ACE Inhibitors: Therapeutic Effects and Side Effects

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Questions and Answers

What is the rate-limiting step in the Renin-Angiotensin-Aldosterone System (RAAS)?

Release of aldosterone from the adrenal glands

Release of renin from the juxtaglomerular cells of the kidney (correct)

Conversion of angiotensin I to angiotensin II

Activation of the sympathetic nervous system

What is the mechanism of action of Aliskiren?

Blocks the action of ACE

Direct renin inhibitor (correct)

Stimulates the release of aldosterone

Converts angiotensin I to angiotensin II

What is a common side effect of ACE inhibitors?

Hypertension

Hyperkalemia (correct)

Hypernatremia

Hypoglycemia

What is the main mechanism of action of ACE inhibitors that contributes to their therapeutic effects?

Increasing the levels of bradykinin Signup and view all the answers

What is the indication for using ACE inhibitors?

To prevent the conversion of angiotensin I to angiotensin II Signup and view all the answers

Which of the following is a common indication for the use of ACE inhibitors?

Diabetic nephropathy Signup and view all the answers

What is a contraindication for the use of ACE inhibitors?

Pregnancy Signup and view all the answers

Which of the following is a common side effect associated with the use of ACE inhibitors?

Cough Signup and view all the answers

What is the main mechanism of action of angiotensin II receptor blockers (ARBs)?

Blocking the action of angiotensin II at its receptor sites Signup and view all the answers

What is the primary mechanism by which beta blockers reduce blood pressure in hypertension?

Decreasing heart rate and contractility by blocking beta 1 receptors Signup and view all the answers

What is the main mechanism of action of nonspecific alpha blockers like phentolamine?

Blocking both alpha 1 and alpha 2 receptors, causing vasodilation Signup and view all the answers

Which of the following is a common indication for the use of nonspecific alpha blockers?

Pheochromocytoma and hypertensive emergencies Signup and view all the answers

What is the mechanism of action of alpha 1 blockers?

Blocking alpha 1 receptors, causing vasodilation Signup and view all the answers

Which of the following is a common drug in the class of nonspecific alpha blockers?

Phentolamine Signup and view all the answers

How do ACE inhibitors lower blood pressure?

By inhibiting the angiotensin-converting enzyme Signup and view all the answers

Which of the following is a common side effect of ACE inhibitors?

Hyperkalemia Signup and view all the answers

What is an indication for using ACE inhibitors?

Hypertension Signup and view all the answers

Which statement is a contraindication for using ACE inhibitors?

Pregnancy Signup and view all the answers

How do ARBs differ in mechanism of action from ACE inhibitors?

By blocking the angiotensin II receptors Signup and view all the answers

What is the primary mechanism of action of carbonic anhydrase inhibitors?

Inhibition of the enzyme carbonic anhydrase in the proximal convoluted tubule, leading to decreased reabsorption of bicarbonate and sodium Signup and view all the answers

Which of the following are common indications for carbonic anhydrase inhibitors?

Glaucoma and altitude sickness Signup and view all the answers

What is the primary mechanism of action of loop diuretics?

Inhibition of the sodium-potassium-chloride cotransporter (NKCC) in the loop of Henle Signup and view all the answers

Which of the following are common side effects of loop diuretics?

Metabolic alkalosis, hyponatremia, hypokalemia, hyperglycemia, and hypocalcemia Signup and view all the answers

What is the primary mechanism of action of thiazide diuretics?

Blockade of the thiazide-sensitive sodium-chloride cotransporter (NCC) in the distal convoluted tubule Signup and view all the answers

Study Notes

ACE Inhibitors

Indications: hypertension, heart failure, and diabetic nephropathy
Contraindications: pregnancy and bilateral renal artery stenosis
Common side effects: cough, hyperkalemia
Common drugs: lisinopril, enalapril, ramipril
Bradykinin: a vasodilator, plays a role in reducing blood pressure and causes cough as a side effect

Angiotensin II Receptor Blockers (ARBs)

Mechanism of action: block the action of angiotensin II at its receptor sites, leading to vasodilation and decreased aldosterone release
Indications: hypertension, heart failure
No dry cough or angioedema due to no effect on bradykinin levels
Common drugs: losartan, valsartan, irbesartan

Angiotensin II (Ang II)

Potent vasoconstrictor that increases blood pressure by constricting blood vessels and stimulating aldosterone release
Dual action helps to lower blood pressure by reducing peripheral vascular resistance

Nebivolol

Mechanism of action: stimulates the release of nitric oxide from the endothelium, leading to vasodilation and decreased blood pressure
Nitric oxide relaxes the smooth muscle in blood vessels, leading to vasodilation

Centrally-acting Sympathetic Agents

Mechanism of action: reduce sympathetic outflow from the brain, leading to a decrease in heart rate and blood pressure
Common drugs: clonidine, methyldopa

Reserpine

Mechanism of action: blocks the uptake of norepinephrine and dopamine into storage vesicles in sympathetic nerve terminals, leading to reduced sympathetic activity and decreased blood pressure

Carbonic Anhydrase Inhibitors

Mechanism of action: block the enzyme carbonic anhydrase in the proximal convoluted tubule of the kidney, leading to decreased reabsorption of bicarbonate and sodium, resulting in metabolic acidosis
Common indications: glaucoma, altitude sickness
Common drugs: acetazolamide, dorzolamide

Loop Diuretics

Mechanism of action: inhibit the reabsorption of sodium and chloride in the loop of Henle, leading to increased urine output
Common indications: heart failure, hypertension, edema
Side effects: metabolic alkalosis, hyponatremia, hypokalemia, hyperglycemia, hypocalcemia
Common drugs: furosemide, torsemide, bumetanide

Thiazide Diuretics

Mechanism of action: inhibit the reabsorption of sodium and chloride in the distal convoluted tubule, leading to increased urine output
Common indications: hypertension, edema
Side effects: metabolic alkalosis, hyponatremia, hypokalemia, hyperglycemia, hypercalcemia
Common drugs: hydrochlorothiazide, chlorothiazide

Renin-Angiotensin-Aldosterone System (RAAS)

Regulates blood pressure and fluid balance in the body
Rate-limiting step: release of renin from the juxtaglomerular cells of the kidney
Factors that stimulate the release of renin: decreased blood pressure, decreased sodium levels, sympathetic nervous system activation
Renin acts on angiotensinogen to produce angiotensin I, which is converted to angiotensin II by ACE

Aliskiren

Mechanism of action: direct renin inhibitor, blocks the conversion of angiotensinogen to angiotensin I, inhibiting the RAAS system
Side effects: diarrhea, cough, hyperkalemia

Beta Blockers

Mechanism of action: block beta 1 receptors in the heart, leading to decreased heart rate and contractility, reducing cardiac output and blood pressure
Block beta 1 receptors in the kidney, reducing renin release and production of angiotensin II
Common drugs: propranolol, metoprolol, atenolol

Nonspecific Alpha Blockers

Mechanism of action: block both alpha 1 and alpha 2 receptors, leading to vasodilation and decreased blood pressure
Indications: pheochromocytoma, hypertensive emergencies
Common drugs: phentolamine

Alpha 1 Blockers

Mechanism of action: block alpha 1 receptors, leading to vasodilation and decreased blood pressure
Indications: hypertension, benign prostatic hyperplasia
Common drugs: prazosin, doxazosin

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Description

Learn about the common indications, contraindications, and side effects of ACE inhibitors. Understand the role of bradykinin in both the therapeutic effects and side effects of ACE inhibitors.