ACE-1, Antihypertensive Flashcards
Benazepril —– Brand name, class and dosage forms?
Brand name: Lotensin
Class: ACE-I, Antihypertensive
Dosage forms: oral tablet (5, 10, 20, 40mg)
Benazepril —– Indication?
Hypertension
Benazepril —– MOA?
Competitive ACE-I; It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system.
Benazepril—– contraindication?
hypersensitivity, history of angioedema, anuria, concomitant use with aliskiren in pt with DM, concurrent sacubitrul
Benazepril—–efficacy monitoring parameters?
Decreased BP
Benazepril—- key patient counseling points?
Avoid in pregnancy
Seek immediate medically attention if you experience an facial swelling
most common adverse effect is a dry cough
use potassium supplements or salt substitutes under under medical supervision
may cause dizziness (worsens with dehydration)
take at the same time everyday
Benazepril—– ADR?
Common: none
Less common: Diarrhea, orthostatic dizziness, dry cough, fatigue, headache, hyperkalemia, nausea, nephrotoxicity, rash, tachycardia, vomiting
serious: angioedema (facial swelling), birth defects, liver failure, stevens-Johnson syndrome
Enalapril —– Brand name, class, and dosage forms?
Brand name: Vasotec
Class: ACEI, antihypertensive
Dosage form: oral tablet and oral solution
Enalapril —– indications?
Heart failure
HTN
Kidney disease (non-DM)
Enalapril—- MOA?
prodrug that is rapidly converted to its active metabolite, enalaprilat, a competitive ACEI. It reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and inhibits the sympathetic nervous system and tissue renin-angiotensin system. The net effect is reduction in total peripheral resistance and BP in hypertensive patients and reduction in elevated afterload in patients with heart failure.
Enalapril —– Contraindications?
hypersensitivity to enalapril, history of angioedema, pregnancy, concurrent sacubitril
Enalapril —–ADR?
common: increased SCr
Less common: diarrhea, dizziness, dry cough, fatigue, headache, hypotension, hyperkalemia, nausea, nephrotoxicity, rash, tachycardia
serious: angioedmea, birth defects and liver failure
Enalapril —–efficacy monitoring parameters?
decreased BP, signs of heart failure
enalapril —- toxicity monitoring parameters
signs of angioedema, severe persistent cough, hypotension, monitor baseline and periodic electrolytes, SCr, BUN, and urine protein
enalapril—– key patient counseling points?
Use potassium supplements or salt substitutes only under medical supervision. Report signs/symptoms of angioedema. May cause dizziness that may worsen if dehydrated. Use caution rising from sitting or lying position, especially when initiating treatment.
Lisinopril—– brand name, dosage form, and class
brand name: Prinivil and Zestril
class: ACEI, antihypertensive
dosage form: oral tablet (2.5, 5, 10,20, 30, 40) and oral solution
lisinopril—–indications?
ST-segment elevation MI
Heart failure with reduced ejection fraction
HTN
Lisinopril ——- MOA?
Lisinopril is a competitive ACEI. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system.
lisinopril —– contraindications?
Hypersensitivity to lisinopril or other ACEIs, history of ACEI-induced angioedema, and hereditary or idiopathic angioedema, concurrent use with aliskiren in diabetic patients, concurrent use with sacubitril
lisinopril —– ADR?
common: none known
less common: Diarrhea, dizziness, dry cough, headache, hypotension, hyperkalemia, nausea, nephrotoxicity, rash, tachycardia, vomiting
serious: angioedmea, birth defects, liver failure
Lisinopril—— monitoring?
efficacy- decreased BP
toxicity- Signs/symptoms of angioedema (swelling of the face, eyes, lips, tongue, or throat), severe persistent cough, hypotension; monitor baseline and periodic electrolytes, SCr, BUN, and urine protein.
Lisinopril ——key counseling points?
Avoid pregnancy. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated.
**can be considered first line agent for HTN management in pt with PMH of DM, or HF w/ reduced ejection fraction
Quinapril—— brand name, class, and dosage form?
Brand name: Accupril
class: ACEI, antirhypertensive
dosage form: oral tablet
Quinapril—-Indications?
heart failure and HTN
Quinapril —- MOA?
competitive ACEI that prevents the conversion of angiotensin 1 to angiotensin II which is a vasoconstrictor; Also reduces aldosterone leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system and alters prostanoid metabolism, and inhibits sympathetic nervous system and the tissue renin-angiotensin system.
Quniapril —- contraindications?
hypersensitivity to quinapril or other ACEI, history of ACEI-induced angioedmea, concurrent sacubitril
Quinapril ——- ADR?
common: nausea
Less common: diarrhea, dizziness, dry cough, fatigue, headache, hypotension, hyperkalemia, nephrotoxicity, rash, tachycardia, vomiting
serious: angioedema, birth defects, liver failure
Quinapril —– Monitoring and key counseling points?
efficacy: BP and signs/symptoms of heart failure
toxicity: Signs/symptoms of angioedema, persistent dry cough, hypotension; monitor baseline and periodic electrolytes, SCr, BUN, urine protein.
key patient counseling points: Avoid pregnancy. Avoid sudden discontinuation; rebound HTN can occur. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated.
Ramipril —– brand name, dosage form, class
brand name: altace
class: ACEI, antihypertensive
dosage form: oral capsule
Ramipril —- indications?
heart failure post-MI
HTN
Reduce risk of myocardial infarction, stroke, and death from CV causes
Ramipril —— MOA?
Ramipril is a competitive ACEI. It is also a prodrug for the more potent ACEI ramiprilat. ACEI prevents conversion of angiotensin I to angiotensin II (a vasoconstrictor). It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and inhibits the tissue renin-angiotensin system.
Ramipril —– contraindications?
Hypersensitivity to ramipril or other ACEIs, history of ACEI-induced angioedema; concurrent sacubitril
Ramipril —– ADR?
Common: none
Less Serious: Diarrhea, dizziness, dry cough, headache, hypotension, hyperkalemia, nausea, nephrotoxicity, rash, tachycardia, vomiting
Serious: Angioedema, birth defects, liver failure
Ramipril —– Monitoring?
Efficacy : BP, progression of heart failure
Toxicity: Angioedema (swelling of the face, eyes, lips, tongue, or throat), persistent dry cough, hypotension; baseline and periodic potassium, SCr, BUN, and urine protein
Fosinopril ——- Brand name, dosage form, class
Brand name: Monopril
Dosage form: oral tablet
Class: ACEI, antihypertensive
Fosinopril —– indication?
Heart failure and HTN
Fosinopril ——– MOA?
Fosinopril is a competitive ACEI. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin–angiotensin system.
Fosinopril —— contraindication?
Hypersensitivity, history of ACEI-induced angioedema, and hereditary or idiopathic angioedema, concomitant use with aliskiren in patients with diabetes
Fosinopril —— ADR?
Common: Dizziness
Less Serious: Diarrhea, dry cough, headache, hypotension, hyperkalemia, nausea, nephrotoxicity, rash, tachycardia, vomiting
Serious: Angioedema, birth defects, liver failure
