Ace Inhibitors

Question 1

Ace inhibitors

Answer 1

Good results for HF in combo with digoxin and diuretics promote longer survival. This is the first line drug for HF. (replaced digoxin which was previously used as a first line drug)

Question 2

Ace inhibitor: Action

Answer 2

Ace inhibitor Action: interferes with the RAAS by inhibiting the enzyme that converts angiotensin I to angiotensin II. This decreases aldosterone release by the adrenal cortex, preventing sodium and water retention. Also reduces peripheral arterial resistance without affecting the heart rate and CO. The result, in a patient with hypertension, is a decreased blood pressure.

Question 3

Ace inhibitor: more about the action

Answer 3

ACE inhibitors prevent sodium and water resorption in the kidney, but potassium is resorbed, so the nurse needs to monitor potassium levels.

Question 4

Ace inhibitor: Uses

Answer 4

Hypertension
Heart Failure
Acute MI (slows the progression of L ventricular hypertrophy post MI)
Patients at high risk for CV events, 
diabetic retinopathy, 
kidney diseases
Drug of choice for HF patients with HTN
Renal protective for DM patients

Question 5

Ace inhibitor: Side effects

Answer 5

Dizziness
Mood changes
Head ache
Dry, nonproductive cough
first dose hypotension
Dysgensia (loss of taste)
Rash, Pruritis
Anemia
Neutropenia,
Thrombocytosis
Agranulocytosis,
Hyperkalemia
Fatigue
Syncope

Question 6

Ace inhibitor: Angioedema (side effect)

Answer 6

Angioedema (itching and swelling of the face and neck) If the drug is not stopped, patient is at a high risk of further episodes with serious morbidity (intubation). Risk of angioedema is 5 times higher in black people than whites. Can also, on rare occasions, cause visceral angioedema which is localized edema and capillary permeability in the gut causing pain, n/v, and/or diarrhea.

Question 7

Ace inhibitor: Interactions

Answer 7

NSAIDS (increase BP)
Diuretics
Other antihypertensives (increased antihypertensive effect)

Question 8

Ace inhibitor: Drugs

captopril (Capoten)

Answer 8

Ace inhibitor
captopril (Capoten)
short half life, so this is good for titrating acutely ill patient.
Give on an empty stomach

Question 9

Ace inhibitor: Drugs

enalapril (Vasotec)

Answer 9

enalapril (Vasotec)
PO, IV
This is a prodrug

Question 10

Ace inhibitor: Drugs

ramipril (Altace)

Answer 10

ramipril (Altace)
effective
Also reduced the new development of DM by 30%, the first drug to be effective in this role.

Question 11

More Ace inhibitor drug types

Answer 11

fosinopril [Monopril]*
lisinopril [Zestril]*
benazepril [Lotensin]

Question 12

Ace inhibitor: Nursing considerations

Answer 12

Get baseline pulse and BP.
Monitor for hypotension.
Monitor liver fx, renal fx, and K+ q month for first 3 months.
If angioedema occurs - stop drug, call MD, may need emergency Tx.