ACEIs/ARBs/CCBs/renin inhibitors Flashcards

1
Q

ACEIs inhibitors examples

A

Enalapril
Lisinopril
Ramipril

-pril

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2
Q

clinical uses of ACEIs

A

°Hypertension
°Heart failure
°Post MI
°High risk of ischemic heart disease
°Diabetic nephropathy
°Chronic renal insufficiency to prevent progression

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3
Q

AE of ACEIs

A

1) Hypotension
2) Dry cough (due to bradykinin accumulation)
3) Hyperkalaemia (because of reduced aldosterone secretion)
4) Angioedema
5) Renal failure in renal artery stenosis

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4
Q

contraindications of ACEIs

A

1)Renal stenosis/ Kidney injury
2)NSAIDS (ACEIs interact Interactions with
NSAIDs at renal A. –> dilation of efferent A. = lower GFR)
3) Pregnancy

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5
Q

MoA of ACEIs

A

blocks the conversion of Angiotensine I to AT II so:
1) ↓Bp
2) ↓ Cardiac load = ↑ CO (to the heart)

So, Renin accumulates, ATI accumulate and ATII is low

*note: ACEIs DO NOT affect Cardiac contractility

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6
Q

ARBs examples

A

Losartan
Valsartan

-sartan

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7
Q

MoA of ARBs

A

Similar to ACEIs but do not cause cough (they do not affect Bradykinin)

Blocks Angiotensine II receptors (on blood vessles) so:
1) ↓Bp
2) ↓ Cardiac load = ↑ CO (to the heart)

when they block the ATII this causes accumulation of renin, ATI and ATII

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8
Q

AE of ARBs

A

Teratogenic

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9
Q

Contraindications of ARBs

A

1) NSAIDS (Interactions with NSAIDs at renal A. –> dilation of efferent A. = lower GFR)
2) PREGNANCY

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10
Q

Clinical uses of ARBs

A

Hypertension in:
1) young patients (as they have higher renin than older people)
2) diabetics
3) Hypertension complicated by LV Hypertrophy
4) HF
5) Diabetic Nephropathy

Used mainly in Asthmatic patietns or when dry cough from ACEIs

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11
Q

Renin Inhibitors Examples

A

Aliskiren

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12
Q

MoA of Aliskiren

A

renin inhibitor–> lowers Bp
(but clinicaly somewhat unsuccessful)

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13
Q

AE of Aliskiren

A

1) Diarrhoea,
2) acute renal failure,
3) angioedema and
4) severe allergies (rare)

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14
Q

Contraindications of Renin Inhibitors?

A

1) PREGNANCY
2) Africans and old patients have lower renin levels thus a renin inhibitor is contraindicated.

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15
Q

The 3 classes of CCBs + Examples

A

1) Phenylalkylamine: Verapamil
2) Benzothiazepines : Dilitiazem
3) Dihydropyridines
a) (Chronic)
- Nifedipine
- Amlodipine

b) (Acute)
- Clevidipine
- Nicardipine

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16
Q

MoA of Verapamil

A

1) Acts mainly on Cardiac Myocytes :
- ↓ HR and
- ↓ force of contraction

2) Strong Intropic effects by blocking phase 2 plateau

*phase 2 platue : when Ca+2 enters the ventricles (Contraction)

17
Q

Clinical uses of Verapamil

A

1) Angina
2) Arrhythmias
3) Hypertension

18
Q

Contraindications of Verapamil

A

1) HF (blocks phase 2 plateau)
2) w/ beta-blockers

19
Q

AE of Verapamil

A

1) Constipation (block CA+2 channels in the GI tract)
2) Effects on cardiac rhythm (heart block) and
contraction force (worsen heart failure)
3) Hyperprolactinemia((because it inhibits dopamine release)

20
Q

MoA of Diltiazem

A

Acts on both cardiac and vascular myocytes.
No change in HR

21
Q

Clinical uses of Dilitiazem

A

°Angina
°Hypertension

22
Q

Contraindications of Dilitiazem

A

Don’t give in case of
HF (since they depress Ca+
channels in the heart) also in combo w/ beta blockers

23
Q

MoA of CCBs Dihydropyridines

*Nifedipine, Amlodipine, Clevidipine, Nicardipine

A

Bind at the A1 subunit in LTCC (LType Ca+ Channels)
-Generalized arterial/arteriolar vasodilation = ↓ BP
-Little effect on veins
- ↓ TPR = ↓ heart afterload but can cause reflex
tachycardia

24
Q

Clinical uses of Nifedipine, Amlodipine, Clevidipine, Nicardipine

A

1) Nifedipine, Amlodipine,
- Varient Angina (vasodialtion of CA)
- Hypertension
- Raynaud Phenomenon

2) Clevidipine, Nicardipine
- Hypertensive Crises Emergency (IV)

Raynaud Phenomenon: decreased blood flow to the fingers

25
Q

AE of CCBs Dihydropyridines

A
  • Flushing and headache (because they vasodilate)
  • Peripheral oedema (ankle swelling)
  • Gingival hyperplasia
26
Q

Contraindications of Dihydropyridines

A

1) Unstable Angina
2) safe in pregnancy