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C. Year 3: Core Drugs > Antihypertensive - Angiotensin-II receptor blockers > Flashcards

Antihypertensive - Angiotensin-II receptor blockers Flashcards

1
Q

Renin in the blood converts angiotensinogen into angiotensin I. Angiotensin converting enzyme (ACE) converts angiotensin I into angiotensin II. Which of the following is NOT a function of angiotensin II?

1 - blood vessels vasoconstriction
2 - vasoconstricts efferent arterioles of glomerulus (preference on efferent arterioles though)
3 - vasodilates afferent and efferent arterioles of glomerulus
4 - binds proximal tubules, increase Na+ and H20 retention
5 - binds adrenal cortex, releasing aldosterone

A

3 - vasodilates efferent arterioles of glomerulus

  • aldosterone increases Na+ and H2O retention
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2
Q

Renin is released from the juxtaglomerular cells of the kidneys. What is the function of renin?

1 - convert angiotensin I into angiotensin II
2 - converts angiotensinogen into angiotensin I
3 - increases anti-diuretic hormone release
4 - increases the release of aldosterone from adrenal glands

A

2 - converts angiotensinogen into angiotensin I

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3
Q

Which of the following are the 2 key core angiotensin-II receptor blockers that we need to be aware of?

1 - Candesartan
2 - Ramipril
3 - Losartan
4 - Doxazosin

A

1 - Candesartan
3 - Losartan

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4
Q

The 2 core angiotensin-II receptor blockers that we need to be aware of are - Candesartan and Losartan. Which is the 1st and most popular drug used in hypertension?

A
  • Losartan
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5
Q

Candesartan and Losartan the core angiotensin receptor II inhibitors inhibitor drugs. What is the mechanism of action of this drug?

1 - binds and inhibits angiotensin II receptors
2 - inhibits ACE
3 - inhibit beta receptors
4 - inhibit alpha receptors

A

1 - binds and inhibits angiotensin II receptors

  • specifically type 1 receptors
  • no angiotensin can bind and therefore it will have no effect
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6
Q

If a patient is <55 y/o and caucasian, the following guidelines are used for treating hypertension.

  • Stage 3: SBP >180 mmHg Treat immediately
  • Stage 2: BP >160/100 mmHg Treat once confirmed on 24hr BP
  • Stage 1: BP > 140/90 mmHg Treat if end-organ damage or if diabetic

Which of the following is indicated as a first line medication for hypertension?

1 - angiotensin-II receptor blockers
2 - β-blockers
3 - ACE inhibitors
4 - Calcium channel blockers

A

1 - angiotensin-II receptor blockers

  • also 2nd line in >55 y/o and black patients, who are less responsive to ACE inhibitors
  • could also prescribe an ACE inhibitors
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7
Q

Angiotensin-II receptor blockers are indicated in which 2 of the following conditions?

1 - embolism
2 - chronic heart failure
3 - 2nd prevention of major cardiovascular event
4 - DVT

A

2 - chronic heart failure
- 1st line for all grades of heart failure

3 - 2nd prevention of major cardiovascular event
- patients with ischaemic heart disease, cerebrovascular disease and PVD

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8
Q

Which drug is indicated in patients with CKD with proteinuria?

1 - α-blockers
2 - β-blockers
3 - angiotensin-II receptor blockers
4 - Calcium channel blockers

A

3 - angiotensin-II receptor blockers

  • reduces SVR and lowers BP
  • all end in sartan
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9
Q

Angiotensin-II receptor blockers (ARB-II) are indicated in patients with CKD with proteinuria. Do ARB-II cause vasodilation of the efferent or afferent glomerular arteriole?

A
  • efferent arteriole
  • vasodilating the efferent arterioles reduces pressure in the glomerulus and reduces kidney damage
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10
Q

Which if the following in diabetes patients indicates the use of angiotensin-II receptor blockers?

1 - diabetic ketoacidosis
2 - diabetic peripheral neuropathy
3 - diabetic nephropathy
4 - diabetic retinopathy

A

3 - diabetic nephropathy

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11
Q

A common adverse effect of angiotensin-II receptor blockers is which of the following?

1 - hypernatraemia
2 - hypokalaemia
3 - hypercalcaemia
4 - hyperkalaemia

A

4 - hyperkalaemia

  • kidneys excrete Cl- and Na+ and retain K+
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12
Q

Can angiotensin-II receptor blockers cause hypo or hypertension following the 1st dose as an adverse event?

A
  • hypotension
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13
Q

Are ACE inhibitors or angiotensin-II receptor blockers (ARB-II) more likely to cause a cough and angioedema?

A
  • ACE inhibitors
  • ARB-II do not inhibit ACE and increase bradykinin
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14
Q

Angiotensin-II receptor blockers should not be used in patients with renal artery stenosis and acute kidney injury for fear of making them worse. However, can ACE inhibitors ever be used in CKD?

A
  • yes when CKD patients have proteinuria
  • lower doses and close monitor should be conducted
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15
Q

Why are angiotensin-II receptor blockers not generally used in patients who are pregnant or breast feeding?

1 - foetal toxicity
2 - increases eGFR
3 - increases foetal immune suppression
4 - induces early labour

A

1 - foetal toxicity

  • has been linked with foetal malformations
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16
Q

Why should angiotensin-II receptor blockers not be prescribed alongside K+ elevating drugs such as aldosterone antagonist and potassium sparing diuretics?

1 - ACE inhibitors increase K+ release
2 - ACE inhibitors inhibit aldosterone release
3 - ACE inhibitors increase aldosterone release
4 - ACE inhibitors damage adrenal glands

A

2 - ACE inhibitors inhibit aldosterone release

  • combined with other drugs this would amplify hyperkalaemia
  • may only be used together in some heart failure patients, BUT closely supervised
17
Q

Which drug class combined with angiotensin-II receptor blockers can increase the risk of nephrotoxicity?

1 - antidepressants
2 - statins
3 - paracetamol
4 - NSAIDs

A

4 - NSAIDs

18
Q

What is the common prescribed dose to start on for losartan in heart failure?

1 - 1.25mg orally/day
2 - 2.5mg orally/day
3 - 5mg orally/day
4 - 12.5mg orally/day

A

4 - 12.5mg orally/day

19
Q

What is the common prescribed dose to start on for losartan in any condition, other than heart failure?

1 - 1.25mg orally/day
2 - 2.5mg orally/day
3 - 50mg orally/day
4 - 12.5mg orally/day

A

3 - 50mg orally/day

20
Q

If a patient is sick and develops diarrhoea and/or vomiting, should they continue to take their angiotensin-II receptor blockers?

A
  • no
  • can further increase risk of dehydration and renal damage
21
Q

Prior to starting angiotensin-II receptor blockers, which 2 of the following MUST be checked?

1 - FBC
2 - WBC
3 - eGFR
4 - U&Es

A

3 - eGFR
4 - U&Es

  • both can be affected by ACE inhibitors
  • should be repeated within 1-2 weeks and if dose changes
22
Q

Angiotensin-II receptor blockers (ARB-II) can generally be a lifetime drug, however, is this always the case?

A
  • no
  • if BP drops or a patient develops frailty or multi morbidity then ARB-II could be reduced or stopped altogether
23
Q

The 2 core

A

C. Year 3: Core Drugs (125 decks)

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