RAAS hemmere - Amboss Flashcards

1
Q

Når aktiveres RAAS?

A
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2
Q

Fyll inn figuren

A
Renin-angiotensin-aldosterone system. Flowchart summarizing the biochemical and physiological effects of the renin-angiotensin-aldosterone system.
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3
Q

Hvilken type medikament er:
- Enalapril
- Lisinopril
- Ramipril
- Captopril
- Benazepril

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4
Q

Ved hvilke indikasjoner gir man ACE hemmere?

A
There is minimal evidence to support primary prevention of moderately increased albuminuria in normotensive and normoalbuminuric type I and type II diabetes. Annual screening to identify persistently increased albuminuria is recommended instead. Treatment with a RAAS inhibitor may be considered if albuminuria persists to delay progression towards severely increased albuminuria, especially in patients with type I diabetes, and cardiovascular events. ACE inhibitors and ARBs are generally recommended in hypertensive diabetic patients to reduce the risk of cardiovascular events, but they are strongly recommended in diabetic patients with concurrent hypertension and an elevated urinary albumin-to-creatinine ratio (as an indicator for microalbuminuria). To reduce the risk of cardiovascular events. Amyl nitrite is a vasodilator that mimics the effects of ACE inhibitors on the heart. The ability of ACE inhibitors to attenuate ventricular dilatation (remodeling) after an MI is responsible for its survival benefit. Patients will still derive benefit from ACE inhibitors or ARBs if they are not administered immediately after the event.
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5
Q

Hvilke type medikament er:
- Valsartan
- Candesartan
- Losartan
- Irbesartan

A
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6
Q

Ved hvilke indikasjoner bruker man ARBs?

A
ARBs can also cause angioedema and their use should be carefully considered in patients with previous angioedema from ACE inhibitors. Like ACEIs, ARBs may cause cough, although the probability is lower.
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7
Q

Hva slags type medikament er sacubitril, og ved hvilke indikasjoner bruker man disse?

A
To block the vasoconstrictive effect of angiotensin II accumulation, sacubitril needs to be combined with an ARB. Trials have shown that ARNIs significantly decrease hospitalization rates and mortality compared to ACEIs.
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8
Q

Hva slags type medikament er Aliskiren, og ved hvilke indikasjoner bruker man disse?

A
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9
Q

På hvilken mekanisme virker ACE-hemmere?

A
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10
Q

Hva er hovedeffekten til ACE hemmere?

A
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11
Q

Utenom hovedeffektene, hvilke andre egenskaper har ACE hemmere?

A
The specific mechanisms are not fully understood, but they may involve the direct effects of ACE inhibitors/kinins on cardiac myocytes and renal growth factors.
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12
Q

Fyll inn figuren

A
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13
Q

Hvordan virker ARB?

A
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14
Q

Hvordan virker ARNIs?

A
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15
Q

Hvordan virker direkte renin hemmere?

A
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16
Q

Fyll inn

A
17
Q

Hvilke bivirkninger forekommer ved ACE hemmere?

A
The mechanism is not fully understood. However, protussive and proinflammatory effects from local accumulation of bradykinin (and other mediators) in the lung are considered most likely. Angioedema typically develops within the first week of treatment. Rarely, it can occur after years of therapy.
18
Q

Hvilket akronym summerer opp bivirkninge til ACE hemmere?

A

CAPTOPRIL

Cough

Angioedema

Pemphigus vulgaris

Teratogenicity

HypOtension

High pOtassium

Renal failure

Low GFR

19
Q

Hva er bivirkninger ved bruk av ARBs?

A
20
Q

Hvilke bivirkninger har ARNIs?

A
21
Q

Hvilke bivirkninger har direkte renin inhibitorer?

A
22
Q

Hva er absolutte kontraindikasjoner for ACE hemmere og ARBs?

A
Particularly during the second and third trimesters. ACE inhibitors should also be avoided in the first trimester, as there is evidence that they may increase the risk of malformations.
23
Q

Hva er relative kontraindikasjoner for ACE hemmere og ARBs?

A
These patients may not be able to further increase their stroke volume to compensate for the peripheral vasodilation caused by ACE inhibitors. Severe hypotension may occur. Even patients with advanced renal dysfunction may benefit from treatment with ACE inhibitors, although there might be an initial drop in GFR and increase in creatinine (tolerable up to 30%). Therefore, regular GFR monitoring is required in patients with chronic kidney disease.
24
Q

Hvilke kontraindikasjoner finnes for direkte reninhemmere?

A
25
Q

Hvilke interaksjoner har ACE hemmere og ARBs?

A
The reason for this is not yet fully understood.
26
Q

Hvilke interaksjoner har direkte renin hemmere?

A
27
Q

Hvilke forhåndsregler bør man ta hvis man starter opp medikamenter som påvirker RAAS?

A