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Pharmacology

ACEIs and ARBs

QuestionAnswer
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