16 Questions
What is the primary mediator of the activity of the renin-angiotensin-aldosterone system?
Angiotensin II
How do ACE inhibitors decrease blood pressure?
By decreasing angiotensin II levels and increasing bradykinin levels
What effect do ACE inhibitors have on bradykinin levels?
Increase levels of bradykinin and other kinins
Where do the renal vasoconstrictive effects of angiotensin II occur primarily?
At the efferent arteriole of the glomerulus
Which ACE inhibitor is excreted by both renal and hepatic pathways?
Fosinopril
Which ACE inhibitor is administered in active form and excreted unchanged by the kidneys?
Lisinopril
Which ACE inhibitor exhibits the pattern of an ester prodrug converted in the plasma to an active metabolite?
Enalapril
Which adverse effect of ACE inhibitors can potentially cause airway obstruction?
Angioedema
In which patients are adverse effects such as first-dose hypotension and acute renal failure more common?
Patients with bilateral renal artery stenosis
What is a relative contraindication to ACE inhibitor therapy?
Bilateral renal artery stenosis
Which condition is a relative contraindication to ACE inhibitor therapy due to its dependence on increased angiotensin II activity?
Bilateral renal artery stenosis
What adverse effect can ACE inhibitors produce due to their reduction of aldosterone synthesis?
Hyperkalemia
What is the primary reason for discontinuation of the combined use of ACE inhibitors and aliskiren?
Increased risk of hyperkalemia
What is the effect of long-term use of ACE inhibitors on diabetic nephropathy?
Delaying progression of diabetic nephropathy
What is the reason for the discontinuation of combined administration of ACE inhibitors and angiotensin receptor blockers (ARBs)?
Increased risk of hyperkalemia
Why are ACE inhibitors contraindicated in pregnancy?
They are teratogenic
Study Notes
Renin-Angiotensin-Aldosterone System
- Angiotensin II is the primary mediator of the renin-angiotensin-aldosterone system.
ACE Inhibitors
- ACE inhibitors decrease blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone production.
- ACE inhibitors increase bradykinin levels, which can cause cough as a side effect.
Angiotensin II Effects
- The renal vasoconstrictive effects of angiotensin II occur primarily in the efferent arterioles.
Specific ACE Inhibitors
- Trandolapril is excreted by both renal and hepatic pathways.
- Enalaprilat is administered in active form and excreted unchanged by the kidneys.
- Enalapril is an ester prodrug converted in the plasma to an active metabolite, enalaprilat.
Adverse Effects of ACE Inhibitors
- ACE inhibitors can cause angioedema, which can lead to airway obstruction.
- First-dose hypotension and acute renal failure are more common in patients with:
- Bilateral renal artery stenosis
- Chronic kidney disease
- Heart failure
- Volume depletion
- A relative contraindication to ACE inhibitor therapy is:
- Bilateral renal artery stenosis
- ACE inhibitors can cause hyperkalemia due to reduced aldosterone synthesis.
Contraindications and Interactions
- ACE inhibitors are contraindicated in pregnancy due to the risk of fetal developmental abnormalities.
- Combined use of ACE inhibitors and aliskiren is contraindicated due to the increased risk of hyperkalemia and kidney injury.
- Combined use of ACE inhibitors and angiotensin receptor blockers (ARBs) is contraindicated due to the increased risk of hyperkalemia, hypotension, and kidney injury.
- Long-term use of ACE inhibitors can slow the progression of diabetic nephropathy.
Test your knowledge of Angiotensin Converting Enzyme Inhibitors (ACE inhibitors) with this pharmacology quiz. Explore the mechanism of action and effects of ACE inhibitors on the renin-angiotensin system and their clinical applications.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
