ACE inhibitors Flashcards
What are examples of ACE inhibitors?
- Remipril
- Lisinopril
- Perindopril
What are ACEi indicated for?
- Hypertension
- Chronic heart failure
- IHD
- Diabetc nephropathy
- CKD
How do ACEi work?
Prevent the conversion of angiotensin I to angiotensin II - reduces peripheral vascular resistance (afterload), which lowers blood pressure. It particularly dilates the efferent glomerular arteriole, which reduces intraglomerular pressure and slows the progression of CKD
Why are ACEi used to treat HF?
Reduces the aldosterone level, which promotes sodium and water excretion. This can help to reduce venous return (preload), which has a beneficial effect in heart failure
What are adverse side effects of ACEi?
- (First dose) hypotension
- Persistent dry cough
- Hyperkalaemia
- Renal failure
- Angiodema
- Anaphylactoid reactions
When are ACEi contraindicated?
- Renal artery stenosis
- AKI
- Pregnancy
- Breastfeeding
What drugs can interact with ACEi?
- Potassium elevating drugs
- Potassium sparing diuretics
- NSAIDs
What dose of lisinopril would you start someone on with hypertension?
2.5 mg daily - can increase to 10 mg daily
What dose of lisinopril would you start someone on for heart failure?
2.5mg once daily - up to 10mg daily
What dose of lisinopril would you start someone on as prophylaxis post-MI with a BP > 120 mmHg?
5mg within 24 hrs of MI, and again 24 hours later. Then increase to 10 mg daily
What dose of perindoprl would you use in heart failure?
Intital dose of 2mg, then up to 4mg daily
What dose of perindopril would you use in hypertension?
Initially 4mg once daily
What dose of ramipril would you start someone on for hypertension?
1.25 mg daily - maximum 10mg daily
What is the most common choice of ACEi used to treat HF?
Ramipril 1.25 mg/day
What monitoring would you want to consider doing before starting someone on an ACEi?
Renal function and electrolytes
