Anti-Hypertensives: RAAS regulators

Question 1

RAAS Regulators types?

Answer 1

1. ACE Inhibitors
2. Angiotensin Receptor Blockers
3. Renin Antagonists

Question 2

ACE Inhibitors drugs?

Answer 2

– Short Acting:
Enalapril, Captopril

– Long Acting: Benazepril, Fosinopril, Moexipril

Question 3

ACE Inhibitors Uses?

Answer 3

– Manage CHF, IHD, Hypertension

– Manage renal failure by stabilizing kidney function and reducing
proteinuria

Question 4

ACE Inhibitors Mechanism of Action?

Answer 4

1. Inhibition of ACE leading to decreased Angiotensin II formation which leads to:
2. Decreased vasoconstriction to decrease TPR

AND

3. Decreased fluid retention by aldosterone activity to reduce preload
4. Inhibition of bradykinin degradation to increase
   vasodilation
5. Effects mediated by renal prostaglandin

Question 5

ACE Inhibitors Side Effects & Contraindications?

Answer 5

• Persistent dry cough and angioedema due to
bradykinin and substance P accumulation

• Hyperkalemia due to insufficient aldosterone
activity

• Hypotension during overdose or for patients
already on diuretics

• Possible acute renal failure (rare)
• Possible teratogenicity

Question 6

Avoid which drugs with ACE Inhibitors?

Answer 6

1. avoid bradykinin inhibitors eg. icabitant to maximise drug effect
2. NSAIDs

Question 7

Angiotensin

Receptor Blockers drugs?

Answer 7

Losartan: Specific for Angiotensin 2 Type 1 receptors

Question 8

Angiotensin Receptor Blockers Mechanism of Action?

Answer 8

• Antagonism of ATII
- May be more efficacious than ACE inhibitors as there may be pathways other than ACE for ATII formation

• Bradykinin spared

Question 9

Angiotensin Receptor Blockers Side Effects & Contraindications?

Answer 9

• No dry cough or angioedema

* Otherwise same as in ACE Inhibitors

Question 10

Renin Antagonists drugs?

Answer 10

Aliskiren

Question 11

Renin Antagonists Mechanism of Action?

Answer 11

Antagonism of renin activity especially to deal with compensatory upregulation of renin activity

Question 12

Renin Antagonists Side Effects & Contraindications?

Answer 12

Generally well tolerated