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Cardio Exam 1 Lecture 3 - HTN
RAS, ACEs, ARBs, Renin inhibitors
39
Aerospace Engineering
Undergraduate 4
01/24/2013

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Term
RAS is an important regulator of __________ and _______ of the body
Definition
BP & hydromineral balance
Term
Protein
Definition
50+ aa sequence - it is a macromolecule
Term
Peptide
Definition
20-30 aa sequence
Term
which form of angiotensin is active?
Definition
Ang II
Term
where is angiotensinogen stored & synthesized?
Definition
liver
Term
where is renin stored & synthesized?
Definition
juxtaglomerular cells of kidney
Term
where is ang I & ang II formed?
Definition
systemic circulation (& tissues)
Term
what is the rate limiting step of the RAS pathway?
Definition
Angiotensinogen --> Ang I (by Renin)
Term
what type of receptors does Ang II bind to?
Definition
AngI & AngII receptors
Term
which peptide has the opposite effect of Ang II?
Definition
Angiotensin 1-7
Term
what does the macula densa sense?
Definition
NaCl levels leaving the loop of Henle
Term
3 pathways that regulate renin release
Definition
1. Macula Densa
2. Baroreceptor in afferent arteriole
3. Beta-adrenergic receptors on juxtaglomerular cells
Term
Vaso________ of the afferent arteriole leads to a decrease in filtration
Definition
Vasoconstriction --> decreased filtration
Term
what type of receptors are Ang I & AngII receptors?
Definition
GPCRs
Term
effect of Ang II on vasculature
Definition
vasoconstriction
promotes smooth muscle hypertrophy
Term
effects of Ang II on adrenal cortex
Definition
synthesize & secrete aldosterone
(leads to Na & water retention)
Term
effects of Ang II on adrenal medulla
Definition
stimulate Epinephrine release
Term
effects of Ang II on kidney
Definition
EFFERENT arteriole vasoconstriction
inhibit renin release from JXG cells
increase Na reabsorption in proximal tubule
Term
effects of Ang II on heart
Definition
myocardial hypertrophy
collagen synthesis
Term
effects of Ang II on brain
Definition
increase vasopressin release (ADH)
stimulate thirst, salt appetite
increase sympathetic tone
Term
pressor effects of Ang II are mediated by the ____ receptor
Definition
AT1
Term
how do ACE inhibitors cause cough?
Definition
coughing is due to increased levels of bradykinin
ACE naturally decreases bradykinin levels
using an ACE inhibitors causes increase in bradykinin levels
Term
3 MOA's of ACEI's
Definition
1. decrease Ang II
2. increase bradykinin
3. increase angiotensin 1-7 (indirectly)
Term
first ACE discovered
Definition
captopril
Term
Ang II acts on the _______ arteriole (afferent/efferent)
Definition
efferent
Term
how do ACEi's affect aldosterone secretion? what does this put the patient at risk for?
Definition
slightly decreases aldosterone secretion

risk for hyperkalemia
Term
overall effect of ACEi's
Definition
reduction of systemic BP
Term
main uses of ACEi's (5)
Definition
HTN
LV systolic dysfunction
acute MI
prevention of CAD events & stroke
chronic renal failure
Term
main ADE's of ACEi's (7)
Definition
hypotension
cough
angioedema
hyperkalemia (due to decreased aldosterone)
acute renal failure
slightly elevated SCr
teratogenic effect - NO PREGGOS
Term
do ACEi's or ARBs reduce activation of AT1 receptors more efficiently?
Definition
ARBs
Term
which is better at reducing activation of AT1 receptors? ACE's or ARBs?
Definition
ARBs
Term
which increases angiotensin 1-7 levels more? ACE's or ARB's?
Definition
ACEs
Term
which increases levels of bradykinin? ACEs or ARBs?
Definition
ACEs
Term
therapeutic uses of ARBs (4)
Definition
HTN
HF
Stroke prophylaxis
Diabetic nephropathy
Term
ADE's of ARBs (3)
Definition
hypotension
hyperkalemia
teratogenic potential - NO PREGGOS
Term
MOA of ARBs
Definition
blocks AT1 receptor & prevents Ang II effects
Term
what is the name of the renin inhibitor?
Definition
Aliskiren
Term
Aliskiren is mainly metabolized by _____
Definition
CYP3A4
Term
ADE's of Aliskiren (6)
Definition
Nosebleed
hyperkalemia
hyperuricemia
HA
Diarrhea
teratogenic effects - NO PREGGOS
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