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Advanced Pharmacology: Chp 44
Drugs Acting on the RAAS
40
Nursing
Graduate
09/13/2013

Additional Nursing Flashcards

 


 

Cards

Term

 

 

 

What does the RAAS regulate?

Definition

 

 

1.  BP

2.  Blood Volume

3. F&E Balance

 

Can promote cardiovascular pathology.

Term

 

 

 

 

What are the 2 things produced by the RAAS system?

Definition

 

 

 

 

1.  Angiotensin II

2.  Aldosterone

Term

 

 

 

 

What are the 2 enzymes that produce angiotensin II

Definition

 

 

 

1.  Renin

2.  angiotensin I

Term

 

 

 

 

How does Aldosterone work?

Definition

 

 

 

 

Acts on kidneys to promote retention of H20 and Na.

 

Can also cause cardiovascular pathology.

Term

 

 

 

 

How does RAAS increase BP?

Definition

 

 

 

1.  Vasoconstriction

2.  Increase in blood volume

Term

 

 

 

 

ACE Inhibitors are beneficial in lowering BP how?

Definition

 

 

 

1.  Block conversion of angiotensin I to angiotensin II

2.  Blocks kinase II (name for ACE when substrate is bradykinin)

 3.  Suppress Aldosterone Release

 

Result is vasodilitation and decreased blood volume.

Term

 

 

 

 

What problems do ACE's and ARB's treat?

 

What are they used to prevent?

Definition

1.  HTN

2.  Heart Failute

3. MI

4. Est. Diabetic Nephropathy

 

1.  MI

2.  Stroke

3.  Death from CV causes in pt's at high risk for CV event

4.  Reduce risk of Diabetic Retinopathy

 

Term

 

 

 

What are ACE's and ARB's NOT effective for?

Definition

 

 

1.  Primary HTN of Diabetic Nephropathy

Term

 

 

 

What is a common first-dose side effect when using ACE's?

Definition

 

 

 

 

Significant first-dose hypotension by causing a sharp decrease in circulating angiotensin II

Term

 

 

 

What is the most common reason for dc'ing ACE Inhibitors?

Definition

 

 

 

 

Cough secondary to accumulation of bradykinin.

Term

 

 

 

What is the common side effect of ACE's when they suppress Aldosterone release? 

 

 

 

 

Definition

 

 

 

Hyperkalemia

Term

 

 

 

Are ACEI's safe during pregnancy?

Definition

 

 

 

Absolutely NOT!  Cause fetal malformations.

Term

 

 

 

 

What do ARB's affect?

Definition

 

Block actions of:

 

1.  blood vessels

2.  adrenals

3.  all other tissues

Term

 

 

 

 

How are ARB's similar to ACE's?

Definition

 

1.  Cause vasodilation

2.  Suppress Aldosterone release

3.  Promote excretion of Na & H20

4. Reduce Bp

5. Cause birth defects

6. Angioedema

Term

 

 

 

 

How do ARB's differ from ACE's?

Definition

 

 

Do not cause cough or hyperkalemia

Term

 

 

 

How do DRI's (direct renin inhibitor) work?

(Aliskiren)

Definition

 

 

Binds tightly with renin inhibiting cleavage of angiotensinogen into angiotensin I. 

Result?  Suppresses entire RAAS

Term

 

 

 

 

How are the ACE's, ARB's, and DRI's alike?

 

Definition

 

1.  Vasodilitation

2.  Suppresses aldosterone release

3.  promotes excretion of h20 and na

4.  reduces bp

5.  causes birth defects

6.  angioedema

3. 

Term

 

 

 

Given the similarities of ACE's, ARB's, and DRI's, are they interchangeable?

Definition

 

 

 

No.

Term

 

 

 

 

What are two common aldosterone antagonists?

Definition

 

 

1.  Spironalactone

2.  Eplerenone

Term

 

 

 

By blocking aldosterone receptors, aldosterone antagonists do what?

 

 

 

 

 

 

Definition

 

 

 

1.  Promote renal excretion of h20 and na - dec BP

2.  prevent or reverse pathologic effects of aldosterone on cv structure and function.

Term

 

 

 

What are some advantagesa of using ACE's?

Definition

 

 

 

1.  Don't interfere with CV reflexes

2.  exercise ok

3.  no orthostatic BP

4.  no problems with asthma

5.  No hypokalemia

6.  No hyperuricemia

7.  No hyperglycemia

Term

 

 

 


What is one of the most important benefits of ACE's?

Definition

 

 

 

Reduce risk of CV mortality secondary to HTN

Term

 



What is the only ACE used for slowing progression of renal disease?

Definition

 

 

 

Captopril

Term

 

 


Which ACE is used to prevent MI, Stroke, Death in pt's with high CV risk?

Definition

 

 

 

Ramipril (AltaCE)

Term

 




Which ACE is used to treat Diabetic Retinopathy?

Definition

 

 

 

 

Enalopril

Term

 

 

 

 

When are ACE's contraindicated with renal failure?

Definition

 

 

 

When pt has bilateral renal artery stenosis

Term

 



What are the common drugs that ACE's interact with?

Definition

 

 

1.  Diuretics - intensify 1st dose effect

2.  Antihypertensives - additive dec BP effect

3.  Drugs that raise K+ - additive to inc K+

4  Lithium - toxicity

5.  NSAIDS - blunt antihypertensive effects

Term

 

 


What is the one possible serious SE of ARB's?

Definition

 

 

 

Cancer

Term

 

 

 

 

What is the first RAAS drug of choice?

Definition

 

 

 

ACE's over ARB's.

ARB's for those who can't tolerate ACE's

Term

 

 

 

What is the one DRI drug available?

Definition

 

 

 

Aliskirin

Term

 

 



What is Aliskirin approved to treat?

Definition

 

 

 

Only HTN

Term

 

 

 

 

What are the SE's of DRI's?

Definition

 

 

 

Tolerated well

Maybe some diarrhea

Term

 

 


What is the first selective aldosterone antagonist?

Definition

 

 

 

Eplerenone

Term

 

 

 

 

CYP34A causes toxicity with which RAAS drug?

Definition

 

 

 

 

Eplerenone

Term

 

 

 

 

Which two ACE's are NOT prodrugs?

Definition

 

 

 

Lisinopril and Fosinopril

Term

 

 

 

 

What is the one blood dyscrasis you should watch for with ACE's

Definition

 

 

 

agranulocytosis - so watch for infection

Term

 

 

 


Which group of RAAS drugs end in "pril"?

Definition

 

 

 

 

ACE's

Term

 

 

 

 

Which group of RAAS drugs end in "sartan?"

Definition

 

 

 

 

ARB's

Term

 

 

 

 

Can you prescribe ACE + ARB + DRI or any combination?

Definition

 

 

 

No, ONLY one at a time

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