HTN: ACE/ARB Flashcards Preview

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Flashcards in HTN: ACE/ARB Deck (19)
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1
Q

What are the two main ACEI?

A
  1. Lisinopril
    - only TRUE QD ACEI (half life = 12hr)**
  2. Enalapril
    - only ACEI that can come IV (prodrug = Enalaprilat)**
2
Q

What is the MOA of ACEI?

A

Inhibit ACE from converted Ang I –> Ang II

result:
VD efferent arteriole (drains glomerular capillary bed) –> dilating efferent arteriole DEC glomerular pressure

3
Q

List the 4 most common uses for ACEI

A
  1. HTN (esp w/LVH)
  2. HFrEF (slows cardiac dysfcn)
  3. CKD (DM, non-DM) - slows rate of kidney loss
  4. Post AMI which resulted in DEC systolic fcn
4
Q

What are 3 pearls of ACEI?

A
  1. Black pt less sensitive to ACEI monotherapy**
  2. Synergistic** w/diuretics
  3. Renal protectors**
    - no absolute GFR when ACEI cannot be used
5
Q

What are some drug interactions to be aware of with ACEI?

A
  • Lisinopril / enalapril = no CYP interactions
  • Anti-HTN & Vasodilators
  • Careful w/other meds leading to Hyperkalemia
6
Q

What are the two precautions / C.I. with ACEI?

A
  1. Pt w/hereditary or idiopathic angioedema

2. Bilateral RAS or stenotic lesion to solitary kidney

7
Q

What are the five ADRs involved with ACEI?

A
  1. Teratogen** (C.I. in pregnancy)
  2. Cough
    - usually recurs with rechallenge w/same or different ACEI
  3. Renal function decline
    - check SCr w/in few wks of starting [up to 30% INC from baseline is acceptable**]
  4. Hyperkalemia
  5. Angioedema
    - more common in blacks
    - d/t inhibiting breakdown of bradykinin
8
Q

Can you use ARBs in pt w/ACEI-induced angioedema?

A
  • ARB is reasonable if angioedema sxs were MILD (swelling of face or tongue)
  • consider another tx if sxs were SEVERE (resp sxs or airway obstruction)

Wait > 4wk after stopping ACEI to start an ARB to make sure angioedema has resolved

9
Q

What are the 3 commonly used ARBs?

A

Losartan**
Valsartan*
Candesartan

10
Q

What is the ARB MOA?

A

Interferes w/RAAS by impairing binding of Ang II to AT1 receptors
- blocks vasoconstricting and aldosterone-secreting effects of Ang II

Does not block AT2 receptor which is beneficial –> can lead to additional vasodilation by generation of NO

11
Q

What is the clinical use of ARBs?

A

Generally the same as ACEI

Most data with losartan > valsartan&raquo_space; others

12
Q

What is the unique clinical use of losartan?

A

Uricosuric activity and is used for Gout Prevention**

13
Q

What are drug interactions to be aware of with ARBs?

A

Mostly minimally metabolized
- Losartan is a 2C9 and 3A4 substrate

Other interactions are same as ACEI

14
Q

What are the ARB ADRs?

A

Same as ACEI without cough and less angioedema risk

15
Q

Olmesartan is an ARB you should not use but he gave a specific ADR, which is…?

A

Sprue-like enteropathy

  • severe chronic diarrhea
  • significant wt. loss
  • intestinal changes
16
Q

What is the one renin inhibitor? What is its MOA?

A

Aliskiren

MOA: binds to renin –> inhibits formation of Ang I/II
- inhibits Activation of entire RAAS system

17
Q

What is the clinical use of Aliskiren?

A

FDA approved for HTN

Almost never a reason to use it**

18
Q

What are two drug interactions to be aware of with Aliskiren?

A

Pgp inhibitors may INC [aliskiren]

Anti-HTN & Vasodilators

19
Q

Should you combine ACEI, ARB, or Aliskiren in a patient?

A

No