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Indications for ACEI and ARB???
- HF-prolong survival- should be given ACEI trial)CAD-prolong survival
- MI- prolong survival
- LV dysfunction- prolongs survival rate( should be given ACEI trial)
- Diabetic neuropathy
- Hypertensive crisis
block the conversion of angiotensin I to angiotensin II (this is very important)
Positive effects of ACEI on cardiac function
- reduces preload and afterload
- increases CI and EF=increased CO (increased blood to coronary arteries, and increased nourishment to the heart)
ACE increase blood flow to which vital organs
- kidneys (without reflex tachycardia)
ACEI and ARB's are ______ protective
block the effect of angiotensin II by blocking angiotensin II to its receptor site.
Unlike ACEI, ARB's do not increase the level of ________?
ACEI increase the level of bradykinin, and ARB's do not.
reason for cough--bradykinnin
Receptor affinity in ARB drugs
candesartan> ibesartan> eprosartan> telmisartan> valsartan> losartan
Does not always mean that candesartan should be started first, it has a lot to do with what the insurance company will pay for.
Dosage of ACEI and ARB's
START LOW AND GO SLOW!!
- vary with drug
- usually given every day or twice per day
ADR of ACEI and ARBs
Very rare and very few
Rare- rash, diaphoresis, flushing, photosensitivity, and puritis, abdominal pain, nausea, diarrhea, constipation, asthma, bronchospasm
- COUGH- RARE WITH ARBS
Common ADR of ACEI
Cough and angioedema (potentially life threatening and is common with ACEI, greater than 50% of occurrences will occur within one week of therapy)
Do not use ______ in patient with renal artery stenosis because blood flow is diminished
ACEI- especially bilateral artery stenosis
ACEI are good for kidneys but not if they have renal stenosis
ACEI and ARBs are not as beneficial in _______ population
Use thiazide diuretic, and CCB
ACEI should be given to all patients with symptomatic or asymptomatic ________?
Monitoring ACEI and ARBs
All patients should have a periodic ______, ______, _______, and _________.
- urinalysis, BUN, creatinine, and serum electrolytes.
- Once dose is stable check creatinine and potassium after 2-4 weeks.
- Then if patient without risk factors can check them every 3-6 months.
ACEI and ARB pregnancy category
C and D