Pharmacology

Question 1

List the 4 ACEIs.

Answer 1

1. Captopril
2. Enalapril
3. Lisinopril
4. Ramipril

Question 2

List the 3 ARBs.

Answer 2

1. Losartan
2. Candesartan
3. Valsartan

Question 3

Compare the MOA os ACEIs and ARBs.

Answer 3

ACEIs - inhibit ACE -> decreased AT II (also increases renin by decreasing negative feedback) and increase bradykinin (potent vasodilator)

Normally, AT II increases BP by constricting renal and peripheral vasculature and increasing sodium reabsorption). Decreased AT II prevents constriction of efferent arterioles and decreases GFR. In addition, ACE normally degrades bradykinin.

ARBs - selectively block AT II binding to its receptor. As above, but NO effect on bradykinin.

Question 4

Compare the indications of ACEIs and ARBs.

Answer 4

Both: hypertension, heart failure, proteinuria, diabetic nephropathy

ACEIs are generally preferred, but ARBs are used in patients who cannot tolerate ACEIs (couch, angioedema, etc.)

Question 5

Why are ACEIs especially favorable in heart failure, chronic hypertension, and chronic kidney disease?

Answer 5

Decrease mortality in heart failure
Prevent unfavorable heart remodeling due to chronic hypertension
Decrease intraglomerular pressure in chronic kidney disease, slowing GBM thickening

Question 6

What medication class in contraindicated in C1 esterase inhibitor deficiency and why?

Answer 6

ACEIs (due to increased bradykinin)

Question 7

MOA and indication - Aliskiren

Answer 7

MOA - direct renin inhibitor (blocks conversion of angiotensinogen to angiotensin I)

Hypertension