Drugs acting on the Renin-Angiotensin-Aldosterone System Flashcards
RAAS
Renin-Angiotensin-Aldosterone system
What does the RAAS help regulate?
Blood pressure, blood volume and fluid and electrolyte balance. The system can promote cardiovascular pathology
RAAS acts through production of __________________ and _______________—
angiotensin II; aldosterone
Angiotensin II is formed by the actions of two enzymes; _________________ and ___________
renin; ACE
Angiotensin II causes _________________ (primarily in arterioles) and release of ______________ . In addition, it can promote ________________ in the heart and blood vessels
vasoconstriction; aldosterone ; pathologic
Aldosterone acts on the kidneys to promote ________________ of sodium and water. In addition it can also mediate ________________ changes in the cardiovascular system
retention; pathologic
The RAAS raises blood pressure by _____________
causing vasoconstriction and by increasing blood volume (secondary to aldosterone mediated retention of sodium and water )
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 _________________-
locally by individual tissues
Beneficial effects of ACE inhibitors result largely from
inhibition of ACE and partly from inhibition of kinase II
the name for ACE when the substrate is bradykinin
By inhibiting _________, ACE inhibitors decrease production of _____________. The result is _____________
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
ACE inhibitors and ARBS are used to treat patients with
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
Preliminary data indicate that ACE inhibitors and ARBS can reduce the risk of developing diabetic _______________, although they can’t ____________ the progression of established retinopathy.
retinopathy; slow
ACE inhibitors can produce significant ____________ by causing a sharp drop in circulating angiotensin II
first dose hypotension
________________-, secondary to accumulation of bradykinin, is the most common reason for discontinuing ACE inhibitors
Cough
by suppressing aldosterone release, ACE inhibitors can cause _______________kalemia. Exercise caution in patients taking
hyper; potassium supplements, salt substitutes or potassium sparing diuretics
ACE inhibitors should be _______________ during pregnancy
avoided
ACE inhibitors can cause a precipitous drop in BP in patients with bilateral renal artery __________________-
stenosis (or stenosis in the artery to a single remaining kidney)
ARBS block the action of _______________________ in blood vessels, the adrenals and all other tissues
angiotensin II
ARBS are similar to ACE inhibitors in that they cause
vasodilation, suppress aldosterone release, promote excretion of sodium and water, reduce blood pressure, and cause birth defects and angioedema
ARBS differ from ACE inhibitors in that they have a much lower incidence of _________________ or ______________
hyperkalemia; cough
Aliskiren, a ________________ inhibitor, binds tightly with renin and thereby inhibits cleavage of angiotensinogen into angiotensin I. As a result the drug suppresses the entire ________________
direct renin inhibitor; RAAS
Like the ACE inhibitors and ARBs, aliskiren causes
vasodilation, suppresses aldosterone release, promotes excretion of sodium and water, reduces blood pressure, and causes birth defects and angioedema
Despite their similarities, aliskiren, ARBS and ACE inhibitors are clinically interchangeable. TRUE OR FALSE
FALSE
NOT CLINICALLY INTERCHANGEABLE
Aldosterone antagonists such as _________ and _________________ block receptors for aldosterone
spironolactone; eplerenone
