DI ACEI/ARB/ARNI (HF) Flashcards
What is the brand name for SACUBITRIL/VALSARTAN?
ENTRESTO
What is the mechanism of action for Sacubitril?
Blocks breakdown of BNP → Natriuresis and Vasodilation
What is the mechanism of action for Valsartan?
Blocks angiotensin receptor
ARNIs are contraindicated in what populations?
Pregnancy
How long is the washout period for ACEi when you add on an ARNi?
36 hours
Combine RAAS drugs whenever possible. T/F?
False (Do NOT use RAAS drugs in combination!)
What are the C/Is for ACEi?
pregnancy, history of angioedema, using an ACEi within 36 hours of an ARNi
What are the monitoring parameters for ACEi and ARB?
Assess the electrolytes and renal functions 2-4 weeks after initiating therapy or changing doses
What is the PREDOMINANT adverse effect for ACEi that we should look out for?
Hyperkalemia
What are the AEs for ACEi (that other RAASi drugs do NOT share)?
Dry Cough, Angioedema
What are ALL of the AEs that RAASi drugs (ACEi, ARBs, ARNi) share?
Hyperkalemia, Acute Renal Failure (in patients with severe bilateral renal artery stensosis), Hypotension
What are the monitoring parameters for ARNIs?
Blood pressure, Assess electrolytes and renal function 2-4 weeks after initiating therapy or changing doses
What is the mechanism of action for ARBs?
Block angiotensin-II activity at the angiotensin receptor on vascular smooth muscle which prevents vasoconstriction
What is a contraindication for ARBs?
Pregnancy
Do not initiate RAASi drugs when K+ >/= ___?____
5 mmol/L
Discontinue RAASi drugs when K+ >/= ____?_____
5.6 mmol/L
What is the MOA for ACEi?
decrease angiotensin-II production –> decreased vasoconstriction and decreased aldosterone secretion
What drugs are available to combine with ACEi/ARBs?
hydrochlorothiazide, CCBs
ACEi/ARB is a drug of choice for: _________
diabetes, HF, post-MI, stroke, and/or CKD
What kind of protection does ACEi/ARBs provide for the myocardium?
It protects the myocardium from remodeling/hypertrophy.
How does ACEi/ARBs benefit patients with diabetes, HF, post-MI, stroke, and/or CKD?
It targets organ protection.
What are the most commonly used ACEi drugs?
Enalapril and Lisinopril
What is the AE for Olmesartan?
sprue-like enteropathy
How long is the washout period for ARBs when you add on an ARNi?
No washout period required when transitioning to a neprilysin inhibitor
Why are ARBs different from ACEi drugs?
ARBs have less dry cough/angioedema due to the lack of peripheral effects on bradykinin
What are the most commonly used ARBs?
Losartan and Valsartan
