ACE Inhibitors

Question 1

ACE inhibitor uses

Answer 1

• Hypertension
• Ischemic Heart Disease (ie post MI)
• Chronic Heart Failure <=40%)
  »> highest tolerated dose = best prognosis
• Diabetic Neuropathy

Question 2

Ventricular Remodeling

Answer 2

• Change in ventricular size, geometry, function
  »> This result is from toxic neurohormonal stimulation
• Hypertrophy of myocytes
  »> Abnormal large cells don’t contract efficiently
• DIlation and Hypertrophy of venticles
• Reshaping of the LV from football to basketball size

Overall: most reversible (ACE inhibitors can reverse), ventricular remodeling leads to decrease contractility and stroke volume

Question 3

ACE and bradykinin

Answer 3

ACE’s inhibit degradation of bradykinin

- Leads to vasodilation and increased capillary permeability

Question 4

Adverse Effects of ACEs

Answer 4

Hypotension (esp with first dose)
Persistent Dry Cough (increase of kinens in the lungs)
Hyperkalemia and Check Creatitine
headache, dizziness, fatigue, n/v

SERIOUS: Angioedema

Question 5

Key Clinical Considerations

Answer 5

• Use with caution with renal impairment
• Do not use with Pregnancy
• Use with caution when prescribed other drugs that increase K levels
  »> K Supplements
  »> Potassium sparing diuretics: amiloride, spirinolactone
• Risk of renal failure increases when ACE are taken with NSAIDs
  »> NSAIDs increase reabsorption of Na and Water and may counteract antihypertensive effects of ACE
  Additive Hypotensive effects with other drugs
• To reduce risk , first dose should be admin before bed
• Added hypotensive effects, anti hypertensive, alcohol, benzo’s
• Reduce effect in AA and higher incidence of angioedema