ACEi/ARBs

Question 1

Angiotensinogen is converted to Angiotensin I by _______

Answer 1

Renin

Question 2

True or False:

Angiotensin converting enzyme (ACE) is the only pathway to convert angiotensin I to angiotensin II

Answer 2

False

Chymase and Tissue ACE also produce angiotensin II

Question 3

What effect does aldosterone have on Na/H20 reabsorption?

Answer 3

Increases

this increases preload and therefore BP

Question 4

What effect does aldosterone have on the heart and blood vessels?

Answer 4

Causes detrimental remodeling

Question 5

Due to effects in the kidneys, ACEi/ARBs may lead to ____ serum K+

Answer 5

Increased

Question 6

True or False:

Angiotensin Receptor Blockers (ARBs) inactivate angiotensin II type 1 AND type 2 receptors

Answer 6

False

Type 1 and type 2 receptors have opposite effects

Question 7

ACEi/ARBs cause a(n) ____ in preload

Answer 7

Decrease

prevents Na/H20 reabsorption

Question 8

ACEi/ARBs cause a(n) ________ in afterload

Answer 8

Decrease

prevention of vasoconstriction by angiotensin II

Question 9

What is the common suffix shared by the ACEi’s

name several ACEi’s

Answer 9

“pril”

e.g. enalapril, lisinopril, captopril

Question 10

What is the common ending or suffix shared by the ARB medications?

name several ARB’s

Answer 10

“sartan”

e.g. losartan, valsartan

Question 11

ARB’s are frequently combined with what other medication class?

Answer 11

Thiazide Diuretics

Question 12

What is the reason that ACEi cause a dry/non-productive cough?

Answer 12

Prevents the metabolism of bradykinin, leading to an increase in NO (causes irritation to lungs)

Question 13

What is the most dangerous ADR of ACEi/ARBs

Answer 13

Angioedema

I’ll take hyperkalemia too…

Question 14

Why can angiotensin II levels rise, even if a patient is compliant with ACEi therapy?

Answer 14

The body has additional routes of producing angiotensin II - may upregulate

This is why the ARB medications were developed

Question 15

As monotherapy, ACEi/ARBs may be ________ effective in the african american population

Bonus points if you can explain why

Answer 15

less

They generally tend to have less renin release

Question 16

True or false:

ACEi/ARBs confer a renal protective effect in diabetics

Answer 16

True

less pressure in glomerulus, prevents remodeling/damage

Question 17

NSAIDs ________ effectiveness of ACEi

bonus for why

Answer 17

decrease

inhibit prostaglandin, which is needed to maintain afferent flow

Question 18

What are the three absolute contraindications to ACEi/ARBs?

Answer 18

Bilateral renal artery stenosis
Angioedema
Pregnancy

Question 19

What is the mechanism of action of ACEi?

Answer 19

prevents the conversion of angiotensin I to angiotensin II

angiotensin II is responsible for vasoconstriction, aldosertone release

Question 20

Describe pseudotolerance in relation to antihypertensive medications

Answer 20

When a medication decreases CO/BP, kidneys release renin to compensate
(ACEi and ARBs do not cause this psuedotolerance)

Question 21

What ACE-I is typically used in acute care for it’s “titratability”

Answer 21

Captopril (Half life around six hours)

Question 22

What ACE-I are NOT prodrugs?

Answer 22

Lisinopril
Captopril

Question 23

ACE-I ___________ insulin sensitivity.

Answer 23

Increase

Question 24

ACE-I/ARBS are first choice options for…

Answer 24

HTN with DMII

Question 25

ACE-I/ARBs are effective monotherapy for African-Americans.

Answer 25

False