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29 Cards in this Set

  • Front
  • Back
Angiotensin II is formed by the actions of two enzymes:
renin and angiotensin-converting enzyme (ACE).
What is Aldosterone's effect on the kidneys?
it promotes the retention of sodium and water.
How does the RAAS raise blood pressure?
by causing vasoconstriction and by increasing blood volume (secondary to aldosterone-mediated retention of sodium and water).
How might Angiotensin II cause pathologic changes in the heart and blood vessels
In the heart the compound may cause hypertrophy (increased cardiac mass) and remodeling (redistribution of mass within the heart).
What might angiotensin II be responsible for in a patient with atherosclerosis?

heart failure and myocardial infarction?

In hypertension?
in atherosclerosis it may be responsible for thickening the intimal surface of blood vessels;

heart failure and myocardial
infarction, it may be responsible for causing cardiac hypertrophy and fibrosis.

increasing the thickness of the blood vessel walls.
What is the function of Renin (pronounced “reenin”) .

factors that lower blood pressure turn the system on; factors that raise blood pressure turn it off.
catalyzes the formation of angiotensin I from angiotensinogen
What is the function of ACE ?
catalyzes the conversion of angiotensin I (inactive) into angiotensin II (highly active).
The RAAS is always poised and ready to be activated when what occurs?

When does it inactivate?
factors that lower blood pressure turn the system on; factors that raise blood pressure turn it off.
The beneficial effects of ACE inhibitors are attributed to what?
inhibition of ACE but also inhibition of its predecessor, kinase II
Inhibition of ACE causes inhibition of _______. This causes ______, ______, and prevention or reversal of pathologic changes in the heart and blood vessels.mediated by angiotensin II and aldosterone.
angiotensin II

vasodilation, decreased blood volume,
ACE inhibitors are used to treat?
patients with hypertension, heart failure, myocardial infarction (MI), and nephropathy, both diabetic and nondiabetic. In addition, they are used to prevent MI, stroke, and death (from cardiovascular causes) in patients at high risk for a cardiovascular event
ACE inhibitors offer several advantages over most other antihypertensive drugs. In contrast to the sympatholytic agents....?
ACE inhibitors do not interfere with cardiovascular reflexes.

Additinoally they can be used safely in patients with bronchial asthma.
What nursing interventions would be appropriate to teach a patient newly prescribed an ACE-I? Would it be safe to let this patient get out of bed if in the hospital? The patient should be discouraged from getting up at this point.
The patient should be discouraged from getting up at this point.

ACE inhibitors can produce serious first-dose hypotension by causing a sharp drop in circulating angiotensin II.
______, secondary to accumulation of ______, is the most common reason for discontinuing ACE inhibitors.
Cough

bradykinin

The cough is usually a dry cough which patients find irritating. Cough occurs in 5% to 10% of patients taking ACE Inhibitors and is due to the accumulation of bradykinin. The cough will subside within 3 days of discontinuing the medication and should be totally absent within 10 days of discontinuation. The cough will not lead to angioedema and does not decrease the immune response, leading to respiratory illness.
By suppressing aldosterone release, ACE inhibitors can cause _____.
hyperkalemia

Exercise caution in patients taking potassium supplements, salt substitutes, or potassium-sparing diuretics.
• ACE inhibitors can cause a precipitous ____ in blood pressure in patients with bilateral renal artery stenosis (or stenosis in the artery to a single remaining kidney).
drop
Ace Inhibitors can cause severe renal insufficiency in patients with ________.
bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney.
What is angioedema and what s/s of it?
a potentially fatal reaction that develops in up to 1% of patients.

Symptoms, which result from increased capillary permeability, include giant wheals and edema of the tongue, glottis, and pharynx
_________, Aleve, etc. may reduce the antihypertensive effects of ACE Inhibitors
NSAIDS such as ibuprofen Aleve, etc
How ARB's and ACE inhibitors similar ?
ARBs are similar to ACE inhibitors in that they cause vasodilation, suppress aldosterone release, promote excretion of sodium and water, reduce blood pressure, and cause birth defects and angioedema.
ARB's are used in the tx of?
hypertension, heart failure, diabetic nephropathy, MI and in stroke prevention.
What isLosartan (Cozaar) an ARB, indicated for
indicated for and reduces the risk of stroke in hypertensive crisis. It has also been approved for the management of nephropathy in hypertensive patients with type II diabetes mellitus. It delays the development of overt nephropathy and slows the progression of established renal disease.
How do ARB's differ from ACE inhibitors?
ARBs differ from ACE inhibitors in that they do not cause hyperkalemia or cough.
T/F/ Due thier similarities, aliskiren, the prototype DRI, ARBs, and ACE inhibitors are for the most part clinically interchangeable.
FAlse
Aliskiren is approved only for treatment of _______.
hypertension.
Aldosterone antagonists (spironolactone, eplerenone) do what?
block receptors for aldosterone.
What are aldosterone antagonists used to treat?
hypertension and heart failure
Eplerenone (an aldosterone antagonist) is generally well tolerated. The incidence of adverse effects is nearly identical to that of placebo. The greatest risk with eplerenone is ________.
hyperkalemia

therefore, there would be risk if this drug were to be combined with a potassium sparing diuretic, like spironolactone (Aldactone).
T/F
Inhibitors of CYP3A4 can increase levels of eplerenone, thereby posing a risk of toxicity.
True

Even weak inhibitors (eg, erythromycin, saquinavir, verapamil, fluconazole) can double eplerenone levels.