chapter 44: drugs acting on RAAS

Question 1

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

Answer 1

blood pressure, blood volume, and fluid and electrolyte imbalance

Question 2

which type of angiotensin has a strong biologic activity?

Answer 2

angiotensin II

Question 3

how quickly does vasoconstriction work?

Answer 3

within minutes

Question 4

renin release will be increased by what things?

Answer 4

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

Question 5

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

Answer 5

beta one stimulation

Question 6

what is renin release suppressed by?

Answer 6

the opposite of the things that cause renin release

Question 7

what are the three actions of angiotensin II?

Answer 7

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

Question 8

what promotes norepi release

Answer 8

sympathetic neurons

Question 9

what promotes the release of epinephrine

Answer 9

adrenal medulla

Question 10

what system has increased outflow to the blood vessels

Answer 10

central nervous system

Question 11

when is the release of aldosterone enhances?

Answer 11

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

Question 12

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

Answer 12

cardiac hypertrophy, cardiac remodeling, cardiac fibrosis

Question 13

where is renin synthesized and stores

Answer 13

juxtaglomerular cells in the kidney

Question 14

what happens when renin enters the blood?

Answer 14

it is converted from angiotensinogen to angiotensin I

Question 15

where is angiotensin I converted to angiotensin II

Answer 15

the lungs

Question 16

angiotensin II stimulated aldosterone secretion to do what?

Answer 16

increase intravascular sodium and water

Question 17

what is angiotensin converting enzyme also known as

Answer 17

kinase II

Question 18

where is kinase II found

Answer 18

luminal surface of all blood vessels

Question 19

if the substrate is angiotensin I what is it?

Answer 19

ACE

Question 20

if the substrate is bradykinin what is it?

Answer 20

Kinase II

Question 21

what class is captopril

Answer 21

ACE inhibitor

Question 22

what are the therapeutic uses for captopril?

Answer 22

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

Question 23

what is the mechanism of action for captopril?

Answer 23

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

Question 24

what are some adverse effects for captopril?

Answer 24

first dose hypotension, hyperkalemia, neutropenia

Question 25

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

Answer 25

sore throat and fever

Question 26

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

Answer 26

persistent and dry cough, and angioedema

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

what is captopril contraindicated in

Answer 29

bilateral renal artery stenosis

Question 30

what are drug/food interactions for captopril?

Answer 30

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

Question 31

what class of drug does losartan belong in?

Answer 31

ARBs

Question 32

losartan is usually administered to who?

Answer 32

patients who cannot tolerate an ACE-I

Question 33

what are the therapeutic effects for losartan?

Answer 33

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

Question 34

what is the mechanism of action for losartan

Answer 34

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

Question 35

losartan has a significant lower risk of what

Answer 35

cough and hyperkalemia

Question 36

what are two ADRs for losartan

Answer 36

angioedema and renal failure

Question 37

all but one ARB are available in combinations with what

Answer 37

hydrochlorothiazide

Question 38

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

Answer 38

entresto, used in heart failure

Question 39

what class drug is aliskiren

Answer 39

direct renin inhibitor

Question 40

aliskerin inhibits the conversion of what

Answer 40

angiotensinogen to angiotensin I

Question 41

aliskiren is approved only to treat what

Answer 41

hypertension

Question 42

aliskiren has low risk for causing what

Answer 42

angioedema and cough

Question 43

what is the most common ADR for aliskerin

Answer 43

diarrhea

Question 44

what is the selective aldosterone antagonist

Answer 44

eplerenone

Question 45

what is the non selective aldosterone antagonsit

Answer 45

spironolactone

Question 46

aldosterone antagonists can be used for what two things

Answer 46

hypertension and heart failure

Question 47

what happens when there is receptor blockade on the kidney

Answer 47

reduced blood volume and blood pressure

Question 48

what happens when there is receptor blockage on non renal sites

Answer 48

prevents or reverses pathologic effects of aldosterone

Question 49

maximal effects of aldosterone antagonists can take up to how long

Answer 49

four weeks

Question 50

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

Answer 50

hyperkalemia

Question 51

what are two contraindications for aldosterone antagonists

Answer 51

hyperkalemia, impaired renal function

Question 52

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

Answer 52

ACE-I or ARB

Question 53

what are some drug-drug interactions for aldosterone antagonists?

Answer 53

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