DI ACEI/ARB/ARNI (HF)

Question 1

What is the brand name for SACUBITRIL/VALSARTAN?

Answer 1

ENTRESTO

Question 2

What is the mechanism of action for Sacubitril?

Answer 2

Blocks breakdown of BNP → Natriuresis and Vasodilation

Question 3

What is the mechanism of action for Valsartan?

Answer 3

Blocks angiotensin receptor

Question 4

ARNIs are contraindicated in what populations?

Answer 4

Pregnancy

Question 5

How long is the washout period for ACEi when you add on an ARNi?

Answer 5

36 hours

Question 6

Combine RAAS drugs whenever possible. T/F?

Answer 6

False (Do NOT use RAAS drugs in combination!)

Question 7

What are the C/Is for ACEi?

Answer 7

pregnancy, history of angioedema, using an ACEi within 36 hours of an ARNi

Question 8

What are the monitoring parameters for ACEi and ARB?

Answer 8

Assess the electrolytes and renal functions 2-4 weeks after initiating therapy or changing doses

Question 9

What is the PREDOMINANT adverse effect for ACEi that we should look out for?

Answer 9

Hyperkalemia

Question 10

What are the AEs for ACEi (that other RAASi drugs do NOT share)?

Answer 10

Dry Cough, Angioedema

Question 11

What are ALL of the AEs that RAASi drugs (ACEi, ARBs, ARNi) share?

Answer 11

Hyperkalemia, Acute Renal Failure (in patients with severe bilateral renal artery stensosis), Hypotension

Question 12

What are the monitoring parameters for ARNIs?

Answer 12

Blood pressure, Assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses

Question 13

What is the mechanism of action for ARBs?

Answer 13

Block angiotensin-II activity at the angiotensin receptor on vascular smooth muscle which prevents vasoconstriction

Question 14

What is a contraindication for ARBs?

Answer 14

Pregnancy

Question 15

Do not initiate RAASi drugs when K+ >/= ___?____

Answer 15

5 mmol/L

Question 16

Discontinue RAASi drugs when K+ >/= ____?_____

Answer 16

5.6 mmol/L

Question 17

What is the MOA for ACEi?

Answer 17

decrease angiotensin-II production –> decreased vasoconstriction and decreased aldosterone secretion

Question 18

What drugs are available to combine with ACEi/ARBs?

Answer 18

hydrochlorothiazide, CCBs

Question 19

ACEi/ARB is a drug of choice for: _________

Answer 19

diabetes, HF, post-MI, stroke, and/or CKD

Question 20

What kind of protection does ACEi/ARBs provide for the myocardium?

Answer 20

It protects the myocardium from remodeling/hypertrophy.

Question 21

How does ACEi/ARBs benefit patients with diabetes, HF, post-MI, stroke, and/or CKD?

Answer 21

It targets organ protection.

Question 22

What are the most commonly used ACEi drugs?

Answer 22

Enalapril and Lisinopril

Question 23

What is the AE for Olmesartan?

Answer 23

sprue-like enteropathy

Question 24

How long is the washout period for ARBs when you add on an ARNi?

Answer 24

No washout period required when transitioning to a neprilysin inhibitor

Question 25

Why are ARBs different from ACEi drugs?

Answer 25

ARBs have less dry cough/angioedema due to the lack of peripheral effects on bradykinin

Question 26

What are the most commonly used ARBs?

Answer 26

Losartan and Valsartan