ACE inhibitors

Question 1

ACE inhibitors-
What are common indications?

Answer 1

Hypertension- 1st or 2nd line, to reduce risk of stroke MI, and death from CVD

Chronic heart failure:
1st line all grades of heart failure to improve symptoms and prognosis

Secondary prevention of major adverse CVE

Diabetic neuropathy and CKD with proteinuria: to reduce proteinuria and progression of nephropathy.

Question 2

ACE inhibitors-
Give examples

Answer 2

ramipril, lisinopril, perindopril

Question 3

ACE inhibitors-
what is the MOA?

Answer 3

Reduce the conversion of angiotensin I to angiotensin I. Angiotensin II is a vasoconstrictor and stimulates aldosterone secretion. Blocking its action reduces peripheral vascular resistance which lowers BP.

Question 4

ACE inhibitors-
What are common side effects?

Answer 4

• hypotension
  -hyperkalaemia (as lower aldosterone which promotes potassium retention)
  -worsen renal failure
  -dry cough
  -angioedema (rare)

Question 5

ACE inhibitors-

When should they be avoided?

Answer 5

-Renal artery stenosis
-AKI
-Pregnant/breastfeeding
(Can be useful in CKD)

Question 6

ACE inhibitors-
What are important interactions?

Answer 6

potassium elevating drugs including aldosterone antagonist and potassium sparing diuretics

NSAIDs-both increase the risk of nephrotoxicity

Question 7

ACE inhibitors-
How should they be taken

Answer 7

with or without food preferably at night to avoid to reduce symptomatic hyPOtension

Question 8

ACE inhibitors-
What are doses

Answer 8

Initially 1.25mg PO OD for heart failure own neuropathy or 2.5mg for other indications.

MAX 10mg (titrated)