Chapter 31: ACE Inhibitors & ARBS (9)

Question 1

What is the RAAS

Answer 1

A key mechanism in controlling BP and fluid balance

Question 2

Where is angiotensinogen synthesized?

Answer 2

In the liver

Question 3

What takes angiotensin 1 and turns it into angiotensin 2?

Answer 3

ACE

Question 4

Angiotensin 2 is a

Answer 4

Potent vasoconstrictor

Question 5

What is renin secretion controlled by?

Answer 5

The juxtaglomerular cells of the kidney and the SNS

Question 6

Steps to form angiotensin 2?

Answer 6

1. Liver secretes angiotensin into plasma
2. Kidney produces renin, which then forms angiotensin 1
3. Angiotensin one is met by ACE and turns into angiotensin 2

Question 7

Angiotensin 2 has effects on CV system

Answer 7

1. Direct vasoconstriction of vascular smooth muscle
2. Increased SNS activity (release of norepinephrine)
3. Alteration in cardiac structure (cardiac remodeling)
4. Release of aldosterone and effects of renal tubule (kidneys)

Question 8

ACE inhibitors

Answer 8

The firs line agents in treatment of HTN and HF

Question 9

ACE inhibitor drugs act by

Answer 9

blocking conversion of angiotensin 1 to angiotensin 2

Question 10

Where do ACE inhibitors act

Answer 10

in the lung
results in decrees in BP and PR
decrease in aldosterone secretion reduces blood volume

Question 11

What do ACE inhibitors have the potential to cause?

Answer 11

potential for a cough

Question 12

What else do ACEI inhibit?

Answer 12

The breakdown of bradykinin (similar to histamine)

Question 13

Accumulation of bradykinin can cause

Answer 13

Several ADEs like angioedema and cough

Question 14

ACEI indications

Answer 14

slow progression of heart failure
lower mortality of recent acute MI
prophylaxis for adverse cardiac events
prevent or delay progression of renal disease and retinopathy of diabetics

Question 15

ACEI contraindications

Answer 15

contraindicated in hyperkalemia
- caution when using with K+ sparing diuretics
watch K+ levels (check lab work regularly)

Question 16

ACEI has a black box warning for

Answer 16

Major congenital defects

Question 17

ACEI Prototype Drug

Answer 17

Lisinopril

Question 18

Lisinopril therapeutic classification

Answer 18

antihypertensive

Question 19

Lisinopril pharmacologic classification

Answer 19

ACEI

Question 20

Lisinopril Uses:

Answer 20

HF
HTN
acute MI

Question 21

Lisinopril MOA

Answer 21

Binds to and inhibits action of ACE
decrease In serum angiotensin 2 reduces aldosterone, which results in less sodium and water retention

Question 22

Lisinopril ADEs

Answer 22

Cough
Headache
Dizziness
Orthostatic Hypotension

Question 23

Lisinopril Serious ADEs

Answer 23

Angioedema
Agranulocytosis
Hepatotoxicity

Question 24

Lisinopril Contraindications

Answer 24

Angioedema
hyperkalemia
serious renal impairment
pregnancy category D

Question 25

Lisinopril Considerations

Answer 25

- check renal labs and K+ levels for hyperkalemia - monitor BP before administration and 30 min to 1 hr after

Question 26

NSAIDs interaction with lisinopril

Answer 26

Decreased antihypertensive activity and worsened renal disease

Question 27

Diuretics interaction with lisinopril

Answer 27

Synergistic hypotensive action

Question 28

K+ supplements, K+ sparing diuretics interaction with lisinopril

Answer 28

Hyperkalemia

Question 29

Lisinopril Treatment of OD

Answer 29

NS or vasopressor hemodialysis

Question 30

Pregnancy category's with lisinopril

Answer 30

Pregnancy Category C first trimester Pregnancy Category D 2nd and 3rd trimester

Question 31

ARBS

Answer 31

Used to treat HTN and HF

Question 32

ARBS act by

Answer 32

Block angiotensin 2 from activating their target receptors (AT1 &2) in smooth muscle

Question 33

ARBS Indications

Answer 33

same as for ACE inhibitors Treat HTN and HF Some approved to treat MI and prophylaxis of CVS Unlike ACE inhibitors, do NOT cause cough and angioedema is less common

Question 34

ARBS prototype drug?

Answer 34

Losartan

Question 35

Losartan therapeutic classification

Answer 35

antihypertensive

Question 36

Losartan pharmacologic classification

Answer 36

angiotensin 2 receptor blocker

Question 37

Losartan uses:

Answer 37

HTN CVA prophylaxis Prevention of diabetic nephropathy Off label use for HF

Question 38

What does Losartan block that ACEI's dont?

Answer 38

Cardiac remodeling and deterioration of renal function in patients with diabetes

Question 39

Losartan ADEs:

Answer 39

Headache Dizziness Nasal congestion fatigue insomnia

Question 40

Losartan serious ADEs:

Answer 40

Angioedema Acute renal failure

Question 41

Losartan Contraindications/Precautions

Answer 41

Hypersensitivity Pregnancy Lactation Angioedema Serious renal/hepatic impairment

Question 42

Losartan Pregnancy Categories

Answer 42

C in 1st trimester D in 2nd and 3rd trimester

Question 43

Losartan treatment of OD

Answer 43

NS or vasopressor NOT removed by hemodialysis

Question 44

Losartan interaction with NSAIDs

Answer 44

Decreased antihypertensive activity

Question 45

Diuretics and losartan interaction

Answer 45

Additive hypotensive action

Question 46

K+ supplements/sparing diuretics interaction with Losartan

Answer 46

Hyperkalemia

Question 47

Alcohol and losartan interaction

Answer 47

Additive hypotensive effect

Question 48

Losartan considerations

Answer 48

Risk of liver or renal disease, CHF, Connective tissue disorders, hypovolemia monitor for hypotension monitor electrolytes, CBC, liver and renal function during therapy

Question 49

What are aldosterone antagonists used for?

Answer 49

Used to treat edema and HTN

Question 50

What is a aldosterone K+ sparing diuretic?

Answer 50

Spironolactone

Question 51

What is spironolactone used for?

Answer 51

Diuretic action

Question 52

What can be a serious result when taking spironolactone?

Answer 52

Potassium retention resulting in hyperkalemia

Question 53

What is the second aldosterone antagonist?

Answer 53

Eplerenone