captopril – n. 卡托普利
convert – v. 转换，转化
angiotensin – n. 血管紧张素
aphthous ulcers – 口炎
peptic ulcers – 消化性溃疡
dysgeusia – n. 味觉异常
proteinuria – n. 蛋白尿
losartan – n. 氯沙坦
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Prototype Drugs
1. Captopril 卡托普利 Indications: Treatment of hypertension, heart failure, diabetic nephropathy, and left ventricular dysfunction after an MI. 适应症：高血压、心衰、糖尿病性肾病和MI后左室功能障碍的治疗
Actions: Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in BP, a decrease in aldosterone production, and a small increase in serum potassium levels, along with sodium and fluid loss. 作用：阻断ACE将血管紧张素I转化血管紧张素II，导致BP下降、醛固酮分泌减少及血清钾水平小量增加及钠和体液丢失。
Pharmacokinetics:药代动力学
Route Onset Peak
Oral 15 min 30-90 min
途径 起效 达峰
口服 15 min 30-90 min
T1/2: 2 hours; excreted in the urine. 半衰期：2 h；随尿排出
2. Losartan 氯沙坦 Indications: Alone or as part of combination therapy for the treatment of hypertension; treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria in patients with type 2 diabetes and hypertension. 适应症：单用或作为联合疗法一部分，用于高血压的治疗；2型糖尿病和高血压患者糖尿病性肾病伴血清肌酸酑和蛋白尿水平升高的治疗
Actions: Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands; blocks the vasoconstriction and release of aldosterone associated with the RAS. 作用：选择性阻断血管紧张素II与血管平滑肌和肾上腺特异性组织受体的结合；阻断血管收缩和RAS相关性醛固酮释放
Pharmacokinetics: 药代动力学
Route Onset Peak Duration
Oral Varies 1-3 h 24 h
途径 起效 达峰 持续时间
口服 不定 1-3 h 24 h
T1/2: 2 hours, then 6 to 9 hours; metabolized in the liver and excreted in urine and feces. 半衰期：2 h，然后6-9 h；代谢于肝，随大、小便排出
1. The client is taking an ACE Inhibitor to manage blood pressure. Which finding below requires immediate nursing action?
A. Urinary output is 190 mL within the past 4 hours.
B. Client has a persistent, dry cough.
C. EKG shows tall, peaked t-waves.
D. Client has a negative Chvostek’s sign. 2. Select all the pharmacodynamic effects of angiotensin II receptor blockers (ARBs):
A. Vasodilation
B. Vasoconstriction
C. Sodium conservation
D. Sodium excretion
E. Water conservation
F. Water excretion
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答案 Answer
1. C. EKG shows tall, peaked t-waves. Rationale: This EKG finding demonstrates hyperkalemia. Remember ACE Inhibitors can cause a high potassium level because the kidneys will keep potassium, but excrete water and sodium (so it has a diuretic effect too). 2. A, D, and F. Rationale: ARBs prevent Angiotensin II Type I Receptors from binding with Angiotensin II. This leads to vasodilation of vessels and decreases the release of aldosterone, which leads to sodium and water excretion (potassium is conserved…so watch out for hyperkalemia).
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