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Renal II Med 215 > Antihypertensives (RAAS) > Flashcards

Antihypertensives (RAAS) Flashcards

1
Q

What are the three types of Primary Hypertension (92% of hypertension)?

A
  • Low Renin (25% A. Americans and elderly)
  • Normal Renin (60%)
  • High Renin (15%)
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2
Q

Reflex circuit with sensing via stretch receptors located in the carotid sinus and aortic arch that opposes attempts to reduce arterial pressure with drugs. Works second-to-second.

A

sympathetic baroreceptor reflex

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3
Q

Controls the slow, but ultimate regulator of blood pressure because of its infinite gain

A

Renal-blood volume pressure control

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4
Q

α1-adrenergic receptors

A

Blood vessels

  • arterial & venous vasoconstriction
  • maintains venous return w/ changes in posture
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5
Q

α2-adrenergic receptors

A

Brain and periphery

​Presynaptic Feedback Inhibitory Receptors:

  • decreases sympathetic tone
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6
Q

β1-adrenergic receptors

A
  • Increase HR
  • increases heart contractility
  • stimulates renin secretion
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7
Q

β2-adrenergic receptors

A
  • Fight or flight response
  • dilates skeletal muscle vasculature
  • dilates bronchioles
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8
Q

What are the Angiotensin-Converting Enzymes (ACE)?

A

-pril

  • Captopril
  • Enalapril (enalaprilate) | prodrug (active form)
  • Lisinopril
  • benazepril
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9
Q

what are the Angiotensin II Receptor drugs (ARBs)?

A

-artan

  • Losartan
  • Valsartan
  • Candesartan (irreversible binding)
  • Aliskiren (expensive, new, unpopular)
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10
Q

How do you calculate Mean Arterial Pressure (MAP) and what is considered a normal MAP?

A

MAP = diastolic (systolic - diastolic) / 3

normal: 100 mmHg

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11
Q

22 year old female comes into your office with hypertension. She is an athletic, healthy, well-maintained invidivdual w/ no family hx of hypertension. What is most likely the cause of her hypertension?

A

Secondary Hypertension due to oral contraceptives

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12
Q

Malignant hypertension and unilateral renovascular diseases are a consequence of what?

A

High Renin secretion

Low aldosterone secretion

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13
Q

Primary hyperaldosteronism and low-renin essential hypertension are a result of what?

A

Low renin secretion

high aldosterone secretion

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14
Q

What has the biggest impact on resistance of a fluid to flow?

A

radius (to the fourth power)

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15
Q

A blood pressure goal of 140/90 is recommended for who?

A
  • < 60 years
  • diabetic patients w/o CKD (all ages)
  • CKD patients (all ages)
    *
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16
Q

For which group of people is a blood pressure goal of < 150/90 indicated?

A

patients age 60 or older

17
Q

Patient presents with a blood pressure greater than 140/90. Describe how you would treat an African American patient versus a non-black patient?

A

African American:

  • 1st - thiazide or calcium channel blocker (CCB)
  • no ACE (-) (ACEI) or Angiotensin receptor blocker (ARB) due to hypertension in this population being a result of low renin

​Nonblack:

  • Thiazide or CCB or ACEI or ARB
18
Q

African Americans with hypertension are not typically treated with ACE inhibitiors (ACEI) or Angiotensin Receptor Blockers (ARB) due to statistics which show African American patients tend to have a type of low renin hypertension. However, regardless of race all patients with hypertension AND CKD or diabetes are treated with ACEI or ARB or a combination of both. Why is this?

A

Chronic Kidney Disease (CKD) & Diabetes:

Both result in high glomerular pressure. ACEI and ARB dilate efferent arteriole allowing relief from some of that glomerular pressure

preserves remaining kidney function

19
Q

Why are β-blockers no longer used for control of hypertension?

A
  • does not prevent MIs, heart failure, or death as well as other therapies
  • associated with significantly higher incidence of stroke than other therapies
20
Q

Once angiotensin I is cleaved by ACE to form angiotensin II, angiotensin II acts to increased EC fluid volume. How does it accomplish this?

A
  • stimulates thirst
  • stimulates aldosterone secretion
  • stimulates ADH secretion
  • cardiovascular remodeling (so BV can vasoconstrict easier)
21
Q

Due to various causes in chronic hyptension you always see…

A

an increase in total peripheral resistance

22
Q

What effect do ACEI, ARBs, and CCBs have on hypertensive vascular remodeling?

A
  • decrease in media thickness of BVs
  • decreased aortic stiffness
23
Q

What is the first move in management of essential hypertension?

A

Lifestyle modification

Once on a BP med you have to stay on one the rest of your life

24
Q

The MOA of ACE inhibitiors is to stop the action of ACE kinase in convertin angiotensin I to angiotensin II. What unwanted consequence occurs as a result of this therapy?

A

ACE kinase also converts converts bradykinin into inactive metabolites.

there is a build-up of bradykinin

25
Q

The use of ACE inhibitors correlates with a build-up of bradykinin within the body. What does bradykinin build-up cause?

A
  • Vasodilation
  • decrease in GFR (result: increase in serum creatinine)
  • Cough (#1 reason people stop using ACEIs)
  • Proinflammatory
  • Angioedema
26
Q

What are the most popular ACEIs? Why?

A

benazepril and lisonopril

  • both have longer half-lives allowing for 1 dose/day
27
Q

Medication fell out of favor due to patients experiencing a loss of taste due to a constant metallic taste in their mouth

A

ACEI - Captopril

28
Q

What’s the number one reason patients stop using their ACE inhibitor? What’s the second reason?

A

#1 reason = cough

#2 reason = angioedema (swollen tongue, choking)

29
Q

Competitive non Peptide angiotensin II receptor antagonist

A

Losartan - selective for AT1 (1000x more than AT2)

30
Q

What are the benefits of Angiotensin II Receptor Blockers over ACEIs?

A
  • less severe cough symptomology (no bradykinin effect)
  • less severe angioedema

Less severe symptoms as compared to ACEIs

31
Q

Angiotensin II Receptor Blocker (ARB) with a half-life of 5-9 hours and characterized by irreversible binding

A

Candesartan

32
Q

An ARB with a half-life of 6-10 hours that is not a prodrug

A

Valsartan

33
Q
A
34
Q

What patients should NOT use a β-blocker?

A
  • Asthmatic patients (bronchodilation needed)
  • diabetics (beta receptors offset hypoglycemia)
35
Q

What type of hypertension is more commonly seen in children?

A

Secondary hypertension (so identify cause)

NO ACEIs or ARBs in sexually active girls

36
Q

What two patient populations should not receive ACEIs?

A
  • Pregnant patients during ALL three trimesters (fetal harm, malformations)
  • bilateral renal stenosis patients (precipitates kidney failure)

Renal II Med 215 (3 decks)

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