing

Question 18

Which famous study has evidence for ACE inhibitors?

Answer 18

CONSENSUS
study of enalapril used for severe congestive heart failure

Reduces mortality and improves symptoms

Question 19

What line of treatment are ACEi and ARBs in heart failure?

Answer 19

First line

Question 20

What is the MoA of ARBs”?

Answer 20

They block angiotensin II type 1 receptors.

prevent angiotensin II from binding to the receptor.

Question 21

What indications are ARBs used for?

Answer 21

Hypertension, Heart failure, left ventricular hypertrophy, albuminuria

Question 22

State the most common ARBs.

Answer 22

Lorsartan
candesartan
Valsartan

Question 23

What is albuminiruia?

Answer 23

Leakage of albumin protein into the urine = early stage of kidney failure

Question 24

What are the side effects of ARBs?

Answer 24

Dizziness 
Fatigue 
Hypertension 
Hyperkalemia 
Acute kidney injury

Question 25

Contraindications of ARBs?

Answer 25

Renal artery stenosis
Pregnancy and breastfeeding
ACEi’s
Peripheral Vascular disease

Question 26

What effect does bradykinin have on blood vessels?

Answer 26

Vasodilation

Question 27

What happens when ACEi deactivate bradykinin?

Answer 27

Bradykinin levels increase, sustained the effects of drug (ramiprilat) by causing increased vasodilation and decreased blood pressure