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39 Cards in this Set

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  • Back
go from angiotensinogen to angiotensin II
angiotensinogen -> (renin) -> angiotensin I -> (ACE chymase) -> angiotensin II
At what receptor does angiotensin II cause
1. Na and fluid retention
vasoconstriction
sympathetic activation
cell growth
aldosterone secretion
AT1
at what receptor does angiotensin II cause
vasodilation
cell growth inhibition
apoptosis
AT2
Name four classes of drugs that act on the RAAS
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)
Name two ACE inhibitors
captopril
enalapril
Are ACE inhibitors less effective in black patients or white patients
black patients
In what population/indication is an ACE inhibitor better than a diuretic/beta-bolocker antihypertensive treatment regimen
preventing cardiac vascular events (MI, stroke) in hypertensive diabetic patients
if ACE inhibitors don't work on the heart, how do they improve the clinical and hemodynamic state of CHF patients
they relax vascular smooth muscle (arterial and venous)
are ACE inhibitors helpful in patients with acute MI
yes
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
no- they can help even in the absence of left ventricular dysfunction
What did the HOPE vs. PROGRESS trial show
ACE inhibitors show 32% relative risk reduction in stroke
What did the HOPE vs. PEACE clinical trial show
ACE inhibitors have a use in stable CAD
Name four contraindications for ACE inhibitors
renal artery stenosis
elevated potassium (>5.5)
symptomatic hypotension
pregnancy
Name 6 side effects of ACE inhibitors
severe hypOtension
chronic non-productive Cough
dysgeusia (Taste problems)
Renal hemodynamic dysfunction
hyperkalemia
Angioedema
Proteinuria
Pregnancy problems
Rash
Lower Angiotensin II

CAPTOPRIL
What interaction occurs between ACE inhibitors and NSAIDS
reduced ACE inhibitor antihypertensive effect
What interaction occurs between digoxin and ACE inhibitors
reduced digoxin clearance
What interaction occurs between K supplements or K sparing diuretics and ACE inhibitors
hyperkalemia
What interaction occurs between thiazide or loop diuretics and ACE inhibitors
enhanced hypotensive effect
Name an ARB drug
losartan
what is losartan's MOA
AT1 antagonist -> interferes with angiotensin II binding to AT1
Would losartan be less effective in black patients or white patients
black patients
when would you use losartan as monotherapy for hypertension
in patients who can't tolerate ACE inhibitors
Does losartan cause cough or angioedema
no
What did the CHARM study show
that losartan reduces CV mortality and hospital admissions in patients with left ventricular dysfunction when substituted for ACE inhibitors
What did the VALIANT study show
that losartan reduces morbidity and mortality after MI
What did the ACCESS study show
losartan reduces mortality and cardivascular events after stroke
Name four contraindications for losartan
renal artery stenosis
elevated serum K
symptomatic hypotension
pregnancy
(just the same as ACE inhibitor contraindications)
Name two aldosterone receptor antagonists
spironolactone
eplerenone
this drug is a potassium sparing diuretic
an aldosterone receptor antagonist
weak androgen antagonist
and progesterone receptor agonist
spironolactone
this drug is a K sparing diuretic, a selective aldosterone receptor blocker with less affinity for androgen, progesterone, and glucocorticoid recptors than spironolactone
eplerenone
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
aldosterone
Name four sites of aldosterone receptors
kidney
brain
heart
blood vessels
What does aldosterone do in the kidney
1. stimulates sodium retention by distal nephrons,
2. K excretion,
3. blood volume expansion,
4. elevation of blood pressure
in patients with normal K and adequate renal function, with severe HF caused by LV dysfunction, what treatment should be considered
low dose spironolactone
What did the EPHESUS trial show
eplerenone is helful in patients with LV dysfunction after MI
Name two contraindications for aldosterone receptor antagonists (spironolactone and eplerenone)
hyperkalemia
cirrhosis
What are unique side effects of spironolactone
progestational and antiandrogenic effects- gynecomastia, impotence, menstrual irregularities
What drug has an interaction with eplerenone and spironolactone
digitalis (effects its clearance)
Captopril or Enalapril inhibit the activity of ___ to reduce the formation of ___
ACE
angiotensin II