angiotensin converting enzyme (ACE) inhibitors Flashcards
what is the indication of ACE inhibitors?
hypertension, symptomatic heart failure, cardiac disease.
what are the contraindications?
the combination of a ACE inhibitor and aliskiren = not allowed in patients with a eGFR less than 60ml/ minute / 1.73m2. Combination is contraindicated in those with diabetes mellitus.
MOA?
work by blocking the renin-angiotensin system, inhibiting the conversion of angiotensin 1 to angiotensin 2. This leads to arterial vasodilation and a reduction in BP. Also prevents left ventricular remodelling following a heart attack.
common side effects?
dry cough- thought to be related to an increase in bardykinin, renal failure if patients have renal stenosis.
monitoring requirements?
renal function and electrolytes should be checked before starting ACE inhibitors (or increasing the dose) and monitored during treatment.
what foods should be avoided when taking an ACE inhibitor?
salt reduces the effects of ACE inhibitors. Whilst it cannot be avoided completely, individuals should be advised to avoid high salt foods and adding extra salt.
Discuss Ramirpil (long acting)
side effects: bronchitis, dysponea, muscle cramps, stomalitis, syncope. Monitoring requirements: patients with hepatic impairment.
Discuss Captopril (short acting)
side effects: alopecia, dry mouth and sleep disorders
what is an ACE inhibitor?
ACE inhibitors can reduce the activity of an enzyme called angiotensin converting enzyme (ACE). The enzyme is responsible for hormones that help controll blood pressure. It has a powerful narrowing effect on the blood vessels, which increases blood pressure. ACE inhibitors limit this enzyme, making the blood vessels relax/ widen. This lowers BP and improves flow to the heart muscle. 1/4 of the blood pumper out in each heartbeat flows through the kidneys, so if the heart becomes less efficient, the kidneys also suffer. Therefore ACE inhibitors improve both kidney and heart function.
