Angiotensin Converting Enzyme Inhibitors

Question 1

ACEi MOA

Answer 1

Inhibits conversion of angiotensin 1 to angiotensin 2

Question 2

What group of patients are ACEi avoided in?

Answer 2

Pregnant- only use if essential

may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported.

Question 3

ACEi e.g., Ramipril in combination with aliskiren is contraindicated in….

Answer 3

Those with eGFR <60ml/min/1.73m

Diabetics

Question 4

Which group of patients respond less well to ACEi? What would you give instead

Answer 4

Afro Caribbean

ARBS

Question 5

Use ACEi with caution with the drugs ….

Answer 5

Diuretics
CCB

Increases risk of hypotension

Question 6

Why is the first ACEi usually taken at night?

Which patients is this found mainly in?

Answer 6

To prevent first dose hypotension
Mainly in those with HF already taking a high dose diuretic e.g., 80mg furosemide

Question 7

In HF, ACEi usually combined with…

Answer 7

BB

Question 8

Before starting an ACEi discontinue…

Can they be used if no alternative?

Answer 8

Potassium sparing diuretic and potassium supplements

Low dose can be used but closely monitored

Question 9

ACEi should be administered under specialist supervision in and careful monitoring in …

Answer 9

Severe HF
pts on multiple or high dose diuretic
On concomitant ace or aliskiren
Pts with hypovolaemia
Unstable HF
renovascular disease
Hyponatraemia <130
Hypotension <90

Question 10

Main SE of Acei

Answer 10

Persistent Dry cough
Skin reactions
Electrolyte imbalance

GI disturbance
Constipation
Angiodeme (common in black)
Alopecia
Angina pectoris

Question 11

Can you give ACEi in those with renal impairment?

Answer 11

Best avoided in renovascular disease but can use reduced dose and adjust

Question 12

ACEi max dose is …… in those with crcl of ……

Answer 12

5mg
30-60ml/min/1.73m

Question 13

Can NSAIDs be given with Acei

Answer 13

Avoid
Risk of renal damage and hyperkalaemia

Question 14

Which group of patients is at high risk of renal impairment when taking acei

Answer 14

Elderly- specialist supervision

Question 15

Why is it important to check renal function before starting Acei

Answer 15

Because those with reduced renal function are at higher risk of SE such as hyperkalaemia

Question 16

Discontinue Acei if there is a marked elevation of ….

Answer 16

Hepatic enzyme or jaundice occurs

Question 17

Can Acei be given during dialysis?
Why?

Answer 17

Avoid
To prevent anaphylactoid reactions

Question 18

Max daily dose of ACEi

Answer 18

10mg daily max

Question 19

ACEi monitoring

When

Answer 19

Renal function and electrolytes before starting and monitored during treatment and after each dose change

Question 20

Do ACEi reduce the synthesis or the breakdown of bradykinin

Answer 20

Breakdown

Question 21

ACEi should be withheld before desensitisation with _____

Answer 21

Bee venom