Hypertension - Lecture 2 (RAAS Drugs)

Question 1

Most patients with essential HTN have a normal Cardiac output but…

Answer 1

increased peripheral resistance

Question 2

Drugs that target inappropriately high renin release?

Answer 2

ACEi
ARBs
Aldosterone Antagonists
Renin Inhibitors

Question 3

Drug that target inappropriately high sympathetic outflow?

Answer 3

a-2 agonist
a-1 antagonist
B-blocker

Question 4

Drugs that target increased Systemic resistance?

Answer 4

CCBs

Direct Vasodilators

Question 5

Drugs that target abnormal renal salt/water handling?

Answer 5

Thiazide
K-sparing
Loop diuretics

Question 6

Primary factors determining blood pressure?

Answer 6

RAAS
Sympathetic nervous system
Plasma volume (mediated by kidneys)

Question 7

Excess stimulation of RAAS can lead to….

Answer 7

increase sympathetic activity
increased PVR
water/salt retention

All leads to increase BP

Question 8

Targets for RAAS Drugs

Answer 8

Renin
ACE
AT1
Aldosterone

Question 9

How do RAAS inhibiting agents lower BP?

Answer 9

via decreased PPR

all work to decreasing activity of Angiotensin II

Question 10

ACEi MOA

Answer 10

block conversion of AT1-AT2 via ACE enzyme

Question 11

ACEi effect on bradykinin

Answer 11

Will cause increase

Leads to cough and angioedema (rare)

Question 12

Enalapril (Vasotec) Dosage and Frequenecy

Answer 12

5-40 mg, 1-2 times daily

Question 13

Lisinopril (Prinivil, Zestril) Dosage and Frequency

Answer 13

10-40 mg, once daily

Question 14

What to monitor in ACEi?

Answer 14

BP
K
ScCr
BUN

Question 15

Are ACEi considered 1st line without compelling indication?

Answer 15

Yes

Question 16

Benefits of ACEi in someone with vasculature issues?

Answer 16

It improves the vasculature

Helps improve blood vessel health and less likely to have that 2nd HA,Stroke, etc

Question 17

Compelling use of ACEi?

Answer 17

Post-MI, HFrEF, ppl with ASVD risk

Renal protection for patients with protein related DM DKD or CKD

Question 18

Contraindications of ACEi?

Answer 18

Pregnancy
Bilateral renal artery stenosis

avoid in women during childbearing years

Question 19

ACEi efficacy in black patients

Answer 19

less efficacy as mono therapy, consider combo

Question 20

Someone has CKD or DKD if they have…..

Answer 20

UACR > 30mg/g

eGFR <60

Question 21

Can you use ACEi and ARB together?

Answer 21

NO

Question 22

ARB MOA

Answer 22

Block the activity of angiotensin II at the AT-type 1 receptor

Question 23

Does ARB have effect on bradykinin metabolism?

Answer 23

nope, so won’t have associated side effect

Question 24

Stimulation at AT-1 gives you….

Answer 24

Vasoconstriction

Dilation when block

Question 25

Irbesartan (Avapro) Dose and Frequency

Answer 25

150-300mg, Daily

Question 26

Lorsartan (Cozaar) Dose and Frequency

Answer 26

50-100mg, 1-2 times daily

Question 27

Valsartan (Diovan) Dose and Frequency

Answer 27

80-320, Daily

Question 28

Are ARBs considered 1st line without compelling indication?

Answer 28

Yes

Question 29

Compelling use of ARBs?

Answer 29

Similar to ACEi Post-MI, HFrEF, ppl with ASVD risk Renal protection for patients with protein related DM DKD or CKD *consider losartsn in pts with PMH of gout due to increased urinary uric acid excretion*

Question 30

ARBs efficacy in black patients

Answer 30

less efficacy as mono therapy, consider combo

Question 31

Contraindications of ARB?

Answer 31

Pregnancy Bilateral renal artery stenosis Don't use ACE with ARBs together

Question 32

Special use of Losartan

Answer 32

*consider in pts with PMH of gout due to increased urinary uric acid excretion*

Question 33

ADE of ACEi and ARBs

Answer 33

Slight SCr rise Hyperkalemia = most common Dry Cough* Angioedema* Rare *= less common ARBs

Question 34

What to monitor in ARB?

Answer 34

BP K ScCr BUN

Question 35

How to deal with ACEi cough

Answer 35

cough meds, etc don't do shit Stop taking med

Question 36

Angioedema info

Answer 36

Not common 2-4 times more frequent in Black people Due to inhibiting breakdown of bradykinin Can try an ARB after 6 week washout

Question 37

ACEi and ARB drug interactions?

Answer 37

K+ sparring diuretics and K+ supplements Both increase K+ = too high

Question 38

Direct Renin Inhibitor MOA

Answer 38

Blocks RAAS at its initial point of activation - prevents formation of AT1 and AT2

Question 39

Aliskiren (Tecturna) Dose and Frequency

Answer 39

150-300mg, daily

Question 40

Can you use Renin inhibitor with ACE and ARB?

Answer 40

No chance

Question 41

What to monitor with Direct Renin inhibitor?

Answer 41

Potassium BUN SCr

Question 42

ADE of Direct Renin Inhibitors?

Answer 42

``` Hyperkalemia Gi upset Cough (Less than ACEi) only 2 cases Angioedema reported high fat meals decrease absorption ```

Question 43

Aldosterone Antagonists MOA

Answer 43

Inhibit Aldosterone receptor in distal tubules, increasing NaCL and H20 excretion while conserving K+ Block effect of aldosterone on arteriolar smooth muscle

Question 44

Spironolactone (Aldactone) Dose and Frequency?

Answer 44

25-100mg, 1-2/day

Question 45

Avoid Aldosterone Antagonists if....

Answer 45

Anuria K+ > 5mEq/L, on K+ supp, or K+ diuretic Acute renal insufficiency (CrCl <30ml/min)

Question 46

Special Populations for Aldosterone Antagonists?

Answer 46

HF patients with HFrEF Primary aldosteronism Resistant HTN

Question 47

ADEs of Aldosterone Antagonists

Answer 47

``` Hyperkalemia Hypoatremia Gynecomastia impotence Hypotension ```