ACEi Flashcards

1
Q

MOA

A

by inhibiting the conversion of angiotensin I to angiotensin II

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2
Q

List some examples of ACE-inhibitors?

pril

A
  • Ramipril
  • Lisinopril
  • Enalapril
  • Perindopril
  • Captopril
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3
Q

Indication

A
  1. HF
  2. HT
  3. DN
  4. Prophylaxis of CV events
  5. CKD
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4
Q

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?

A
  • profound first dose hypotension
  • Take first dose at bedtime
  • Temporary withdrawal of loop diuretic reduces the risk
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5
Q

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?

A

withdrawal may reduce risk of hypotension but can cause severe rebound pulmonary oedema

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6
Q

If a heart failure patient is taking a low dose loop diuretic and is initiated on an ACE/ 1, is there a risk?

A
  • care is still required, even for those who are at low risk of severe hypotension
  • a low dose ACE-inhibitor should be given initially
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7
Q

Which patients tend to respond less well to ACE/l in hypertension?

A
  • Black
  • 55+
    hence why they are not first-line for these patients in hypertension
  • primary aldosteronism
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8
Q

CI

A
  • pregnancy
  • bilateral renal atery/ aortic stenosis
  • AKI
  • Very low BP
  • Hyperkalaemia (5.5 +)
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9
Q

Monitoring before starting ACEi

A
  • Renal function
  • electrolytes - SE = hyperkalaemia
  • BP

these should be checked whenever there’s a dose increase as well)

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10
Q

ACEi - renal impairment

A
  • 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
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11
Q

SE

A

Cough (give ARB instead) - due to breakdown of bradykinin
Hyperkalaemia
Hepatic Failure
Angioedema
Renal Impairment
Dizziness and Headaches
CHHAReD

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12
Q

Which patients are at high risk of developing hyperkalemia whilst on ACE-inhibitors?

A
  • 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
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13
Q

Serious side effects

A
  1. Hypotension on first dose
  2. Angioedema
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14
Q

Hypotension on first dose

A
  • Symptoms include dizziness or fainting
  • Common when taking with other drugs that cause hypotension e.g. diuretics
  • Take first dose at night
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15
Q

Angiodoema

A
  • Serious allergic reaction causing swelling of face, lips, tongue or throat
  • Uncommon but serious side effect
  • Requires urgent referral
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16
Q

Which ethnic origin is angioedema most likely to occur in whilst taking ACE inhibitors?

A

Black

17
Q

Can ACE-inhibitors be taken during pregnancy?

A
  • NO!!
  • May cause congenital malformations
18
Q

Can ACE-inhibitors be taken by breastfeeding patients?

A
  • Low levels of present in breast milk, information on use is limited
  • Enalapril preferred
19
Q

Interactions

A
  1. ARBs
  2. K supps, K sparing diuretics (increased hyperk)
  3. Lithium
  4. NSAIDs (can reduce effect of ACEi)
  5. Diuretics (hypotension)
20
Q

ACE inhibitors and
Alcohol

A

Alcohol and ACE inhibitors can increase the risk of hypotension
Recommend no excessive alcohol drinking, so 2 units a day for both men and women

21
Q

ACE inhibitors concomitant treatment with NSAIDS

A
  • Increases the risk of renal damage
  • Advise patients to avoid buying OTC NSAIDs (e.g.
    Ibuprofen)