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Pharmacology
ACEIs and ARBs
| Question | Answer |
|---|---|
| effect on the renin-angiotensin-aldosterone system | lowers BP, improves oxygenation to heart muscle, decreases remodeling of heart muscle after MI or HF, reduces adverse effects of diabetes on the kidney |
| thought to be a factor in the cough associated with ACEIs | bradykinin |
| mechanism of ARBs | angiotensin II receptor blockers |
| do ARBs affect bradykinin | no therefore they do not have side effect of cough as ACEIs do |
| do ACEIs and ARBs produce reflex tachycardia | no |
| ACEIs help to prevent diabetic nephropathy by | improved renal hemodynamics, diminished proteinuria, retarded glomerular hypertrophy, slower rate of decline in GFR |
| ACEIs | benazepril (Lotensin), captopril (Capoten), Enalapril (Vasotec), fosinopril (Monopril), lisinopril(Prinivil,Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril(Altace), trandolaparil(Mavik) |
| ARBs | candesartan(Atacand), eprosartan(Teveten), irbesartan(Avapro), losartan(Cozaar), olmesartan(Benicar), telmisartan(Micardis), valsartan(Diovan) |
| only short-acting ACEI | Captropril (Capoten) |
| kidney is primary organ of excretion for ACEIs except for | fosinopril (Monopril) and moexipril(Univasc) |
| 3 absolute contraindications for ACEIs | 1. bilateral renal artery stenosis 2. angioedema 3. pregnancy |
| what must be adequate before starting these drugs to prevent renal dysfunction | hydration status |
| what electrolyte imbalance contraindicates use | hyperkalemia |
| most common side adverse drug reactions | those associated with hypotension (dizziness, h/a, fatigue, orthostatic hypotension) |
| concurrent use of K supplements, K sparing diuretics or cyclosporine may result in | hyperkalemia |
| drug of choice for treatment of HTN in which pts | young, white, DM, HF, MI |
| diuretics with ACEIs and ARBs | diuretics should be stopped for 2-3 days prior to starting then reintroduced sin data suggest that all pts with HTN should be on a diuretic |
| Which diuretic is best choice with ACEIs | thiazides because reduced aldosterone secretion associated with ARBs may cause hyperkalemia |
| in pts with DM II, HTN, and microalbuminuria ACEIs and ARBs have been shown to delay the progression to | macroalbuminuria |
| in pts with DMII, HTN, macroalbuminuria, and renal insufficiency ARBs have been shown to delay the progression to | diabetic nephropathy |
| for DM, dual blockade with ACEIs and ARBs(safe but requires monitoring for hyperkalemia) has been shown to statistically significant reduction in | albuminuria and BP |
| recommended for use for all patients with | chronic stable angina, CAD to prevent MI or death and to reduce symptoms |
| Medications recommended post MI | ACEI, beta blocker, antiplatelet therapy, lipid lowering therapy |
| ARBs affect not only ATII receptors but | ATI receptors |
| may be beneficial to use combo of ACEIs and ARBs post MI because | bradykinin has cardioprotective effects, and provides complete inhibition of ATII |
| ACEIs should be started regardless early after MI in stable high risk pts and continued indefinitely for | pts with LV dysfunction (EF<40%) |
| ACEIs and ARBs principal mechanism in treating HF is | their role in reducing remodeling |
| a cornerstone of therapy for HF pts in all guidelines | ACEIs |
| ACEIs address all causes of HF | CAD, HTN, |
| in HF pts who cannot tolerate an ACEI, what other combination is equally effective in reducing morbidity and mortality from CHF | hydralazine with a long acting nitrate (Bidil) |
| initiate tx with short acting captopril to determing pt tolerance then | convert to a longer acting to improve adherence |
| which ACEI can be mixed in foods for those who have difficulty swallowing | ramipril (Altace) |
| when initiating therapy check BP when | before and within 1 hour of first dose |
| monitor creatinine levels when | before, 1 week, monthly x 3 months, with any dose change |
| ACEI should be reduced if creatinine is > | 2.5mg/dL |
| monitor CBC when | before, monthly x 3-6months. d/c if neutrophil count is < 1000/mm3 |
| many salt substitutes contain | potassium |
| rash may occur with which ACEI and is not a class phenomenon | captopril |
Created by:
heatherbrown2020
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