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Pharm 2 Exam > ch 38 - second A > Flashcards

ch 38 - second A Flashcards

1
Q

what RAAS inhibitors have been used safely in infants for management of HTN

A

Captopril and Enalapril

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2
Q

Some ACE inhibitors and ARBs are approved for use in children older than ___ years for treatment of HTN

A

6

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3
Q

Are RAAS inhibitors safe in pregnancy

A

No esp not in the second and third trimesters

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4
Q

RAAS inhibitors and breastfeeding

A

Data lacking, caution is advised

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5
Q

SCOPE and LIFE trials revealed a 25% decrease in stroke in pt 55-80 years old using _____ compared to _____

A

losartan compared with atenolol

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6
Q

A 20% decreased risk for new onset diabetes in older adults was seen with ________

A

Candesartan

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7
Q

what is the effect of angiotensin II in RAAS

A

vasoconstrictor - increase BP

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8
Q

What is the effect of aldosterone in RAAS

A

retains sodium

increases water retention

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9
Q

ACE inhibitors are important drugs for treating

A 
hypertension
heart failure
diabetic nephropathy
MI
prevent adverse cardiovascular events 
acute LV dysfunction
Diabetic and non-diabetic neuropathy
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10
Q

Most prominent risks associated with ACE inhibitors

A

Cough
angioedema
first dose hypotension
hyperkalemia

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11
Q

what does renin do

A 
decrease BP'
decrease Blood volume
decrease renal perfusion
sodium depletion
Bets 1 stimulation
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12
Q

why do ARBs not have the potential for cough like ACE

A

one way that an ACE works is increasing levels of bradykinin

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13
Q

what ACE is administered IV

A

Enalaprilat (Enalapril), all others are PO

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14
Q

What ACE inhibitors should be administered on a empty stomach

A

Captopril

Moexipril

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15
Q

Which ACE inhibitor has the shorter half life and has to be administered 2-3 times per day

A

Captopril (most are once or twice a day)

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16
Q

what ACE inhibitor is given in its active form instead of the prodrug that must undergo conversion to its active form in the small intestine and liver

A

Lisinopril

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17
Q

Pt has a heart attack, what are they discharged on

A

At least a ACE inhibitor and a B blocker (for at least 6 weeks)

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18
Q

What ACE inhibitor does not require renal dosing

A

Fosinopril

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19
Q

all ace inhibitors are approved for what

A

hypertension

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20
Q

What medication does not impair exercise capacity (interfere with cardiovascular reflexes)

A

ACE inhibitors

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21
Q

Does ACE inhibitors cause orthostatic hypotension

A

minimum

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22
Q

Bronchial asthma and ACE

A

fine to use

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23
Q

electrolyte and ACE

A

Hyperkalemia

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24
Q

ACE inhibitors rarely induce ____, ___, ____

A

lethargy, weakness, sexual dysfunction

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25
Q

What drugs reduce the risk for cardiovascular mortality caused by hypertension

A

ACE inhibitors
B blockers
Diuretics

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26
Q

what 3 ACE inhibitors are approved for patients with MI

A

Captopril
Lisinopril
Trandolapril

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27
Q

How does ACE inhibitors help in diabetic and nondiabetic neuropathy

A

principal protective mechanism is reduction of GFR

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28
Q

The only ACE inhibitor approved for nephropathy

A

Captopril (treats but does not prevent)

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29
Q

ACE inhibitor approved for reducing the risk for MI, stroke and death from cardiovascular causes

A

Ramipril (Altace)

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30
Q

Approved in reducing morbidity and mortality in patients at risk for major cardiovascular events

A

Perindopril (Aceon)

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31
Q

What ACE inhibitor can reduce the risk for type 1 diabetic retinopathy in some patients (prevent or slow development)

A

enalapril

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32
Q

when taking a ACE inhibitor if hypotension develops, what should the pt do

A

assume a supine position and seek medical attention if symptoms do not resolve

33
Q

How do you minimize the first dose effect of an ACE inhibitor

A

start on low doses and. Monitor BP

34
Q

factors that increase the risk for cough while on an ACE are

A

advanced age
Asian ancestry
Female

35
Q

what dietary supplements should a pt avoid while on ACE inhibitors

A

Potassium supplements

salt substitutes using potassium chloride

36
Q

what diuretic to avoid while on an ACE

A

Potassium sparing diuretic (pg 302)

37
Q

Renal and ACE inhibitors

A

ACE inhibitors are contraindicated for patients with bilat renal artery stenosis or stenosis in the artery to a single remaining kidney

38
Q

how do you treat angioedema in a pt who is on an ACE inhibitor

A

Subcutaneous EPI

d/c ACE, never use again

39
Q

Angioedema is caused by accumulation of ____

A

bradykinin

40
Q

What hematologic side effect does an ACE have

A

Neutropenia

41
Q

while on an ACE, neutropenia is most likely in which patients

A

Pt with renal impairment and in those with collagen vascular diseases (ie systemic lupus erythematosus, scleroderma) - withdraw immediately . Neutropenia should resolve in approx 2 weeks.

42
Q

what happens if Neutropenia caused by ACE is not caught early enough what can happen

A

can progress to fatal agranulocytosis

advise pt to call provider if has fever, sore throat, ect

43
Q

what ACE inhibitor is more likely to cause neutropenia

A

Captopril

44
Q

What drug class when combined with ACE inhibitors can worsen first dose hypotension

A

Diuretics (should be withdrawn 2-3 days prior to starting an ACE inhibitor)

45
Q

electrolytes and ACE inhibitors

A

can reduce excretion of potassium.

46
Q

What ACE inhibitor does not need renal dosing

A

fosinopril

47
Q

Bloodwork with ACE inhibitors

A

consider checking creatinine 2-4 weeks after starting. Have pt track blood pressures

48
Q

ACE inhibitors and lithium

A

ACE can cause lithium to accumulate to toxic levels. Monitor frequently

49
Q

NSAIDS and ACE

A

NSAIDS may reduce the antihypertensive effects of ACE inhibitors

50
Q

What ACE inhibitor is not given orally

A

Enalapril

51
Q

What 2 side effects that ACEs have do ARBs have a lesser chance of

A

Cough

hyperkalemia

52
Q

what ARBs are approved for HTN

A

All of them

53
Q

What ARBs are approved for Heart Failure

A

Valsartan (Diovan)

Candesartan (Atacand)

54
Q

What ARBS are approved for managing nephropathy in HTN patients with type 2 DM

A

irbesartan (Avapro)

losartan (Cozaar)

55
Q

What ARB is approved for reducing cardiovascular mortality in post MI patients with heart failure or LV dysfunction.

A

Valsartan (Diovan)

56
Q

What ARB is approved for reducing the risk for stroke in pt with HTN an LV hyperthrophy

A

Losartan (Cosaar)

57
Q

What ARB is approved for reducing the risk for MI, stroke and death from cardiovascular causes in pt 55 and older but only if they are intolerant of ACE

A

Telmisartan (Micardis)

58
Q

what ARB Slowed the development and progression of retinopathy in pt with type 1 without established retinopathy

A

Losartan (cozaar)

59
Q

Can angioedema occur in ARBS

A

yes, but incidence is much lower than in ACEs

60
Q

renal and ARBS

A

Like ACE inhibitors, ARBS can cause renal failure in pt with bilat renal artery stenosis or stenosis in the artery to a single remaining kidney. Use in extreme caution with this populus

61
Q

what bloodwork with ARBS

A

consider checking creatinine about 2-4 weeks after starting, track BP

62
Q

What drug is a Direct Renin Inhibitor (DRI)

A

Aliskiren (Tekturna)

63
Q

What is Aliskiren (Tekturna) approved for

A

only for HTN

64
Q

diet and dosing for DRIS

A

dosing with a high fat meal with make the availability lower

65
Q

metabolism and DRI s

A

CYP3A4

66
Q

GI effects of Aliskiren (Tekturna)

A

diarrhea
abd pain
dyspepsia

women and older adults are most susceptible

67
Q

Hyperkalemia and Aliskiren (Tekturna)

A

rarely cause hyperkalemia alone but might be expected if aliskiren were combined with and ACE, potassium sparing diuretic or potassium supplements

68
Q

What drug class?

eplerenone
spironolactone

A

Aldosterone antagonists

69
Q

What are Aldosterone antagonists used for

eplerenone
spironolactone

A

HTN

heart failure

70
Q

what is the significant side effect of Eplerenone (Inspra)

A

hyperkalemia

71
Q

Maximal reductions in BP in the drug Eplerenone (Inspa) occurs within _______

A

4 weeks

72
Q

side effects of Eplerenone

A 
diarrhea
abd pain
cough
fatigue
gynecomastia
flu like syndrome
73
Q

metabolism concern of eplerenone

A

Inhibitors of CYP3A4 can increase levels of eplerenone therefore posing a risk for tox

weak inhibitors

  • erythromycin
  • saquinavir
  • verapimil
  • fluconazole

strong inhibitors
ketoconazole
itraconazole

74
Q

lithium and Eplerenone

A

can raise levels

75
Q

how do ACE inhibitors work

A

blocks Angiotensin converting enzyme so the angiotensin I cannot change renin to angiotensin II which causes vasodilation

76
Q

How do ARBs work

A

block receptor sides of angiotensin II

77
Q

How do DRIs work

A

Blocks renin so angiotensinogen cannot go to angiotensin II

78
Q

what is JNC8

A

Eighth joint national committee guidelines on HTN

Pharm 2 Exam (18 decks)

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