The Vascular System Flashcards
released by the kidneys in response to decreased perfusion
renin
Released by the liver and converted to angiotensin I by renin
Angiotensinogen
Activity unknown; converted to angiotensin II by ACE
Angiotensin I
Causes vasoconststriction, salt retention & vascular growth
angiotensin II
Angiotensin II stimulates the release of:
aldosterone
Decreased renal perfusion pressure leads to: (3)
- INCREASED renin release
- INCREASED renal sympathetic activity
- DECREASED glomerular filtration
What three scenarios lead to INCREASED renin release?
- Decreased renal perfusion pressure
- Decreased glomerular filtration
- Increased renal sympathetic nerve activity
Angiotensinogen acts on :
Angiotensin I
Angiotensin I is acted on by ____ to produce angiotensin II
ACE
What do ACE inhibitors decrease? What does this lead to?
ACE: No angiotensin II production
Angiotensin II acts on ____ receptors
AT1
What are the receptor antagonists for AT1 receptors?
Angiotensin II AT1 subtype receptor antagonists
What are the 3 effects of angiotensin II acting on AT1 receptors?
- vascular growth
- vasconstriction
- salt retention
Describe the vascular growth caused by angiotensin II:
- hyperplasia
- hypertrophy
Describe the vasoconstriction caused by angiotensin II:
- Direct
- Via increased noradrenaline release from sympathetic nerves
Describe the salt retention caused by angiotensin II:
- Aldosterone secretion
- Tubular Na+ resorption
AT1:
angiotensin 1 receptor
ACE:
angiotensin converting enzyme
List the different drug class medications effecting RAAS:
- Direct renin inhibitor
- ACE inhibitors
- Angiotensin receptor blockers
- Aldosterone agonists
Blocks renin activity on angiotensinogen:
Direct renin inhibitor
Prevents ACE from converting angiotensin 1 to angiotensin 2
ACE inhibitors
Blocks angiotensin II activity at the AT1 receptor:
Angiotensin receptor blockers
Blocks the activity of aldosterone in the kidneys and other tissues (i.e. heart, smooth muscle)
Aldosterone antagonists
Give an example of a direct renin inhibitor:
Aliskiren
Give an example of an ACE inhibitor:
- Captopril
- Enalapril
Give an examples of an angiotensin receptor blockers:
- Candesartan
- Valsartan
Give an example of aldosterone antagonists:
- Eplerenone
- Spironolactone
Aliskerin is a:
direct renin inhibitor
- Direct renin inhibitor
- Used for hypertension
- ADRs: diarrhea, dyspepsia, and hypotension
- DDI: Increased levels when combined with CYP3A4 Inhibitors like macrolide antibiotics
Aliskerin
Dental implications for aliskerin:
- monitor vital signs
- avoid sitting patient tup too fast
the “prils” =
ACE inhibitors
- Benazepril
- Captopril
- Enalapril
- Fosinopril
- Lisinopril
- Moexopril
- Perindopril
- Quinapril
- Ramipril
- Trandolapril
ACE INHIBITORS
What acronym can be used for adverse drug reactions of ACE inhibitors? (list them out)
CAPTOPRIL
C: Cough
A: Angioedema & Agranulocytosis & Acute renal insufficiency
P: Potassium excess (hyperkalemia) & Proteinuria
T: Taste change
O: Orthostatic hypotesnion
P: Pregnancy (contraindication)
R: Renal artery stenosis (contraindication)
I: Increased serum creatinine
L: Leukopenia & Liver toxicity
Lisinopril is an example of:
ACE inhibitor
Lisinopril can be used to treat:
- HTN
- HF
- Post MI
- Kidney disease
What are some dental implications for patients on ACE inhibitors?
- Orthostatic hypotension
- Monitor vitals
- Cough may cause lengthy procedures
- If dental surgery is anticipated, evaluate risk of hypotensive episode
The “sartans”
angiotensin receptor blockers
- Azilsartan
- Candesartan
- Eprosaarton
- Irbesartan
- Losartan
- Olmesartan
- Telmisartan
- Valsartan
Angiotensin receptor blockers (sartans)
Angiotensin receptor blockers ADRs:
HDH:
- Headache/ Hypotension
- Dizziness
- Hyperkalemia
- Cough
- Angioedema
What are angiotensin receptor blockers used for?
- hypertension
- HF
- Kidney disease
Drug-Drug Interactions for angiotensin receptor blockers:
- Sedative meds- increased anti-hypotensive effects
- NSAIDs- reduced anti-hypertensive effect
- General anesthesia- increased anti-hypertensive effect
Dental implications for angiotensin receptor blockers:
- orthostatic hypotension
- monitor vital signs
- if dental surgery is anticipated, evaluate risk of hypotensive episode