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