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16 Cards in this Set
- Front
- Back
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What increases release of renin?
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prostaglandins (increased BP--> JG cells, inhibit release of prostaglandins, so that would decrease renin secretion), decrease in NaCl (sensed by macula densa), beta1 adrenergic receptors
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What are three general effects of Angiotensin II?
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1. increased arterial pressure
2. Na/H2O retention (aldosterone) 3. cardiac and vascular remodeling |
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What is the effect of ATII on peripheral resistance?
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directly increases constriction of arteriolar smooth muscle cells, greatest in kidney and least in vascular beds (kidney gets LEAST blood flow)
Enhances release or NE from sympathetic nerves and epinephrine from adrenal glands and increases sympathetics tone on CNS areas NOT protected by BBB |
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What are the effects of ATII on renal function?
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stimulates Na/H+ exchange, enhances aldosterone secretion, constricts mesangial cells
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What are the effects of ATII on cardiovascular structure?
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increases migration, prolif and hypertrophy of SM cells (increased wall:lumen ratio, reason for ventricular hypertrophy in hypertension)
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What are two important ACE inhibitors?
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enalapril, lisinopril
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pharmacological effects of enalapril, lisinopril
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inhibit ACE! powerful. Result: decrease peripheral resistance (don't decrease HR), reduce cardiac & vacular remodeling, promote natriuesis
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enalapril, lisinopril uses in cardiovascular medicine?
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useful in hypertension, heart failure (decrease preload/afterload, increase stroke volume), ventricular dysfunction after infarct, diabetic neuropathy
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elanapril, lisinopril MOA?
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both prodrugs, activated in liver, first pass metabolism
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untoward effects of elanapril, lisinopril?
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if high plasma renin levels.... severe hypotension can occur; dry cough, hyperkalemia (renal insufficiency or K sparing diuretics), teratogenic
NSAIDS may cause hyperkalemia |
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ACE inhibitors in chronic renal disease?
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decrease resistance in glomerular efferent arteriole and reduce intra-glom pressure, reducing protinurea and improved function
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What is aliskiren?
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a renin inhibitor: inhibits renin competitively and reduces angiotensin synthesis
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Mech and SE of aliskiren?
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competitive inhibitor or renin; cough and GI disturbances
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What are the AT1 Antagonists?
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losartan and valsartan
(VAL LOST her ART on the AT) |
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What do AT1 antagonists do and when are they useful?
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They antagonize ATII at the ATI receptor; they are useful for those who develop a cough on ACE inhibitors; otherwise, same as ACE inhibitors
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Why are ACE inhbitors used with diuretics?
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ACE inhibitors retain K (aldosterone) and diuretics, esp. thiazidine, reduce K. It balances out.
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