RAAS Meds Flashcards
Explain how the renin-angiotensin-aldosterone system (RAAS) helps regulate blood pressure.
a) Liver produces Angiotensinogen
b) Renin (enzyme) converts Angiotensinogen to Angiotensin-I
c) ACE (Angiotensin Converting Enzyme) converts Angiotensin-I to angiotensin-II
i) ACE found in lungs
d) Angiotensin-II activates receptors on the Kidney which facilitates the release of Aldosterone
i) Aldosterone causes the Kidney to retain sodium and H2O follows sodium, this increases the BP.
e) We can decrease Bp by blocking ACE ( pril) or blocking the Angiotensin-II receptor (Sartan)
How do ACE inhibitors and ARBs interfere with RAAS?
a) ACE inhibitors stop the conversion of Angiotensin-I to Angiotensin-II, so you can’t activate the release of Aldosterone
b) ARBs or Angiotensin-II Receptor Blockers also prevent the release of Aldosterone
What do RAAS medications treat?
Hypertension (HTN) Heart Failure Left Ventricular Dysfunction (LVD) Acute MI Diabetic and non diabetic Neuropathy Coronary artery disease (CAD) Cardiovascular Disease (CVD)
ACE inhibitors and Cardioprotection?
Ace inhibitors can
-prevent MI, stroke, hypertrophy, and death in patients at high cardiovascular risk.
Your patient has Hyperkalemia and HTN. The doctor orders RAAS meds. Should you administer the meds? why not?
NO! Can cause arrhythmias
Your patient has angioedema and swelling in the face. Should you administer the RAAS meds?
Nope. Could make it worse
A pregnant lady in her third trimester comes in to the hospital. She has hypertension. Do you administer the RAAS meds?
No, just no. Will cause fetal injury.
Patient has acute Kidney injury. What meds should you avoid?
Meds that reduce blood flow even more such as RAAs meds.
What should you keep in mind when first giving an ACE inhibitor?
First dose Hypotension (Occurs due to REDUCTION in Angiotensin II)
First dose should be low
Tell patient to watch for: falls dizziness fatigue lightheadedness and to use call light. Get up slowly.
You are about to give a patient their first dose of Lisinopril, you notice that they are on a diuretic. What should you do?
Do not give first dose with diuretic (discontinue diuretic 2-3 days before)
Na depleted- Hyponatremia
Volume depleted Hypovolemia
Which adverse effects are common to both ACE inhibitors and ARBs?
Renal Failure
Angioedema
Fetal injury
What causes angioedema?
increase in Bradykinin ( ACE inhibitors inhibit its break down, but ARBs, through an indirect mechanism, increase Bradykinin synthesis)
Therapeutic effects of RAAS meds?
Decreased blood volume
Vasodilation
Cardioprotection
Lisinopril
ACE inhibitor - most common
Lisinopril/HCTZ
Lisinopril with HCTZ diuretic
You don’t want to start this as first dose because you don’t want to take a diuretic when you first take an ACE inhibitor.
