Renin Angiotensin System

Question 1

List 3 drugs that are classified as Renin secretion blockers.

Answer 1

• Clonidine
• Propranolol
• Methyldopa

Question 2

Other clinical applications of ACE Inhibitors?

Answer 2

• Treatment of hypertension.
• Decrease morbidity and mortality in heart failure and left ventricular dysfunction after myocardial infarction.
• Delaying the progression of diabetic nephropathy.

Question 3

List down the major drugs classified ads Angiotensin II Receptor Blockers.

Answer 3

• Losartan
• Valsartan
• Olmesartan
• Irbesartan
• Candesartan
• Eprosartan
• Telmisartan

Question 4

List down the major drugs classified as Renin Inhibitors .

Answer 4

• Aliskiren
• Remikiren
• Enalkiren
• Pepstatin
• N- acetyl pepstatin

Question 5

Why is Aliskiren considered to be a more potent anti - hypertensive drug compared to other renin inhibitors?

Answer 5

• Aliskiren decreases plasma baseline activity of renin hormone in hypertensive subjects .
• Also eliminates the rise produced by ACE inhibitors, ARBs and diuretics, therefore has a stronger anti - hypertensive effect.

Question 6

Site of synthesis & storage of renin hormone?

Answer 6

Juxtaglomerular apparatus of the kidney made up of afferent arterioles, efferent arterioles & macula densa cells.

Question 7

Mention 3 factors that increase production of Angiotensinogen.

Answer 7

• Corticosteroids
• Estrogen
• Thyroid hormone
• Angiotensin II

Question 8

Angiotensin Converting Enzyme is mainly found in ?

Answer 8

The luminal surface of vascular endothelium.

Question 9

Outline the major biological substrates of Angiotensinogen Converting Enzyme.

Answer 9

• Angiotensin I
• Bradykinin - inactivates it
• Enkephalins
• Substance P

Question 10

State the major physiological actions of Angiotensin II hormone.

Answer 10

• Vasoconstriction.
• Aldosterone release from the zona glomerulosa of the adrenal cortex.
• Increased sympathetic activity with catecholamine release.
• Stimulates angiogenesis and myocardial fibre hypertrophy.

Question 11

List 5 major drugs classified as ACE Inhibitors.

Answer 11

CCRP BELT
* Catopril
* Cilazapril
* Ramipril
* Perindopril
* Benazepril
* Enalapril
* Lisinopril
* Trandolapril

Question 12

All ACE inhibitors are eliminated through the kidney except?

Answer 12

• Fosinopril
• Moexopril

Question 13

Outline the major clinical indications of ACE inhibitors.

Answer 13

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* Hypertension ( mild or moderate).
* Congestive Cardiac Failure.
* Myocardial infarction.
* Angina pectoris.
* Prophylaxis of cardiovascular risk subjects .
* Diabetic nephropathy.
* Scleroderma crisis .
* Hypertensive heart disease.

Question 14

State the major adverse effects seen after use of ACE inhibitors.

Answer 14

CAPTOPRIL
* Cough ( dry cough , +/- wheezing)
* Acute Renal Failure
* Pregnancy contraindication
* Taste changes
* Oedema ( angioedema)
* Proteinuria
* Rashes
* Increased Potassium levels ( hyperkalemia)
* Low BP ( hypotension) in the first dose

Question 15

Drugs that may have negative interactions with ACE inhibitors?

Answer 15

• Potassium supplements
• Potassium sparing diuretics
• NSAIDS