Block 3: Raas

Front 1

go from angiotensinogen to angiotensin II

Back 1

angiotensinogen -> (renin) -> angiotensin I -> (ACE chymase) -> angiotensin II

Front 2

At what receptor does angiotensin II cause
1. Na and fluid retention
vasoconstriction
sympathetic activation
cell growth
aldosterone secretion

Back 2

AT1

Front 3

at what receptor does angiotensin II cause
vasodilation
cell growth inhibition
apoptosis

Back 3

AT2

Front 4

Name four classes of drugs that act on the RAAS

Back 4

1. renin inhibitors
2. ACE inhibitors (captopril and enaapril)
3. ARBs (losartan) (stops angiotensin II from progressing to AT1)
4. MR antagonists (spironolactone and eplerenone) (stops aldosterone from acting on Mineralocorticoid receptors)

Front 5

Name two ACE inhibitors

Back 5

captopril
enalapril

Front 6

Are ACE inhibitors less effective in black patients or white patients

Back 6

black patients

Front 7

In what population/indication is an ACE inhibitor better than a diuretic/beta-bolocker antihypertensive treatment regimen

Back 7

preventing cardiac vascular events (MI, stroke) in hypertensive diabetic patients

Front 8

if ACE inhibitors don't work on the heart, how do they improve the clinical and hemodynamic state of CHF patients

Back 8

they relax vascular smooth muscle (arterial and venous)

Front 9

are ACE inhibitors helpful in patients with acute MI

Back 9

yes

Front 10

Are ACE inhibitors helpful in reducing the rates of death, MI, stroke, cardiac arrest, heart failure, and/or complications of diabetes ONLY in the presence of left ventricular dysfunction

Back 10

no- they can help even in the absence of left ventricular dysfunction

Front 11

What did the HOPE vs. PROGRESS trial show

Back 11

ACE inhibitors show 32% relative risk reduction in stroke

Front 12

What did the HOPE vs. PEACE clinical trial show

Back 12

ACE inhibitors have a use in stable CAD

Front 13

Name four contraindications for ACE inhibitors

Back 13

renal artery stenosis
elevated potassium (>5.5)
symptomatic hypotension
pregnancy

Front 14

Name 6 side effects of ACE inhibitors

Back 14

severe hypOtension
chronic non-productive Cough
dysgeusia (Taste problems)
Renal hemodynamic dysfunction
hyperkalemia
Angioedema
Proteinuria
Pregnancy problems
Rash
Lower Angiotensin II

CAPTOPRIL

Front 15

What interaction occurs between ACE inhibitors and NSAIDS

Back 15

reduced ACE inhibitor antihypertensive effect

Front 16

What interaction occurs between digoxin and ACE inhibitors

Back 16

reduced digoxin clearance

Front 17

What interaction occurs between K supplements or K sparing diuretics and ACE inhibitors

Back 17

hyperkalemia

Front 18

What interaction occurs between thiazide or loop diuretics and ACE inhibitors

Back 18

enhanced hypotensive effect

Front 19

Name an ARB drug

Back 19

losartan

Front 20

what is losartan's MOA

Back 20

AT1 antagonist -> interferes with angiotensin II binding to AT1

Front 21

Would losartan be less effective in black patients or white patients

Back 21

black patients

Front 22

when would you use losartan as monotherapy for hypertension

Back 22

in patients who can't tolerate ACE inhibitors

Front 23

Does losartan cause cough or angioedema

Back 23

no

Front 24

What did the CHARM study show

Back 24

that losartan reduces CV mortality and hospital admissions in patients with left ventricular dysfunction when substituted for ACE inhibitors

Front 25

What did the VALIANT study show

Back 25

that losartan reduces morbidity and mortality after MI

Front 26

What did the ACCESS study show

Back 26

losartan reduces mortality and cardivascular events after stroke

Front 27

Name four contraindications for losartan

Back 27

renal artery stenosis
elevated serum K
symptomatic hypotension
pregnancy
(just the same as ACE inhibitor contraindications)

Front 28

Name two aldosterone receptor antagonists

Back 28

spironolactone
eplerenone

Front 29

this drug is a potassium sparing diuretic
an aldosterone receptor antagonist
weak androgen antagonist
and progesterone receptor agonist

Back 29

spironolactone

Front 30

this drug is a K sparing diuretic, a selective aldosterone receptor blocker with less affinity for androgen, progesterone, and glucocorticoid recptors than spironolactone

Back 30

eplerenone

Front 31

this is a mineralocorticoid hormone produced in the adrenal cortex and in extra-adrenal sites whose synthesis and secretion are affected by angiotensin II, K levels, ACTH and other stimuli

Back 31

aldosterone

Front 32

Name four sites of aldosterone receptors

Back 32

kidney
brain
heart
blood vessels

Front 33

What does aldosterone do in the kidney

Back 33

1. stimulates sodium retention by distal nephrons,
2. K excretion,
3. blood volume expansion,
4. elevation of blood pressure

Front 34

in patients with normal K and adequate renal function, with severe HF caused by LV dysfunction, what treatment should be considered

Back 34

low dose spironolactone

Front 35

What did the EPHESUS trial show

Back 35

eplerenone is helful in patients with LV dysfunction after MI

Front 36

Name two contraindications for aldosterone receptor antagonists (spironolactone and eplerenone)

Back 36

hyperkalemia
cirrhosis

Front 37

What are unique side effects of spironolactone

Back 37

progestational and antiandrogenic effects- gynecomastia, impotence, menstrual irregularities

Front 38

What drug has an interaction with eplerenone and spironolactone

Back 38

digitalis (effects its clearance)

Front 39

Captopril or Enalapril inhibit the activity of ___ to reduce the formation of ___

Back 39

ACE
angiotensin II