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NRSG 220 > Chapter 31: ACE Inhibitors & ARBS (9) > Flashcards

Chapter 31: ACE Inhibitors & ARBS (9) Flashcards

1
Q

What is the RAAS

A

A key mechanism in controlling BP and fluid balance

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2
Q

Where is angiotensinogen synthesized?

A

In the liver

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3
Q

What takes angiotensin 1 and turns it into angiotensin 2?

A

ACE

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4
Q

Angiotensin 2 is a

A

Potent vasoconstrictor

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5
Q

What is renin secretion controlled by?

A

The juxtaglomerular cells of the kidney and the SNS

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6
Q

Steps to form angiotensin 2?

A
  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
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7
Q

Angiotensin 2 has effects on CV system

A
  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)
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8
Q

ACE inhibitors

A

The firs line agents in treatment of HTN and HF

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9
Q

ACE inhibitor drugs act by

A

blocking conversion of angiotensin 1 to angiotensin 2

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10
Q

Where do ACE inhibitors act

A

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

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11
Q

What do ACE inhibitors have the potential to cause?

A

potential for a cough

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12
Q

What else do ACEI inhibit?

A

The breakdown of bradykinin (similar to histamine)

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13
Q

Accumulation of bradykinin can cause

A

Several ADEs like angioedema and cough

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14
Q

ACEI indications

A

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

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15
Q

ACEI contraindications

A

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

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16
Q

ACEI has a black box warning for

A

Major congenital defects

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17
Q

ACEI Prototype Drug

A

Lisinopril

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18
Q

Lisinopril therapeutic classification

A

antihypertensive

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19
Q

Lisinopril pharmacologic classification

A

ACEI

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20
Q

Lisinopril Uses:

A

HF
HTN
acute MI

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21
Q

Lisinopril MOA

A

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

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22
Q

Lisinopril ADEs

A

Cough
Headache
Dizziness
Orthostatic Hypotension

23
Q

Lisinopril Serious ADEs

A

Angioedema
Agranulocytosis
Hepatotoxicity

24
Q

Lisinopril Contraindications

A

Angioedema
hyperkalemia
serious renal impairment
pregnancy category D

25
Q

Lisinopril Considerations

A
  • check renal labs and K+ levels for hyperkalemia
  • monitor BP before administration and 30 min to 1 hr after
26
Q

NSAIDs interaction with lisinopril

A

Decreased antihypertensive activity and worsened renal disease

27
Q

Diuretics interaction with lisinopril

A

Synergistic hypotensive action

28
Q

K+ supplements, K+ sparing diuretics interaction with lisinopril

A

Hyperkalemia

29
Q

Lisinopril Treatment of OD

A

NS or vasopressor
hemodialysis

30
Q

Pregnancy category’s with lisinopril

A

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

31
Q

ARBS

A

Used to treat HTN and HF

32
Q

ARBS act by

A

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

33
Q

ARBS Indications

A

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

34
Q

ARBS prototype drug?

A

Losartan

35
Q

Losartan therapeutic classification

A

antihypertensive

36
Q

Losartan pharmacologic classification

A

angiotensin 2 receptor blocker

37
Q

Losartan uses:

A

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

38
Q

What does Losartan block that ACEI’s dont?

A

Cardiac remodeling and deterioration of renal function in patients with diabetes

39
Q

Losartan ADEs:

A

Headache
Dizziness
Nasal congestion
fatigue
insomnia

40
Q

Losartan serious ADEs:

A

Angioedema
Acute renal failure

41
Q

Losartan Contraindications/Precautions

A

Hypersensitivity
Pregnancy
Lactation
Angioedema
Serious renal/hepatic impairment

42
Q

Losartan Pregnancy Categories

A

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

43
Q

Losartan treatment of OD

A

NS or vasopressor
NOT removed by hemodialysis

44
Q

Losartan interaction with NSAIDs

A

Decreased antihypertensive activity

45
Q

Diuretics and losartan interaction

A

Additive hypotensive action

46
Q

K+ supplements/sparing diuretics interaction with Losartan

A

Hyperkalemia

47
Q

Alcohol and losartan interaction

A

Additive hypotensive effect

48
Q

Losartan considerations

A

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

49
Q

What are aldosterone antagonists used for?

A

Used to treat edema and HTN

50
Q

What is a aldosterone K+ sparing diuretic?

A

Spironolactone

51
Q

What is spironolactone used for?

A

Diuretic action

52
Q

What can be a serious result when taking spironolactone?

A

Potassium retention resulting in hyperkalemia

53
Q

What is the second aldosterone antagonist?

A

Eplerenone

NRSG 220 (8 decks)

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