renin angiotensin system inhibitors

Question 1

what are the 3 types of renin system inhibitors?

Answer 1

1- Angiotensin converting enzyme inhibitors (ACE inhibitors )—> PRILS

2- Angiotensin receptor blocker (ARBS )—> Atran

3- Renin inhibitors ——-> skirin

Question 2

what are the effects of angiotensin 2?

Answer 2

1- potent vasoconstrictor via gq, AT1 receptors (ADH, Alpha agonists , endothelin also work on this receptors )

2-increase aldestrone release (Increase water retention )

3- Increase apoptosis—> thats why its bad for pregnancy cuz apoptosis is important for newborn development

4- Increase ADH/Vasopressin release (Increase water retention and vasoconstriction

Question 3

ace inhibitors MOA

Answer 3

1- vasodilation ( directly) ( EVEN IF RENIN IS NOT THE PROBLEM)

2- Decrease aldosterone release and ADH ( INDIRECT VASODILATION cuz it blocks vasopressin which is adh )

3- inhibit apoptosis BAX. BAD1( Bad for pregnancy )

4- Increase bradykinin /prostaglandins which induce VASODILATION (indirect vasodilation mechanism)

5- reset baroreceptors like bb no reflex tachy cardia and activate parasympathetic activity

Question 4

What are examples of ace inhibitors

Answer 4

Captopril —> الكابتن –> prototype
Enalapril
lisinopril
Fosinopril
Benzapril
Ramipril
enalaprilat IV formula

Question 5

which ace inhibitor has sulfate group

Answer 5

captopril
zofenopril

Question 6

what does the sulfate group does?

Answer 6

cause immune problems and angioedema ( With bradykenin) , Rash, leukopenia

Question 7

which ace inhibitor is iv and given in emergencies

Answer 7

enalaprilat

Question 8

which of the ace inhibitors is not a prodrug and that doesnt require activation

Answer 8

lisinopril and can be used in hepatic failure cuz it doesn’t require activation

Question 9

which of the ace drug is not primarily eliminated by kidneys

Answer 9

Fosinopril

Question 10

whats the relation between nsaids and ace inhibitors/antihypertensive agents?

Answer 10

nsaids inhibit the actions of all antihypertensive drugs

Question 11

what are the uses of ace inhibitors

Answer 11

1- NUMBER 1 drug used for hypertension

2- congestive heart failure cuz it leads to vasodilation of vessels and reduce the pressure and decrease afterload

3- after MI cuz they inhibit apoptosis and stop the heart from remodeling

4- diabetes + hypertension = whenever you see diabetes + hypertension give ACE CUZ DIABETES CAUSE DIABETES NEPHROPATHY

Question 12

What are the adverse effects of ACE inhibitors

Answer 12

C = cough caused by bradykinin SWITCH TO ARB

A= angioedema caused by bradykinin/sulfate SWITCH TO ARB

P= proteinurea = caused by kidney failure = stop medication cuz kidney needs RAAS

T= taste loss = temporarily
O= orthstatic hyptension = temporarily

P= pregnancy ( fetal abnormalities ) = never give

R = rash due to sulfate = switch to something without sulfate

I= increased potassium / hyperkalemia = need to stop medication cuz it leads to paralysis

L = leukopenia = due to sulfate = switch to something without sulfate

Renal failure

Also lead to increased renin secretion cuz of negative feedback

Question 13

what are the contraindicated scenarios where you cant give aces

Answer 13

1- pregnancy
2- hyperkalemia
3-proteinurea
4-leukopenia
5- BILATERAL RENAL STENOSIS AND RENAL FAILURE

Question 14

when do you give ACE and whats the relation between creatinine

Answer 14

creatinine levels indicate kidney function

0.8 - 1.2 = normal kidney
1.2 - 3 = minor kidney damage
3+ = sever kidney ischemia = never give AC

Question 15

what are angiotensin receptor blockers ( ARBS)

Answer 15

Atrans : block AT1 receptor leading to the same effects as ace inhibitors

Question 16

give examples of ARBS

Answer 16

loseratran, valsartran , telmeatran, comedyatran

Question 17

what are the advantages of ARBS over ACE inhibitors

Answer 17

1- no braddykinine accumulation side effects : no angioedema/no dry cough

2- Spares AT2 receptors which is a good receptor that causes vasodilation cuz ARB only blocks AT1

3- avoids the problem with none angiotensin converting enzyme ( there are other enzymes that convert angiotensin 1 into ang 2 that are not ACE so sometimes when you give ACE inhibitors it will only block ace but not the others and the other enzymes that are non ace will convert ang 1 into ang 2 so you are not actually blocking ang 2) ARB avoids this

Question 18

what are renin release inhibitors :

Answer 18

ALISIRKIN which block the renin release directly

Question 19

what are the side effects of aliskirin

Answer 19

1- Diarrhea
2- cough
3-angioedema

Question 20

which liver enzyme metabolizes aliskirin

Answer 20

CYP3A4

Question 21

when is alirskirin contraindicated

Answer 21

pregnancy