Angiotensin inhibitors (general + ACE inhibitors) Flashcards
Angiotensin inhibitors - 3 groups
Angiotensin converting enzyme (ACE) inhibitors.
Angiotensin receptor blockers (ARBs)
Direct renin inhibitor (Aliskiren)
ACE inhibitors - cardiovascular effects
PVR: Decrease
Plasma renin activity: (compensatory) increase
Left ventricular hypertrophy: Decrease
Blood pressure: decreases both arterial and venous.
ACE inhibitors - effects on potassium
Serum potassium: Increase
ACE inhibitors - adverse effects
Acute renal failure (in bilateral renal artery stenosis), angioedema, dry cough, hyperkalemia, loss of taste, neutropenia, rash. Fetal and neonatal injury and death.
ACE inhibitors - interactions
Increase lithium.
Potassium sparing diuretics and K supplements - increased hyperkalemic effects.
NSAIDs: decreased hypotensive effect
Shorter acting ACE inhibitor
Captopril (6-12 h)
Angiotensin inhibitors whose absorption is inhibited by food
Captopril Quinapril Losartan Valsartan Aliskiren (high fat meal)
Angiotensin inhibitors that are preferred for initial treatment of HT - and advantages
ACE inhibitors and ARBs. These groups reduce risk of stroke. Useful in diabetes or heart failure.
ACE inhibitors - MOA
Bind to the zinc atom at the active site of ACE. Hypotensive effect by blocking angiotensin II formation, and by blocking breakdown of bradykinin. Increased renal prostaglandin synthesis
ACE inhibitors - administration
Oral
How can the compensatory increase in renin secretion caused by ACE inhibitors be prevented?
By adding aliskiren.
ACE inhibitors - contraindications
Pregnancy
ACE inhibitors - indications
Mild to severe HT.
DM with kidney involvement (ACE inhibitors are renoprotective).
ACE inhibitors are especially good for pts with..
Heart failure, MI, chronic kidney disease, DM.
ACE inhibitors - are protective of which organs?
Renoprotective.
Cerebroprotective
