ACE inhibitors Flashcards
Name examples of ACE inhibitors.
captopril, lisinopril, enalapril, fosinopril, imidapril, moexipril, perindopril, quinapril, ramipril, trandolapril.
What are the indications of ACE inhibitors?
heart failure, hypertension, diabetic neuropathy, prophylaxis of cardiovascular events, essential hypertension if used in volume depletion, cardiac decompensation, short-term treatment within 24hrs onset of myocardial infarction (captopril), renal complications of diabetes mellitus (lisinopril), essential hypertension (imidapril, moexipril, quinapril), nephropathy (ramipril).
What are the contraindications of ACE inhibitors?
avoid using in combination with aliskiren in patients with diabetes, or with an eGFR of less than 60ml/minute/1.73m2.
What is the mechanism of action of ACE inhibitors?
ACE inhibitors block angiotensin-converting enzyme and prevent synthesis of angiotensin-II from angiotensin-I.
They disrupt the renin-angiotensin system by inhibiting the conversion of angiotensin I to angiotensin II. The renin-angiotensin system involves the kidneys releasing the hormone renin in response to low blood pressure, and renin metabolises angiotensinogen to angiotensin-I, which is metabolised to angiotensin-II by angiotensin-converting enzyme (ACE). Angiotensin-II is a potent vasoconstrictor that results in increased blood pressure. It also stimulates the adrenal glands to release aldosterone which increases he reabsorption of sodium from urine to the blood and leads to an increase in circulating blood volume due to osmosis, and a subsequent increase in blood pressure. They also prevent left ventricular remodelling following a heart attack (think balloon!).
What are the common/very common unwanted side effects of ACE inhibitors?
alopecia, dry mouth, dyspnoea, asthenia, blurred vision, depression, chest pain, musculoskeletal pain, mood disturbances, sleep disturbances , impotence, flatulence, nervousness, oedema, bronchitis, stomatitis, syncope.
What are the monitoring requirements of ACE inhibitors?
Renal function and electrolytes should be checked before starting/increasing dose of ACE inhibitors and monitored during treatment.
Careful clinical monitoring required in those with severe heart failure or those who are receiving multiple or high dose diuretic therapy, or who are receiving concomitant angiotensin-II receptor antagonist or aliskiren, or who have hypovolaemia, hyponatraemia, hypotension, unstable heart failure, are receiving high dose vasodilator therapy, or have known renovascular disease.
