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Year 1 - HLB Core Drugs > Angiotensin Converting Enzyme (ACE) Inhibitors > Flashcards

Angiotensin Converting Enzyme (ACE) Inhibitors Flashcards

1
Q

What is the renin angiotensin aldosterone system, commonly referred to as RAAS?

A
  • hormone system that regulates blood pressure
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2
Q

Why is the renin angiotensin aldosterone system (RAAS) written in this order?

A
  • this is the order blood pressure is controlled
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3
Q

What is renin (also known as angiotensinogenase) as part of RAAS?

A
  • proteolytic enzyme
  • cleaves angiotensinogen released from the liver
  • creates angiotensin 1
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4
Q

What is angiotensinogen as part of the RAAS?

A
  • alpha 2 globulin
  • released by the liver, a precursor for angiotensin 1
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5
Q

When do the kidneys secrete renin in the RAAS system?

A
  • when blood flow or blood volume to the kidneys is reduced
  • specifically the juxtaglomerular cells in the kidneys
  • blood vessels vasoconstrict in attempt to increase blood flow
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6
Q

What is angiotensin I as part of the RAAS?

A
  • a weak vasoconstrictor
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7
Q

Is angiotensin II, part of the RAAS the strongest vasodilator in the body?

A
  • no
  • 2nd strongest vasoconstrictor in the body
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8
Q

What is angiotensin converting enzyme?

A
  • enzyme able to cleave amino acid off angiotensin I
  • creates angiotensin II
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9
Q

What type of receptor is present on smooth muscles that angiotensin II is able to act upon and cause vasoconstriction?

A
  • GPCR - specifically Gaq
  • ⬆️ Ca2+ = contraction
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10
Q

To help identify which drugs are ACE inhibitors, what do the drugs names generally end in?

A
  • pril
  • like ramipril
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11
Q

What is bradykinin?

A
  • peptide
  • promotes inflammation and vasodilation
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12
Q

What does bradykinin trigger the release of from endothelium cells?

A
  • prostacyclin
  • nitric oxide
  • endothelins (strongest dilator in the body)
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13
Q

What is one of the most commonly prescribed ACE inhibitors?

A
  • ramipril
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14
Q

Although ramipril is an effective hypertensive agent, there are some side effects that patients may experience. What are those?

A
  • dry cough (due to bradykinin accumulation)
  • renal impairment
  • hyperkalaemia (can be given with diuretic)
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15
Q

ACE inhibitors such as ramipril are generally used to treat hypertension, but why can they be useful when treating heart failure?

A
  • ⬇️ systemic vascular resistance (SVR)
  • ⬇️ SVR = ⬇️ afterload (resistance against heart beat)
  • heart failure patients have a weak heart
  • ⬇️ afterload reduces workload on the heart
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16
Q

What is the normal physiological effect of angiotensin II on aldosterone levels?

A
  • stimulates the adrenal cortex
  • aldosterone is released from zona glomerulosa cells
  • increases blood volume and BP
17
Q

Angiotensin II is able to stimulate zona glomerulosa cells of the adrenal cortex releasing aldosterone, which can then go on to increase blood volume and BP. How does aldosterone increase blood volume and BP?

A
  • signals to distal tubules in renal tubules
  • retain Na+ and and H2O
  • ⬆️ Na+ and H2O = ⬆️ blood volume
  • ⬆️ blood volume = ⬆️ BP
18
Q

What is the normal physiological effect of angiotensin II on the pituitary gland?

A
  • baroreceptors recognise need to ⬆️ BP
  • hypothalamus signals pituitary gland
  • pituitary gland secretes anti-diuretic hormone
19
Q

The pituitary gland secretes anti-diuretic hormone (opposite effect of diuretci drugs to treat hypertension) in response to angiotensin II. How does the release of anti-diuretic hormone effect BP?

A
  • stimulates kidneys to retain H2O
  • ⬆️ H2O = ⬆️ blood volume
  • ⬆️ blood volume = ⬆️ BP
  • partial arteriole vasoconstrction
20
Q

Ramipril is an ACE inhibitor, which means it can inhibit the conversion of angiotensin I to angiotensin II. If ACE is inhibited by Ramipril, what are the 3 main effects this can have on the RAAS system?

A
  • ⬇️ smooth muscle vasoconstriction
  • ⬇️ H2O retention due to anti-diuretic hormone
  • ⬇️ Na+ and H2O retention due to aldosterone
21
Q

When treating hypertension, we need to remember how to calculate BP, which is cardiac output (CO) x systemic vascular resistance (SVR). Therefore what are the main effects on CO and/or SVR that ACE inhibitors have?

A
  • ⬇️ systemic vascular resistance

Year 1 - HLB Core Drugs (21 decks)

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