okay so now we are in the angiotensin ii receptor blockers um or we call them antagonists okay these are known as arbs and their suffix of their name is startin okay so i'm gonna flip to this okay so these are our angiotensin ii receptor blockers or arbs so mechanism of action really important to remember for all of these drugs okay for all of these classes really so it blocks the binding of angiotensin ii to its receptors okay to its angiotensin receptors it blocks the binding of them so if you see like in the picture here we have angiotensinogen right by the enzyme running converts to angiotensin 1 and then in then angiotensin one um converts to the so you have the angiotensin converting enzyme that will convert angiotensin 1 to angiotensin 2. remember angiotensin ii is our very potent vasoconstrictor so the conversion to angiotensin ii is actually happening with arbs remember with ace inhibitors it's not happening it's blocking here so it's blocking here with with ace inhibitors you don't have one that converts to two okay with arbs that's not what's happening you have the conversion from one to two right angiotensin one to angiotensin ii into that very potent vasoconstrictor but what's not happening is it is not binding to that receptor site it's blocking it here okay so no right here it's blocking it you don't get that binding to that receptor site so therefore we don't have the vasoconstrictive effects that angiotensin would use because it blocks at that binding site okay so that is the point of that here okay um so that is the mechanism of action right so therapeutic effects what are we trying to do with the drug what are we trying to achieve well decreased blood pressure so you're going to kind of see the same theme going on here with a lot of these classes right so if we decrease the blood pressure right so we're decreasing constriction we're decreasing systemic vascular resistance and we're decreasing afterload so we're decreasing the resistance that heart has to work against to pump or reject blood throughout the rest of the body okay so you're seeing that as a common theme all right angiotensin receptor blockers also have renal vascular protective effects similar to that of ace inhibitors so they could be given this particular medication simply for the renal protective effects of the drug indications why are we giving it well if a patient had hypertension so this could often be a second line treatment if patients are intolerant to ace inhibitors so generally we start with ace inhibitors but remember we talked about a population that doesn't do so well with ace inhibitors all the time because of angioedema but maybe for that particular population of people or just a person in general who is not doing well with ace inhibitors we can try an arb an angiotensin receptor blocker okay so major use of this class is afterload reduction okay so we can use this class for afterload reduction so those patients with or that have congestive heart failure which is chf or an mi myocardial infarction and then again there's the diabetic patient so we might for the diabetic patient give it for simply because of the renal protective properties that it has it protects those kidneys so remember a patient that has um diabetes right they have maybe thinning their or not thinning narrowing um or sclerotic vessels so what's happening is those vessels um don't adequately feed the rest of our body with blood and oxygen saturation right so what's not being fed well all major organs such as the kidneys so again we can give it hopefully for some renal protective agent or properties and it also interrupts the raw system similar to ace inhibitors just a different mechanism of action all right precaution so concurrent use of multiple drugs affecting blood pressure why because we're going to increase the hypotensive effect if they're on too many medications that decrease blood pressure what's going to happen that blood pressure is going to bottom out and then again you see it again impaired renal function because of excretion right so our kidneys excrete most of these a lot of these drugs and um although we give it for protective property if the kidneys are already impaired it's going to be hard for that patient for that kidney to excrete the drug contraindication so similar to ace inhibitors it's going to affect potassium okay so we want to know what the potassium levels are so if they have baseline hyperkalemia so if they have elevated potassium levels because remember we have decreased aldosterone so therefore we have decreased potassium secretion um also contraindicated with pregnant lactating women and then pediatric patients less than a year old really just affects their very immature developing kidneys so we want to be careful about that all right side and adverse effects okay so angioedema cough fatigue dizziness hyperkalemia so similar to that of the prills right of our ace inhibitors um a bigger one that i want you to remember for this one because if you remember the prills the know the side effects are similar right for the arbs for our angiotensin receptor blockers so the one you should really remember for this one that differentiates from the prills or ace inhibitors is the headache and upper respiratory infection okay so that one's important to remember for this particular class and that's actually most common for this particular class nursing action so we are going to assess assess right we're going to make sure we're monitoring their blood pressure looking at their eyes and o's input and outtake daily weights so if they're retaining fluid or not um and any of the side effects physical assessment this is a cardiac drug so what goes hand in hand cardiac and pulmonary lab work same as the pearls we're looking at the renal function and we're looking at potassium levels and then patient education is the same too they need to know about the drug they need to know about the side effects they need to know how to take their blood pressure at home right how often should they be monitoring their blood pressure well a patient on a new home med for blood pressure medication especially should be checking it pretty frequently like daily right they want me to make sure that the medication that they're taking is working adequately right so we want to educate appropriately and then again if there's any other drugs that we know that would interact or affect that particular medication again hypo and hypertensive symptoms and then um renal function and labs okay so this is where i accidentally scrolled to too quickly when i was flipping screens so i apologize so these are the list of medications or or um lists of meds for our arvs but remember you only have to know the asterisk ones the starred ones for purposes of testing okay so omnisarton and low certain are your two prototypes for this particular class and so you see there the suffix for this particular class of drugs is certain so you'll know if you see sartin that is an arb an angiotensin receptor blocker you