ACE Inhibitors and ARBs DSA I Flashcards Preview

RENAL II Exam 3 > ACE Inhibitors and ARBs DSA I > Flashcards

Flashcards in ACE Inhibitors and ARBs DSA I Deck (24):
1

ANP

vasodilator - inhibits RAAS

2

renin

released with sympathetic activation of beta-1 receptors on JG cells

3

angiotensinogen

synthesized in liver
> ANG I (renin)

-can be increased in inflammation, corticosteroids, insulin, estrogen, thyroid, ANG II

4

ANG I

> ANG II (ACE)

5

ANG II

activates GPCRs
-rate of synthesis - depends on renin

EFFECTS
-vasoconstriction vas. smooth m
-adrenal - aldosterone
-renin inhibition from kidney (- feedback)
-heart - hypertrophy/remodeling
-brain - baroreceptor to higher set point

6

ACE

activates ANG I > ANG II
inactivates bradykinin > inactive metabolite

7

ANG II receptor

GPCRs - AT1 and AT2

AT1 - major in adults
-PLC > IP3 and DAG > smooth m. contraction

AT2 - bradykinin and NO production (vasodilation)

8

aldosterone

increased reabsorption of Na - DCT and collecting tubules

increased ENaC and Na/K ATPase
-increased Na reabsorption and K secretion

9

ACE inhibitors

inhibit ANG II formation and bradykinin inhibition
-decrease TPR ** (good in physically active patients)

10

BP agents for athletes

ACE inhibitors

11

ACE inhibitor clinical use

HTN, nephropathy, heart failure, left V dysfunction, AMI, prophylaxis of CVD events

12

ACE inhibitor toxicity

hypotension
ARF (renal a stenosis )
hyperkalemia
cough**
angioedema

13

ACE inhibitor contraindication

pregnancy
-fetal hypotension, anuria, renal failure, fetal malformation, tetarogen during first trimester

14

ACE inhibitor drug drug interactions

potassium supps and K sparing diuretics
-hyperkalemia

NSAIDs - block hypertensive effects (bradykinin prostaglandin mediated)

15

ARBs

selective blockade of AT1 receptors
-decreased smooth m contraction

16

AT1 receptors

GPCR > PLC > IP3 and DAG > smooth muscle contraction

17

ARB clinical use

HTN, diabetic nephropathy, HF, left ventricular dysfunction, AMI, prophylaxis for CV events

18

effects of ARBs

(-) of ANG II
-block smooth m contraction
-decreases pressor response
-decreased aldosterone
-changed renal function
-decreased cellular hypertrophy and hyperplasia

19

ACE (-) vs. ARB

ARB - only at AT1 receptors

20

ARB toxicity

-lower cough and angioedema
-not recommended during pregnancy

21

losartan

metabolized by CYP450 to more potent metabolite

22

clonidine

alpha-2 agonist in brainstem - blocks renin secretion

23

propanolol

non-selective beta agonist
-block JG cell beta-1 release of renin
-decrease blood pressure

24

aliskiren

direct renin inhibitor
-decreased ANG I, ANG II, and aldosterone

fetal and neonatal morbidity in pregnancy

use with caution in patients with kidney insufficiency