ACE inhibitors

Question 1

What are the actions of ACE inhibitors?

Answer 1

Red BP, red aldosterone/adh secretion, red. symp activation (Noradrenaline), inc bradykinin/ PG vasodil, red eGFR and HT related remodelling

Question 2

Where are ACE inhibitors activated and excreted?

Answer 2

Prodrug activated by liver metabolism (enalaprilAT pd)

Mainly cleared renally

Question 3

What are some examples of ACEi’s

Answer 3

Captopril/ Enalapril
Lisinopril, Ramipril, Perindopril, Trandolapril - slower onset, longer duration (1pd)
less rash/ taste disturbance so more common

Question 4

Clinical uses of ACEi’s

Answer 4

HT, Post MI (esp w/ vent dysf), high risk IHD, HF, diabetic nephropathy (esp t1), prog. renal insufficiency

Question 5

Adverse effects of ACEi’s

Answer 5

dry cough (VD bradykinin accm), angioodema, acute renal failure (mainly RVD/atheroscl)
1st dose HT (HF, ^renin levels e.g diuretics etc)
Hyperkalaemia, teratogenicity, skin rash/ taste disturbances (esp. captopril)

Question 6

ACEi interactions

Answer 6

Diuretics, K+ sparing diuretics (HK), other hypotensives, NSAIDS (dec. renal perfusion inc risk renal impairment)

Question 7

Guidance on administering ACEi’s

Answer 7

low starting dose in HF, monitor BP/renal function
Avoid in RVD- watch for HK
AVOID if pregnancy planned