Chapter 44: Renin-Angiotensin-Aldosterone System (RAAS) Drugs

Question 1

What is the commonality in the naming of ACE inhibitors? What are some common ones?

Answer 1

All Angiotensin Coenzyme Inhibitors all end in -pril

Lisinopril, enalopril, captopril

Question 2

What do ACE Inhibitors do that is so useful?

Answer 2

Decrease levels of Angiotensin II, which results in vasodilation, decrease in blood volume, decrease in cardiovascular remodeling, and potassium retention.

Question 3

What conditions are ACE Inhibitors used to treat?

Answer 3

hypertension, heart failure, MI, DM, and diabetic/non-diabetic nephropathy, and diabetic retinopathy. They are useful in treating pulmonary and peripheral edema.

Question 4

What effect do ACE Inhibitors have on the heart?

Answer 4

Improve blood flow, reduce cardiac afterload, and increase cardiac output.

Question 5

What effect do ACE inhibitors have on the kidneys?

Answer 5

Increase renal flow, reduce edema, and reduce stress on the right side of the heart. GFR is reduced

Question 6

What are other ways in which ACE inhibitors benefit patients?

Answer 6

Reduce mortality in pts who have had MI, can slow progression of renal disease and delay onset of nephropahty. These drugs help prevent: MI, stroke, and death for patients with high CV risk.

Question 7

Ace inhibitors block the production of what?

Answer 7

Angiotensin II

Question 8

Which patients should NOT use Ace inhibitors?

Answer 8

Patients who have bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney.

Question 9

What are the adverse effects of ACE inhibitors?

Answer 9

First dose hypotension, cough, hyperkalemia, RENAL FAILURE(-NOt used with pts who have bilateral renal artery stenosis). fetal injury, angioedema, neutropenia
Pregnant women should NOT take these.,

Question 10

When can a patient NEVER take an ACE inhibitor?

Answer 10

If they have ever experienced angioedema

Question 11

What drugs will interact adversely with ACE-inhibitors by counteracting their antihypertensive effects?

Answer 11

Diuretics: may intensify first dose hypotension, these drugs need to be stopped 2-3 days before taking an ACE inhibitor.
Antihypertensive agents: Enhance and intensify effects of ACE inhibitors.
Increased risk of hyperkalemia
Increased risk of Lithium toxicity
NSAIDS reduce the antihypertensive effects of ACE inhibitors

Question 12

What is the mechanism of Angiotensin II Receptor Blockers?

Answer 12

Angiotensin II Receptor Blockers (ARB) block the action of angiotensin II. This group of antihypertensives work by blocking access of angiotensin II to their receptors in the blood vessels, adrenals, and other tissues.

Question 13

ARBs promote and prevent which actions?

Answer 13

Promote: dilation of arterioles and veins,
Prevent: angiotensin II from inducing pathological changes in the heart tissue and decrease release of aldosterone which increases excretion of sodium and water.

Question 14

Are ARBs used for the same group of patients as the ACE inhibitors?

Answer 14

ARBs are used largely for the same populations of patients who use ACE inhibitors.

Question 15

Are there certain side effects that are less common with ARBs than with ACE inhibitors?

Answer 15

Cough associated with antihypertensives is more common with ace inhibitors than ARBs.

Question 16

How is Aliskirin (tekturna) different from ARBs and ACE inhibitors

Answer 16

Direct Renin Inhibitor (DRI) This drug prevents the conversion of angiotensin to angiotensin I.

Question 17

How is the drug spironolactone different from eplerenone and triamterine?

Answer 17

Spironolactone: aldosterone blocker in an indirect manner; it blocks the synthesis of new proteins.
Triamterene: Aldosterone blocker; direct inhibitor of the exchange mechanism.
Eplerenone: Selective aldosterone receptor blocker
*both spirononlactone and eplerenone block the potassium-sodium pump in the kidney.