ace inhibitors

Question 1

What are Angiotensin-converting enzyme (ACE) inhibitors primarily used for?

Answer 1

First-line treatment in younger patients with hypertension and treatment of heart failure

ACE inhibitors are also used for diabetic nephropathy and secondary prevention of ischaemic heart disease.

Question 2

In which patient demographic are ACE inhibitors less effective for hypertension?

Answer 2

Hypertensive Afro-Caribbean patients

This demographic shows a reduced response to ACE inhibitors.

Question 3

What is the mechanism of action of ACE inhibitors?

Answer 3

Inhibits the conversion of angiotensin I to angiotensin II

This leads to vasodilation, reduced blood pressure, and decreased aldosterone release.

Question 4

What effect does angiotensin II have on the kidneys?

Answer 4

Constricts the efferent glomerular arterioles

This constriction increases glomerular capillary pressure.

Question 5

How do ACE inhibitors provide a renoprotective mechanism?

Answer 5

They dilate the efferent arterioles, reducing glomerular capillary pressure

This decreases mechanical stress on the filtration barriers of the glomeruli.

Question 6

What is a common side effect of ACE inhibitors?

Answer 6

Cough

Occurs in around 15% of patients and may appear up to a year after starting treatment.

Question 7

What causes the cough associated with ACE inhibitors?

Answer 7

Increased bradykinin levels

This is thought to be the mechanism behind the cough.

Question 8

Name a side effect of ACE inhibitors that may occur up to a year after starting treatment.

Answer 8

Angioedema

This is another adverse effect that can arise during treatment.

Question 9

What is a significant risk associated with the first dose of ACE inhibitors?

Answer 9

First-dose hypotension

More common in patients taking diuretics.

Question 10

In which conditions should ACE inhibitors be avoided?

Answer 10

Pregnancy and breastfeeding, renovascular disease, aortic stenosis, hereditary or idiopathic angioedema

Specialist advice is recommended for patients with potassium >= 5.0 mmol/L.

Question 11

What is a potential interaction when taking ACE inhibitors?

Answer 11

High-dose diuretic therapy (more than 80 mg of furosemide a day)

This significantly increases the risk of hypotension.

Question 12

What should be monitored before and after starting ACE inhibitors?

Answer 12

Urea and electrolytes

A rise in creatinine and potassium may be expected after starting treatment.

Question 13

What is an acceptable increase in serum creatinine after starting ACE inhibitors?

Answer 13

Up to 30% from baseline

Additionally, potassium can increase up to 5.5 mmol/L.

Question 14

List some common ACE inhibitors.

Answer 14

• Ramipril
• Enalapril
• Lisinopril

These are examples of medications that fall under the ACE inhibitor class.