ACEI

Question 1

List the ACEI.

Answer 1

Captopril (Capoten, Zedace)
Enalapril (Ranitec, Auspril)
Fosinopril (Monopril, Monace, Fosipril)
Lisinopril 
Perindopril (Coversyl, Indopril)
Quinapril (Accupril, Qpril)
Ramipril (Ramace, Tritace)
Trandolapril (Dolapril, Gopten)

Question 2

What is the mode of action of ACEI?

Answer 2

> block conversion of angiotensin I to angiotensin II, therefore reduce effects of angiotensin II-induced
- vasoconstriction
- sodium retention
- aldosterone release
> inhibit breakdown of bradykinin

Question 3

What are the indications of ACEI?

Answer 3

Indications:

• HTN
• HF
• diabetic nephropathy (type 1 diabetes)
• prevention of progressive RF in patients with persistent proteinuria (>1 g/day)
• asymptomatic left ventricular dysfunction
• post MI
• reduction of risk of cardiovascular events in specific patients

Question 4

What are the AEs of ACEI?

Answer 4

Common

• hypotension
• cough
• hyperkalaemia
• headache
• dizziness
• fatigue
• renal impairment

Infrequent

• angioedema (early or delayed onset)
• elevated hepatic aminotransferases and bilirubin

Rare

• myalgia, arthralgia
• hepatitis
• pancreatitis

Question 5

What are the counseling points of ACEI?

Answer 5

• you may feel dizzy when you start taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy or light-headed
• don’t take potassium supplements while you are taking this medicine unless your doctor tells you to

Question 6

Monitoring?

Answer 6

• renal function (b4 tx)
• electrolytes (b4 tx)
• BP

Question 7

What are the dose ranges of ACEI?

Answer 7

1.25mg-10mg d (1 or 2 doses) > Ramipril

2. 5mg
   - max 10mg d > perindopril
   (2. 5mg perindopril arginine = 2mg perindopril erbumine)
   - max 40mg d > enalapril, lisinopril, quinapril

5mg
- max 40mg d > fosinopril

6.25 bd/tds - 75mg BD, max. 150 mg daily > captopril