ACEi Flashcards
MOA
by inhibiting the conversion of angiotensin I to angiotensin II
List some examples of ACE-inhibitors?
pril
- Ramipril
- Lisinopril
- Enalapril
- Perindopril
- Captopril
Indication
- HF
- HT
- DN
- Prophylaxis of CV events
- CKD
If heart failure patients are taking a high dose loop diuretic (e.g. > furosemide 80mg OD) and have just started an ACE inhibitor, what can occur?
- profound first dose hypotension
- Take first dose at bedtime
- Temporary withdrawal of loop diuretic reduces the risk
If the withdrawal of loop diuretic is needed in heart failure patients to reduce the risk of profound first-dose hypotension because they are starting an ACE inhibitor, what is the risk in doing that?
withdrawal may reduce risk of hypotension but can cause severe rebound pulmonary oedema
If a heart failure patient is taking a low dose loop diuretic and is initiated on an ACE/ 1, is there a risk?
- care is still required, even for those who are at low risk of severe hypotension
- a low dose ACE-inhibitor should be given initially
Which patients tend to respond less well to ACE/l in hypertension?
- Black
- 55+
hence why they are not first-line for these patients in hypertension - primary aldosteronism
CI
- pregnancy
- bilateral renal atery/ aortic stenosis
- AKI
- Very low BP
- Hyperkalaemia (5.5 +)
Monitoring before starting ACEi
- Renal function
- electrolytes - SE = hyperkalaemia
- BP
these should be checked whenever there’s a dose increase as well)
ACEi - renal impairment
- ACE inhibitors can be used in some renal diseases e.g. CKD
- However, they can occasionally cause renal impairment
- Side effects such as hyperkalemia are more likely to occur in renal impaired patients
SE
Cough (give ARB instead) - due to breakdown of bradykinin
Hyperkalaemia
Hepatic Failure
Angioedema
Renal Impairment
Dizziness and Headaches
CHHAReD
Which patients are at high risk of developing hyperkalemia whilst on ACE-inhibitors?
- renal insufficiency/ impairment
- > 70
- uncontrolled DM
- those using potassium salts, potassium retaining diuretics and other plasma potassium increasing active substances
- conditions such as: dehydration, acute cardiac decompensation, metabolic acidosis
Serious side effects
- Hypotension on first dose
- Angioedema
Hypotension on first dose
- Symptoms include dizziness or fainting
- Common when taking with other drugs that cause hypotension e.g. diuretics
- Take first dose at night
Angiodoema
- Serious allergic reaction causing swelling of face, lips, tongue or throat
- Uncommon but serious side effect
- Requires urgent referral