6526153
Description
Flashcards by Andrew Street, updated more than 1 year ago
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Created by Andrew Street
about 8 years ago
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| Question | Answer |
| Give eg's of & indications for ARB's | eg's: losartan, candesartan, irbesartan Indications: ARB's are generally used when ACEi's are not tolerated due to cough. The indications are the same: • HT • CHF • Ischaemic HT disease • Diabetic neuropathy • CKD with proteinuria |
| MOA of ARB's. | ARBs have similar effects to ACEi's, but instead of inhibiting the conversion of angiotensin I to angiotensin II, ARB's block the action of angiotensin II on the AT1 receptor. Angiotensin II is a vasoconstrictor & stimulates aldosterone secretion. Blocking its action reduces peripheral vascular resistance (afterload), which lowers BP. It particularly dilates the efferent glomerular arteriole, which reduces intraglomerular pressure & slows the progression of CKD. Reducing the aldosterone level promotes sodium & water excretion. This can help to reduce venous return (preload), which has a beneficial effect in HF. |
| SE's of ARB's. | • Hypotension • Hyperkalaemia • Renal failure - this is particularly relevant in patients with renal artery stenosis, who rely on constriction of the efferent glomerular arteriole to maintain glomerular filtration |
| CI's, cautions, & important interactions of ARB's. | CI's: • Renal artery stenosis • AKI Cautions: • Pregnancy • Breastfeeding • CKD - lower dose & monitor carefully Important interactions: Due to the risk of hyperkalaemia, avoid prescribing ARBs with other potassium-elevating drugs, including potassium supplements (oral or IV) and potassium-sparing diuretics except under specialist advice for advanced HF. In combination with other diuretics they may be associated with profound first-dose hypotension. The combination of NSAID's with ARB's ^risk of renal failure. |
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