Pharm Exam III

Question 1

Released by the kidneys in response to decreased perfusion:

Answer 1

renin

Question 2

Released by the liver and converted to angiotensin I by renin:

Answer 2

angiotensinogen

Question 3

Activity unknown; converted to angiotensin II by ACE:

Answer 3

Angiotensin I

Question 4

Causes vasostriction, salt retention, vascular growth:

Answer 4

Angiotensin II

Question 5

Stimulates the release of aldosterone:

Answer 5

Angiotensin II

Question 6

Angiotensin II stimulates the release of:

Answer 6

Aldosterone

Question 7

Decreased renal perfusion pressure leads to: (3)

Answer 7

1. INCREASED renin release
2. INCREASED renal sympathetic nerve activity
3. DECREASED glomerular filtration

Question 8

What three scenarios lead to INCREASED renin release?

Answer 8

1. DECREASED renal perfusion pressure
2. DECREASED glomerular filtration
3. INCREASED renal sympathetic nerve activity

Question 9

Angiotensinogen acts on _____

Answer 9

Angiotensin I

Question 10

Angiotensin I is acted on by _____ to produce angiotensin II

Answer 10

ACE

Question 11

What do ACE inhibitors decrease? What does this lead to?

Answer 11

ACE; no angiotensin II production

Question 12

Angiotensin II acts on _____ receptors

Answer 12

AT1

Question 13

What are the receptor antagonist for AT1 receptors?

Answer 13

Angiotensin II AT1 subtype receptor antagonist

Question 14

What are the three effects of angiotensin II acting on AT1 receptors?

Answer 14

1) Vascular growth
2) Vasoconstriction
3) Salt retention

Question 15

Describe the vascular growth caused by angiotensin II:

Answer 15

1. Hyperplasia
2. Hypertrophy

Question 16

Describe the vasoconstriction caused by angiotensin II:

Answer 16

1. Direct
2. Via increased noradrenaline released from sympathetic nerves

Question 17

Describe the salt retention caused by angiotensin II:

Answer 17

1. aldosterone secretion
2. tubular Na+ resportion

Question 18

AT1:

Answer 18

Angiotensin type 1 receptor

Question 19

ACE:

Answer 19

Angiotensin converting enzyme

Question 20

List the different drug class medications affecting RAAS:

Answer 20

1. Direct renin inhibitor
2. ACE inhibitors
3. Angiotensin receptor blockers
4. Aldosterone antagonsit

Question 21

Blocks renin activity on angiotensinogen:

Answer 21

Direct renin inhibitor

Question 22

Prevents ACE from converting angiotensin I to angiotensin II:

Answer 22

ACE inhibitors

Question 23

Blocks angiotensin II activity at the AT1 receptor:

Answer 23

Angiotensin II receptor blockers

Question 24

Blocks activity of aldosterone in the kidneys and other tissues (i.e. heart, smooth muscle):

Answer 24

Aldosterone antagonist

Question 25

Give an example of a direct renin inhibitor:

Answer 25

Aliskiren

Question 26

Give an example of an ACE inhibitor:

Answer 26

1. Captopril
2. Enalapril

Question 27

Give an example of an angiotensin receptor blocker:

Answer 27

1. Candesartan
2. Valsartan

Question 28

Give an example of aldosterone antagonist:

Answer 28

1. Eplerenone
2. Spironolactone

Question 29

Aliskerin is a:

Answer 29

direct renin inhibitor

Question 30

-Direct renin inhibitor
-Used for HTN
-ADRs: diarrhea, dyspepsia, hypotension
-DDI: Increased levels when combined with CYP3A4 like macrolide antibiotics

Answer 30

Aliskerin

Question 31

Dental implications for Aliskerin:

Answer 31

1. monitor vital signs
2. avoid standing patient up too fast

Question 32

the “prils”:

Answer 32

ACE inhibitors

Question 33

-Benazepril
-Captopril
-Enalapril
-Fosinopril
-Lisinopril
-Moexipril
-Perindopril
-Quinapril
-Ramipril
-Trandolapril

These are all:

Answer 33

ACE inhibitors (Prils)

Question 34

What acronym can be used to memorize the ADIs of ACE inhibitors? (list them)

Answer 34

CAPTOPRIL

C: Cough
A: Angioedema & Agranulocytosis & Acute renal insufficiency
P: Potassium excess (hyperkalemia) & Proteinuria
T: Taste change
O: Orthostatic hypotension
P: Pregnancy ** contraindication
R: Renal artery stenosis ** contraindication
I: Increased serum creatinine
L: Leukopenia & Liver toxicity

Question 35

Lisinopril is an example of:

Answer 35

ACE inhibitor

Question 36

Lisinopril can be used to treat:

Answer 36

1. HTN
2. HF
3. Post-MI
4. Kidney disease

Question 37

What are some dental implications for patients on ACE inhibitors?

Answer 37

1. Orthostatic hypotension
2. Monitor vitals
3. Cough may cause lengthy procedures
4. If dental surgery is anticipated evaluate risk of hypotensive episode

Question 38

The “sartans”:

Answer 38

Angiotensin receptor blockers

Question 39

-Azilsartan
-Candesartan
-Eprosartan
-Irbesartan
-Losartan
-Olmesartan
-Telmisartan
-Valsartan

These are all:

Answer 39

Angiotensin receptor blockers (Sartans)

Question 40

Angiotensin receptor blockers ADRs:

Answer 40

HDH

1. Headache/Hypotension
2. Dizziness
3. Hyperkalemia
4. Cough
5. Angioedema

Question 41

What are angiotensin receptor blockers used to treat?

Answer 41

1. Hypertension
2. HF
3. Kidney disease

Question 42

What are the DDIs of angiotensin receptor blockers?

Answer 42

1. sedative meds –> increased anti-hypotensive effects
2. NSAIDs –> reduced anti-hypertensive effect
3. General anesthesia –> increased anti-hypertensive effect

Question 43

Dental implications of angiotensin receptor blockers:

Answer 43

1. orthostatic hypotension
2. monitor vital signs
3. if dental surgery is anticipated evaluate risk of hypotensive episode