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41 Cards in this Set

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  • Back
What are the most prominent actions of angiotensin II? What do these actions accomplish?
vasoconstriction and stimulation of aldosterone release. These cause a rise in blood pressure.
In the hypertensive patient, how might angiotensin II actually promote high blood pressure? Can this tendency to cause structural changes in the heart and blood vessels cause other problems?
By causing increased thickness of blood vessel walls.

Yes. In atherosclerosis it may cause thickening in the intimal surface of blood vessels and in heart failure and MI it may cause cardiac hypertrophy and fibrosis.
Which part of the nephron does aldosterone act on? What function does it serve?
The distal tubules

Causes retention of sodium and excretion of potassium and hydrogen. This results in an increase of blood volume and blood pressure.
What are some of the adverse pathologic effects of aldosterone?
cardiac remodeling and fibrosis, suppressed uptake of norepinephrine in the heart, dysrhythmias, vascular fibrosis, and baroreceptor reflex disruption.
How does renin affect angiotensin?
It catalyzes the formation of angiotensin I from angiotensinogen.
How does blood pressure, blood volume, plasma sodium content and renal perfusion pressure affect the release of renin? Which of these is most important?
When they decline, renin release is increased.

Reduced renal perfusion pressure is most important.
What converts angiotensin I to angiotensin II? Where is this enzyme located?
Angiotensin-Convertin Enzyme (Kinase II)

On the luminal surface of all blood vessels
How is the RAAS turned off and on?
factors that lower BP turn it on, factors that raise BP turn it off.
When is the RAAS particularly effective?
When the patient is hemorrhaging, dehydrated, or sodium deficient.
What is the advantage of vasoconstriction over renal correction of blood pressure?
It acts much more quickly
How does angiotensin II reduce glomerular filtration?
by constricting renal blood vessels and reducing renal blood flow
What other substance does angiotensin II stimulate the release of?
Aldosterone
Can drugs that inhibit ACE completely block angiotensin II production? Why or why not?
No, because some angiotensin II production occurs in local tissue and is not stimulated by ACE.
What is ACE?
Angiotensin-Converting Enzyme
What are drugs that inhibit ACE used for?
treating hypertension, heart failure, diabetic nephropathy, and myocardial infarction. They are also used to prevent adverse cardiovascular events in patients at risk.
How do ACE inhibiting drugs work?
1. they suppress the formation of angiotensin II
2. They increase levels of bradykinin through the inhibition of kinase II (ACE)
What is a positive effect of ACE inhibitors?
it can prevent or reverse pathologic changes in the heart and blood vessels caused by angiotensin II and aldosterone.
Where do almost all ACE inhibitors convert to their active form? Which one is the exception?
The liver and small intestine.

Lisinopril
Which patients must receive reduced dosages of ACE inhibitor drugs?
Patients with kidney disease
What are the advantages of ACE inhibitors over other antihypertensive drugs?
1. They do not interfere with cardiovascular reflexes like sympatholytic agents so exercise capacity is not impaired and orthostatic hypotension is minimal.
2. They can be used safely in patients with bronchial asthma unlike beta2-adrenergic antagonists
3. They do not promote hypokalemia, hyperuricemia or hyperglycemia like thiazide diuretics
4. They do not induce lethargy, weakness or sexual dysfunction as some other antihypertensives do.
What is the most important effect of ACE inhibitors?
They reduce the risk of cardiovascular mortality caused by hypertension
How do ACE inhibitors benefit in the case of heart failure?
1. They lower arterial tone, improving regional blood flow, reduce cardiac afterload and increase cardiac output.
2. They cause venous dilation, reducing pulmonary congestion and peripheral edema
3. They dilate renal blood vessels, increasing renal blood flow and promoting excretion of sodium and water.
4. They suppress aldosterone and reduce local production of angiotensin II in the heart, preventing or reversing pathologic changes in cardiac structure.
How do ACE inhibitors reduce heart size?
By encouraging excretion of water and sodium and reducing edema they lower blood volume, which decreases venous return to the heart.
What is the leading cause of end-stage renal disease in the United States?
diabetic nephropathy
What is the principle method by which ACE inhibitors benefit patients with nephropathy?
reduction in glomerular filtration pressure by reducing angiotensin II levels.
Which ACE inhibitor is approved for use with nephropathy?
Captopril
Which ACE inhibitor adverse effects are due to a reduction in angiotensin II?
First dose hypotension, hyperkalemia
Which ACE inhibitor side effects are due to elevation in bradykinin?
cough, angioedema
When is first dose hypotension with ACE inhibitors most likely?
In patients with severe hypertension, in patients taking diuretics, and in patients who are sodium or volume depleted
Why should patients taking ACE inhibitors avoid potassium supplements?
Because inhibition of angiotensin II can cause potassium retention by the kidneys and lead to hyperkalemia
When should diuretics be withdrawn to prevent first-dose hypotension?
One week prior to administering an ACE inhibitor
What should be done to other antihypertension medications a patient is taking when an ACE inhibitor is added to the regimen?
The dosages may need to be reduced
What special considerations must be made for a patient taking Lithium and ACE inhibitors?
frequent monitoring of lithium levels
What problems can NSAIDs have when taken with ACE inhibitors?
they can reduce the antihypertensive effects of the ACE inhibitor
What are angiotensin II receptor blockers (ARB) used for?
hypertension, heart failure, diabetic nephropathy, myocardial infarction, prevention of stroke, MI and death in people at high risk for cardiovascular events
What is the difference between ARBs and ACE inhibitors?
1. ACE inhibitors block production of angiotensin II while ARBs block the actions of angiotensin II.
2. ARBs don't cause cough or hyperkalemia but may increase the risk of cancer
What are direct renin inhibitors (DRI)?
Drugs that act on renin to inhibit the conversion of angiotensinogen to angiotensin I, thereby suppressing the entire RAAS.
Which condition are DRIs approved for?
hypertension
What are aldosterone antagonists?
drugs that block receptors for aldosterone.
What are aldosterone antagonists used for?
hypertension and heart failure
Why is the aldosterone antagonist eplerenone preferred over spironolactone?
Spironolactone has more side effects