Drugs acting on Renin-Angiotensin-Aldosterone system Lecture PDF

Question 1

ARB is short for…

Answer 1

Angiotensin II receptor blockers

Question 2

Some angiotensin II is produced without requiring ____, therefore drugs that block this enzyme do not completely stop angiotensin II production

Answer 2

ACE

Question 3

ACE inhibitors mech of action and ADR’s (5)

Answer 3

Prevents conversion from angiotensin I to II, major response is vasodilation, reduced aldosterone promoting renal retention of K+ and excretion of Na+ and H2O

• hypotension
• cough due to increased bradykinin levels
• hyperkalemia
• fetal injury use during 2nd or 3rd trimester
• neutropenia

Question 4

ACE is also known as…

Answer 4

….Kinase II when it functions on bradykinin metabolism

Question 5

ACE inhibitors therapuetic uses (4) and administration

Answer 5

• hypertension and reduce risk of cardiovascular mortality caused by HTN
• heart failure
• ASAP therapy after MI
• slow progression of established nephropathy (diabetic and nondiabetic)

Oral administration

Question 6

ACEI advantages to other antihypertensive agents (4)

Answer 6

• no cardiovascular reflexes
• used safely with bronchial asthma
• does not promote hypokalemia or hyperglycemia like seen with thiazide diuretics
• does not induce lethargy, weakness, or sexual dysnfunciton

Question 7

Angiotensin II action in the vasculature and at the kidney

Answer 7

-constricts afferent arterioles and constricts efferent glomerular arteriole raising glomerular pressure and stasis in high enough conc.

Question 8

ACEI drug interactions (3)

Answer 8

• Diuretics should be withdrawn 2-3 days earlier and can be started later if needed
• hypotensive agents are additive effects
• hyperkalemia if administered with K+ supplements or K+ sparing diuretics

Question 9

ARB’s therapeutic uses (4) and mech of action

Answer 9

• hypertension
• diabetic neuropathy
• MI
• prevention of MI, stroke, and death in patients with high CV risk

-block binding of angiotensin II to type 1 angiotensin II receptors in blood vessels and other tissues causing dilation of arterioles and veins, block all angiotensin II regardless of where it is produced, decrease release of aldosterone from adrenals, does not impact bradykinin

Question 10

ARB vs ACEI

Answer 10

ARBs have lower risk of cough/hyperkalemia than ACEI

Question 11

ARB’s therapuetic uses

Answer 11

• hypertension
• heart failure
• diabetic neurpathy
• MI
• stroke prevention
• prevention of MI, stroke, and death of patients with high CV risk

Question 12

ARB’s ADR’s (4)

Answer 12

• low incidence of dizziness
• rare angioedema (discontinue if occurs)
• hyperkalemia may occur
• fetal harm in 2nd 3rd trimesters

Question 13

Aliskiren (tekturna) drug class and mech of action

Answer 13

• Direct renin inhibitor

- binds renin blocking cleavage of angiotensinogen to angiotensin I leading to decreased levels of II and aldosterone

Question 14

Aliskiren (tekturna) effectiveness

Answer 14

Seen to reduce BP to same extent as ACEI, ARB, or ca2+ blockers, not DOC until long term benefits are found out

Question 15

Aliskiren (tekturna) ADRs (4)

Answer 15

• does not increase bradykinin levels
• diarrhea
• hyperkalemia
• fetal harm same as ARBS and ACEI’s, contraindicated in 2nd and 3rd trimesters

Question 16

Spironolactone (aldactone) function

Answer 16

Block action of aldosterone at distal tubule causing retention of K+ and increased excretion of Na+ over 48 hr period, has diuretic effects that can treat hypertension or edema (often alongside thiazide or loop diuretic as its weak), can act like progesterone and other steroids and cause gynecomastia or hirsutism (or hyperkalemia obvi!!)

Question 17

Eplerenone (Inspra)) function

Answer 17

Produces blockade of aldosterone receptors with no effect on receptors for other steroid hormones, weak K+ sparing diuretic used to treat HTN with other agents, only ADR is hyperkalemia