Renin Angiotensin Aldosterone System

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Tarang Patel
DNP-NA,RN,CCRN, RPh
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Study Tools For Renin Angiotensin Aldosterone System

RAAS and Cardiac Drugs (Cheatsheet)
140 Must Know Meds (Book)

Outline

Overview

  1. Renin Angiotensin Aldosterone System helps the body…
    1. Regulate blood pressure
    2. Regulate blood volume
    3. Regulate fluid and electrolytes
  2. RAAS is active when the kidneys sense…
    1. Hypotension
    2. Decreased blood volume (blood loss, severe dehydration)
    3. Lack of blood flow to the kidneys.
  3. Understanding RAAS helps better understand the following medication classes
    1. Angiotensin Converting Enzyme Inhibitors
    2. Angiotensin II Receptor Blockers (ARBS)
    3. Renin Antagonists

Nursing Points

General

  1. Goals of RAAS-
    1. Improve perfusion to the kidneys
    2. Increase blood pressure
    3. Increase blood volume
  2. How the RAAS works-
    1. Kidneys sense they are getting a decreased amount of blood flow
    2. Kidneys activate the RAAS by releasing the hormone renin
    3. Renin converts Angiotensinogen (an inactive protein) to Angiotensin I (active)
    4. Angiotensin I goes to the lungs where it is converted to Angiotensin II
      1. Converted by an enzyme called an angiotensin-converting enzyme (also known as ACE – a la ACE Inhibitor)
    5. Angiotensin II has a lot of functions in the body
      1. Increases sympathetic nervous system response causing vasoconstriction
        1. This increases blood pressure
      2. Causes kidneys to reabsorp more sodium which increases water retention
        1. This increases blood volume
      3. Causes the pituitary gland to increases secretion of Anti-diuretic Hormone (ADH)
        1. This increases water reabsorption in the kidneys
      4. Causes the adrenal gland to increase secretion of Aldosterone (another hormone)
        1. Causes the kidneys to increase their sodium and water retention

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Transcript

Okay, so we gonna talk about the RAA System in our body and the reason that we gonna talk about RAA system and covering it in our video, that it will help to better understand the Angiotensin Converting Enzyme Inhibitor medications, ARBs which is also called as Angiotensin II receptor blockers and Renin Antagonists. So, if you have a better understanding of the RAA system in our body, it will really help you to understand these 3 pharmacological classes of drugs and it will helpful to understand the side effects, why do we have the side effects and why do we use this medication for the particular diseases.

So, let’s go to the next slide and have a take a look at the RAA system. So, this diagram is basically presenting the RAA system. It may look complicated at first look, but it’s not really. So, if you look at the renin enzyme right here, we have a renin enzyme that gets secreted by the kidneys. When our kidney does not get enough blood flow or due to the blood pressure fall or if we have a blood loss, or it could be different reasons that the kidney is not getting enough blood flow. Or, if our body does not have enough sodium to reabsorb the water, kidney is not getting enough blood flow. Then, there’s a specialized cell in the kidney that’s gonna release renin. Now, what this renin gonna do, it’s gonna convert angiotensinogen protein which is in the inactive form in our blood to angiotensin I. So, the work of the renin, it’s gonna convert angiotensinogen to the angiotenisin I. Now, when the angiotensin I goes to the lungs, through the blood stream, the enzyme here, it’s called ACE inhibitor, right here in the lungs, gonna convert this angiotensin I into angiotensin II. So, this is the enzyme which is really important to remember. This is gonna help you in the ACE inhibitors. So, this is called Angiotensin Converting Enzyme which is present in the lung. Now, when angiotensin I gets converted into the angiotensin II, angiotensin II has many effects on our body. The first effect, when you take a look, it’s gonna increase the sympathetic system. Okay, so when it does increase the sympathetic system, nervous system, it’s gonna increase the vasoconstriction and if you really know your sympathetic nervous system. It’s gonna cause the vasoconstriction and it’s gonna increase the blood pressure. When there’s an increase in the blood pressure, kidneys gonna get enough blood flow. That’s how kidneys gonna get re-perfused. Now, the second action that angiotensin II have is on the kidney tubules. Well, it’s gonna increase the reabsorption of sodium and it’s gonna increase the excretion of potassium. Now, when it increases the reabsorption of sodium, it’s gonna increase the H2O retention, basically, the water retention. When that happens, it’s gonna increase a lot of volume, blood volume increases. When the blood volume increases, it’s gonna increase the blood pressure and that’s how it’s gonna cause, that’s how the kidneys get re-perfused which is the main problem why the renin got secreted. It also has effect on the adrenal gland as well. Angiotensin II is gonna go to the adrenal gland and it’s gonna increases the secretion of Aldosterone which is basically gonna do the same thing. Increase the sodium reabsorption, and it’s gonna increase the potassium excretion. Sodium reabsorption is gonna increase the water reabsorption as well as it’s gonna increase the blood volume. And, the final effect that angiotensin II has, it’s on the collecting ducts of the kidney. Our collecting ducts gonna, it’s main site where all the water excretion or the reabsorption happens. So, what it’s gonna do is it’s gonna go to the pituitary gland and gonna increase the secretion of ADH which is also called as antidiuretic hormone. What this antiduretic is gonna do, it’s gonna increase the water reabsorption in the kidney and it’s gonna increase blood volume. And that’s how kidney is gonna get re-perfused. So, this is how basically the RAA System works, so, have a better understanding of the RAA System and then we can understand ACE inhibitors, ARBs inhibitors and renin antagoist medication wear easily, which we’re gonna cover in the following presentation.

If you have any question about RAA System, then you can e-mail us or contact us. Thanks.

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Pharmacology for Nursing (MedMaster)

The Pharmacology Course is a one-stop-shop for all things medication related! We’ll talk you through how to be successful in pharmacology and how to be safe when administering meds. We break down the most common and most important medication classes into easy-to-understand sections. We even walk you through how to conquer the often intimidating med math and drug calculations! When you finish this course you’ll be able to confidently and safely administer medications to your patients!

Course Lessons

0 - Pharmacology Course Introduction
Pharmacology Course Introduction
1 - NCLEX Must Knows
12 Points to Answering Pharmacology Questions
54 Common Medication Prefixes and Suffixes
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Essential NCLEX Meds by Class
6 Rights of Medication Administration
Pharmacodynamics
Pharmacokinetics
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
2 - Math for Meds
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Oral Medications
Injectable Medications
IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
Pediatric Dosage Calculations
3 - Disease Specific Medications
Disease Specific Medications
4 - Antianxiety Agents
Antianxiety Meds
Benzodiazepines
Alprazolam (Xanax) Nursing Considerations
Lorazepam (Ativan) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Diazepam (Valium) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Antianxiety Meds
5 - Antiarrhythmics
ACLS (Advanced cardiac life support) Drugs
Amiodarone (Pacerone) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
6 - Anticoagulants & Thrombolytics
Anti-Platelet Aggregate
Clopidogrel (Plavix) Nursing Considerations
Coumarins
Warfarin (Coumadin) Nursing Considerations
Thrombin Inhibitors
Enoxaparin (Lovenox) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Thrombolytics
Alteplase (tPA, Activase) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
7 - Anticonvulsants
Anticonvulsants
Carbamazepine (Tegretol) Nursing Considerations
Divalproex (Depakote) Nursing Considerations
Gabapentin (Neurontin) Nursing Considerations
Lamotrigine (Lamictal) Nursing Considerations
Levetiracetam (Keppra) Nursing Considerations
Phenytoin (Dilantin) Nursing Considerations
8 - Antidepressants
Antidepressants
Bupropion (Wellbutrin) Nursing Considerations
MAOIs
Selegiline (Eldepyrl) Nursing Considerations
SSRIs
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Paroxetine (Paxil) Nursing Considerations
Sertraline (Zoloft) Nursing Considerations
TCAs
Amitriptyline (Elavil) Nursing Considerations
9 - Antidiabetic Agents
Antidiabetic Agents
Glipizide (Glucotrol) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Insulin
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
10 - Antihistamines
Histamine 1 Receptor Blockers
Diphenhydramine (Benadryl) Nursing Considerations
Promethazine (Phenergan) Nursing Considerations
Histamine 2 Receptor Blockers
Cimetidine (Tagamet) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
11 - Antihypertensives
Renin Angiotensin Aldosterone System
Sympatholytics (Alpha & Beta Blockers)
Atenolol (Tenormin) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
ACE (angiotensin-converting enzyme) Inhibitors
Captopril (Capoten) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Angiotensin Receptor Blockers
Losartan (Cozaar) Nursing Considerations
Calcium Channel Blockers
Amlodipine (Norvasc) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Cardiac Glycosides
Digoxin (Lanoxin) Nursing Considerations
12 - Anti-Infectives
Anti-Infective – Aminoglycosides
Gentamicin (Garamycin) Nursing Considerations
Anti-Infective – Antifungals
Metronidazole (Flagyl) Nursing Considerations
Nystatin (Mycostatin) Nursing Considerations
Anti-Infective – Antitubercular
Isoniazid (Niazid) Nursing Considerations
Rifampin (Rifadin) Nursing Considerations
Anti-Infective – Antivirals
Acyclovir (Zovirax) Nursing Considerations
Anti-Infective – Carbapenems
Meropenem (Merrem) Nursing Considerations
Anti-Infective – Fluoroquinolones
Ciprofloxacin (Cipro) Nursing Considerations
Levofloxacin (Levaquin) Nursing Considerations
Anti-Infective – Glycopeptide
Vancomycin (Vancocin) Nursing Considerations
Anti-Infective – Lincosamide
Clindamycin (Cleocin) Nursing Considerations
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Erythromycin (Erythrocin) Nursing Considerations
Azithromycin (Zithromax) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Amoxicillin (Amoxil) Nursing Considerations
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Cefdinir (Omnicef) Nursing Considerations
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13 - Antipsychotics
Atypical Antipsychotics
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14 - Autonomic Nervous System Meds
Autonomic Nervous System (ANS)
Methylphenidate (Concerta) Nursing Considerations
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Dobutamine (Dobutrex) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Parasympathomimetics (Cholinergics) Nursing Considerations
Neostigmine (Prostigmin) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Benztropine (Cogentin) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
15 - Bronchodilators & Respiratory Drugs
Guaifenesin (Mucinex) Nursing Considerations
Bronchodilators
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Montelukast (Singulair) Nursing Considerations
Salmeterol (Serevent) Nursing Considerations
16 - Diuretics
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Furosemide (Lasix) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Spironolactone (Aldactone) Nursing Considerations
Mannitol (Osmitrol) Nursing Considerations
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18 - Hormone & Immune Related Drugs
Epoetin Alfa
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Glucagon (GlucaGen) Nursing Considerations
Iodine Nursing Considerations
Levothyroxine (Synthroid)
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Cyclosporine (Sandimmune) Nursing Considerations
19 - Lipid Lowering Drugs
HMG-CoA Reductase Inhibitors (Statins)
Atorvastatin (Lipitor) Nursing Considerations
20 - Mineral and Electrolyte Drugs
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Magnesium Sulfate (MgSO4) Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Ferrous Sulfate (Iron) Nursing Considerations
Alendronate (Fosamax) Nursing Considerations
21 - Mood Stabilizers
Mood Stabilizers
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22 - Non-Opioid Analgesics
Acetaminophen (Tylenol) Nursing Considerations
Phenazopyridine (Pyridium) Nursing Considerations
NSAIDs
ASA (Aspirin) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Ibuprofen (Motrin) Nursing Considerations
Indomethacin (Indocin) Nursing Considerations
Ketorolac (Toradol) Nursing Considerations
Naproxen (Aleve) Nursing Considerations
23 - OB Meds
Tocolytics
Terbutaline (Brethine) Nursing Considerations
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Meds for Postpartum Hemorrhage (PPH)
Methylergonovine (Methergine) Nursing Considerations
Oxytocin (Pitocin) Nursing Considerations
Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
Lung Surfactant for Newborns
Eye Prophylaxis for Newborn
Phytonadione (Vitamin K) for Newborn
Hepatitis B Vaccine for Newborns
24 - Opioid Analgesics
Opioids
Opioid Analgesics in Pregnancy
Butorphanol (Stadol) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Morphine (MS Contin) Nursing Considerations
Nalbuphine (Nubain) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
25 - Sedatives / Hyponotics
Sedatives-Hypnotics
Barbiturates
Phenobarbital (Luminal) Nursing Considerations
Pentobarbital (Nembutal) Nursing Considerations
Anesthetic Agents
Propofol (Diprivan) Nursing Considerations
Lidocaine (Xylocaine) Nursing Considerations
26 - Steroids
Corticosteroids
Betamethasone and Dexamethasone in Pregnancy
Cortisone (Cortone) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Fluticasone (Flonase) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
27 - Vasodilators
Hydralazine
Hydralazine (Apresoline) Nursing Considerations
Nitro Compounds
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
28 - Vasopressors
Vasopressin
Epinephrine (EpiPen) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
29 - Medications By Class
ACLS (Advanced cardiac life support) Drugs
Anti-Infective – Aminoglycosides
Anti-Infective – Carbapenems
Anti-Infective – Macrolides
Anti-Infective – Fluoroquinolones
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Anti-Infective – Antifungals
Anti-Infective – Antivirals
Anti-Infective – Lincosamide
Thrombolytics
Anticonvulsants
Antidiabetic Agents
Sympatholytics (Alpha & Beta Blockers)
Anti-Infective – Antitubercular
Anti-Infective – Glycopeptide
Bronchodilators
Opioids
Barbiturates
Anesthetic Agents
30- Antineoplastics
Antineoplastics
Alkylating Agents
Antimetabolites
Anti Tumor Antibiotics
Plant Alkaloids Topoisomerase and Mitotic Inhibitors
31 – Medication Infusion
Patient Controlled Analgesia (PCA)
Epidural
Insulin Drips