CKD progression Flashcards
Angiotensin converting enzyme inhibitors (ACEi)
examples:
Class: Ace inhibitors
Indication:
Mechanism of Action:
Effects of mechanism of Action:
Adverse Effects:
Absolute Contraindications:
Pregnancy:
Warning/ Precautions: in CKD–
Drug-Drug Interactions (DDIs):
Monitoring Parameters:
Angiotensin converting enzyme inhibitors (ACEi)
examples: end in -PRIL. Lisinopril (Privinil/Zestril), Enalapril (Vasotec), Quinapril (Accupril)
Class: Ace inhibitors
Indication: I. Management of hypertension.
II. Proteinuric chronic kidney disease (Diabetic or Non diabetic)
Mechanism of Action:Prevents conversion of angiotensin 1 to angiotensin II by way of the angiotensin converting enzyme. this prevents actions such as vasoconstriction, sympathetic activation, and aldosterone release.
Effects of mechanism of Action: hypertension:decreased vasoconstriction and decreased aldosterone( corticosteroid that stimulates absorption of sodium by the kidneys) release.
CKD: reduce albuminuria (irrespective of blood pressure lowering). Class effect
Adverse Effects: HYPERkalemia, acute renal failure (in its with severe bilateral renal stenosis), dry cough( because of bradykinin), angioedma, orthostatic hypotension.
Absolute Contraindications:pregnancy, history of angioedema, 36 hours of an angiotensin receptor/ neprilysin inhibitor[ARNI-sacubritil/valsartan], bilateral renal stenosis
Pregnancy: DO NOT USE
Warning/ Precautions: in CKD–
Drug-Drug Interactions (DDIs): NSAIDS (can cause acute kidney injury), Potassium supplements (can cause hyperkalemia), other RAAS drugs (can cause AKI and Hyperkalemia, Lithium (increase lithium concentrations). Quinalipril contains magnesium: avoid with fluoroquinones and tetracyclines.
Monitoring Parameters: Assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses.
Pearls: 1.drug of choice in its with diabetes, heart failure, post MI, stroke, and/ or CKD due to target organ protection
2. do not use in combo with RAAS drugs
3. protect the myocardium from remodeling/ hypertrophy in patients with heart failure
4. combos available (with HTCZ, CCBs)
5. CKD pearls: I. start low and go slow if concerned about hyperkalemia/increase in serum creatnine.
II. when initiating, might be a slight decrease in eGFR and increase in SCr. That is normal! use Scr to calculate eGFR
a. if GFR is less than 30%, no dose change
b. if GFRchange 30-50%, lower dose. repeat eGFR in Q 7 days
c. if GFR change >50 %: hold therapy. this is AKI. hold until creatinine comes back to normal and resumé at lower dose
III. if K >5.0 mEq/L: counsel on potassium dietary restriction
if k>6.0 mEq/L: can use loop diuretic +/- SPS or partiromer (kayexalate)
