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16 Cards in this Set

  • Front
  • Back
Types of Renin Angiotensin Inhibitors
ACEi
Angiontension Receptor Blockers
Direct Renin Inhibitor
ACEi
Included Drugs
Captopril
Enalapril
Lisinopril
Ramipril
ACEi
MOA
Early:
• Inhibit ACE
→ Angiotensin II ↓
(Later → Angiotensin II escape from ↑Renin )

Late:
• Inhibit ACE involved in bradykinin breakdown
→ Bradykinin ↑
→ NO↑, PGE2, PGI2↑
→ Vascular relaxation
ACEi
ADME
• Absorption: Oral
• Distribution: Lipid soluble
• Metabolism:
• Elimination: Renal
ACEi
Clinical Use
HTN
CHF
Diabetes
Renal Disease (usually from diabetes)
ACEi
Adverse Effects
Common:
• Functional renal insufficiency
• Cough (very common)
• Hyperkalemia

Life threatening:
• Angioedema
ACEi
Contraindications and Interactions
Contraindications -
Pregnancy - AT2 receptors more prominent in fetal life

Interactions -
• Aspirin
- Offsets action by inhibiting prostaglandin synthesis
Angiotension Receptor Blockers
Included Drugs
Losartan
Angiotensin Receptor Blockers
MOA
1. Competitive inhibition of AT1 receptor
→Blocked effects of angiotensin II

2. Residual angiotensin II levels binding AT2 receptor
- Opposite effects of AT1 receptor
Angiotensin Receptor Blockers
ADME
• Absorption: Oral
• Distribution:
• Metabolism:
• Elimination: Biliary
Angiotensin Receptor Blockers
Clinical Use
When ACEi can't be used
If patient can't handle cough of ACEi
Angiotensin Receptor Blockers
Adverse Effects
Hyperkalemia
Cough (4x less likely than with ACEi)
Direct Renin Inhibitor
Included Drugs
Aliskiren
Direct Renin Inhibitor
MOA
Direct inhibition of Renin (rate limiting step)
Direct Renin Inhibitor
Adverse Effects
• Renal impairment
• Hypotension
• Hyperkalemia
• Slight increase in CV events
Direct Renin Inhibitor
Contraindications and Interactions
Contraindications:
- Diabetes
- GFR <60 mL/min