ACE Inhibitors Flashcards
Give 5 examples of ACE inhibitors
- Captopril
- Enalapril
- Lisinopril
- Perindopril
- Ramipril
What is the mechanism of action of ACE inhibitors?
They inhibit the conversion of angiotensin I to angiotensin II by blocking angiotensin converting enzyme (ACE)
What does blocking angiotensin II do?
Angiotensin II is a potent vasoconstrictor, so blocking its production causes blood vessels to relax and dilate
How are ACE inhibitors administered?
PO
What can ACE inhibitors be combined with in a single pill?
Can be used in combination drugs with calcium channel blockers or diuretics
What is the advantage of combination drugs include ACEi?
It can make it easier for patients who take multiple medications to control their BP
What are the indications for ACEi?
- Hypertension
- Coronary heart disease
- Ischaemic heart disease
- Diabetic nephropathy
Describe the role of ACEi in hypertension?
(as in ‘first’ line etc.)
First line in Caucasian people and those aged <55
Describe the role of ACEi in CHD?
First line
Describe the role of ACEi in ischaemic heart disease?
One of the 5 drugs indicated post-MI
When can ACEi not be used in diabetic nephropathy?
When there is renal impairment
Describe the role of ACEi in diabetic nephropathy?
Slows progression of renovascular disease
What are the cautions and contraindications to ACEi?
- Renal artery stenosis or known renal impairment
- Known hypersensitivity
- Hyperkalaemia
- Women who are pregnant
Why should you avoid using ACEi in renal artery stenosis/known renal impairment?
ACEi reduces glomerular filtration
Why should you avoid using ACEi in women who are pregnant?
Teratogenic, and can damage fetal renal function and BP control
When should you seek specialist advice before using ACEi?
- Aortic stenosis
- Mitral stenosis
- Hypertrophic cardiomyopathy
Why should you seek specialist advice before using ACEi in patients with aortic stenosis, mitral stenosis, and hypertrophic cardiomyopathy?
ACEi can cause vasodilation, which can cause blood pressure reduction in those with fixed cardiac outputs
Can you use ACEi when breastfeeding?
You can use some but not others
What monitoring should be done with ACEi?
Check U&Es prior to starting treatment and 1-2 weeks after, and on increasing dose
Why do you need to check U&Es prior to starting treatment with ACEi?
To establish baseline renal function
What other drugs might interact with ACEi?
- Nephrotoxic drugs
- K-sparing diuretics and K supplements
- Other drugs affecting the renin-angiotensin-aldosterone system
Give 4 examples of nephrotoxic drugs
- NSAIDs
- Lithium
- Metformin
- Diuretics
What might result from interaction between ACEi’s and nephrotoxic drugs?
Increased risk of AKI
What might result from the interaction between ACEi and K-sparing diuretics/K supplements?
Increased risk of hyperkalaemia
What might result from the interaction between ACEi and other drugs affecting the RAAS system?
Increased risk of hypotension, hyperkalaemia, and renal impairment compared to use of single drugs
What are the common side effects of ACEi’s?
- Dry cough
- 1st dose hypotension
- Hyperkalaemia
Why do ACEi’s cause a dry cough?
Because ACEi inhibit bradykinin metabolism and free bradykinins cause bronchoconstriction
What is a less common but very important side effect of ACEi?
Angio-oedema
What pneumonic (is that spelt right) can be used to remember the side effects of ACEi’s?
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
What needs to be talked about in patient counselling when starting ACEi?
- Dry cough
- 1st dose hypotension
- NSAIDs
- Surgery
- Pregnancy
- Angio-oedema/allergic reactions
What needs to be talked about regarding dry cough in ACEi counselling?
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
What needs to be talked about regarding 1st dose hypotension in ACEi counselling?
If the patient is at risk of 1st dose hypotension, suggest the dose is taken at night
What needs to be talked about regarding NSAIDs in ACEi counselling?
Should be advised not to take NSAIDs, e.g. ibuprofen, whilst taking ACEi
What needs to be talked about regarding surgery in ACEi counselling?
ACEi are normally stopped on the day of surgery, unless told otherwise
What needs to be talked about regarding pregnancy in ACEi counselling?
If the patient becomes pregnant, ACEi should be stopped immediately and alternatives offered
What needs to be talked about regarding angio-oedema/allergic reactions in ACEi counselling?
If swelling of the face, eyes, lips, or tongue develops, of if breathing difficulties occur, stop drug and call ambulance
