ACE inhibitors Flashcards
what is the definition of ACE inhibitors?
Angiotensin-converting enzyme (ACE) inhibitors
Help relax the veins and arteries to lower blood pressure.
What do ACE inhibitors do?
widens and dilates blood vessels
How do the blood vessels widen?
They prevent Angiotensin-converting enzyme in the body from converting angiotensin I into angiotensin II
What does angiotensin II do?
A substance that narrows blood vessels, therefore, lowers blood pressure
What do ACE inhibitors treat?
Treatment of cardiovascular and renal diseases, including heart failure, acute coronary syndrome, nephrotic syndrome, diabetes, and hypertension
What is the difference between ACS and Myocardial infarction?
CORONARY ARTERY DISEASES:
either stable angina or scute coronary syndrome which can lead to unstable angina or Myocardial infarction
What are common names of ACE inhibitor medication?
Lisinopril (Prinivil, Zestril)
Benazepril (Lotensin)
Captopril
Enalapril (Vasotec)
How can you recognise that a medication is an ACE inhibitor?
Ends in -pril
or -il
What is sometimes prescribed alongside ACE inhibitors when it comes to blood pressure?
calcium channel blockers
diuretics
How do ACE inhibitors treat renal diseases?
ACE inhibitors work by interfering with the body’s renin-angiotensin-aldosterone system (RAAS)
What does RAAS do?
RAAS is a complex system responsible for regulating the body’s blood pressure. The kidneys release an enzyme called renin in response to low blood volume, low salt (sodium) levels or high potassium levels.
How do ACE inhibitors treat heart failure?
ACE inhibitors dilate the blood vessels to improve your blood flow. This helps decrease the amount of work the heart has to do. They also help block a substance in the blood called angiotensin that is made as a result of heart failure.
How do ACE inhibitors treat nephrotic syndrome?
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce intraglomerular pressure by inhibiting angiotensin II ̶ mediated efferent arteriolar vasoconstriction. These drugs also have a proteinuria-reducing effect that is independent of their antihypertensive effect.
How do ACE inhibitors treat diabetes?
Treat high blood pressure.
Prevent or slow kidney damage.
Lower the risks of stroke and heart attack.
How are ACE inhibitors administered?
All of the ACE inhibitors are prescribed orally, except for enalapril, which can be given intravenously. Enalapril’s IV dosage is initially 0.625 to 1.25 mg every 6 hours.
What can ACE inhibitors interact with?
What are the main negative interactions with ACE inhibitors?
- Renin-inhibitors- Aliskiren
- Prophylaxis of Uric acid and gout- Allopurinol
- Azathioprine - increases risk of anaemia
- Everolimus- increases risk of angioedema
- lithium
What are the contraindications of ACE inhibitors?
Hereditary or idiopathic angioedema; history of angioedema associated with prior ACE inhibitor therapy; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m2; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
What are common side effects of ACE inhibitors?
Alopecia; angina pectoris; angioedema (can be delayed; more common in black patients); arrhythmias; asthenia; chest pain; constipation; cough; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting
What are some cautions to be aware of with ACE inhibitors?
- diuretics- can cause hypotension on low-sodium diet or dialysis
- diabetes (may lower blood glucose; increased risk of hyperkalaemia- high potassium levels)
- peripheral vascular disease or generalised atherosclerosis
- The risk of agranulocytosis is possibly increased in collagen vascular disease
- use with care in patients with aortic or mitral valve stenosis (risk of hypotension)
- use with care in patients with hypertrophic cardiomyopathy
What is the recommendation with pregnancy and ACE inhibitors?
ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported.
What are the risks of the elderly taking ACE inhibitors?
Postural hypotension
Hyperkalaemia
How to ACE inhibitors cause anaphylactoid reactions?
To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux membranes (e.g. polyacrylonitrile) and during low-density lipoprotein apheresis with dextran sulfate; they should also be withheld before desensitisation with wasp or bee venom.
