Angiotensin Converting Enzyme inhibitor

Question 1

ACEi: Agents

Answer 1

Ramipril&raquo_space; 1.25mg - 2.5mg OD&raquo_space; max 10mg OD
Lisinopril
Perindopril

Question 2

ACEi: Indications

Answer 2

Chronic Kidney Disease
Diabetic Nephropathy
Heart Failure
Hypertension
Ischaemic Heart Disease
Secondary prevention of CVD
Stroke

Question 3

ACEi: Mechanism of Action

Answer 3

> > Inhibits the action of Angiotension Converting Enzyme
Angiotensin I not converted to Angiotension II
Angiotension II cannot cause vasodilation, release of aldosterone from adrenal gland, or sodium and water uptake in kidneys

> > vasodilation, lowers peripheral vascular resistance, causes diuresis (increases production of urine) and natriuresis (excretion of sodium).
dilates efferent glomerular arteriole&raquo_space; slows progression of CKD

Question 4

ACEi: Side Effects

Answer 4

Hypotension
Hyperkalemia: increased potassium retention
Worsen or cause renal failure
Renal artery stenosis: reversible if caught early
Dry cough: due to increased levels of bradykinin: normally inactivated by ACE

RARE: angioedema and anaphylactoid reactions

Question 5

ACEi: Contrainidications

Answer 5

Renal artery stenosis
Acute renal injury
Pregnant or breastfeeding
Chronic kidney disease&raquo_space; low doses can be used and renal function monitored

Question 6

ACEi: Interactions

Answer 6

Already have high potassium or potassium-elevating drugs
ACEi + diuretics (excretes Na+, K+, Mg+): risk of hypotension
ACEi + NSAID: risk of nephrotoxicity
ACEi + ARBs: can cause hyperkalemia

Question 7

ACEi: Monitoring

Answer 7

Moniter efficacy clinically: if HF, check breathlessness + if hypertension, check BP

For safety renal function BEFORE treatment
Repeat renal check 1-2 weeks after starting treatment

Max dosage is 10mg OD