ACEi

Question 1

ACEi indications

Answer 1

Hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy, CKD with proteinuria

Question 2

ACEi MOA

Answer 2

Block ACE to stop conversion of Angiotensin 1 to 2 as angiotensin 2 is a vasoconstrictor stimulating aldosterone secretion so blocking it reduces vascular resistance (afterload) which lowers BP . It dilates glomerular arteriole to reduce pressure there thus slowing CKD. reducing aldosterone is good in heart failure as it promotes sodium and water excretion

Question 3

ACE side effects

Answer 3

hypotension especially after first dose, hyperkalaemia and renal failure , dry cough as ACEi increases bradykinin, worsens renal failure, anaphylactoid reactions angioedema

Question 4

ACE to be avoided when

Answer 4

renal artery stenosis, AKI, pregnant, breastfeeding some CKD e.g. without proteinuria

Question 5

What to do with ACE in renal failure

Answer 5

Reduce

Question 6

ACEi interactions

Answer 6

NSAIDs due to renal failure risk. Other potassium increasing drugs like potassium sparing drugs and drugs that cause first dose hypotension

Question 7

ACEi doses e.g. ramipril

Answer 7

heart failure/nephropathy lower = 1.25mg , 2.5mg for other indications titrated up 10 max 10mg

Question 8

How to take ACEi

Answer 8

With/without food, first dose before bed

Question 9

ACEi counselling

Answer 9

Use to reduce pressure to reduce strain on heart. Advise about dry cough, possibility of dizziness due to low blood pressure, severe allergic reactions, Advise to avoid OTC NSAID due to kidney damage risk