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Therapeutics 2 Exam 5 > ACEs and ARBs > Flashcards

ACEs and ARBs Flashcards

1
Q

What does renin do?

A

Works on angiotensinogen to produce angiotensin I

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2
Q

What does the Angiotensin Converting Enzyme (ACE) do?

A

Works on Angiotensin I to produce Angiotensin II

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3
Q

What do ARBs target?

A

Angiotensin II

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4
Q

What are the 2 functions of angiotensin II that are blocked by ARBs?

A

-Vasoconstriction

-Aldosterone secretion

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5
Q

What is the main effect of Angiotensin II that ARBs want to block?

A

Increased blood pressure

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6
Q

What else does ACE work on and what is its effect?
(Another reason why we want to block ACE)

A

Besides Angiotensin I, Ace also works on Bradykinin

ACE inactivates bradykinin

Bradykinin produces decreased blood pressure so we do NOT want it inactivated. By using ACE inhibitors, we block the degradation of bradykinin

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7
Q

What drug is a renin inhibitor?

A

Aliskiren

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8
Q

How does Aliskiren work?

A

Direct inhibitor of renin

-Decreases formation of angiotensin I from angiotensinogen

**Not first line for hypertension

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9
Q

What is a contraindication of Aliskiren?

A

Cannot be used in pregnant or nursing mothers

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10
Q

What word ending signifies that a drug is an ACE Inhibitor?

A

“pril”

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11
Q

What are the 3 classes of ACE inhibitors?

A

-Sulfhydryl-containing (similar to Captopril)
-Dicarboxyl-containing (similar to enalapril) *most potent
-Phosphorus-containing (similar to fosinopril)

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12
Q

What two ACE inhibitors are not pro-drugs?

A

Lisinopril

Captopril

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13
Q

What is the first-line hypertension treatment?

A

ACE and ARB

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14
Q

What is the function of Captopril and Lisinopril?

A

ACE inhibitors

-First line monotherapy for hypertension

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15
Q

What are some important considerations with Captopril and Lisinopril?

A

-Useful in whites but not people of African descent

-Beneficial in patients with heart failure or chronic kidney disease

-Better for patients with diabetes than thiazides

-Better for patients with ischemic heart disease than vasodilators

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16
Q

What are some side effects of Lisinopril and Captopril?

A

-Cough
-Angioedema
-Hyperkalemia

17
Q

What are the contraindications for Captopril and Lisinopril?

A

-Pregnancy

-Do not use if GFR drops by more than 30%

18
Q

What affect can NSAIDs have on ACE inhibitors?

A

-Block production of prostaglandins which mediate the vasodilation produced by bradykinin

-Because of this, NSAIDs decrease the effect of ACE inhibitors

19
Q

What causes ACE inhibitors to have cough and angioedema as a side effect?

A

Accumulation of bradykinin

20
Q

Why can ACE inhibitors cause hyperkalemia?

A

Decreased production of aldosterone

(Aldosterone secretion is a function of Angiotensin II)

21
Q

What word-ending is indicative of ARBs?

A

“sartan”

22
Q

What drug is prototypical for ARBs?

A

Losartan

23
Q

What ARB has the lowest potency?

A

Losartan

*drug itself does not have much activity, but its metabolite is potent

24
Q

What ARB has the highest potency?

A

Candesartan

25
Q

What is the angiotensin II receptor?

A

AT1

26
Q

When are ARBs used?

A

First-line treatment for hypertension

*Often used in patients who do not tolerate ACE inhibitors

27
Q

What are the adverse effects of ARBs?

A

-Hypotension
-Hyperkalemia
-Low rate of angioedema
-Fetal pathologies
-Reduction in GFR

28
Q

What is the function of spironolactone and eplerenone?

A

Aldosterone Receptor Antagonists (block reabsorption of sodium and decrease blood pressure)

-Potassium-sparing diuretics

29
Q

What are spironolactone and eplerenone used for?

A

Chronic heart failure

*not monotherapy for hypertension but used to reduce hypokalemia

30
Q

What are the adverse effects associated with spironolactone and eplerenone?

A

-Hyperkalemia
-Antiandrogen effects

31
Q

What are all of the first-line treatment options for hypertension?

A

-Diuretics (thiazides)

-ACE Inhibitors

-ARBs

-L-Type Ca++ Channel Antagonists (CCBs)

32
Q

What drug is the one thiazide mentioned?

A

Chlorthalidone

33
Q

How does Chlorthalidone work?

A

-Blocks sodium-chloride symporter on the distal convoluted tubule

34
Q

What are 2 important notes with use of chlorthalidone?

A

**Effective in people of African ancestry

*Not the drug of choice for people with diabetes, hyperlipidemia, or gout

35
Q

What drugs can be used to treat hypertension in pregnancy?

A

-Methyldopa
-Labetalol
-Metoprolol
*other beta blockers

36
Q

What hypertension drugs should be avoided in pregnancy?

A

-ACE inhibitors
-ARBs
-Direct renin inhibitors
-Aldosterone receptor antagonists

Therapeutics 2 Exam 5 (9 decks)

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