Angiotensin-Converting Enzyme Inhibitors

Question 1

What do ACE inhibitors treat

Answer 1

-hypertension
-HF
-diabetic neuropathy
-MI

Question 2

What do ACE inhibitors prevent

Answer 2

-adverse cardiovascular events in patients at risk

Question 3

ACE inhibitors adverse effects

Answer 3

-cough
-angioedema
-first-dose hypotension
-hyperkalemia

can cause fetal injury

Question 4

ACE inhibitors mechanisms of action

Answer 4

1)reducing levels of angiotensin II (through inhibition of ACE)
2) increasing levels of bradykinin (through inhibition of kinase II)
by reducing levels of angiotensin II, ACE inhibitors can dilate blood vessels, reduce blood volume (through effects on kidney), and prevent of reverse pathologic changes in the heart and blood vessels mediated by angiotensin II and aldosterone
-elevation of bradykinin causes vasodilation (secondary to increased production of prostaglandins and nitric oxide) and can also promote cough and angioedema

Question 5

ACE inhibitors pharmacokinetics

Answer 5

-Orally given (exception: enalaprilat given IV)
-administerd with food (Exceptions: captopril & enalaprilat)
-all have prolonged half lives, so only given once or twice a day (exception: captopril is administered 2-3/day)
-all are prodrugs that must undergo conversion to their active forms in the small intestine and liver (Except: Lisinopril is already in active form)
-All ACE inhibitors are excreted in kidneys (Caution for pt with kidney disease)

Question 6

ACE inhibitors therapeutic uses

Answer 6

-Hypertension (all approved)
ACE inhibitors do not interfere with cardiovascular reflexes
-HF (by lowering arteriolar tone, these drugs improve regional blood flow, and, by reducing cardiac afterload, they increase cardiac output/ also reduces edema and decreases venous return to heart)
-MI (decrease mortality)
-Diabetic and nondiabetic nephrotoxicity
-prevention of MI, stroke, and death in pts at high cardiovascular risk
-diabetic retinopathy (enalapril)

Question 7

ACE inhibitors drug interaction

Answer 7

-diuretics (intensifies first dose hypotension
-Anti-hypertensives
-Drugs that raise potassium levels
-lithium
-NSAIDs (may reduce antihypertensive effects)

Question 8

Benazepril

Answer 8

class: ACE inhibitor
indication: HYPERTENSION

Question 9

Captopril

Answer 9

class: ACE INHIBITOR
indication:
-HYPERTENSION
-HF
-LVD after MI
-DIABETIC NEPHROPATHY

Question 10

Enalapril

Answer 10

class: ACE INHIBITOR
indication:
-HYPERTENSION
-HF
-ASYMPTOMATIC LVD

Question 11

Enalaprilat

Answer 11

given IV
class: ACE INHIBITOR
Indications: HYPERTENSION
not used for maintenance

Question 12

Fosinopril

Answer 12

ACE INHIBITOR
-HYPERTENSION
-HF

Question 13

Lisimopril

Answer 13

ACE INHIBITOR
-HYPERTENSION
-HF
-ACUTE MI

Question 14

Moexipril

Answer 14

ACE INHIBITOR
-HYPERTENSION

Question 15

Perindopril

Answer 15

ACE INHIBITOR
-HYPERTENSION
-STABLE CAD

Question 16

Quinapril

Answer 16

ACE INHIBITOR
-HYPERTENSION
-HF

Question 17

Ramipril

Answer 17

ACE INHIBITOR
-HYPERTENSION
-HF AFTER MI
-Prevention of MI, STROKE, & DEATH in people at high risk for CVD