RAAS antagonists

Question 1

Angiotensin converting enzyme inhibitors example

Answer 1

Lisinopril

Question 2

ACEI MOA in HF

Answer 2

Inhibits ACE conversion of Ang I to Ang II, blocking Ang II-induced vasoconstriction and decreasing preload/afterload. Other mechanism is decrease of Ang II-induced release of aldosterone which moderates the myocardial hypertrophy and remodeling response to aldosterone. Decreases Bradykinin, reduces SNS

Question 3

ACEI pharmacokinetics

Answer 3

All are well absorbed orally. All ACEIs, except lisinopril and captopril, are prodrugs that are converted to the active metabolite in the liver. • The active metabolites are primarily eliminated by the kidneys (except moexipril and fosinopril). Once daily dosing

Question 4

Describe dosing for ACEI

Answer 4

start at low dose then titrate to goal

Question 5

ACEI side effects

Answer 5

Contraindicated in pregnancy. Dry cough, Hyperkalemia, hypotension, acute renal failure

Question 6

Angiotensin II receptor (AT1) Antagonists examples

Answer 6

Valsartan, Losartan

Question 7

ARBs MOA in HF

Answer 7

Prevent remodeling and reduce SNS. Similar to ACEI

Question 8

Compare and contrast ACEI and ARBs

Answer 8

ARBs have more complete block of angiotensin action since ACEI do not block alternative pathways. ARBs do not affect bradykinins so NO cough. ARBs only block actions at AT1 receptors while ACEIs will block actions mediated by both AT1 and AT2

Question 9

ARBs pharmacokinetics

Answer 9

Oral

Question 10

ARBs side effects

Answer 10

contraindicated in pregnancy, NO cough or angioedema.

Question 11

Should ACEI and ARBs be used together?

Answer 11

No apparent benefit from dual therapy