Renin Angiotensin Aldosterone System

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Tarang Patel
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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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Pharmocology

Concepts Covered:

  • Test Taking Strategies
  • Prefixes
  • Suffixes
  • Bipolar Disorders
  • Immunological Disorders
  • Medication Administration
  • Urinary System
  • Cardiac Disorders
  • Personality Disorders
  • Nervous System
  • Substance Abuse Disorders
  • Cardiovascular Disorders
  • Respiratory Disorders
  • Pregnancy Risks
  • Hematologic Disorders
  • Liver & Gallbladder Disorders
  • Upper GI Disorders
  • Vascular Disorders
  • Disorders of Pancreas
  • Depressive Disorders
  • Urinary Disorders
  • Anxiety Disorders
  • Disorders of the Posterior Pituitary Gland
  • Noninfectious Respiratory Disorder
  • Concepts of Pharmacology
  • Dosage Calculations
  • Learning Pharmacology
  • Adult
  • Shock
  • Male Reproductive Disorders
  • Sexually Transmitted Infections
  • Microbiology
  • Emergency Care of the Cardiac Patient
  • Female Reproductive Disorders
  • Central Nervous System Disorders – Brain
  • Labor Complications
  • Musculoskeletal Trauma
  • EENT Disorders
  • Acute & Chronic Renal Disorders
  • Psychotic Disorders
  • Postpartum Complications
  • Prenatal Concepts
  • Intraoperative Nursing
  • Infectious Respiratory Disorder
  • Newborn Care
  • Oncology Disorders
  • Gastrointestinal Disorders
  • Neurologic and Cognitive Disorders
  • Integumentary Disorders
  • Disorders of the Adrenal Gland
  • Peripheral Nervous System Disorders
  • Postoperative Nursing
  • Neurological
  • Lower GI Disorders
  • Disorders of the Thyroid & Parathyroid Glands

Study Plan Lessons

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
Renin Angiotensin Aldosterone System
ACE (angiotensin-converting enzyme) Inhibitors
Angiotensin Receptor Blockers
Atypical Antipsychotics
Autonomic Nervous System (ANS)
Benzodiazepines
Cardiac Glycosides
Corticosteroids
Calcium Channel Blockers
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Epoetin Alfa
Histamine 1 Receptor Blockers
Histamine 2 Receptor Blockers
Hydralazine
HMG-CoA Reductase Inhibitors (Statins)
Insulin
Magnesium Sulfate
MAOIs
NSAIDs
Nitro Compounds
Nitro Compounds
Parasympatholytics (Anticholinergics) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Proton Pump Inhibitors
SSRIs
TCAs
Vasopressin
Disease Specific Medications
NG Tube Medication Administration
Pharmacodynamics
Pharmacokinetics
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Oral Medications
Injectable Medications
IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
The SOCK Method – S
The SOCK Method – C
The SOCK Method – K
The SOCK Method – O
The SOCK Method – Overview
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
ACLS (Advanced cardiac life support) Drugs
Parasympathomimetics (Cholinergics) Nursing Considerations
Anti-Infective – Aminoglycosides
Anti-Infective – Carbapenems
Anti-Infective – Macrolides
Anti-Infective – Fluoroquinolones
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Anti-Infective – Antifungals
Anti-Infective – Antivirals
Acyclovir (Zovirax) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Alendronate (Fosamax) Nursing Considerations
Alprazolam (Xanax) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Amitriptyline (Elavil) Nursing Considerations
Amlodipine (Norvasc) Nursing Considerations
Ampicillin (Omnipen) Nursing Considerations
Anti-Platelet Aggregate
Coumarins
Opioids
Amoxicillin (Amoxil) Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
Sympatholytics (Alpha & Beta Blockers)
Antianxiety Meds
Antipsychotics
Tocolytics
Mood Stabilizers
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Meds for Postpartum Hemorrhage (PPH)
Opioid Analgesics in Pregnancy
Sedatives-Hypnotics
Betamethasone and Dexamethasone in Pregnancy
Anti-Infective – Antitubercular
Antidepressants
Thrombin Inhibitors
Hepatitis B Vaccine for Newborns
Phytonadione (Vitamin K) for Newborn
Eye Prophylaxis for Newborn
Lung Surfactant for Newborns
Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
Barbiturates
Anti-Infective – Lincosamide
Thrombolytics
Antidiabetic Agents
Anti-Infective – Glycopeptide
Anticonvulsants
Bronchodilators
Anesthetic Agents
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
Epidural
Patient Controlled Analgesia (PCA)
Insulin Drips
Interactive Practice Drip Calculations
Interactive Pharmacology Practice
Plant Alkaloids Topoisomerase and Mitotic Inhibitors
Pediatric Dosage Calculations
Alkylating Agents
Antimetabolites
Antineoplastics
Anti Tumor Antibiotics
Captopril (Capoten) Nursing Considerations
Azithromycin (Zithromax) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
ASA (Aspirin) Nursing Considerations
Acetaminophen (Tylenol) Nursing Considerations
Atenolol (Tenormin) Nursing Considerations
Atorvastatin (Lipitor) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Benztropine (Cogentin) Nursing Considerations
Bupropion (Wellbutrin) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Dobutamine (Dobutrex) Nursing Considerations
Epinephrine (EpiPen) Nursing Considerations
Escitalopram (Lexapro) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Lorazepam (Ativan) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Diphenhydramine (Benadryl) Nursing Considerations
Divalproex (Depakote) Nursing Considerations
Epoetin (Epogen) Nursing Considerations
Erythromycin (Erythrocin) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Carbamazepine (Tegretol) Nursing Considerations
Cefaclor (Ceclor) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Clopidogrel (Plavix) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Cortisone (Cortone) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Losartan (Cozaar) Nursing Considerations
Iodine Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Isoniazid (Niazid) Nursing Considerations
Metronidazole (Flagyl) Nursing Considerations
Nystatin (Mycostatin) Nursing Considerations
Fluticasone (Flonase) Nursing Considerations
Levofloxacin (Levaquin) Nursing Considerations
Hydralazine (Apresoline) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
Haloperidol (Haldol) Nursing Considerations
Olanzapine (Zyprexa) Nursing Considerations
Nitroglycerin (Nitrostat) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Neostigmine (Prostigmin) Nursing Considerations
Meropenem (Merrem) Nursing Considerations
Morphine (MS Contin) Nursing Considerations
Magnesium Sulfate (MgSO4) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Methylphenidate (Concerta) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Mannitol (Osmitrol) Nursing Considerations
Loperamide (Imodium) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Lactulose (Generlac) Nursing Considerations
Pancrelipase (Pancreaze) Nursing Considerations
Ondansetron (Zofran) Nursing Considerations
Omeprazole (Prilosec) Nursing Considerations
Pantoprazole (Protonix) Nursing Considerations
Glucagon (GlucaGen) Nursing Considerations
Lithium (Lithonate) Nursing Considerations
Lidocaine (Xylocaine) Nursing Considerations
Ibuprofen (Motrin) Nursing Considerations
Indomethacin (Indocin) Nursing Considerations
Ketorolac (Toradol) Nursing Considerations
Naproxen (Aleve) Nursing Considerations
Methylergonovine (Methergine) Nursing Considerations
Oxytocin (Pitocin) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Nalbuphine (Nubain) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Digoxin (Lanoxin) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Enoxaparin (Lovenox) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Furosemide (Lasix) Nursing Considerations
Gabapentin (Neurontin) Nursing Considerations
Gentamicin (Garamycin) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Glipizide (Glucotrol) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Cephalexin (Keflex) Nursing Considerations
Chlorpromazine (Thorazine) Nursing Considerations
Cimetidine (Tagamet) Nursing Considerations
Clindamycin (Cleocin) Nursing Considerations
Diazepam (Valium) Nursing Considerations
Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Lamotrigine (Lamictal) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
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
Albuterol (Ventolin) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Ferrous Sulfate (Iron) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Phenazopyridine (Pyridium) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
Sertraline (Zoloft) Nursing Considerations
Pentobarbital (Nembutal) Nursing Considerations
Alteplase (tPA, Activase) Nursing Considerations
Rifampin (Rifadin) Nursing Considerations
Phenytoin (Dilantin) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Propylthiouracil (PTU) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Tetracycline (Panmycin) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
Selegiline (Eldepyrl) Nursing Considerations
Warfarin (Coumadin) Nursing Considerations
Sucralfate (Carafate) Nursing Considerations
Spironolactone (Aldactone) Nursing Considerations
Salmeterol (Serevent) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
Vancomycin (Vancocin) Nursing Considerations
Trimethoprim-Sulfamethoxazole (Bactrim) Nursing Considerations
Terbutaline (Brethine) Nursing Considerations
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Promethazine (Phenergan) Nursing Considerations
Paroxetine (Paxil) Nursing Considerations
Phenobarbital (Luminal) Nursing Considerations
Levetiracetam (Keppra) Nursing Considerations
Butorphanol (Stadol) Nursing Considerations