ACE Inhibitors-HTN and HF Drugs

Question 1

Lisinopril

Answer 1

ACE inhibitor
Indication – hypertension, HF, MI, diabetic nephropathy.
Mechanism – ACEI: reduces angiotensin II (which reduced aldosterone), elevates bradykinin

Adverse effects –
Contraindicated in pregnancy

ACEI are generally well tolerated
Advantage over other anti-hypertensives because they don’t interfere with cardiac reflexes, don’t have asthma confers, reduced glomerular filtration pressure–>benefit for diabetic neuropathy

Question 2

Losartan

Answer 2

ACE inhibitor
Indication – hypertension, HF, stroke prevention, diabetic nephropathy
Mechanism – ARB: blocks angiotensin II type 1 receptor

Well tolerated

Question 3

Aliskiren

Answer 3

ACE inhibitor
Indication – Hypertension (approved 2007)
Mechanism – Renin inhibitor (inhibits conversion of Angiotensinogen to Ang I -> suppresses entire RAAS)

Only DRI on the market. Long term benefits not yet well-established.

2 weeks for maximum effete

Question 4

Eplerenone

Answer 4

Indication – hypertension, heart failure
Mechanism – selective aldosterone antagonist

Adverse effects
Hyperkalemia (major concern)

4 weeks for maximum affect

Generally well tolerated