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Flashcards in ACE Inhibitors/ARBs Deck (20):
1

Outline the RAS

Hypotension – renin secretion – angiotensin I secretion – angiotensin I conversion to angiotensin II by ACE – angiotensin II vasoconstricts and stimulates aldosterone secretion – aldosterone causes sodium retention and potassium excretion

2

What electrolyte imbalance are ace inhibitors commonly associated with?

Hyperkalemia (inhibit sodium retention and potassium excretion)

3

What harmful effect of angiotensin II can ace inhibitors help to prevent?

Remodeling of cardiac and vascular smooth muscle

4

What is kinase II and what effect do ace inhibitors have on it?

Kinase II is an enzyme responsible for degradation of Bradykinin, a vasodilator that amplifies production of prostaglandins that also vasodilate
Ace inhibitors inhibit kinase II (less kinase II = more bradykinin = more vasodilation)

5

List four adverse effects of ace inhibitors

Dry hacking cough, hyperkalemia, angioedema, renal dysfunction in patients with renal artery stenosis

6

Why do ace inhibitors cause a dry hacking cough, and how is it treated?

Result of increased bradykinin in the lungs, potentially treated with aspirin but NOT responsive to any cough suppressants

7

What medications other than ace inhibitors commonly cause angioedema?

NSAIDS (overload of bradykinin)

8

Which trimester of pregnancy is especially important to avoid ace inhibitors?

Third trimester

9

What was the first ace inhibitor?

Captopril

10

What four uses do ACE inhibitors have?

Long term CHF symptom treatments, delay in progression of asymptomatic LV dysfunction, survival benefit for patients with NYHA II- IV (heart failure), renal protection in patients with diabetes (independent of effects on blood pressure)

11

How many times a day is captopril taken?

Three

12

What creatinine clearance suggests necessity for dose adjustment when taking captopril?

CrCl less than 50 mL/minute

13

What is a normal creatinine clearance?

100 to 125 mL per minute

14

What labs must be monitored closely when patients take captopril?

Serum creatinine, BUN, potassium

15

Which ace inhibitor is a prodrug?

Enalapril

16

Name the only ace inhibitor to come in IV dosage form

Enalapril

17

List potential adverse effects of ARB's

Hyperkalemia
(do not cause cough because do not inhibit kinase)

18

How do ARB's work?

Block angiotensin II receptors to prevent binding

19

What is the major use of Neprilysin?

Treatment of CHF (when coformulated with valsartan)

20

How does Neprilysin in combination with valsartan work?

Inhibits enzymes that breakdown vasoactive peptides
(when the heart stretches, peptides make you pee and cause vasodilation. More peptides available = more fluid excretion.)