ACE INHIBITORS

Question 1

ACE inhibitors - examples

Answer 1

Ramipril
Lisinopril
Perindopril

Question 2

ACE inhibitors - indications

Answer 2

Hypertension

Chronic heart failure

Ischaemic heart disease - reduce risk of CV events (e.g.- MI, stroke)

Diabetic nephropathy and chronic kidney disease with proteinuria

Question 3

ACE inhibitors - MOA for HTN

Answer 3

Inhibit ACE to prevent conversion of ATI –> ATII

This blocks ATII vasoconstrictor effect = reduces afterload (PVR) = lowers BP

Question 4

ACE inhibitors - MOA for heart failure

Answer 4

ATII also stimulates aldosterone secretion

Blocking ATII = reduce aldosterone levels = promotes Na+/H2O excretion = reduce preload = beneficial in HF

Question 5

ACE inhibitors - adverse effects (common and important)

Answer 5

→Hypotension (especially after first dose)

→Hyperkalaemia

→Persistent dry cough

→Cause of worsen renal failure

Question 6

ACE inhibitors - adverse effects (rare and important)

Answer 6

→Angioedema

→Anaphylactoid reaction

Question 7

ARBs/ACE inhibitors - interactions

Answer 7

K+ ELEVATING DRUGS
Avoid use with potassium elevating drugs (including potassium supplements or potassium sparing diuretics)

NSAIDS
Avoid use in combination with NSAID → this increases risk of nephrotoxicity

DIURETICS
Use with diuretics may increase effect of first-dose hypotension

Question 8

ARBs/ACE inhibitors - caution

Answer 8

Lower doses should be used and carefully monitored in patients with chronic kidney disease

Question 9

ARBs/ACE inhibitors - contraindications (avoid)

Answer 9

→ renal artery stenosis
→ acute kidney injury
→ women who are/could become pregnant
→ women who are breastfeeding