ACE/ARBs

Question 1

ACE MOA

Answer 1

inhibit conversion of angiotensin I to angiotensin II.

Question 2

ACE inhibitors and HF

Answer 2

~ ACE inhibitors used in all grades of HF, in combo with BB.
~ DISCONTINUE K supplements + K-sparing diuretics before starting ACE inhibitor because of risk of hyperkalaemia. However, low dose of spironolactone may be beneficial in severe heart failure and can be used with an ACE inhibitor provided serum potassium is monitored carefully.

Profound first-dose hypotension may occur when ACE inhibitors are introduced to patients with heart failure who are already taking a high dose of a loop diuretic (e.g. furosemide 80 mg daily or more). Temporary withdrawal of loop diuretic reduces the risk, but may cause severe rebound pulmonary oedema. Therefore, for patients on high doses of loop diuretics, the ACE inhibitor may need to be initiated under specialist supervision
~ ACEi can be initiated in community in patients receiving a low dose of diuretic or not otherwise at risk of serious hypotension;

Question 3

HTN and ACE inhibitor

Answer 3

ACE inhibitor most appropriate drug for HTN in younger Caucasian
~ particularly indicated for HTN in patients with type 1 diabetes with nephropathy
~ reduce BP very rapidly in some patients particularly in those receiving diuretic therapy.

Question 4

renal function and ACE inhibitors

Answer 4

Renal function + electrolytes checked before starting + monitored during tx hyperkalaemia & other SE of ACE inhibitors more common in those with impaired renal function, dose may need to be reduced

Question 5

severe bilateral renal artery stenosis & ACE inhibitors

Answer 5

reduce or abolish glomerular filtration & likely to cause severe & progressive renal failure. SO not recommended

Question 6

Aliskiren is a

Answer 6

renin inhibitor for HTN tx

Question 7

Combination therapy with 2 drugs affecting renin-angiotensin system (ACE inhibitors, ARB, aliskiren)

Answer 7

not recommended due to increased risk of hyperkalaemia, hypotension, & renal impairment,

Question 8

ONLY 1 ACE inhibitor has BD dosing rest have OD

Answer 8

Captopril (1st dose @bedtime)

Question 9

ACE + diuretics

Answer 9

volume depletion = low BP !

Question 10

ACE + renin-angiotensin system drugs i.e. ACEi/ARB, renin inhibitors

Answer 10

AVOID using together in diabetic nephropathy
as
renal impairment
HyPERkalaemia
Hypoension

Question 11

ACE + NSAIDs

Answer 11

Nephrotoxicity + reduced eGFR

Question 12

ACEi side effects

Answer 12

• persistent dry cough
• HyPOkalaemia (higher risk in DM, renal impairment)
• Anaphylaxis reaction e.g. angio-oedema
  ~ renal effects
  ~ hepatic effects
  ~ Oral ulcers
  ~ taste disturbances
  ~ hypoglycaemia

Question 13

ACEi renal effects

Answer 13

~ protective in CKD
~ TOXIC in AKI (DAMN)
~ avoid in renovascular disease (bilateral renal artery stenosis)

Question 14

ACEi hepatic effects

Answer 14

Choelstatic jaundice
Hepatic failure
STOP if liver x3 higher or jaundice occurs