RAS HTN

Question 1

RAS is important regulator of?

Answer 1

BP and hydromineral balance

Question 2

RAS has a key role in?

Answer 2

HTN
Heart failure
Vascular Disease
Renal Failure

Question 3

Define Renin

Answer 3

Enzyme stored and released by the juxtaglomerular cells

Converts angiotensinogen to Ang1

Question 4

Define Angiotensinogen

Answer 4

Glycoprotein

Synthesized and released form the liver

Question 5

Define Angiotensin I

Answer 5

Inactive protein

Formed in systemic circulation

Question 6

Define ACE

Answer 6

Angiotensin converting enzyme

Question 7

Define Angiotensin II

Answer 7

Active peptide

Question 8

Define Angiotensin 1-7

Answer 8

Peptide

Opposite effect to angiotensin II via Mas receptors

Question 9

What is the rate limiting step in the angiotensinogen to angII pathway?

Answer 9

Angiotensinogen to Ang1 via renin

Question 10

Define AT1 Receptor

Answer 10

Mediator of pressor effects of angiotensin II

Question 11

Define NEP

Answer 11

Neutral Endin Peptidase

Makes Angiotensin 1-7 from Ang1

Question 12

Increased release of renin leads to?

Answer 12

Increased Ang II

Question 13

Increased Ang II leads to?

Answer 13

Increased blood pressure!

Question 14

Regulation of renin release via? Increase release?

Answer 14

↓ NaCl flux across macula densa
↓ BP in afferent arterioles
Activation of B1-receptors on juxtaglomerular cells
↓ circulating ang II

Question 15

Increase in the macula densa pathway means?

Answer 15

Increased filtration and more sodium being absorbed

DECREASED RENIN

Question 16

Increased intraarenal baroreceptor pathway means?

Answer 16

Increased blood pressure in the afferent arteriole

DECREASED RENIN

Question 17

Decrease in beta-adrenergic receptor pathway means?

Answer 17

Decrease release of NE from synaptic terminals leading to a decreased activation of beta receptors
DECREASED RENIN

Question 18

Short loop negative feedback on renin?

Answer 18

Stimulate angiotensin receptors on juxtaglomerular cells

DECREASED RENIN

Question 19

Long loop negative feedback on renin

Answer 19

Increased circulating AngII which increase BP
Through the macula densa pathway, intrarenal baroreceptors pathway, beta-adrenergic receptor pathway
DECREASED RENIN

Question 20

In vasculature, AT2 receptors mediate?

Answer 20

Vasodilation

Question 21

Adult tissues have much less of which type of receptors?

Answer 21

AT2

Question 22

AT1 receptors in the vasculature cause?

Answer 22

Vasoconstriction
SM hypertrophy (chronic)

Question 23

AT1 receptors in the adrenal cortex cause?

Answer 23

Synthesis and secretion of aldosterone

Question 24

AT1 receptors in the adrenal medula cause?

Answer 24

Epinephrine release

Question 25

AT1 receptors in the Kidney cause?

Answer 25

Efferent Arteriole vasoconstriction Inhibition of renin release Increased sodium reabsorption

Question 26

AT1 receptors in the heart cause?

Answer 26

Myocardioal hypertrophy and collagen synthesis

Question 27

AT1 receptors in the brain cause?

Answer 27

Release of vasopressin (ADH), stimulation of thirst and salt appetite, increased central sympathetic outflow

Question 28

Define Bradykinin

Answer 28

Potent vasodilator peptide

Question 29

ACE does what?

Answer 29

AngI to Ang II | Breaks down bradykinin

Question 30

ACE Inhibitors Mechanisms of Action?

Answer 30

Decrease formation of AngII Increased levels of bradykinin Increased (indirectly) formation of Ang1-7

Question 31

ACE Inhibitor Drugs

Answer 31

End in -pril Lisinopril (Privinil; Zestril) Benazepril (Lotensin) Etc

Question 32

Sensitivity of ACEI is increased in pts with?

Answer 32

Activated RAS (low salt diet, heart failure)

Question 33

HTN pts and ACEI?

Answer 33

Decreased vascular resistance and BP Increase the compliance of large arteries Slight decrease in GFR

Question 34

Constriction of the afferent arteriole causes? Dilation?

Answer 34

Decreased GFR bc not as much blood can get through; increased

Question 35

Constriction of the efferent arteriole causes? Dilation?

Answer 35

Increased GFR; decreased GFR

Question 36

Increased Ang II means what for the glomerulus?

Answer 36

Constriction of both afferent and efferent but preference for efferent first

Question 37

ACEI Therapeutic Uses?

Answer 37

``` HTN Left ventricular systolic dysfunction Acute MI Prevention of CAD event and stroke Chronic renal failure ```

Question 38

ACEI Adverse Effects

Answer 38

``` HYPOtension Cough HYPERkalemia Acute renal failure Modest elevation of serum creatinine + NSAIDs = ↓ GFR Teratogenic!!! ```

Question 39

What causes a cough?

Answer 39

Accumulation of bradikynin, substance P and PGs in lung

Question 40

How do NSAIDs ↓ GFR?

Answer 40

Inhibit formation of PGs which are potent vasoconstrictors

Question 41

Most severe adverse reaction of ACEI?

Answer 41

ANGIOEDEMA: rapid swelling of nose, throat, and mouth | Occurs suddenly and unexpected (no time frame

Question 42

AT1 Receptor Antagonists

Answer 42

All end in -sartan losartan (Cozaar) candesartan (Atacand)

Question 43

AT1 Receptor Antagonists Result in?

Answer 43

``` Arterial vasodilation and decrease peripheral resistance Reduction of aldosterone Inhibition of peripheral SNS Increased renin release and activity Increased Ang II levels ```

Question 44

Another name for AT1 Receptor Antagonists is?

Answer 44

Angiotensin Receptor Blockers

Question 45

Differences between ARBs and ACEI

Answer 45

ARB reduce AT1 receptor activity more ACEI increase renin levels but not ang II ARBs generate AngII can act on AT2 (opposite effect of AT1) ACI increase Ang1-7 more than ARBs and levels of bradykinin

Question 46

ARBs Main therapeutic effects

Answer 46

HTN Heart Failure Stroke Prophylaxis Diabetic Nephropathy

Question 47

ARBs adverse effects

Answer 47

HYPOtension (salt depleted pts) HYPERkalemia (renal disease or supplements) Teratogenic potential

Question 48

ARBs have less?

Answer 48

Angioedema potential | And don't cause cough

Question 49

Aliskiren is a ?

Answer 49

3rd generation renin inhibitor

Question 50

Aliskiren Indications

Answer 50

HTN

Question 51

Aliskiren adverse effects?

Answer 51

``` Headache, fatigue, dizziness Diarrhea Nose bleeds HYPERkalemia HYPERuricemia Teratogenic ```