Chapter 38: Drugs Acting on Renin-Angiotensin-Aldosterone System

Question 1

ACEI

Answer 1

captopril (Capoten),
enalapril (Vasotec),
fosinopril (Monopril),
lisinopril (Prinivil,Zesteril),
ramipril (Altace)

Cardiac medications
-pril drugs
Block RAAS system
Top line tx for HTN

Question 2

ACEI MOA

Answer 2

Inhibits angio converting enzyme, interfering w/ conversion of angiotensin 1 to angiotensin II

Question 3

ACEI use

Answer 3

HTN, Heart Failure. Reduce mortality in MI, Diabetic and nondiabetic nepropathy, reduces the risk for MI and stroke

Question 4

ACEI SE

Answer 4

dizziness

hypotension

irritating cough (~30% of people get irritating, dry cough secondary to bradykinin secretion. Most common reason for d/c.)

hyperkalemia (Lose Na and water. Hold onto K),

renal failure (Renal failure in renal artery stenosis –need high levels of renin and constriction in efferent arterioles. If not, can progress into worse renal failure.)

peripheral vasodilation (edema)

angioedema (Angioedema in 1-5% of pt. fatal reaction. Increase permeability and edema that mainly effects mouth and throat. Swollen lips and gums. D/c and NEVER use again –does not just happen with first dose.)

neutropenia -rare

Question 5

ACEI safety and monitoring

Answer 5

BUN/Cr, K+, BP –any increase consider d/c

Question 6

contraindications for ACEI

Answer 6

K sparing diuretic, Salt substitutes

Question 7

Angiotensin II receptor blockers (ARBs)

Answer 7

Losartan potassium (Cozaar)
Valsartan (Diovan)

-sartan drugs

Block RAAS

Less potent than ACEI

Question 8

ARBs uses

Answer 8

HTN, CHF, diabetic nephropathy, MI and prevention of MI and stroke

Vasodilation = decrease in BP. Coronary arteries open up –helpful for angina or MI.

Question 9

ARBs SE

Answer 9

Angioedema, Renal Failure, Dizziness, hypotension, hyperkalemia.

May also cause cough -Only ~ 10% of patient get a cough. If patient gets a cough with ACEI, will try them on ARB . Another reason to swtich to ARB from ACEI is if ACEI is too potent and pt has hypotension.

Question 10

ARBs MOA

Answer 10

Function similar to ACE inhibitors. Selectively antagonizes angiotensin II receptors.

lower BP and increase blood to heart. block vasoconstriction.

Question 11

DRI MOA

Answer 11

aliskiren
inhibit renin from converting angiotensinogen to angiotensin I

Question 12

ARB safety and monitoring

Answer 12

BUN/Cr, K, BP

caution in RF patient

Question 13

aldosterone antagonist MOA

Answer 13

spironolactone, eplernone

block aldosterone from target cells

Question 14

ACEI and ARB prescribing considerations

Answer 14

*Therapeutic Goal: Decrease BP in patient with HTN, improve hemodynamics in patients with HF and reduce mortality

*Baseline Data: Determine BP and renal function
*Monitoring: Consider checking Creatinine 2-4 weeks after starting. Have patients track BP values.

*Identify High Risk Patients: Contraindicated in pregnancy and in patient with bilateral renal artery stenosis. Hold in K> 5, Cr > 2.

*Evaluating Therapeutic Effects: Monitor for decreased BP

*Minimizing adverse effects: Instruct patient to consult the prescriber if experiencing cough or facial swelling. Use cautiously in combination with other meds that cause increased K+