module 7 ACE inhibitors, angiotensin receptor blockers, renin inhibitors Flashcards
angiotensin-converting enzyme inhibitors (ACEI)
benezapril captropril lisinopril ramipril - block ACE converting angiotensin 1 to angiotensin 2
ACEI uses
HTN
prevention of diabetic nephropathy
neurohormonal (RAAS) blockade in HF
acute MI (dec. heart remodeling)
angiotensin receptor blockers (ARB)
irbesartan losartan telmisartan valsartan - competitive binding at angiotensin 2 receptors -> dec. peripheral vasoconstriction
ARB uses
HTN prevention of diabetic nephropathy dec. proteinuria neurohormonal (RAAS) blockade in HF acute MI
ACEI and ARB mechanism of action
inhibit the effects of angiotensin 2 leading to vasodilation and dec. afterload
dec. the release of aldosterone -> dec. Na and H2O retention.
Renal protective in chronic kidney diseases
bradykinin and ACEI
bradykinin is broken down by enzyme identical to ACE, therefore breakdown of bradykinin is blocked by ACEI.
-> vasodilation and inflammation -> cough
ACEI adverse effects
block-box: fetal toxicity, category D. angioedema cough (bradykinin) hyperkalemia (monitor K) renal insufficiency in acute setting(monitor creatinine)
ACEI contraindications
allergy
hyperkalemia
renal dysfunction (renal artery stenosis)
pregnancy
ARB black box
fetal morbidity/mortality
category D
Direct renin inhibitor and use
aliskiren
use: HTN
Direct renin inhibitor (aliskiren) mechanism
binds to renin, inhibits angiotensin 1 formation (prevents renin release)
- vasodilation
- dec. Na and H2O retention
aliskiren adverse effects
preg. category X diarrhea cough hyperkalemia angioedema impared renal function
aliskiren interactions
K sparing diuretic
K supplement
NSAID
Metabolized by CYP3A4
ARB adverse effects
hyperkalemia
renal insufficiency in acute setting (monitor creatinine)
