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Drugs - CPT Sem 4 > ACE Inhibitors > Flashcards

ACE Inhibitors Flashcards

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1
Q

Give 5 examples of ACE inhibitors

A
  • Captopril
  • Enalapril
  • Lisinopril
  • Perindopril
  • Ramipril
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2
Q

What is the mechanism of action of ACE inhibitors?

A

They inhibit the conversion of angiotensin I to angiotensin II by blocking angiotensin converting enzyme (ACE)

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3
Q

What does blocking angiotensin II do?

A

Angiotensin II is a potent vasoconstrictor, so blocking its production causes blood vessels to relax and dilate

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4
Q

How are ACE inhibitors administered?

A

PO

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5
Q

What can ACE inhibitors be combined with in a single pill?

A

Can be used in combination drugs with calcium channel blockers or diuretics

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6
Q

What is the advantage of combination drugs include ACEi?

A

It can make it easier for patients who take multiple medications to control their BP

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7
Q

What are the indications for ACEi?

A
  • Hypertension
  • Coronary heart disease
  • Ischaemic heart disease
  • Diabetic nephropathy
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8
Q

Describe the role of ACEi in hypertension?

(as in ‘first’ line etc.)

A

First line in Caucasian people and those aged <55

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9
Q

Describe the role of ACEi in CHD?

A

First line

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10
Q

Describe the role of ACEi in ischaemic heart disease?

A

One of the 5 drugs indicated post-MI

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11
Q

When can ACEi not be used in diabetic nephropathy?

A

When there is renal impairment

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12
Q

Describe the role of ACEi in diabetic nephropathy?

A

Slows progression of renovascular disease

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13
Q

What are the cautions and contraindications to ACEi?

A
  • Renal artery stenosis or known renal impairment
  • Known hypersensitivity
  • Hyperkalaemia
  • Women who are pregnant
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14
Q

Why should you avoid using ACEi in renal artery stenosis/known renal impairment?

A

ACEi reduces glomerular filtration

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15
Q

Why should you avoid using ACEi in women who are pregnant?

A

Teratogenic, and can damage fetal renal function and BP control

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16
Q

When should you seek specialist advice before using ACEi?

A
  • Aortic stenosis
  • Mitral stenosis
  • Hypertrophic cardiomyopathy
17
Q

Why should you seek specialist advice before using ACEi in patients with aortic stenosis, mitral stenosis, and hypertrophic cardiomyopathy?

A

ACEi can cause vasodilation, which can cause blood pressure reduction in those with fixed cardiac outputs

18
Q

Can you use ACEi when breastfeeding?

A

You can use some but not others

19
Q

What monitoring should be done with ACEi?

A

Check U&Es prior to starting treatment and 1-2 weeks after, and on increasing dose

20
Q

Why do you need to check U&Es prior to starting treatment with ACEi?

A

To establish baseline renal function

21
Q

What other drugs might interact with ACEi?

A
  • Nephrotoxic drugs
  • K-sparing diuretics and K supplements
  • Other drugs affecting the renin-angiotensin-aldosterone system
22
Q

Give 4 examples of nephrotoxic drugs

A
  • NSAIDs
  • Lithium
  • Metformin
  • Diuretics
23
Q

What might result from interaction between ACEi’s and nephrotoxic drugs?

A

Increased risk of AKI

24
Q

What might result from the interaction between ACEi and K-sparing diuretics/K supplements?

A

Increased risk of hyperkalaemia

25
Q

What might result from the interaction between ACEi and other drugs affecting the RAAS system?

A

Increased risk of hypotension, hyperkalaemia, and renal impairment compared to use of single drugs

26
Q

What are the common side effects of ACEi’s?

A
  • Dry cough
  • 1st dose hypotension
  • Hyperkalaemia
27
Q

Why do ACEi’s cause a dry cough?

A

Because ACEi inhibit bradykinin metabolism and free bradykinins cause bronchoconstriction

28
Q

What is a less common but very important side effect of ACEi?

A

Angio-oedema

29
Q

What pneumonic (is that spelt right) can be used to remember the side effects of ACEi’s?

A

CAPTOPRIL

C - cough
A - angio-oedema/anaphylaxis
P - palpitations
T - taste disturbance
O - orthostatic hypotension
P - potassium elevated
R - renal impairment
I - impotence
L - leucocytosis
30
Q

What needs to be talked about in patient counselling when starting ACEi?

A
  • Dry cough
  • 1st dose hypotension
  • NSAIDs
  • Surgery
  • Pregnancy
  • Angio-oedema/allergic reactions
31
Q

What needs to be talked about regarding dry cough in ACEi counselling?

A

If the patient develops a dry cough within the first months of starting ACEi, they should report this to their GP and be switched to an ARB

32
Q

What needs to be talked about regarding 1st dose hypotension in ACEi counselling?

A

If the patient is at risk of 1st dose hypotension, suggest the dose is taken at night

33
Q

What needs to be talked about regarding NSAIDs in ACEi counselling?

A

Should be advised not to take NSAIDs, e.g. ibuprofen, whilst taking ACEi

34
Q

What needs to be talked about regarding surgery in ACEi counselling?

A

ACEi are normally stopped on the day of surgery, unless told otherwise

35
Q

What needs to be talked about regarding pregnancy in ACEi counselling?

A

If the patient becomes pregnant, ACEi should be stopped immediately and alternatives offered

36
Q

What needs to be talked about regarding angio-oedema/allergic reactions in ACEi counselling?

A

If swelling of the face, eyes, lips, or tongue develops, of if breathing difficulties occur, stop drug and call ambulance

Drugs - CPT Sem 4 (81 decks)

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