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CDM 1 Exam 1 > Hypertension - Lecture 2 (RAAS Drugs) > Flashcards

Hypertension - Lecture 2 (RAAS Drugs) Flashcards

1
Q

Most patients with essential HTN have a normal Cardiac output but…

A

increased peripheral resistance

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2
Q

Drugs that target inappropriately high renin release?

A

ACEi
ARBs
Aldosterone Antagonists
Renin Inhibitors

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3
Q

Drug that target inappropriately high sympathetic outflow?

A

a-2 agonist
a-1 antagonist
B-blocker

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4
Q

Drugs that target increased Systemic resistance?

A

CCBs

Direct Vasodilators

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5
Q

Drugs that target abnormal renal salt/water handling?

A

Thiazide
K-sparing
Loop diuretics

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6
Q

Primary factors determining blood pressure?

A

RAAS
Sympathetic nervous system
Plasma volume (mediated by kidneys)

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7
Q

Excess stimulation of RAAS can lead to….

A

increase sympathetic activity
increased PVR
water/salt retention

All leads to increase BP

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8
Q

Targets for RAAS Drugs

A

Renin
ACE
AT1
Aldosterone

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9
Q

How do RAAS inhibiting agents lower BP?

A

via decreased PPR

all work to decreasing activity of Angiotensin II

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10
Q

ACEi MOA

A

block conversion of AT1-AT2 via ACE enzyme

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11
Q

ACEi effect on bradykinin

A

Will cause increase

Leads to cough and angioedema (rare)

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12
Q

Enalapril (Vasotec) Dosage and Frequenecy

A

5-40 mg, 1-2 times daily

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13
Q

Lisinopril (Prinivil, Zestril) Dosage and Frequency

A

10-40 mg, once daily

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14
Q

What to monitor in ACEi?

A

BP
K
ScCr
BUN

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15
Q

Are ACEi considered 1st line without compelling indication?

A

Yes

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16
Q

Benefits of ACEi in someone with vasculature issues?

A

It improves the vasculature

Helps improve blood vessel health and less likely to have that 2nd HA,Stroke, etc

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17
Q

Compelling use of ACEi?

A

Post-MI, HFrEF, ppl with ASVD risk

Renal protection for patients with protein related DM DKD or CKD

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18
Q

Contraindications of ACEi?

A

Pregnancy
Bilateral renal artery stenosis

avoid in women during childbearing years

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19
Q

ACEi efficacy in black patients

A

less efficacy as mono therapy, consider combo

20
Q

Someone has CKD or DKD if they have…..

A

UACR > 30mg/g

eGFR <60

21
Q

Can you use ACEi and ARB together?

A

NO

22
Q

ARB MOA

A

Block the activity of angiotensin II at the AT-type 1 receptor

23
Q

Does ARB have effect on bradykinin metabolism?

A

nope, so won’t have associated side effect

24
Q

Stimulation at AT-1 gives you….

A

Vasoconstriction

Dilation when block

25
Q

Irbesartan (Avapro) Dose and Frequency

A

150-300mg, Daily

26
Q

Lorsartan (Cozaar) Dose and Frequency

A

50-100mg, 1-2 times daily

27
Q

Valsartan (Diovan) Dose and Frequency

A

80-320, Daily

28
Q

Are ARBs considered 1st line without compelling indication?

A

Yes

29
Q

Compelling use of ARBs?

A

Similar to ACEi

Post-MI, HFrEF, ppl with ASVD risk
Renal protection for patients with protein related DM DKD or CKD

consider losartsn in pts with PMH of gout due to increased urinary uric acid excretion

30
Q

ARBs efficacy in black patients

A

less efficacy as mono therapy, consider combo

31
Q

Contraindications of ARB?

A

Pregnancy
Bilateral renal artery stenosis

Don’t use ACE with ARBs together

32
Q

Special use of Losartan

A

consider in pts with PMH of gout due to increased urinary uric acid excretion

33
Q

ADE of ACEi and ARBs

A

Slight SCr rise
Hyperkalemia = most common
Dry Cough*
Angioedema* Rare

*= less common ARBs

34
Q

What to monitor in ARB?

A

BP
K
ScCr
BUN

35
Q

How to deal with ACEi cough

A

cough meds, etc don’t do shit

Stop taking med

36
Q

Angioedema info

A

Not common
2-4 times more frequent in Black people
Due to inhibiting breakdown of bradykinin

Can try an ARB after 6 week washout

37
Q

ACEi and ARB drug interactions?

A

K+ sparring diuretics and K+ supplements

Both increase K+ = too high

38
Q

Direct Renin Inhibitor MOA

A

Blocks RAAS at its initial point of activation - prevents formation of AT1 and AT2

39
Q

Aliskiren (Tecturna) Dose and Frequency

A

150-300mg, daily

40
Q

Can you use Renin inhibitor with ACE and ARB?

A

No chance

41
Q

What to monitor with Direct Renin inhibitor?

A

Potassium
BUN
SCr

42
Q

ADE of Direct Renin Inhibitors?

A 
Hyperkalemia
Gi upset
Cough (Less than ACEi)
only 2 cases Angioedema reported
high fat meals decrease absorption
43
Q

Aldosterone Antagonists MOA

A

Inhibit Aldosterone receptor in distal tubules, increasing NaCL and H20 excretion while conserving K+

Block effect of aldosterone on arteriolar smooth muscle

44
Q

Spironolactone (Aldactone) Dose and Frequency?

A

25-100mg, 1-2/day

45
Q

Avoid Aldosterone Antagonists if….

A

Anuria
K+ > 5mEq/L, on K+ supp, or K+ diuretic
Acute renal insufficiency (CrCl <30ml/min)

46
Q

Special Populations for Aldosterone Antagonists?

A

HF patients with HFrEF
Primary aldosteronism
Resistant HTN

47
Q

ADEs of Aldosterone Antagonists

A 
Hyperkalemia
Hypoatremia
Gynecomastia
impotence
Hypotension

CDM 1 Exam 1 (14 decks)

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