Lecture Notes: ACE Inhibitors vs. ARBs

Introduction

• Presenter: Turner
• Topic: Comparison of ACE Inhibitors and ARBs
• Context: Importance in exams and real-world application
• Resources: Free quizzes available after watching the video

Overview of ACE Inhibitors and ARBs

• ACE Inhibitors (ACEI): Angiotensin-Converting Enzyme Inhibitors
• ARBs: Angiotensin II Receptor Blockers
• Target System: Renin-Angiotensin-Aldosterone System (RAAS)

Function of RAAS

• Purpose: Manage blood pressure, especially when it drops
• Key Hormone: Angiotensin II
  • Major vasoconstrictor
  • Increases blood pressure
  • Maintains tissue perfusion

RAAS Mechanism

1. Drop in Blood Pressure: Sensed by kidney cells
2. Release of Renin into circulation
3. Angiotensinogen (from liver) converts to Angiotensin I
4. ACE Conversion: Angiotensin I to Angiotensin II
5. Angiotensin II: Binds to angiotensin II type 1 receptors
   • Causes vasoconstriction
   • Triggers aldosterone release (increases blood volume)
   • Retains sodium and water, excretes potassium

Impact of ACE Inhibitors

• Inhibition of ACE: Prevents conversion of Angiotensin I to II
• Result: Decreased vasoconstriction, decreased blood pressure
• Side Effects:
  • Hyperkalemia (due to reduced aldosterone release)
  • Dry, nagging cough (due to bradykinin buildup)
  • Risk of angioedema

Impact of ARBs

• Blockage of Receptors: Prevents Angiotensin II from binding
• Result: Decreased vasoconstriction, decreased blood pressure
• Side Effects:
  • Less likely to cause cough
  • Rare angioedema incidents

Clinical Uses

• Conditions Treated:
  • Hypertension
  • Heart failure
  • Post-myocardial infarction
  • Diabetic nephropathy
• Benefits:
  • Reduce afterload and preload in heart failure
  • Protect renal function by reducing proteinuria

Nursing Interventions and Patient Education

• Monitor Potassium Levels: Risk of hyperkalemia
• Dietary Advice: Avoid high-potassium foods (spinach, avocados, bananas)
• Preventing Rebound Hypertension: Avoid abrupt discontinuation
• Blood Pressure Monitoring: Regular home checks
• Lifestyle Recommendations: Healthy diet, exercise, smoking cessation
• Monitor Liver and Renal Function: Check BUN, creatinine, and urinary output
• Cough and Angioedema: Educate on differentiating cough causes and signs of angioedema
• Heart Failure Consideration: Investigate any new coughs for pulmonary involvement

Conclusion

• Key Takeaways: Importance of drug mechanism understanding for safe and effective treatment
• Further Learning: Take quizzes and subscribe for more content