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30 Cards in this Set
- Front
- Back
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What are the 3 types of drugs that block the renin-angiotensin-aldosterone system?
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Angiotensin Converting Enzyme inhibitors
Angiotension Receptor Blockers Renin inhibitors |
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What is the function of ACE?
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Converts angiotensin I to angiotensin I, using up bradykinin.
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What is the function of renin?
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Released with a drop in BP, converts angiotensinogen to angiotensin I.
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What are the 6 actions and main consequences of angiotensin II?
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Potent vasoconstriction
Release of aldosterone from adrenal cortex (Na retention, volume expansion) Release of ADH from posterior pituitary (fluid retention) enhances sympathetic nervous system activity centrally and peripherally Promotes growth (myocardial and vascular remodeling) Inhibits renin production Serves to increase intravascular volume and increase BP. |
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What secretes renin?
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Juxtaglomerular apparatus
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What 3 things result in renin secretion?
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Decreased sodium delivery to the macula densa
Decreased renal blood flow Sympathetic activation |
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ACE: where is it located? what is its biochemical function? why is it really important?
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Membrane-bound in endothelial cells
Cleaves C-terminal dipeptide from Ang I and bradykinin Poised to regulate balance between Ang II and bradykinin |
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Why do Ang II and bradykinin oppose one another?
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Vasodilation vs vasoconstriction
Bradykinin activates tPA, angiotensin II activates PAI-I |
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What are the key effects of bradykinin?
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Vasodilation (NO production, PG production, endothelial-derived hyperpolarizing factor)
Natriuresis |
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What is the suffix associated with ACE inhibitors?
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Pril
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What is the route of elimination of ACE inhibitors?
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Renal clearance except fosinopril and trandolapril (which are also hepatically metabolized)
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What ACE inhibitor has the shortest half life? What does this result in?
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Captopril
Good in test-dose situations |
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What structural characteristics allow for differentiation of ACE inhibitors?
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Structure of Zinc ligand site
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What are the 4 indicators for ACE inhibitors?
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HTN (systolic and diastolic)
CHF Diabetic nephropathy IHD |
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How do ACE inhibitors lower blood pressure?
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Reduce SVR without increasing heart rate
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When are ACE inhibitors most effective?
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More effective as a single agent in patients with normal-to-high renin levels
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How does ethnicity affect ACE inhibitors?
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Renin dependent to volume dependence transition occurs at a younger age in African Americans
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How do ACE inhibitors affect CHF? (4 ways)
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Reduce afterload and systolic wall stress
Increase CO without increasing HR Decreased scarring Increased survival |
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What 3 actions of ACE inhibitors make them useful in diabetic nephropathy?
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Decrease glomerular capillary pressure
Decrease proteinuria Anti-proliferative effects |
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Describe the side effects of captopril.
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Skin rash
Neutropenia, associated with renal dz or collagen-vascular dz Sulfhydryl group related |
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What side effects are common to all ACE inhibitors?
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Fetal anomalies
Hypotension Hyperkalemia Cough Renal failure Angioedema CHAR Holland Fire |
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Describe the epidemiology of cough caused by ACE inhibitors.
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1/10
Women>men Asians |
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Why can renal insufficiency occur with ACE inhibition?
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With decreased flow, GFR is maintained by constriction of the efferent arteriole, but that is where ACE inhibitors work.
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Give the drug interactions and potential effects with ACE inhibitors.
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Hyperkalemia: with K-sparing diuretics or K supplements
Decreased anti-HTN effect: with NSAIDs Decreased bioavailability: antacids Cough: capsaicin Angioedema: DPPIV inhibitors |
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What are the good effects of bradykinin?
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ACE inhibitors lower BP even in low-renin patients, perhaps a bradykinin effect.
May contribute to anti-ischemic effects by increasing tPA |
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What are the bad effects of bradykinin?
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May underlie angioedema and other side effects of ACE inhibitors, like cough
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What are the side effects of ARBs?
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Hypotension
Hyperkalemia Fetopathic? GI, hepatic |
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What is the ARB?
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Losartan
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What drug is a renin inhibitor?
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Aliskiren
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How does ACE inhibition affect glucose?
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Increases glucose uptake in skeletal muscle, promoting insulin sensitivity
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