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Renin Angiotensin Aldosterone System (RAAS)
Order of events
Hemorrhage > Low Blood volume >Low Blood Pressure > Low blood flow to your kidneys > Kidneys will produce/secrete RENIN
Renin does two things
1. Renin converts angiotensinogen (what is in our blood stream) into angiotension 1
2. Renin goes into the lungs
What is angiotension 1
Angiotensin 1 is a weak vasoconstrictor
What does renin do in the lungs?

in the lungs activates an enzyme called ACE> ACE converts Angiotensin 1 into Angiotensin 2
Angiotensin 2 does three things
1. Angiotensin 2 stimulates the adrenals

2.Angiotensin 2 stimulates posterior pituitary

3. Angiotensin 2 is a really strong vasoconstrictor
What happen when Angiotensin 2 stimulates the adrenals
Angiotensin 2 stimulates the adrenals > Releases aldosterone > aldosterone reabsorb (pour) sodium and water into the blood vessels (but since sodium goes up, your body lowers potassium) > increase blood volume >increase blood pressure
What happens when Angiotensin 2 stimulates posterior pituitary
Angiotensin 2 stimulates posterior pituitary (in brain) > secrete ADH (antidiuretic hormone) > Keeps water in only > increase blood volume >increase blood pressure
What happens when Angiotensin 2 becomes a really strong vasoconstrictor
Increase blood pressure a lot.
When can the RAAS system be bad
Hypertension and diabetes

It lowers kidney function and damages the glomerulus > makes scar tissue > lowers blood flow >starts the RAAS system > increase Blood pressure (what we don’t want)
What can we give to a patient if they have hypertension or diabetes?
- Ace inhibitors and Angiotensin 2 receptor blocker (ARB)
ACE Inhibitors
Mechanism of action
Mechanism of action
Blocks the conversion of Angiotensin 1 into Angiotensin 2.
ACE Inhibitors Effect
Effect Dilatory effect (lowers blood pressure) diuretic effect (pee out NA+ but keep K+, high risk for hyperkalemia). Decreases pulmonary congestion and peripheral edema.
ACE Inhibitors Side effects
Side effects

Monitor for first dose hypotension, Cough (nagging, unable to tolerate), hyperkalemia, angioedema (allergic reaction) discontinue immediately
ACE Inhibitors
ends with “-pril”
Angiotensin 2 Receptor Blocker (ARB)
Mechanism of action
Mechanism of action

It blocks Angiotensin 2 from binding to its receptors
Angiotensin 2 Receptor Blocker (ARB) Effect
Effect Dilate blood vessels, and a diuretic (lower blood pressure) decrease ventricular remodeling related to heart failure or MI.
When to use Angiotensin 2 Receptor Blocker (ARB) instead of an ACE inhibitor?  
- Used in patients who develop the cough or hyperkalemia with ACE inhibitors
Angiotensin 2 Receptor Blocker (ARB) Name

ends in “-sartan”
Can Ace inhibitors and ARB''s work together?
What do Diuretics do, how?

What are they used for?
- Lowers blood volume and blood pressure by blocking reabsorbtion of sodium and chloride - Used for hypertension and heart failure
- 3 types of diuretics
K+ wasting diuretics

K+ sparing diuretics

Osmotic diuretic
What does K+ wasting diuretic release?
Releases Na+, K+, and H20
What does K+ wasting diuretic cause?



What are the 2 types of K+ wasting diuretics?
- Loop diuretic

- Thiazide diuretic
What is a Loop diuretic
Lasix (florosemide)
What is a Thiazide diuretic
Hydrochlorothiazide (HCTZ)
Which K+ wasting diuretic is better? why?

It works faster
What does K+ sparing diuretic wastes?
Wastes only Na+ and H2O
What does K+ sparing diuretic cause?
What the name of a K+ sparing diuretic
What are Osmotic diuretics used for?
- Used to lower ICP when patient has brain injury - Not used for heart failure  
What is the name of a Osmotic diuretic?
- Mannitol
Patient teaching while on a diuretic
- Weight themselves every day, same time, wearing the same thing - Report any weight gain of three or more pounds in one day - Take diuretic in the morning because it will increase the need to urinate for 6-8 hours - Be careful with orthostatic hypotension - Changing position (from laying to standing) will cause BP to go down, and HR to go up - One cause of OH is dehydration
S/S of hypocalcemia (cause form pancreatitis, or pregnancy) CATS
C > Convulsions = positive chevostek’s sign (cheek) A > Arrhythmias = Torsades T > Tetany = muscle spasms, tingling in fingers and mouth, positive trousseaus sign (BBP cuff) S > Spasms = stridor (air cant go in)
What do Vasodilators do?
- Dilate blood vessels to decrease ventricular filling, preload, and myocardial oxygen demand - Lowers blood preasure
What are contraindicated for people taking vasodilators
- Contraindicated for men taking erectile dysfunction medication
What are the 2 vasodilator drugs
Nitroglycerin and Isosorbide
What are Nitroglycerin's used for?

Forms of nitro?
Angina Sublingual, paste, patch, spray
Nitro side effects?
- Causes a strong head ache (expected) dizziness, hypotension
Directions on how to take Nitro
- For angina, take 1 tab every 5 min, for a max of 3 doses. If still have angina, call 911
What is Isosorbide used for?

What route do you take it?
- Maintenance, preventative - PO
Patient education while taking a nirto  
- Keep in original container - Keep with you at all times - Get up slowly - Monitor for hypotension - No erectile dysfunction medication
What kind of drug is digoxin?

What is Positive inotropic medication used for?
Positive inotropic medication
What is Positive inotropic medication used for?
if patient in heart failure, this will cause the heart to contract, but can cause A-Fib with RVR
What does digoxin do?
- Increase force of ventricular contraction; decrease automaticity of the SA node to maintain an acceptable heart rhythm
What to monitor/assess before giving digoxin?
- Apical pulse for 1 min (if <60 don’t give) - Potasium levels (if low, it can cause digoxin toxicity) - Digoxin therapeutic value è 0.5-2.0ng/ml - You can give digoxin with Lasix, but not if potasium is low
S/S of digoxin toxicity
Eye, GI, and bradycardia - Eye > Halo, blurry, Diplopia - GI > Nausea, vomiting, diarrhea and anorexia  
anti for digoxin
- Digibind
Where is Alpha 1 located?
Blood vessels
What does Alpha 1 do?
Vasoconstriction > increased blood pressure
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