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Pharm 2 Exam > ch 38 - second A > Flashcards

ch 38 - second A Flashcards

1
Q

what RAAS inhibitors have been used safely in infants for management of HTN

A

Captopril and Enalapril

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2
Q

Some ACE inhibitors and ARBs are approved for use in children older than ___ years for treatment of HTN

A

6

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3
Q

Are RAAS inhibitors safe in pregnancy

A

No esp not in the second and third trimesters

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4
Q

RAAS inhibitors and breastfeeding

A

Data lacking, caution is advised

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5
Q

SCOPE and LIFE trials revealed a 25% decrease in stroke in pt 55-80 years old using _____ compared to _____

A

losartan compared with atenolol

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6
Q

A 20% decreased risk for new onset diabetes in older adults was seen with ________

A

Candesartan

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7
Q

what is the effect of angiotensin II in RAAS

A

vasoconstrictor - increase BP

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8
Q

What is the effect of aldosterone in RAAS

A

retains sodium

increases water retention

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9
Q

ACE inhibitors are important drugs for treating

A 
hypertension
heart failure
diabetic nephropathy
MI
prevent adverse cardiovascular events 
acute LV dysfunction
Diabetic and non-diabetic neuropathy
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10
Q

Most prominent risks associated with ACE inhibitors

A

Cough
angioedema
first dose hypotension
hyperkalemia

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11
Q

what does renin do

A 
decrease BP'
decrease Blood volume
decrease renal perfusion
sodium depletion
Bets 1 stimulation
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12
Q

why do ARBs not have the potential for cough like ACE

A

one way that an ACE works is increasing levels of bradykinin

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13
Q

what ACE is administered IV

A

Enalaprilat (Enalapril), all others are PO

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14
Q

What ACE inhibitors should be administered on a empty stomach

A

Captopril

Moexipril

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15
Q

Which ACE inhibitor has the shorter half life and has to be administered 2-3 times per day

A

Captopril (most are once or twice a day)

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16
Q

what ACE inhibitor is given in its active form instead of the prodrug that must undergo conversion to its active form in the small intestine and liver

A

Lisinopril

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17
Q

Pt has a heart attack, what are they discharged on

A

At least a ACE inhibitor and a B blocker (for at least 6 weeks)

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18
Q

What ACE inhibitor does not require renal dosing

A

Fosinopril

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19
Q

all ace inhibitors are approved for what

A

hypertension

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20
Q

What medication does not impair exercise capacity (interfere with cardiovascular reflexes)

A

ACE inhibitors

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21
Q

Does ACE inhibitors cause orthostatic hypotension

A

minimum

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22
Q

Bronchial asthma and ACE

A

fine to use

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23
Q

electrolyte and ACE

A

Hyperkalemia

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24
Q

ACE inhibitors rarely induce ____, ___, ____

A

lethargy, weakness, sexual dysfunction

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25
What drugs reduce the risk for cardiovascular mortality caused by hypertension
ACE inhibitors B blockers Diuretics
26
what 3 ACE inhibitors are approved for patients with MI
Captopril Lisinopril Trandolapril
27
How does ACE inhibitors help in diabetic and nondiabetic neuropathy
principal protective mechanism is reduction of GFR
28
The only ACE inhibitor approved for nephropathy
Captopril (treats but does not prevent)
29
ACE inhibitor approved for reducing the risk for MI, stroke and death from cardiovascular causes
Ramipril (Altace)
30
Approved in reducing morbidity and mortality in patients at risk for major cardiovascular events
Perindopril (Aceon)
31
What ACE inhibitor can reduce the risk for type 1 diabetic retinopathy in some patients (prevent or slow development)
enalapril
32
when taking a ACE inhibitor if hypotension develops, what should the pt do
assume a supine position and seek medical attention if symptoms do not resolve
33
How do you minimize the first dose effect of an ACE inhibitor
start on low doses and. Monitor BP
34
factors that increase the risk for cough while on an ACE are
advanced age Asian ancestry Female
35
what dietary supplements should a pt avoid while on ACE inhibitors
Potassium supplements | salt substitutes using potassium chloride
36
what diuretic to avoid while on an ACE
Potassium sparing diuretic (pg 302)
37
Renal and ACE inhibitors
ACE inhibitors are contraindicated for patients with bilat renal artery stenosis or stenosis in the artery to a single remaining kidney
38
how do you treat angioedema in a pt who is on an ACE inhibitor
Subcutaneous EPI | d/c ACE, never use again
39
Angioedema is caused by accumulation of ____
bradykinin
40
What hematologic side effect does an ACE have
Neutropenia
41
while on an ACE, neutropenia is most likely in which patients
Pt with renal impairment and in those with collagen vascular diseases (ie systemic lupus erythematosus, scleroderma) - withdraw immediately . Neutropenia should resolve in approx 2 weeks.
42
what happens if Neutropenia caused by ACE is not caught early enough what can happen
can progress to fatal agranulocytosis advise pt to call provider if has fever, sore throat, ect
43
what ACE inhibitor is more likely to cause neutropenia
Captopril
44
What drug class when combined with ACE inhibitors can worsen first dose hypotension
Diuretics (should be withdrawn 2-3 days prior to starting an ACE inhibitor)
45
electrolytes and ACE inhibitors
can reduce excretion of potassium.
46
What ACE inhibitor does not need renal dosing
fosinopril
47
Bloodwork with ACE inhibitors
consider checking creatinine 2-4 weeks after starting. Have pt track blood pressures
48
ACE inhibitors and lithium
ACE can cause lithium to accumulate to toxic levels. Monitor frequently
49
NSAIDS and ACE
NSAIDS may reduce the antihypertensive effects of ACE inhibitors
50
What ACE inhibitor is not given orally
Enalapril
51
What 2 side effects that ACEs have do ARBs have a lesser chance of
Cough | hyperkalemia
52
what ARBs are approved for HTN
All of them
53
What ARBs are approved for Heart Failure
Valsartan (Diovan) | Candesartan (Atacand)
54
What ARBS are approved for managing nephropathy in HTN patients with type 2 DM
irbesartan (Avapro) | losartan (Cozaar)
55
What ARB is approved for reducing cardiovascular mortality in post MI patients with heart failure or LV dysfunction.
Valsartan (Diovan)
56
What ARB is approved for reducing the risk for stroke in pt with HTN an LV hyperthrophy
Losartan (Cosaar)
57
What ARB is approved for reducing the risk for MI, stroke and death from cardiovascular causes in pt 55 and older but only if they are intolerant of ACE
Telmisartan (Micardis)
58
what ARB Slowed the development and progression of retinopathy in pt with type 1 without established retinopathy
Losartan (cozaar)
59
Can angioedema occur in ARBS
yes, but incidence is much lower than in ACEs
60
renal and ARBS
Like ACE inhibitors, ARBS can cause renal failure in pt with bilat renal artery stenosis or stenosis in the artery to a single remaining kidney. Use in extreme caution with this populus
61
what bloodwork with ARBS
consider checking creatinine about 2-4 weeks after starting, track BP
62
What drug is a Direct Renin Inhibitor (DRI)
Aliskiren (Tekturna)
63
What is Aliskiren (Tekturna) approved for
only for HTN
64
diet and dosing for DRIS
dosing with a high fat meal with make the availability lower
65
metabolism and DRI s
CYP3A4
66
GI effects of Aliskiren (Tekturna)
diarrhea abd pain dyspepsia women and older adults are most susceptible
67
Hyperkalemia and Aliskiren (Tekturna)
rarely cause hyperkalemia alone but might be expected if aliskiren were combined with and ACE, potassium sparing diuretic or potassium supplements
68
What drug class? eplerenone spironolactone
Aldosterone antagonists
69
What are Aldosterone antagonists used for eplerenone spironolactone
HTN | heart failure
70
what is the significant side effect of Eplerenone (Inspra)
hyperkalemia
71
Maximal reductions in BP in the drug Eplerenone (Inspa) occurs within _______
4 weeks
72
side effects of Eplerenone
``` diarrhea abd pain cough fatigue gynecomastia flu like syndrome ```
73
metabolism concern of eplerenone
Inhibitors of CYP3A4 can increase levels of eplerenone therefore posing a risk for tox weak inhibitors - erythromycin - saquinavir - verapimil - fluconazole strong inhibitors ketoconazole itraconazole
74
lithium and Eplerenone
can raise levels
75
how do ACE inhibitors work
blocks Angiotensin converting enzyme so the angiotensin I cannot change renin to angiotensin II which causes vasodilation
76
How do ARBs work
block receptor sides of angiotensin II
77
How do DRIs work
Blocks renin so angiotensinogen cannot go to angiotensin II
78
what is JNC8
Eighth joint national committee guidelines on HTN

Pharm 2 Exam (18 decks)

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