ACEIs and ARBs

Question 1

ACE Inhibitors

Answer 1

**Captopril
**Enalapril
Benazepril
Enalaprilat
Fosinopril
Lisinopril
Moexipril
Perindopril
Quinapril
Ramipril
Trandolapril

MOA: reduce ang II (also prevent inactivation of vasodilation by bradykinin)
Decrease peripheral resistance without changing CO, baroreceptor reflexes intact
Dosing based on half life

Question 2

Captopril

Answer 2

ACE Inhibitor
Active metabolite
Short half life

Question 3

Enalapril

Answer 3

ACE Inhibitor
Short half life
IV use is approved

Question 4

Benazepril

Answer 4

ACE Inhibitor

Long half life

Question 5

Enalaprilat

Answer 5

ACE Inhibitor

HTN emergencies

Question 6

Fosinopril

Answer 6

ACE Inhibitor
Renal and hepatic elimination
Long half life

Question 7

Lisinopril

Answer 7

ACE Inhibitor

Long half life

Question 8

Moexipril

Answer 8

ACE Inhibitor

Long half life

Question 9

Perindopril

Answer 9

ACE Inhibitor

Question 10

Quinapril

Answer 10

ACE Inhibitor

Short half life

Question 11

Ramipril

Answer 11

ACE Inhibitor

Long half life

Question 12

Trandolapril

Answer 12

ACE Inhibitor

Renal and hepatic elimination

Question 13

Angiotensin receptor blockers

Answer 13

**Losartan
**Valsartan
Azilsartan
Candesartan
Eprosartan
Irbesartan
Olmesartan
Telmisartan

MOA: selective blocking of angiotensin II AT1 receptors
No effect on bradykinin

Question 14

Losartan

Answer 14

Angiotensin receptor blockers

Metabolized by CYP450

Question 15

Valsartan

Answer 15

Angiotensin receptor blockers

Question 16

Azilsartan

Answer 16

Angiotensin receptor blockers

Question 17

Candesartan

Answer 17

Angiotensin receptor blockers

Question 18

Eprosartan

Answer 18

Angiotensin receptor blockers

Question 19

Irbesartan

Answer 19

Angiotensin receptor blockers

Question 20

Olmesartan

Answer 20

Angiotensin receptor blockers

Question 21

Telmisartan

Answer 21

Angiotensin receptor blockers

Question 22

Drugs that block renin secretion

Answer 22

Clonidine (alpha 2 - brain)

Propranolol (beta 1 - JGM cells)

Question 23

Renin inhibitor

Answer 23

Aliskiren
Inhibits entire RAS through renin
Renin levels increase - rapid increase in renin effect with rapid withdrawal
No bradykinin increase

Question 24

RAS

Answer 24

Decrease BP, decrease BV, increase B1 Sympathetic -> increase renin -> increase ang I -> ACE converts ang I to ang II -> increase aldosterone

Ang II -> increase vasoconstriction, increase NaCl/H2O reabsorption
Aldosterone -> increase NaCl/H2O reabsorption

Question 25

ACEIs use

Answer 25

HTN, nephropathy, HF, left ventricular dysfunction, AMI, prophylaxis of CVD Can be used in athletes

Question 26

ACEIs adverse effects

Answer 26

**Cough (switching ACEIs can reduce this) **Angioedema **Hyperkalemia **ARF **Contraindicated in pregnancy Hypotension Avoid when using K sparing diuretics, NSAIDs, lithium, allopurinol

Question 27

Renal considerations with ACEIs

Answer 27

Prevent/delay progression of renal disease Dilate efferent > afferent arterioles -> reduce back pressure Improve RBF and Na excretion in CHF Rapid decrease in GFR may lead to ARF

Question 28

ACEI induced ARF Risk factors

Answer 28

Poor MAP Volume depletion Renal vascular disease (stenosis, atherosclerosis) Vasoconstrictor agents

Question 29

Ang II receptors

Answer 29

AT1 - major in adults, vasoconstriction AT2 - minor in adults, vasodilation Blocker - AT1 >>> AT2 -> leaving only effects of AT2

Question 30

ARB uses

Answer 30

HTN, diabetic nephropathy, HF, AMI, cardio prophylaxis

Question 31

ARB vs ACEIs

Answer 31

ARB more effectively inhibits AT1 ARB allows AT2 to remain active ACEI increase bradykinin Less cough and edema with ARB

Question 32

ARB adverse effects

Answer 32

Similar to ACEIs without cough | No use during pregnancy