ACEi and ARBs Flashcards
What is the main indication for ACEi?
Heart failure
hypertension
What is the mechanism of action for ACEi?
It blocks the angiotensin converting enzyme responsible for converting inactive angiotensin I into vasoconstrictor angiotensin II.
(Reduces the levels of angiotensin II)
State the 3 hormones involved in the RAAS?
Renin
Aldosterone
Angiotensin
Explain the role of renin.
A hormone released by the juxtaglomerular apparatus.
It converts angiotensin into angiotensin I.
What effect does angiotensin II have?
Acts on blood vessels stimulating vasoconstriction
How does angiotensin II effect the release of aldosterone?
Angiotensin II acts on the adrenal gland to stimulate release of aldosterone.
Explain the role of aldosterone.
Aldosterone acts on the kidney and stimulates reabsorption of salt and water
What are the indications for ACEi use?
Heart failure
Hypertension
Post-myocardial infarction
Diabetic neuropathy ot retinopathy
What is diabetic neuropathy?
Type of nerve damage as a result of diabetes, it most often damages nerves in the legs and feet
What is diabetic retinopathy?
A complication of high blood sugar levels causing damage to the retina.
What effect to ACE inhibitors have?
They inhibit angiotensin II levels and allow vasodilatation which lowers blood pressure
What is the most common side effect of ACEi?
Dry cough
State the most common used ACEi?
Captopril.
Short acting
give x3 a day
What are ACEi called? (last syllable)
(-pril)
Side effects of ACEi are:
Dizziness Hypotension Rash Dry cough Hyperkaleamia
What are the contraindications of ACEi?
Renal artery stenosis Pregnancy & breastfeeding Low BP High dose diuretics Age > 70yrs
What are some symptoms of heart failure?
Shortness of breath
Fatigue and weakness
Oedema
Persistent cough to wheezing
Which famous study has evidence for ACE inhibitors?
CONSENSUS
study of enalapril used for severe congestive heart failure
Reduces mortality and improves symptoms
What line of treatment are ACEi and ARBs in heart failure?
First line
What is the MoA of ARBs”?
They block angiotensin II type 1 receptors.
prevent angiotensin II from binding to the receptor.
What indications are ARBs used for?
Hypertension, Heart failure, left ventricular hypertrophy, albuminuria
State the most common ARBs.
Lorsartan
candesartan
Valsartan
What is albuminiruia?
Leakage of albumin protein into the urine = early stage of kidney failure
What are the side effects of ARBs?
Dizziness Fatigue Hypertension Hyperkalemia Acute kidney injury
Contraindications of ARBs?
Renal artery stenosis
Pregnancy and breastfeeding
ACEi’s
Peripheral Vascular disease
What effect does bradykinin have on blood vessels?
Vasodilation
What happens when ACEi deactivate bradykinin?
Bradykinin levels increase, sustained the effects of drug (ramiprilat) by causing increased vasodilation and decreased blood pressure
