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
Lisinopril Considerations
- check renal labs and K+ levels for hyperkalemia - monitor BP before administration and 30 min to 1 hr after
26
NSAIDs interaction with lisinopril
Decreased antihypertensive activity and worsened renal disease
27
Diuretics interaction with lisinopril
Synergistic hypotensive action
28
K+ supplements, K+ sparing diuretics interaction with lisinopril
Hyperkalemia
29
Lisinopril Treatment of OD
NS or vasopressor hemodialysis
30
Pregnancy category's with lisinopril
Pregnancy Category C first trimester Pregnancy Category D 2nd and 3rd trimester
31
ARBS
Used to treat HTN and HF
32
ARBS act by
Block angiotensin 2 from activating their target receptors (AT1 &2) in smooth muscle
33
ARBS Indications
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
ARBS prototype drug?
Losartan
35
Losartan therapeutic classification
antihypertensive
36
Losartan pharmacologic classification
angiotensin 2 receptor blocker
37
Losartan uses:
HTN CVA prophylaxis Prevention of diabetic nephropathy Off label use for HF
38
What does Losartan block that ACEI's dont?
Cardiac remodeling and deterioration of renal function in patients with diabetes
39
Losartan ADEs:
Headache Dizziness Nasal congestion fatigue insomnia
40
Losartan serious ADEs:
Angioedema Acute renal failure
41
Losartan Contraindications/Precautions
Hypersensitivity Pregnancy Lactation Angioedema Serious renal/hepatic impairment
42
Losartan Pregnancy Categories
C in 1st trimester D in 2nd and 3rd trimester
43
Losartan treatment of OD
NS or vasopressor NOT removed by hemodialysis
44
Losartan interaction with NSAIDs
Decreased antihypertensive activity
45
Diuretics and losartan interaction
Additive hypotensive action
46
K+ supplements/sparing diuretics interaction with Losartan
Hyperkalemia
47
Alcohol and losartan interaction
Additive hypotensive effect
48
Losartan considerations
Risk of liver or renal disease, CHF, Connective tissue disorders, hypovolemia monitor for hypotension monitor electrolytes, CBC, liver and renal function during therapy
49
What are aldosterone antagonists used for?
Used to treat edema and HTN
50
What is a aldosterone K+ sparing diuretic?
Spironolactone
51
What is spironolactone used for?
Diuretic action
52
What can be a serious result when taking spironolactone?
Potassium retention resulting in hyperkalemia
53
What is the second aldosterone antagonist?
Eplerenone