MN 553 ACTUAL 2026 STUDY GUIDE QUESTIONS AND
SOLUTIONS RATED A+
✔✔How do you increase the effects of ACEs in the African American population -
✔✔Combine with a diuretic
✔✔What is the biggest risk with ACEs in AA and Asian populations - ✔✔3-4 times
greater risk of angioedema
✔✔ACE ADRs - ✔✔Dry cough (bradykinin mediated)
Hypotension
Loss of taste
Angioedema
Blood dycrasias
Teratogenicity
Hyperkalemia
Acute renal failure
Cholestatic jaundice
Pancreatitis
Rash
✔✔ACE monitoring - ✔✔Possible orthostasis within 1 hour of administration when
starting and with each dosage change
✔✔ACE patient education - ✔✔Do not double dose if one is missed
Hypotension
Cough is common with the older generation
✔✔Angiotensin II Receptor blocker MOA - ✔✔Prevent the binding of AT II to receptors
in the kidneys, brain, heart, and arterial walls
Inhibit the renin-angiotension aldosterone system (RAAS) and cause fall in peripheral
resistance
,✔✔Can you use AT II receptor blockers in kidney disease and HF - ✔✔Yes until late
stage, but not all forms are renal protective like ACEs
✔✔What are the benefits of AT II receptor blockers - ✔✔No bradykinin-mediated cough
like ACEs
✔✔What are considered alternatives for patients who cannot tolerate ACEs or become
resistant - ✔✔ARBs
✔✔What medication will you see ARBs combined with - ✔✔Hydrochlorothiazide
✔✔ARB ADRs - ✔✔Similar to ACEs without the cough (typically)
✔✔ARB monitoring - ✔✔Similar to ACE
Orthostasis with dose changes
✔✔ARB patient education - ✔✔Do not double doses
Watch for hypotension
✔✔Example of a direct renin inhibitor - ✔✔Alsikiren (Tekturna)
✔✔Tekturna MOA - ✔✔Works on the RAAS
Inhibits renin release (stops)
✔✔Tekturna uses - ✔✔HTN
Awaiting word on HF
Not same MI indication as ACEs and ARBs
✔✔True or false
Tekturna has the same renal protective properties as ACEs - ✔✔False
✔✔When a patient is on an ACE and creatinine rises what should you do -
✔✔Discontinue medication
✔✔True or false
, Tekturna shares the same issues in pregnancy as ACEs and ARBS but fewer issues
with K+ and cough - ✔✔True
✔✔Neprilysin inhibitor medications - ✔✔Sacubitiril
Valsartan (Entresto)
✔✔Neprilysin inhibitor indications - ✔✔Decreases hospitalizations and death in chronic
HF
(EF less than 40%)
Taken in place of ACE or ARB
Not given with BBs
✔✔Neprilysin inhibitor outcomes - ✔✔Increases renal blood flow and improves diuresis
✔✔What is the washout time between using Neprilysin inhibitors and ACEs/ARBs/BBs -
✔✔36 hours
✔✔Calcium channel blockers MOA - ✔✔Functionally act as vasodilators, lowering
calcium influx into smooth muscle
✔✔What is the first choice of drug class for AA with HTN - ✔✔CCBs
✔✔Can CCBs be used as add on medications - ✔✔Yes
✔✔CCB MOA - ✔✔Metabolized by the liver
✔✔CCB ARDs - ✔✔Very constipating
Can cause dizziness
HA
Edema
Rash
Gingival hyperplasia
✔✔CCB monitoring - ✔✔Verapamil has the strongest negative inotropic effect and
should be avoided in patients with HF
SOLUTIONS RATED A+
✔✔How do you increase the effects of ACEs in the African American population -
✔✔Combine with a diuretic
✔✔What is the biggest risk with ACEs in AA and Asian populations - ✔✔3-4 times
greater risk of angioedema
✔✔ACE ADRs - ✔✔Dry cough (bradykinin mediated)
Hypotension
Loss of taste
Angioedema
Blood dycrasias
Teratogenicity
Hyperkalemia
Acute renal failure
Cholestatic jaundice
Pancreatitis
Rash
✔✔ACE monitoring - ✔✔Possible orthostasis within 1 hour of administration when
starting and with each dosage change
✔✔ACE patient education - ✔✔Do not double dose if one is missed
Hypotension
Cough is common with the older generation
✔✔Angiotensin II Receptor blocker MOA - ✔✔Prevent the binding of AT II to receptors
in the kidneys, brain, heart, and arterial walls
Inhibit the renin-angiotension aldosterone system (RAAS) and cause fall in peripheral
resistance
,✔✔Can you use AT II receptor blockers in kidney disease and HF - ✔✔Yes until late
stage, but not all forms are renal protective like ACEs
✔✔What are the benefits of AT II receptor blockers - ✔✔No bradykinin-mediated cough
like ACEs
✔✔What are considered alternatives for patients who cannot tolerate ACEs or become
resistant - ✔✔ARBs
✔✔What medication will you see ARBs combined with - ✔✔Hydrochlorothiazide
✔✔ARB ADRs - ✔✔Similar to ACEs without the cough (typically)
✔✔ARB monitoring - ✔✔Similar to ACE
Orthostasis with dose changes
✔✔ARB patient education - ✔✔Do not double doses
Watch for hypotension
✔✔Example of a direct renin inhibitor - ✔✔Alsikiren (Tekturna)
✔✔Tekturna MOA - ✔✔Works on the RAAS
Inhibits renin release (stops)
✔✔Tekturna uses - ✔✔HTN
Awaiting word on HF
Not same MI indication as ACEs and ARBs
✔✔True or false
Tekturna has the same renal protective properties as ACEs - ✔✔False
✔✔When a patient is on an ACE and creatinine rises what should you do -
✔✔Discontinue medication
✔✔True or false
, Tekturna shares the same issues in pregnancy as ACEs and ARBS but fewer issues
with K+ and cough - ✔✔True
✔✔Neprilysin inhibitor medications - ✔✔Sacubitiril
Valsartan (Entresto)
✔✔Neprilysin inhibitor indications - ✔✔Decreases hospitalizations and death in chronic
HF
(EF less than 40%)
Taken in place of ACE or ARB
Not given with BBs
✔✔Neprilysin inhibitor outcomes - ✔✔Increases renal blood flow and improves diuresis
✔✔What is the washout time between using Neprilysin inhibitors and ACEs/ARBs/BBs -
✔✔36 hours
✔✔Calcium channel blockers MOA - ✔✔Functionally act as vasodilators, lowering
calcium influx into smooth muscle
✔✔What is the first choice of drug class for AA with HTN - ✔✔CCBs
✔✔Can CCBs be used as add on medications - ✔✔Yes
✔✔CCB MOA - ✔✔Metabolized by the liver
✔✔CCB ARDs - ✔✔Very constipating
Can cause dizziness
HA
Edema
Rash
Gingival hyperplasia
✔✔CCB monitoring - ✔✔Verapamil has the strongest negative inotropic effect and
should be avoided in patients with HF
