RAAS hemmere - Amboss

Question 1

Når aktiveres RAAS?

Answer 1

Question 2

Fyll inn figuren

Answer 2

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

Question 3

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

Answer 3

https://www.legemiddelhandboka.no/L8.6.1/Angiotensinkonverterende_enzymhemmere

Question 4

Ved hvilke indikasjoner gir man ACE hemmere?

Answer 4

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.

Question 5

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

Answer 5

Question 6

Ved hvilke indikasjoner bruker man ARBs?

Answer 6

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.

Question 7

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

Answer 7

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.

Question 8

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

Answer 8

Question 9

På hvilken mekanisme virker ACE-hemmere?

Answer 9

Question 10

Hva er hovedeffekten til ACE hemmere?

Answer 10

Question 11

Utenom hovedeffektene, hvilke andre egenskaper har ACE hemmere?

Answer 11

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.

Question 12

Fyll inn figuren

Answer 12

Question 13

Hvordan virker ARB?

Answer 13

Question 14

Hvordan virker ARNIs?

Answer 14

Question 15

Hvordan virker direkte renin hemmere?

Answer 15

Question 16

Fyll inn

Answer 16

Question 17

Hvilke bivirkninger forekommer ved ACE hemmere?

Answer 17

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.

Question 18

Hvilket akronym summerer opp bivirkninge til ACE hemmere?

Answer 18

CAPTOPRIL

Cough

Angioedema

Pemphigus vulgaris

Teratogenicity

HypOtension

High pOtassium

Renal failure

Low GFR

Question 19

Hva er bivirkninger ved bruk av ARBs?

Answer 19

Question 20

Hvilke bivirkninger har ARNIs?

Answer 20

Question 21

Hvilke bivirkninger har direkte renin inhibitorer?

Answer 21

Question 22

Hva er absolutte kontraindikasjoner for ACE hemmere og ARBs?

Answer 22

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.

Question 23

Hva er relative kontraindikasjoner for ACE hemmere og ARBs?

Answer 23

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.

Question 24

Hvilke kontraindikasjoner finnes for direkte reninhemmere?

Answer 24

Question 25

Hvilke interaksjoner har ACE hemmere og ARBs?

Answer 25

Question 26

Hvilke interaksjoner har direkte renin hemmere?

Answer 26

Question 27

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

Answer 27