Ace Inhibitors Flashcards
what does Ace inhibitor stand for
angiotensin converting enzyme inhibitor
what are the indications for Ace inhibitors?
- Hypertension
- 1st or 2nd line treatment - chronic heart failure
- first line treatment - ischaemic heart disease
- to stop any further CVD events. - diabetic nephropathy and chronic kidney disease with proteinuria
- to stop proteinuria and reduce nephropathy
what is the mechanism of action of Ace inhibitors?
they prohibit the formation of angiotensin II.
angiotensin I is converted into angiotensin II by ACE. Ace inhibitors inhibitors inhibit this enzyme stopping angiotensin II from being made.
this causes
- vasodilation of the blood vessels reducing arterial pressure and preload/afterload of the heart
- promotes renal excretion of water and sodium
- depresses sympathetic activity
- inhibits cardiac and vascular hypertrophy
- ACE also breaks down bradykinin and so increases bradykinin levels
what are the adverse effects of ace inhibitors?
Hypotension
dry cough
hyperkalaemia
renal failure
angioedema
anaphylactoid reactions
what are the contraindications of ace inhibitors
- history of angioedema
- renal disease (eGFR less than 60ml/minute/1.73m2)
- pregnancy (teratogenic)
what are the interactions of ace inhibitors?
- diuretics (increases risk of hypotension, omit diuretic during first dose of ai and start up again)
- NSAIDS - increases risk of renal failure
- Antacids they interfere with absorption of ace inhibitors
- avoid with other potassium elevating drugs
what are some of the pharmacodynamics of ace inhibitors?
activated under phase 1 metabolisms in the liver.
how are ace inhibitors eliminated?
predominantly via the kidneys
which group of people may ace inhibitors not work as well in?
it may not work was well in afro-carribean people.
as they 2 - 4x more likely to get the adverse effect of angioedema cue to elevated levels of bradykinin
