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Pharm > chapter 44: drugs acting on RAAS > Flashcards

chapter 44: drugs acting on RAAS Flashcards

1
Q

the RAAS system plays an important role in the regulation of what?

A

blood pressure, blood volume, and fluid and electrolyte imbalance

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2
Q

which type of angiotensin has a strong biologic activity?

A

angiotensin II

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3
Q

how quickly does vasoconstriction work?

A

within minutes

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4
Q

renin release will be increased by what things?

A

low blood pressure, low blood volume, renal stenosis, and sodium depletion

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5
Q

what activates SNS which then in turn causes the RAAS system to activate

A

beta one stimulation

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6
Q

what is renin release suppressed by?

A

the opposite of the things that cause renin release

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7
Q

what are the three actions of angiotensin II?

A

vasoconstriction, release of aldosterone, and alteration in cardiac and vascular structure

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8
Q

what promotes norepi release

A

sympathetic neurons

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9
Q

what promotes the release of epinephrine

A

adrenal medulla

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10
Q

what system has increased outflow to the blood vessels

A

central nervous system

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11
Q

when is the release of aldosterone enhances?

A

if sodium levels are LOW and/or potassium levels are HIGH

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12
Q

what are examples of alterations in cardaic/vascular structure that angiotensin II causes?

A

cardiac hypertrophy, cardiac remodeling, cardiac fibrosis

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13
Q

where is renin synthesized and stores

A

juxtaglomerular cells in the kidney

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14
Q

what happens when renin enters the blood?

A

it is converted from angiotensinogen to angiotensin I

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15
Q

where is angiotensin I converted to angiotensin II

A

the lungs

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16
Q

angiotensin II stimulated aldosterone secretion to do what?

A

increase intravascular sodium and water

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17
Q

what is angiotensin converting enzyme also known as

A

kinase II

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18
Q

where is kinase II found

A

luminal surface of all blood vessels

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19
Q

if the substrate is angiotensin I what is it?

A

ACE

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20
Q

if the substrate is bradykinin what is it?

A

Kinase II

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21
Q

what class is captopril

A

ACE inhibitor

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22
Q

what are the therapeutic uses for captopril?

A

hypertension, heart failure, diabetic nephropathy, MI, prevents adverse CV events in at-risk patients

23
Q

what is the mechanism of action for captopril?

A

reduces the levels of angiotensin II and increases the levels of bradykinin

24
Q

what are some adverse effects for captopril?

A

first dose hypotension, hyperkalemia, neutropenia

25
Q

what may a patient complain of if they are experiencing neutropenia due to captopril?

A

sore throat and fever

26
Q

what are the adverse effects of captopril due to increased bradykinin?

A

persistent and dry cough, and angioedema

27
Q

what medication changes should you make for a patient experiencing persistent dry cough due to captopril?

A

if intolerable, take off of the ACE-I and put on an ARB

28
Q

what are some clinical manifestations of angioedema due to increased bradykinin?

A

large wheals, edema in tongue and lips, periorbital edema, increased capillary permeability

29
Q

what is captopril contraindicated in

A

bilateral renal artery stenosis

30
Q

what are drug/food interactions for captopril?

A

diuretics, antihypertensives, agents that increase serum K+ levels, foods high in K+, lithium, NSAIDs

31
Q

what class of drug does losartan belong in?

A

ARBs

32
Q

losartan is usually administered to who?

A

patients who cannot tolerate an ACE-I

33
Q

what are the therapeutic effects for losartan?

A

HTN, heart failure, diabetic nephropathy, MI, CVA prevention

34
Q

what is the mechanism of action for losartan

A

blocks action of angiotensin II or prevents angiotensin II from binding to its receptors

35
Q

losartan has a significant lower risk of what

A

cough and hyperkalemia

36
Q

what are two ADRs for losartan

A

angioedema and renal failure

37
Q

all but one ARB are available in combinations with what

A

hydrochlorothiazide

38
Q

what drug is a combination of an ARB and a neprilysin inhibitor, and what is it used for?

A

entresto, used in heart failure

39
Q

what class drug is aliskiren

A

direct renin inhibitor

40
Q

aliskerin inhibits the conversion of what

A

angiotensinogen to angiotensin I

41
Q

aliskiren is approved only to treat what

A

hypertension

42
Q

aliskiren has low risk for causing what

A

angioedema and cough

43
Q

what is the most common ADR for aliskerin

A

diarrhea

44
Q

what is the selective aldosterone antagonist

A

eplerenone

45
Q

what is the non selective aldosterone antagonsit

A

spironolactone

46
Q

aldosterone antagonists can be used for what two things

A

hypertension and heart failure

47
Q

what happens when there is receptor blockade on the kidney

A

reduced blood volume and blood pressure

48
Q

what happens when there is receptor blockage on non renal sites

A

prevents or reverses pathologic effects of aldosterone

49
Q

maximal effects of aldosterone antagonists can take up to how long

A

four weeks

50
Q

what is a major adr to watch out for when taking an aldosterone antagonist

A

hyperkalemia

51
Q

what are two contraindications for aldosterone antagonists

A

hyperkalemia, impaired renal function

52
Q

you would use an aldosterone antagonist cautiously in patients who are taking what?

A

ACE-I or ARB

53
Q

what are some drug-drug interactions for aldosterone antagonists?

A

lithium and/or digoxin, potassium supplements, salt substitutes, potassium sparing diuretics

Pharm (11 decks)

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