Angiotensin receptor blockers

Question 1

ARB-
What are they indicated for?

Answer 1

hypertension
chronic heart failure
secondary prevention of major adverse CVD events
diabetic neuropathy and CKD(but low doses and monitor renal function) with proteinuria

Question 2

ARB-
What are examples?

Answer 2

losartan, candersartan, irbersartan

Question 3

ARB-
How do they work?

Answer 3

Blocking the angiotensin type 1 receptor thereby blocking angiotensin II action, which reduces peripheral vascular resistance.

Also slows progression of CKD by dilating efferent glomerular arteriole

Beneficial in heart failure- reducing aldosterone conc promotes water and sodium retention thereby reducing venous return.

Question 4

ARB-

What are common side effects?

Answer 4

hypotension (esp after first dose)
hyperkaelemia,
renal failure
renal stenosis

(may be preferred in black ppl at higher risk of angioedema)

Question 5

ARB-

who should they be avoided in?

Answer 5

Patients with renal stenosis
AKI
Pregnant and breastfeeding

Question 6

ARB-

What are common interactions?

Answer 6

Potassium-elevating drugs
aldosterone antagonists
potassium sparing diuretic
NSAIDs -inreased risk of nephrotoxicity

Question 7

ARB-
How do you take ARBs?

Answer 7

Low dose for heart failure e.g losartan 12.5mg OD
Other indications- 50mg OD
Dose is titrated up to MAX recommended dose based on response and renal function
Take at first dose at night to avoid symptomatic hypotension

Question 8

ARB-
What would you monitor?

Answer 8

Clinical efficacy
severity of breathlessness
electrolytes
renal function

Stop if serum creatinine rises more than 30% or eGFR is falls more than 25%

Question 9

ARB Entresto-

what does it consist of?

What is the indication?

Answer 9

Sabrutil/valsartan

Sacubitril- neprilysin inhibitor
Valsartan- ARB

Additional treatment option for symptomatic heart failure with reduced ejection fraction