Angiotensin Modifiers Flashcards
What is the MOA of direct renin inhibitor and what is it called?
Aliskiren acts by blocking the activity of renin, an enzyme that initiates the RAAS cascade.
Renin normally converts angiotensinogen to angiotensin I. By inhibiting renin, Aliskiren reduces angiotensin levels causing vasodilation and decreased BP
What is the primary indication for giving Aliskiren?
HTN (when other medications are insufficient)
What are contraindications for prescribing Aliskiren?
Pregnancy
Taking ACE/ARBs (increased risk of renal impairment, hyperkalemia, and low BP).
Potassium supplements/diuretics: Aliskiren can raise potassium levels, so avoid combining these two to avoid hyperkalemia.
How is Aliskiren eliminated?
Through hepatic metabolism so liver function should be assessed for those taking this medication.
What are the ACE inhibitors and what is their MOA?
Prils
They block the angiotensin converting enzyme from converting angiotensin I to II, a powerful vasoconstrictor that also stimulates aldosterone release. Inhibiting ACE leads to vasodilation, lowers BP (with less aldosterone, the kidneys excrete more sodium and water, reducing blood volume and further lowering BP), and causes bradykinin accumulation.
What is bradykinin accumulation?
ACE breaks down bradykinin, a vasodilator. By inhibiting ACE, these drugs increase bradykinin levels, which contributes to the blood pressure-lowering effect but may cause side effects like cough and angioedema.
What are indications for use when prescribing ACE inhibitors?
HTN (considered first line), especially in those with CKD or diabetes as they offer kidney protection.
HF
Post MI: ACE inhibitors prevent heart remodeling after a heart attack
CKD: Slows progression of kidney damage
What are contraindications for taking ACE inhibitors?
Pregnancy
Renal artery stenosis
Angioedema
Hyperkalemia
What are drug-drug interactions to monitor when taking ACE inhibitors?
Diuretics
ARBs
NSAIDs
What ace inhibitor is the only one not eliminated through the kidneys?
Fosinopril is eliminated through the liver making it optimal for those with kidney dysfunction.
What are adverse effects of ACE inhibitors?
Cough/Angioedema
Hypotension
What is the MOA of ARBs and what are they?
“Sartans”
They work by blocking angiotensin II receptors. This causes vasodilation and decreased aldosterone secretion
What are indications for use when prescribing ARBs?
HTN
HF
CKD
Stroke prevention
What are contraindications for prescribing ARBs?
Pregnancy
Renal artery stenosis
Hyperkalemia
What is one side effect that ACEs and ARBs differ in?
ARBs do not break down bradykinin, so there is no possible side effect of cough or angioedema which could happen when taking ACEs
