hey everyone its air threats Turner sorry end comm and today we're going to compare some medications we're going to look at ace inhibitors and ARBs and as always whenever you get done watching this YouTube video you can access the free quizzes that will test you on these two medications so let's get started in our previous lectures we went in depth over ace inhibitors and ARBs but now let's do a quick review so we can see the similarities and the differences so when you take an exam you can easily differentiate between these two medications so we have ace inhibitors a stands for angiotensin converting enzyme ARB stands for angiotensin 2 receptor blockers now these medications affect rass they do it in different ways however they both achieve the same results now what is wrath well rice is the renin-angiotensin-aldosterone system but what does this system do well it manages our blood pressure specifically whenever it drops and the whole goal of Wrath is to get angiotensin 2 on board because it is a major active vasoconstrictors if we can vaso constrict other things we can increase our blood pressure we increase blood pressure we maintain tissue perfusion so what happens with rafts is that whenever the blood pressure drops the kidneys some cells in the kidneys will sense this and they will release renin when marooning goes into the circulation it is going to stimulate a substance that is in the liver called angiotensinogen and angiotensinogen is going to turn into angiotensin 1 well we got to get to angiotensin 2 so to do that ace will help us out that is angiotensin converting enzyme it's going to convert angiotensin 1 into angiotensin 2 so we're there we have this major vasoconstrictor present but it has to bind to some receptors because then we can get things going so one type of receptor that this angiotensin 2 is going to bind to is called an angiotensin ii receptor site type 1 and whenever angiotensin ii binds with those type 1 receptors it is going to lead to the results we need it's going to cause vasoconstriction of our smooth vessels so when we constrict vessels that is going to clamp down and is that that is going to help increase blood pressure increase our systemic vascular resistance in addition we are going to trigger the release of a substance called aldosterone by the adrenal cortex and the whole reason for this is to help increase blood volume because if we can increase blood volume we constrict our vessels we are definitely going to increase blood pressure and maintain tissue perfusion and to do this is this aldosterone will cause the kidneys to keep sodium in water but excrete potassium now let's look at how these two medications affect rats because remember they do it in different ways but they achieve the same results and really what they're targeting is this angiotensin 2 so let's look at ace inhibitors what ACE inhibitors are going to do is they are going to inhibit ACE hence their name so they inhibit this part of rass they prevent angiotensin 1 from turning into angiotensin 2 so we don't have angiotensin 2 being able to do its job now ARBs what it's going to do is it's going to inactivate the angiotensin ii receptor sites type 1 so we will have the conversion of angiotensin 1 to angiotensin 2 you have a snoo in its job but what we're going to prevent is as angiotensin 2 being able to bind with these type 1 receptors so you don't get the effects of angiotensin 2 so as you can see they're both affecting angiotensin ii ace inhibitors is just preventing this ace ARBs it's preventing the activation of these receptor sites either way they are affecting how Angie to works therefore with both of these medications what they're going to achieve is that they're going to cause vasodilation instead of vasoconstriction so that's going to decrease systemic vascular resistance and decrease the blood pressure and it's going to make it a little bit easier on the heart to pump and here in a moment where we talk about what these drugs are used for you'll see why they're beneficial on some patients in addition they're both going to decrease that secretion of aldosterone which again was to help increase our blood volume so instead of keeping sodium and water we're going to excrete it but they will cause the kidneys to keep potassium so we really have to watch out for hyperkalemia in these patients who take these drugs now some other things you want to remember to help you differentiate between them is how their generic name is what is it specifically in with with ACE inhibitors the generics are going to end with pril like lisinopril with ARDS the generics will end with Soren like losartan so when you're looking at the meds and you're trying to turn exist an ace or ARB look at the ending of those generic names it'll really help you and another thing I want to point out is with ace inhibitors some patients not all can develop this persistent nagging dry cough and the reason for that is because of how this ACE inhibitor is influencing this ACE enzyme that is converting angiotensin 1 into angiotensin 2 over here with ARBs a dry persistent nagging cough is not likely and a lot of times if a patient does develop this dry persistent cough with an ace the physician may put them on an ARB because that will help clear that up so the reason for that is because ace normally will inactivate a substance called Brady Kannan Brady Kannan is an inflammatory substance and what it will do is a little break it down so don't and activate it but if we're blocking this by throwing on an ACE inhibitor we're not going to be in debating this Brady cotton so it can increase and it can cause this coughing another thing with ace inhibitors that you want to watch out for as the nurse is something that can happen called angio edema this is where you have swelling of the deep tissues and it can present up swelling of the face the tongue the lips and it can cause a difficulty breathing and if that happens that's a medical emergency it's less likely to happen with an ARB so there's a low chance of it happening but you always just want to monitor for that as well now let's wrap up this review and let's talk about what these medications are used for and look at our nursing interventions and our patient education together so water ace and ARBs used to treat well we've already learned that they help lower the blood pressure so they're great in helping patients who have hypertension managing that blood pressure keeping it low in addition patients who have heart failure this is where the heart muscle is damaged and it can't really pump so it's not really maintaining cardiac output plus blood can backflow go into the lungs lead to pulmonary edema and how ace and ARBs will work is that they can help decrease the after load in the preload on the heart making it easier to pump and get blood out to maintain cardiac output in addition ace and arts can be used after a patient has a myocardial infarction again just helping the heart pump easier after it's been damaged and these medications can help decrease the progression of diabetic nephropathy in those patients who have type 2 diabetes now what is diabetic nephropathy well this is kidney disease caused by diabetes and whenever a patient has kidney disease those little nephrons and the kidneys are affected because that's a functional unit of the kidney that doesn't work and they really lose the ability to filter the blood very well so protein will start to leak into the urine well if you have high blood pressure you're increasing the amount of protein that's going into the urine well if we throw an ace and Arbonne that can help lower the blood pressure which will decrease now a protein that's going into the urine hints slowing down our kidney disease so these medications have like that renal protective mechanism now what are some patient education and things you want to watch out for eisenerz well we've learned that this meant these medications can increase the potassium level with the way that it affects aldosterone because aldosterone is not really going to be released so now the kidneys are going to start keeping potassium so there's a risk for hyperkalemia therefore you want to monitor the potassium levels but you want to tell the patient to avoid consuming a diet really high in potassium so watch those salt substitutes that have potassium and those foods that are high in potassium like spinach avocados bananas etc because I can increase our potassium levels in addition you want to talk to the patient about how to prevent a condition called rebound hypertension this is where the blood pressure will get so high it'll be hard to actually bring the blood pressure down and this tends to happen when a patient just abruptly quits taking their ace or their arm so educate the patient about the importance of never just quit taking the medication because sometimes patient let's say they're started on an ACE inhibitor they develop that dry nagging persistent cough it's driving them crazy and it's driving everyone else around them crazy because they keep coughing so they may just quit taking the medication but instead of doing that they need to talk to their doctor and their doctor can switch them to something else where they won't have that dry cough so just let them know that that can happen if they just abruptly quit taking it in addition they need to make sure they're monitoring their blood pressure at home they need to get a device they need to write down the recordings of what their blood pressure is daily doing this is best because we want to make sure that these medications are in fact managing their blood pressure or are they still hypertensive or is it too much they're hypotensive so definitely communicate that to them and lifestyle changes that they need to do if they're taking these medications to help lower the blood pressure let them know that anti hypertensive medications are not cure for high blood pressure they need to manage their diet by eating healthy exercising or quit smoking if they're smoking to help with that as well so we want to monitor the potassium level as we discussed over here because of hyperkalemia but we also want to look at the liver enzymes making sure the liver is not being affected and renal function because in some patients who are dependent on the RAF's because let's say they have severe heart failure with severe heart failure or their cardiac output isn't that great so they depend on this rafts to maintain cardiac output for them so if we give them an ace and an ARB which affects Rask that's really going to cause some kidney issues so we want to be making sure we monitor the BU in the creatinine what's the renal out there urinary output is at least 30 CC's an hour are they having any abnormal swelling going on in their body where they're retaining fluid and lastly you want to talk to the patient about this cough that can happen with these ACE inhibitors and if they can't tolerate it what should they do and remember they can be switched to arms which doesn't have that dry persistent cough now one thing you really want to watch out for if you're working with patients who have heart failure and they're on an ACE inhibitor let's say that all of a sudden they get this coffee well you want to further investigate this call if you don't want to just write it off oh it's that coffee that you get with ace inhibitors because with heart failure they their heart will be weak the blood will back up into the lungs or they'll get pulmonary edema so they'll start getting a call but this coffee will be like a wet COFF you'll hear crackles if you listen to their lungs they'll have difficulty breathing with just any movement like movie from the bedside chair to the bed they get really winded so you want to make sure that is this just that Koff that you get with ace inhibitors which is dry it's not gonna be have crackles or wet or is this heart failure exacerbation so make sure you look at that in addition educate the patient about this angioedema that's more likely to happen with the ACE inhibitors but can happen with ARBs it's less likely it's rare to but educate them about the swelling of the face the mouth the lips difficulty breathing and let them know that's a medical emergency and that they should seek attention immediately okay so that wraps up this review over ace inhibitors versus ARBs thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos