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Flashcards in HTN: ACE/ARB Deck (19)
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What are the two main ACEI?

1. Lisinopril
- only TRUE QD ACEI (half life = 12hr)**

2. Enalapril
- only ACEI that can come IV (prodrug = Enalaprilat)**


What is the MOA of ACEI?

Inhibit ACE from converted Ang I --> Ang II

VD efferent arteriole (drains glomerular capillary bed) --> dilating efferent arteriole DEC glomerular pressure


List the 4 most common uses for ACEI

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


What are 3 pearls of ACEI?

1. Black pt less sensitive to ACEI monotherapy**

2. Synergistic** w/diuretics

3. Renal protectors**
- no absolute GFR when ACEI cannot be used


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

- Lisinopril / enalapril = no CYP interactions

- Anti-HTN & Vasodilators

- Careful w/other meds leading to Hyperkalemia


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

1. Pt w/hereditary or idiopathic angioedema

2. Bilateral RAS or stenotic lesion to solitary kidney


What are the five ADRs involved with ACEI?

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


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

- 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


What are the 3 commonly used ARBs?



What is the ARB MOA?

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


What is the clinical use of ARBs?

Generally the same as ACEI

Most data with losartan > valsartan >> others


What is the unique clinical use of losartan?

Uricosuric activity and is used for Gout Prevention**


What are drug interactions to be aware of with ARBs?

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

Other interactions are same as ACEI


What are the ARB ADRs?

Same as ACEI without cough and less angioedema risk


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

Sprue-like enteropathy
- severe chronic diarrhea
- significant wt. loss
- intestinal changes


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


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


What is the clinical use of Aliskiren?

FDA approved for HTN

Almost never a reason to use it**


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

Pgp inhibitors may INC [aliskiren]

Anti-HTN & Vasodilators


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