CV Meds - Angiotensin Receptor Blockers (ARBs) Flashcards
give 4 indications of ARBs/ACEi
- hypertension
- chronic heart failure
- secondary prevention of major CV events
- Diabetic nephropathy and CKD with proteinuria
name 3 ARBs and 3 ACEi
candesartan, losartan, irbesartan
how do ARBs work differently to ACEi?
they block the action of angiotensin II on the angiotensin type 1 receptor instead of inhibiting the conversion of angiotensin I to angiotensin II
what is angiotensin II?
vasoconstrictor - stimulates aldosterone secretion
how do ARBs/ACEi help CKD?
due to dilating the efferent glomerular arteriole which reduces intraglomerular pressure, slowing progression of CKD
how do ARBs/ACEi help heart failure?
by reducing aldosterone promotes sodium and water excretion = helps reduce venous return (prelaod)
give 2 main adverse effects of ARBs/ACEi
hyperkalaemia and renal failure
explain the risk of renal artery stenosis
constriction of the efferent glomerular arteriole is required to maintain glomerular filtration
why are ARBs less likely to cause cough and angiodeama then ACEi?
why are ARBs preferred in Black/African origin?
becuase they don’t affect angiotension converting enzyme so dont impact bradykinin metabolism
preferred in Black people becuase they are at higher risk of angiodeama.
when should ARBs/ACEi be avoided?
renal artery stenosis, AKI, pregnancy, breastfeeding
what are some key interactions?
- other potassium-elevating drugs (K+ supplements, aldesterone antagonists, K+ sparing diuretics
- NSAIDs due to increased risk of nephrotoxicity
what are the monitoring requirements?
- electrolytes and reanl function 1 - 2 weeks nto starting treatment and increasing doses
- BP
why should to question somone prescribed entresto and ACEi?
becuase entresto contains ARB (valsartan) and sacubirtil
what rules apply to ACEi/ARBs and what adivse should you give?
sick day rules (D&V) - reduce risk of dehydration, low BP, and kindey injury
maintain fluid intake
stop taking until symptoms resolve
