ACE inhibitors Flashcards
What does ACE stand for in ACE inhibitors?
Angiotensin-Converting Enzyme
Which class of drugs do ACE inhibitors belong to?
Antihypertensives
What is a common initial dosing consideration for ACE inhibitors?
Start at a low dose to assess tolerance.
What is the typical route of administration for ACE inhibitors?
Oral
Which ACE inhibitor has the longest half-life?
Ramipril
What is the mechanism of action of ACE inhibitors?
ACE inhibitors block the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion, and lowering blood pressure.
why do they call ace inhibitors balanced vasodilators?
ACE inhibitors are called “balanced vasodilators” because they reduce both preload and afterload.
True or False: ACE inhibitors are primarily used to treat hypertension.
True
What affect does low AT II levels have on ADH production?
Reduced ADH release, which helps in decreasing water retention and plasma volume.
What is the first-line treatment for hypertension in patients with diabetes?
ACE inhibitors
What is the role of ACE inhibitors in diabetic nephropathy?
They slow the progression of kidney disease, therefore they are indicated when the patient has proteinuria.
Which cardiovascular condition is commonly treated with ACE inhibitors?
Heart failure
Which ACE inhibitor is often used in patients with heart failure?
Enalapril
Name one advantage of using ACE inhibitors over ARBs.
ACE inhibitors reduce mortality in heart failure.
Fill in the blank: The primary benefit of ACE inhibitors in heart failure is _______.
reduction in mortality
Fill in the blank: ACE inhibitors can cause _______ due to increased bradykinin levels.
dry cough
A patient was prescribed an ACE inhibitor for conditions like hypertension (HTN), coronary artery disease (CAD), and post-myocardial infarction (MI), likely to reduce mortality and prevent cardiac remodeling. However, they developed a dry cough, what is the best way to manage this patient pharmacologically?
This patient developed a dry cough, which is a well-known side effect of ACE inhibitors due to increased bradykinin levels. This occurs because ACE (angiotensin-converting enzyme) is also responsible for degrading bradykinin. When ACE is inhibited, bradykinin accumulates, leading to irritation of the airways and a persistent dry cough.Since this patient has a history of cardiovascular disease, discontinuing RAAS blockade is not an option, as it provides significant benefits in preventing heart failure progression and reducing mortality. Instead, the best alternative is an ARB (e.g., losartan, valsartan, candesartan), which provides similar cardiovascular benefits without affecting bradykinin levels, thereby avoiding the cough.
Name the potential side effect of ACE inhibitors when a patient has facial swelling.
Angioedema, a rare but life-threatening reaction caused by bradykinin accumulation. ACE inhibitors (eg, enalapril) can lead to the development of angioedema in approximately 0.1%-0.7% of patients. They typically cause non-pitting swelling of the subcutaneous or submucosal tissue and most commonly affects the lips, tongue, face, and upper airway. ACE inhibitors do not cause peripheral or dependent edema.
True or False: ACE inhibitors are contraindicated in patients with a history of angioedema.
True
Which electrolyte imbalance can ACE inhibitors cause?
Hyperkalemia
True or False: ACE inhibitors are effective in preventing heart failure.
True
What is the effect of ACE inhibitors on renal blood flow?
Renal blood flow increases.
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ACE inhibitors (ACEIs) have distinct effects on renal blood flow, primarily due to their impact on the renin-angiotensin-aldosterone system (RAAS). The key mechanisms are related to the reduction of angiotensin II (AT II), which regulates both afferent and efferent arteriolar tone. ACE inhibitors block the formation of AT II, causing efferent arteriolar dilation, which will lower GFR. Due to increased overall perfusion, Renal Blood Flow (RBF) will increase.
True or False: ACE inhibitors should be used with caution in patients with renal artery stenosis.
True
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One of ways to determine that a patient has RAS following an ACE inhibitor is to observe an increase in creatinine levels shortly after prescribing an ACE inhibitor. Under normal circumstances, creatinine levels will raise just by using ACE inhibitors, but when a patient has bilateral RAS, creatinine levels will raise expeditiously.
Which lab test should be monitored regularly in patients taking ACE inhibitors?
Serum potassium levels. ACE inhibitors cause hyperkalemia due to lower aldosterone levels (from low AT II).
What is the effect of ACE inhibitors on the sympathetic nervous system?
They reduce sympathetic outflow.
Fill in the blank: ACE inhibitors can lead to _______ in the first few doses.
hypotension
What is a major contraindication for ACE inhibitors?
Pregnancy
Can you prescribe ACE inhibitors to a patient with hypertrophic cardiomyopathy?
NO! NEVER!
