Drugs acting on the Renin-Angiotensin-Aldosterone System

Question 1

RAAS

Answer 1

Renin-Angiotensin-Aldosterone system

Question 2

What does the RAAS help regulate?

Answer 2

Blood pressure, blood volume and fluid and electrolyte balance. The system can promote cardiovascular pathology

Question 3

RAAS acts through production of __________________ and _______________—

Answer 3

angiotensin II; aldosterone

Question 4

Angiotensin II is formed by the actions of two enzymes; _________________ and ___________

Answer 4

renin; ACE

Question 5

Angiotensin II causes _________________ (primarily in arterioles) and release of ______________ . In addition, it can promote ________________ in the heart and blood vessels

Answer 5

vasoconstriction; aldosterone ; pathologic

Question 6

Aldosterone acts on the kidneys to promote ________________ of sodium and water. In addition it can also mediate ________________ changes in the cardiovascular system

Answer 6

retention; pathologic

Question 7

The RAAS raises blood pressure by _____________

Answer 7

causing vasoconstriction and by increasing blood volume (secondary to aldosterone mediated retention of sodium and water )

Question 8

In addition to the traditional RAAS, in which angiotensin II is produced in the blood and then carried to target tissues, angiotensin II can be produced _________________-

Answer 8

locally by individual tissues

Question 9

Beneficial effects of ACE inhibitors result largely from

Answer 9

inhibition of ACE and partly from inhibition of kinase II

the name for ACE when the substrate is bradykinin

Question 10

By inhibiting _________, ACE inhibitors decrease production of _____________. The result is _____________

Answer 10

ACE; angiotensin II; vasodilation, decreased blood volume and prevention or reversal or pathologic changes in the heart and blood vessels mediated by angiotensin II and aldosterone

Question 11

ACE inhibitors and ARBS are used to treat patients with

Answer 11

hypertension, heart failure, MI and established diabetic nephropathy
in addition they are used to prevent MI, stroke, and death from cardiovascular causes in patients at high risk for a CV event

ACE inhibitors and ARBS are not effective for primary prevention of diabetic nephropathy

Question 12

Preliminary data indicate that ACE inhibitors and ARBS can reduce the risk of developing diabetic _______________, although they can’t ____________ the progression of established retinopathy.

Answer 12

retinopathy; slow

Question 13

ACE inhibitors can produce significant ____________ by causing a sharp drop in circulating angiotensin II

Answer 13

first dose hypotension

Question 14

________________-, secondary to accumulation of bradykinin, is the most common reason for discontinuing ACE inhibitors

Answer 14

Cough

Question 15

by suppressing aldosterone release, ACE inhibitors can cause _______________kalemia. Exercise caution in patients taking

Answer 15

hyper; potassium supplements, salt substitutes or potassium sparing diuretics

Question 16

ACE inhibitors should be _______________ during pregnancy

Answer 16

avoided

Question 17

ACE inhibitors can cause a precipitous drop in BP in patients with bilateral renal artery __________________-

Answer 17

stenosis (or stenosis in the artery to a single remaining kidney)

Question 18

ARBS block the action of _______________________ in blood vessels, the adrenals and all other tissues

Answer 18

angiotensin II

Question 19

ARBS are similar to ACE inhibitors in that they cause

Answer 19

vasodilation, suppress aldosterone release, promote excretion of sodium and water, reduce blood pressure, and cause birth defects and angioedema

Question 20

ARBS differ from ACE inhibitors in that they have a much lower incidence of _________________ or ______________

Answer 20

hyperkalemia; cough

Question 21

Aliskiren, a ________________ inhibitor, binds tightly with renin and thereby inhibits cleavage of angiotensinogen into angiotensin I. As a result the drug suppresses the entire ________________

Answer 21

direct renin inhibitor; RAAS

Question 22

Like the ACE inhibitors and ARBs, aliskiren causes

Answer 22

vasodilation, suppresses aldosterone release, promotes excretion of sodium and water, reduces blood pressure, and causes birth defects and angioedema

Question 23

Despite their similarities, aliskiren, ARBS and ACE inhibitors are clinically interchangeable. TRUE OR FALSE

Answer 23

FALSE

NOT CLINICALLY INTERCHANGEABLE

Question 24

Aldosterone antagonists such as _________ and _________________ block receptors for aldosterone

Answer 24

spironolactone; eplerenone

Question 25

By blocking aldosterone receptors, aldosterone antagonists can

Answer 25

1) promote renal excretion of sodium and water (and can thereby reduce blood volume and blood pressure) and 2) prevent or reverse pathologic effects of aldosterone on CV structure and function