ACE Inhibitors (Ramipril)

Question 1

What are ACE inhibitors such as ramipril used for?

Answer 1

1) Hypertension
2) Chronic Heart Failure
3) Ischaemic Heart Failure
4) Diabetic Neuropathy
5) chronic kidney disease with proteinuria

Question 2

How to ACE inhibitors work?

Answer 2

ACEi stops the enzyme from converting Angiotensin 1 into angiotensin 2.

• Angiotensin II is a vasoconstrictor and stimulates aldoterone secretion which promotes Na+ and water retention.
• ACEi —->
  1) reduces vascular resistance, (Lowers BP)
  2) reduces preload, (cardio protective)
  3) also causes dilation of efferent glomerular arteriole this reduces intraglomerular pressure and slows progression of CKD.

Question 3

What are the side effects of ACEi (ramipril)?

Answer 3

1) Hypotension
2) persistent dry cough
3) Hyperkalaemia (low aldosterone promotes K+ retention.
4) Renal failure in RENAL ARTERY STENOSIS
5) angioedema
6) anaphylactoid reaction

Question 4

In what patients should ACEi (ramipril) be avoided in?

Answer 4

1) Renal artery stenosis (can causes renal failure)
2) Acute kidney injury
3) Pregnant / breastfeeding

Question 5

What are the important drug interactions of ACEi?

Answer 5

1) Potassium elevating drugs (e.g. spironolactone)

2) NSAID (increase risk of renal failure)

Question 6

What is the maximum dose of ramipril?

Answer 6

10mg daily

Question 7

What route is ramipril given?

Answer 7

orally

Question 8

how is the efficacy of ramipril monitored?

Answer 8

• reduced SOB

- lower BP

Question 9

How do we ensure safe use of ramipril/

Answer 9

monitor electrolytes e.g. K+ and renal function before treatment and after starting.

• creatinine should not rise by more than 30%
• eGFR should not fall by more than 25%
• K+ should not rise above 6.0 mmol/L