ACE inhibitors (-"pril")

Question 1

MoA

Answer 1

1. inhibits production of angiotensin II via inhibition of ACE enzyme
   
   • causes increase in renin (loss of negative feedback from AT2)
   • prevents secondary activation of aldosterone and ADH
   • prevents bradykinin IN-activation –> cough & angioedema side effects
2. Decreases GFR by promoting efferent arteriole vasodilation

Question 2

Clinical Uses

Answer 2

1. **first line for treating diabetic nephropathy or other conditions associated with proteinuria
2. heart failure (decreases mortality)
3. HTN

Question 3

Adverse Effects

Answer 3

1. decrease in GFR –> increase in serum creatinine levels
   
   • need to distinguish between normal response to ACE inhibitor therapy vs. acute renal failure (ex: patient had undetected bilateral renal artery stenosis prior to starting treatment)
2. cough
3. angioedema
4. **teratogen
5. hypotension
6. hyperkalemia & hyponatremia
   
   • secondary to lack of aldosterone

Question 4

Contraindications

Answer 4

1. bilateral renal artery stenosis
   
   • rely on efferent arteriole constriction to maintain GFR –> ACE inhibitors cause acute renal failure
   • *look for signs of widespread atherosclerosis (ex: hyperlipidemia, history of angina, carotid bruit, etc.) because this increases likelihood of there being some degree of bilateral renal artery stenosis
2. c1 esterase inhibitor deficiency (autosomal dominant)
3. pregnant women