Antihypertensives (Renin-Angiotensin Agents) - Week 2

Question 1

ACEi’s and ARBs reduce mortality in ____ and ____ .

Answer 1

CHF and CAD

decreased CO --> 
decreased BP --> 
decreased renal perfusion --> 
renin release --> vasoconstriction --> 
worsening of CHF and CAD

Question 2

ACEi’s and ARBs are first choice for tx of HTN in DM because:

Answer 2

they preserve renal fx

Question 3

How are B-blockers also beneficial to tx HTN?

Answer 3

B1 activation can cause release of renin. B-blockers reduce renin release and therefore decrease the BP.

Question 4

T/F: ARB’s reduce the effect of ischemic damage after MI.

Answer 4

True

Question 5

ACEi’s, aside from their effects on fluid volume, are primarily venous or arterial vasodilators?

Answer 5

Arterial

Question 6

ACEi’s treat CHF and MR by:

Answer 6

after load reduction

Question 7

T/F: ACEi’s increase CO w/o excessive dec in preload.

Answer 7

True

Question 8

Identify the biphasic effect ACEi’s have on renal function depending on baseline BP

Answer 8

Baseline HTN:
- decreased renal vasc resistance –> improved RBF and GFR

Baseline normotension:
- if BP is dec, renal fx may deteriorate b/c compensatory efferent arteriolar constriction (mediated by angiotensin II) is blocked –> dec glomerular filtration pressure and GFR –> acute hyperK

Question 9

ACEi’s should be avoided in pts w _____ or _____.

Answer 9

dec renal fx

renal artery stenosis

Question 10

When is Elanaprilat good, and when is it bad?

Answer 10

Good:
pts that could have improved renal fx from increased CO induced by after load reduction

Bad:
hemodynamic instability or renal insufficiency post op

Question 11

How do ACEi’s cause a cough?

Answer 11

An increase in bradykinin. cough syrup doesn’t work because you have to stop the bradykinin.

Question 12

3 most common s/e of ACEi’s

Answer 12

cough
congestion
rhinorrhea

Question 13

T/F: angioedema is a serious s/e of ACEi’s.

Answer 13

True.

Question 14

Is it save to d/c ACEi’s w/o a taper?

Answer 14

Yes

Question 15

Is ARF and hyperK caused by ACEi’s reversible w d/c’ing the drug?

Answer 15

yes.

Question 16

Why are ACEi’s not save to use at all during pregnancy?

Answer 16

They have demonstrated renal morbidity and mortality.

Question 17

Why should serum K levels be monitored in a pt on ACEi’s?

Answer 17

inhibition of aldosterone secretion –> increase K

Question 18

In June 2011, researchers in Toronto found that in 61,000 non-cardiac surgical pts, those who continued their ACEi to the day of surgery had similar outcomes to those who stopped their ACEi several days before. They found that pts on ACEi’s have a lower 30 day mortality post procedure than those who are not.

Answer 18

ACEi’s and ARBs can cause prolonged HoTN in pts undergoing anes and can also put pts at risk for ARF. Risk is esp if large blood or fluid shifts occur. Prep ACEi’s and intra-op serotonin in CABG pts may contribute to significant reductions in glomerular perfusion pressure and post-op ARF

Question 19

ACEi’s have increased HoTN effects w ____, ____, and ____. _____ and _____ may decrease hypertensive (??) effects.

Answer 19

diuretics, vasodilators, anesthetics

NSAIDs and ASA

Question 20

T/F: ARBs have the same hemodynamic effects as ACEi’s with less cough an angioedema.

Answer 20

True.