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Cardio > Exam 1 - RAAS, ACEIs, ARBs, and Renin Inhibitors > Flashcards

Exam 1 - RAAS, ACEIs, ARBs, and Renin Inhibitors Flashcards

1
Q

Explain the RAAS pathway

A

Decreased renal blood flow stimulates receptors in juxtaglomerular apparatus of kidney to secrete renin (hormone/enzyme)

Renin converts angiotensinogen (produced by liver) to angiotensin I

ACE (from the lungs) converts angiotensin I to angiotensin II

Angiotensin II (potent vasoconstrictor) increases BP and glomerular secretion

Angiotensin II stimulates aldosterone secretion

Aldosterone increases Na+ and water retention, which increases blood volume, which increases BP

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2
Q

what mediates the BP increase from RAAS?

A

stimulation of angiotensin II type 1 receptors

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3
Q

What effects can result from a chronic elevation of angiotensin II?

A

Volume overload + increased SVR

Renal damage

Risk of increased CV related morbidity and mortality

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4
Q

What can be seen with the volume overload and increased SVR resulting from a chronic elevation of angiotensin II?

A

Cardiac hypertrophy and remodeling

Coronary vascular damage and remodeling

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5
Q

Hypovolemia (low blood volume) and dehydration stimulate the ___ in the ___ to release ___ from the the ___ gland

A
  1. Osmoreceptors
  2. Hypothalamus
  3. ADH
  4. Posterior pituitary gland
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6
Q

What does ADH cause? What does this lead to?

A

Causes water reabsorption at kidney tubules

Leads to increased blood volume and BP

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7
Q

what is the main regulator of Na+ retention?

A

NB (can’t find what this stands for - coming back to it)

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8
Q

What else is produced when ACE converts angiotensin I to angiotensin II? What is it and what does it do?

A

Bradykinins
Potent vasodilator
Decreases BP

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9
Q

what drugs are ACE inhibitors?

A

Lisinopril (zestril, prinivil)
Enalapril (vasotec)
Enalaprilat (IV vasotec)
Captopril (Capoten)
Ramipril (altace)
Benazepril (lotensin)
Quinapril (accupril)
Trandolapril (mavik)
Perindopril (aceon)

(Just know they end in -pril but don’t forget enalaprilat)

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10
Q

(ACEi pharmacological effects): how do ACE inhibitors dilate arteries and veins? What does this do?

A

Dilation by blocking angiotensin II formation and inhibiting bradykinin metabolism

Vasodilation reduces:
- Arterial pressure
- Preload
- Afterload

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11
Q

What are the pharmacological effects of ACE inhibitors?

A

Dilate arteries

Down regulate sympathetic adrenergic activity

Promote renal excretion of sodium and water (natriuretic and diuretic effects)

Inhibit cardiac and vascular remodeling

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12
Q

(ACEi pharmacological effects): how do they down regulate sympathetic adrenergic activity?

A

Blocking the effects of angiotensin II on sympathetic nerve release and reuptake of NE

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13
Q

(ACEi pharmacological effects): how do they promote renal excretion of Na+ and water? What does this do?

A

Blocking effects of angiotensin II in kidney

Blocking angiotensin II stimulation of aldosterone secretion

This reduces blood volume, venous pressure, and arterial pressure

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14
Q

Why can ACEIs cause a dry cough?

A

increase in bradykinin

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15
Q

(ACEi pharmacological effects): Inhibit cardiac and vascular remodeling associated with ___

A

HTN
Heart failure
MI

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16
Q

What are the AEs of ACE inhibitors?

A

Dry cough in ~ 10% of pts

Hypotension

Angioedema (life threatening airway swelling and obstruction; 0.1 - 0.2% of pts)

Hyperkalemia

Pts w/ bilateral renal artery stenosis may experience renal failure

(Playing Hay Day At Home)

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17
Q

ACEI use can cause hypotension, especially in ___ pts

A

heart failure

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18
Q

Why can hyperkalemia occur as a SE of ACEI?

A

reduced aldosterone formation

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19
Q

What is a contraindication for ACEI? Why?

A

Pregnancy

Can induce fetal malformations (teratogenic)

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20
Q

ACEI may cause hyperkalemia in what patients?

A

CKD

Those taking:
- K+ sparing diuretic
- Aldosterone antagonists
- ARB
- Direct renin inhibitor

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21
Q

What is an ARB?

A

angiotensin II receptor blocker

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22
Q

The starting dose of an ACEI should be reduced by ___ in pts who are ___, ___, or ___. Why?

A

Reduced by 50%

On a thiazide
Volume depleted
Very elderly

Risk of hypotension

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23
Q

what drugs are ARBs?

A

Candesartan (atacand)
Valsartan (diovan)
Losartan (cozaar)
Olmesartan (benicar)
Irbesartan (avapro)
Telmisartan (micardis)
Eprosartan (teveten)

(Just remember -sartan)

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24
Q

What is the MOA of ARBs?

A

Block angiotensin receptors on blood vessels and other tissues

Decreases the activation of angiotensin I receptors by angiotensin II

Vasodilation

Blocked aldosterone secretion

Lowers BP

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25
what are the pharmacological actions of ARBs?
Dilate arteries and veins Down regulate sympathetic adrenergic activity Promote renal excretion of Na+ and water Inhibits cardiac and vascular remodeling (DIP Down)
26
(ARB pharmacological effects): what does dilation of arteries and veins do?
reduces arterial pressure, preload, and afterload
27
(ARB pharmacological effects): how do they down regulate sympathetic adrenergic activity?
by blocking effects of angiotensin II on sympathetic nerve release and reuptake of NE
28
(ARB pharmacological effects): How do they promote renal excretion of Na+ and water?
Blocks the effects of angiotensin II in the kidney Blocks aldosterone secretion
29
(ARB pharmacological effects): Inhibits cardiac and vascular remodeling associated with ___
Chronic HTN Heart failure MI
30
What should be monitored w/ ARBs?
BP K+ levels Renal function
31
What do ARBs NOT do that ACE inhibitors do? Why is this important?
ARBs don’t inhibit the ACE enzyme, meaning they will NOT increase bradykinin levels Important because bradykinin produces cough and angioedema (meaning risk is there w/ ACEI but not ARB)
32
ARBs may cause hyperkalemia in what pts?
CKD Receiving: - K+ sparing diuretic - Aldosterone antagonist - ACEi - Direct renin inhibitor
33
ARBs can cause acute kidney failure in patients with ___ or ___
Severe bilateral renal artery stenosis Severe stenosis in artery to solitary kidney
34
What is a contraindication of ARBs? Why?
Pregnancy - teratogenic
35
ARB dose should be reduced 50% in patients who are ___, ___, or ___. Why?
On a thiazide Are volume depleted Very elderly Risk of hypotension
36
What drug is a renin inhibitor?
Aliskiren (tekturna)
37
what is the MOA of renin inhibitors?
Directly inhibits renin Blocks conversion of angiotensinogen to angiotensin I Block RAAS Vasodilation and decrease in CO Decrease BP
38
What AEs do renin inhibitors have?
Diarrhea (3%) (esp at higher doses) Cough Angioedema (Cough and angioedema are less likely in renin inhibitors compared to ACEI)
39
what is a contraindication for renin inhibitors?
pregnancy
40
what are the pharmacological effects of renin inhibitors?
Dilate arteries and veins by blocking angiotensin II formation — reduces arterial pressure, preload, and afterload Down regulate sympathetic adrenergic activity — done by blocking effects of angiotensin II on sympathetic nerve release and reuptake of NE Promote renal excretion of Na+ and water — by blocking effects of angiotensin II in kidney and blocking aldosterone secretion (reduces blood flow, venous pressure, arterial pressure) Inhibits cardiac and vascular remodeling associated with chronic HTN, heart failure, and MI (DIP Down)
41
What pts may experience hyperkalemia when taking renin inhibitors
CKD Diabetes Receiving: - K+ sparing diuretic - Aldosterone antagonist - ACEi - ARB
42
renin inhibitors may cause acute kidney failure in pts with ___ or ___
Severe bilateral renal artery stenosis Severe stenosis in artery to solitary kidney
43
What is the brand name, class, usual dose range, and frequency of benazepril?
Lotensin ACEi 10 - 40 mg/day 1-2 daily
44
What is the brand name, class, usual dose range, and frequency of captopril?
Capoten ACEi 12.5 - 150 mg/day 2 or 3 daily
45
What is the brand name, class, usual dose range, and frequency of enalapril?
Vasotec ACEi 5-40 mg/day 1 or 2 daily
46
What is the brand name, class, usual dose range, and frequency of fosinopril?
Monopril ACEi 10-40 mg/day 1 daily
47
What is the brand name, class, usual dose range, and frequency of lisinopril?
Prinivil, Zestril ACEi 10-40 mg/day 1 daily
48
What is the brand name, class, usual dose range, and frequency of perindopril?
Aceon ACEi 4-16 mg/day 1 daily
49
What is the brand name, class, usual dose range, and frequency of moexipril?
Univasc ACEi 7.5 - 30 mg/day 1 or 2 daily
50
What is the brand name, class, usual dose range, and frequency of quinapril?
Accupril ACEi 10-80 mg/day 1 or 2 daily
51
What is the brand name, class, usual dose range, and frequency of ramipril?
Altace ACEi 2.5 - 10 mg/day 1 or 2 daily
52
What is the brand name, class, usual dose range, and frequency of trandolapril?
Mavik ACEi 1-4 mg/day 1 daily
53
What is the brand name, class, usual dose range, and frequency of azilsartan?
Edarbi ARB 40-80 mg/day 1 daily
54
What is the brand name, class, usual dose range, and frequency of candesartan?
Atacand ARB 8-32 mg/day 1 or 2 daily
54
What is the brand name, class, usual dose range, and frequency of eprosartan?
Teveten ARB 600-800 mg/day 1 or 2 daily
55
What is the brand name, class, usual dose range, and frequency of irbesartan?
Avapro ARB 150-300 mg/day 1 daily
56
What is the brand name, class, usual dose range, and frequency of losartan?
Cozaar ARB 50-100 mg/day 1 or 2 daily
57
What is the brand name, class, usual dose range, and frequency of olmesartan?
Benicar ARB 20-40 mg/day 1 daily
58
What is the brand name, class, usual dose range, and frequency of telmisartan?
Micardis ARB 20-80 mg/day 1 daily
59
What is the brand name, class, usual dose range, and frequency of valsartan?
Diovan ARB 80-320 mg/day 1 daily

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