RAAS drugs

Question 1

RAAS fxn

Answer 1

increase blood volume and blood pressure when it is low

Question 2

what does blocking RAAS do?

Answer 2

reduce blood volume and pressure

Question 3

RAAS regulates

Answer 3

Blood pressure

Blood volume

Fluid and Electrolyte balance

• also mediates changes associated with hypertension, heart failure and MI

Question 4

Where does RAAS exerts its effect through

Answer 4

angiotensin II and aldosterone

Question 5

aldosterone

Answer 5

increases Na+ reabsorption form the nrpgron tubule

Question 6

angiotensin II

Answer 6

increased release of vasopressin
= increased H2) reabsorption from kidneys
= increased blood volume and blood pressure

Question 7

actions of angiotensin II

Answer 7

vasoconstriction
- stimulates posterior pituitary to release vasopressin
- a) vasoconstriction
-b) increased H2) reabsorption from nephron

Stimulate aldosterone
- acts on adrenal cortex –> secrete aldosterone
- enhances Na+ reabsorption from nephron
Both raise BP

Question 8

Actions of Aldosterone

Answer 8

acts on distal nephron tubule
- increase Na+ reabsorption
–> h20 follows na
- increases BP/volume

Question 9

Renin

Answer 9

converts angiotensinogen into angiotensinogen I

Question 10

Angiotensin - Converting Enzyme (ACE)

Answer 10

converts angiotensin I into active state angiotensin II.

Question 11

2 process of BP regulation by RAAS

Answer 11

1) Vasoconstriction- occurs within MINUTES

2) Renal retention of sodium - DAYS/ WEEKS

Question 12

what are 2 ways angiotensin II promotes water retention

Answer 12

1) reducing glomerular filtration
- reduce urinary output (via vasoconstriction)

2) Aldosterone
- increase Na+ reabsorption and water follows na+

Question 13

ACE inhibitor drug name

Answer 13

Catopril

Question 14

ACE inhibitor fxn

Answer 14

prodrug treating hypertension, heart failure, and MI

Question 15

Mechanism of ACE inhibitors

Answer 15

reduce angio II levels by inhibiting ACE
- decrease BV

Increase levels of Bradykinin
- natural body vasodilator

Question 16

Pharmakinetics of ACE inhibitors

Answer 16

A) PO with food

M) Prolonged half-life, administration 2x / day

Excretion: KIDNEYS = dangerous levels = kidney disease

Question 17

therapeutic use of ACE inhibitors

Answer 17

reduction of hypertension

Heart failure
- prevent/ reverse pathologic changes in cardiac structure

Prevention of MI and Stroke
- reduction BP/BV

Diabetic Nephropathy: leading cause of end stage renal disease
– slow progression of disease by lowering systemin BP= reducing glomerular filter pressure

Question 18

ACE inhibitor Adverse Effects

Answer 18

First Dose hypotension (wide-spread vasodilation

Hyperkalemia

Increased bradykinin
- cough
- angioedema: swelling like hives but underneath skin

Contradiction Renal failure in patients with renal artery stenosis (RAS)
- pt require greater pressure to overcome RAS
–> kidney secretes large amounts of renin
- ACE inhibitors stop this adaptation
- Contraindication for pt with RAS

Question 19

ACE inhibitor drug interactions

Answer 19

Diuretics
- may intensify first dose hypotension

Antihypertensive drugs
- may need to be reduced

NSAIDs
- reduce antihypertensive effects of ACE inhibitors

Question 20

Preparation and administration of anti ACE inhibitors

Answer 20

PO

available in combo with hydrochlorothiazide and perindopril

some combined with calcium channel blockers

Question 21

Angiotensin II Receptor Blocker drug name

Answer 21

Losartan

Question 22

ANG II receptor blockers work by

Answer 22

blocking action of ANG II

Question 23

Difference between ANG II receptor blockers and ACE inhib.

Answer 23

ace inhib- block production of ANG II

ang II recept. blockers = block action of ANG II
- less risk of cough and hyperkalemia

ACE inhib. preferred

Question 24

Direct Renin Inhibitors (DRI)

Answer 24

Aliskiren

Question 25

DRI mechanism

Answer 25

binds tightly with renin -inhibits cleavage of ANG into ANG I reduces influence of entire RAAS - reduced BV/BP

Question 26

Therapeutic uses of DRI

Answer 26

Hypertension - reduces BP to same level as ACE inhib

Question 27

Pharmacokinetics of DRI

Answer 27

OP with high fat meal Half-life = 24 hours

Question 28

DRI adverse effects

Answer 28

Well tolerated GI: dose dependent diarrhea, abd. pain, dyspepsia Hyperkalemia if used with ACE inhib.

Question 29

dyspepsia

Answer 29

indigestion, upset stomach

Question 30

Prep, dosage, admin of DRI

Answer 30

Alone: 150 mg/day - may increase to 300 mg - above this diarrhea increased significantly

Question 31

Aldosterone Antagonist

Answer 31

Eplerenone - first line

Question 32

Mech of Aldosterone Antagonist

Answer 32

Blocks aldosterone receptors - decreased Na+ reabsorption = water stays in kidney = reduced BP/BV

Question 33

Therapeutic uses of Aldosterone Antagonist

Answer 33

Hypertension - max reduction takes 4 weeks - combination with ACE inhib or ARB produces further redicution in BP Heart Failure

Question 34

Aldosterone Antagonist Pharmacokinetic

Answer 34

OP- not affected by food

Question 35

Adverse effects of Aldosterone Antagonist

Answer 35

Hyperkalemia (occurs secondary to sodium retention) - don't combine with sodium potassium supplements - contraindication for patients with high serum potassium (above 5.5 mEq/L)

Question 36

Aldosterone Antagonist drug interactions

Answer 36

P450 inhibitors - increased levels eplerenone = toxicity Drugs that raise potassium blood levels