RAAS agents

Question 1

what are the ace inhibitors

Answer 1

fosinopril, captopril, benazepril, enalapril, moexipril, quinapril, ramipril

Question 2

what is the mechanism of the ace inhibitors

Answer 2

they bind to and inhibit ACE; thus preventing the formation of angiotensin II from angiotensin I

Question 3

when would we not see much of a response in patients taking ace inhibitors

Answer 3

if the patient has low renin levels

Question 4

what are the 2 major things that account for the BP lowering effect of ace inhibitors

Answer 4

prevention of vascular smooth muscle constriction by angiotensin II, and reduction in the secretion of aldosterone

Question 5

relaxation of arterial vascular smooth muscle results in decreased ___

Answer 5

TPR

Question 6

the decrease in TPR with ACEi is seen ___

Answer 6

rapidly

Question 7

how does blocking aldosterone secretion with ACEi decrease BP?

Answer 7

more sodium eliminated—> urinary output increases—> extracellular fluid volume decreases–> circulatory filling pressure decreases–> venous output decreases–> cardiac output decreases

Question 8

ACEi red

Question 9

ACE is also called ____

Answer 9

kininase II

Question 10

ACE is also responsible for the metabolism of the vasodilator ____

Answer 10

bradykinin

Question 11

increased bradykinin levels lead to what adverse effect

Answer 11

dry cough

Question 12

clinical uses of ACEi

Answer 12

treat all stages of HTN, monotherapy or combo, used in heart failure, prevent pathological effects of angiotensin on blood vessels, prevent damaging effect of angiotensin which promote myocardial damage

Question 13

adverse effects of ACEi

Answer 13

dry cough, angioedema, exaggerated fall in BP in hypovolemic patients

Question 14

which drug combos work well with ACEi

Answer 14

thiazides, loops, vasodilators

Question 15

drug interactions with ACEi

Answer 15

potential for hyperkalemia when used with potassium sparing diuretics, NSAIDs reduce the hypotensive effect of ACEi’s

Question 16

what are the ARBs

Answer 16

losartan, candesartan, eprosartan, irbesartan, telmisartan, valsartan, olmesartan, azilsartan

Question 17

mechanism of ARBs

Answer 17

competitive antagonists of the AT1 receptor located on vascular smooth muscle that synthesizes and releases aldo and causes vasoconstriction

Question 18

as a consequence of angiotensin receptor blockade, vascular smooth muscle is _____

Answer 18

relaxed (decrease TPR, seen early)

Question 19

as a consequence of angiotensin receptor blockage, aldosterone secretion is blocked which decreases ____

Answer 19

cardiac output; takes time to develop effect

Question 20

use of ARBs in hypertension

Answer 20

used to treat all stages of HTN, can be used alone or in combo, cough is not an adverse effect and angioedema is even more rare

Question 21

name the renin inhibitor

Answer 21

aliskiren

Question 22

what is the mechanism of aliskiren

Answer 22

it binds to and inhibits renin, preventing angiotensinogen from binding to the enzyme in the blood. so there is no formation of angiotensin I and II

Question 23

the utility of aliskiren in treatment is similar to __

Answer 23

ACEis and ARBs

Question 24

name the Angiotensin-Receptor-Neprilysin Inhibitor (ARNi)

Answer 24

Sacubitril/Valsartan (Entresto)

Question 25

____ is an enzyme that degrades important vasodilator peptides and vasoconstrictors

Answer 25

neprilysin

Question 26

why is sacubitril not used alone

Answer 26

there is little effect on BP when used alone because it increases both vasodilators AND vasoconstrictors

Question 27

why can’t we combo an ACEi with sacubitril

Answer 27

increased risk for angioedema seen in trials

Question 28

clinical application of ARNi therapy

Answer 28

management of chronic heart failure