GENERAL ACEI

Question 1

All persons with BP over 120/80 should initiate?

Answer 1

Lifestyle Modifications

Question 2

Treatment threshold goals without DM and kidney disease?

Answer 2

over 140/90

Question 3

Treatment threshold goals with DM or kidney disease?

Answer 3

over 130/80

Question 4

First line therapy for HTN is? Unless?

Answer 4

Thiazide diuretic unless there is a compelling medication to reach goal

*most patients will require at least 2 medications to reach goal

Question 5

What are compelling indications?

Answer 5

Heart Failure, MI, High CVD, DM, CKD, Stroke and isolated systolic hypertension.

Question 6

Describe HTN urgency?

Answer 6

Diastolic pressure over 120 with evidence of progressive end organ damage. Goal is to decrease DBP to 100-105 within 24 hours.

*Progressive end organ damage can be noted by increased BUN/Creat. Don’t want to decrease DBP too much because brain is dependent on higher pressure!

Question 7

Describe HTN crisis?

Answer 7

Diastolic pressure over 120 with evidence of end organ FAILURE. Goal is to decrease DBP to 100-105. Using Nitroprusside, NTG or Labetalol.

Question 8

Angiotension II is a potent vasoconstrictor responsible for what kind of constriction?

Answer 8

Arterial Smooth Muscle Constriction.

Question 9

What does Angiotension II increase the secretion of?

Answer 9

Aldosterone.

Question 10

What is the MOA of Angiotension II Converting Enzyme Inhibitors?

Answer 10

Block the conversion of Angiotension I to Angiotension II through the interaction with the zinc ion of angiotension converting enzyme therefore preventing conversion of angiotension I to II. Thus preventing vasoconstriction, sodium retention and SNS stimulation.

Question 11

End result of ACEI that Vicki wants us to know?

Answer 11

Prevents Na resorption, vasoconstriction and the breakdown of bradykinin causes vasodilation which helps us with afterload but causes the cough.

Question 12

Name some popular ACE Inhibitors?

Answer 12

Captopril (capoten)
Enalapril (vasotec)
Lisinopril (zestril, prinivil)

Question 13

What important system does the ACEI block?

Answer 13

RAAS

Question 14

What three conditions are ACEI considered first line therapy for?

Answer 14

1. HTN
2. CHF
3. MR

Question 15

What kind of condition is DM is more effective? Why?

Answer 15

Diabetes. Delayed progression of renal disease.

Question 16

The major difference among the ACEI class is?

Answer 16

DOA

Question 17

Name some important things about ACEI.

Answer 17

They are potent, minimal side effects, good patient compliance. We don’t want them to have the morning of and they always tank their BP on induction because they are DRY. Contraindicated in pregos (we don’t want to decrease the blood volume). Be careful with ACEI and NSAIDS they both block bradykinin related vasodilation

Question 18

Side Effects of ACEI include?

Answer 18

Granulocytopenia, angioedema, proteinuria, prolonged HTN, cough, upper respiratory congestion, rhinorrhea.