ACE inhibitors

Question 1

what is the definition of ACE inhibitors?

Answer 1

Angiotensin-converting enzyme (ACE) inhibitors

Help relax the veins and arteries to lower blood pressure.

Question 2

What do ACE inhibitors do?

Answer 2

widens and dilates blood vessels

Question 3

How do the blood vessels widen?

Answer 3

They prevent Angiotensin-converting enzyme in the body from converting angiotensin I into angiotensin II

Question 4

What does angiotensin II do?

Answer 4

A substance that narrows blood vessels, therefore, lowers blood pressure

Question 5

What do ACE inhibitors treat?

Answer 5

Treatment of cardiovascular and renal diseases, including heart failure, acute coronary syndrome, nephrotic syndrome, diabetes, and hypertension

Question 6

What is the difference between ACS and Myocardial infarction?

Answer 6

CORONARY ARTERY DISEASES:

either stable angina or scute coronary syndrome which can lead to unstable angina or Myocardial infarction

Question 7

What are common names of ACE inhibitor medication?

Answer 7

Lisinopril (Prinivil, Zestril)
Benazepril (Lotensin)
Captopril
Enalapril (Vasotec)

Question 8

How can you recognise that a medication is an ACE inhibitor?

Answer 8

Ends in -pril

or -il

Question 9

What is sometimes prescribed alongside ACE inhibitors when it comes to blood pressure?

Answer 9

calcium channel blockers

diuretics

Question 10

How do ACE inhibitors treat renal diseases?

Answer 10

ACE inhibitors work by interfering with the body’s renin-angiotensin-aldosterone system (RAAS)

Question 11

What does RAAS do?

Answer 11

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.

Question 12

How do ACE inhibitors treat heart failure?

Answer 12

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.

Question 13

How do ACE inhibitors treat nephrotic syndrome?

Answer 13

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.

Question 14

How do ACE inhibitors treat diabetes?

Answer 14

Treat high blood pressure.
Prevent or slow kidney damage.
Lower the risks of stroke and heart attack.

Question 15

How are ACE inhibitors administered?

Answer 15

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.

Question 16

What can ACE inhibitors interact with?

Question 17

What are the main negative interactions with ACE inhibitors?

Answer 17

• Renin-inhibitors- Aliskiren
• Prophylaxis of Uric acid and gout- Allopurinol
• Azathioprine - increases risk of anaemia
• Everolimus- increases risk of angioedema
• lithium

Question 18

What are the contraindications of ACE inhibitors?

Answer 18

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

Question 19

What are common side effects of ACE inhibitors?

Answer 19

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

Question 20

What are some cautions to be aware of with ACE inhibitors?

Answer 20

• 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

Question 21

What is the recommendation with pregnancy and ACE inhibitors?

Answer 21

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.

Question 22

What are the risks of the elderly taking ACE inhibitors?

Answer 22

Postural hypotension

Hyperkalaemia

Question 23

How to ACE inhibitors cause anaphylactoid reactions?

Answer 23

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.