Drug Class: ACEi, ARB, CCB

Question 1

Examples of ACEi drugs (4)

Answer 1

RAMIPRIL
PERINDOPRIL
ENALAPRIL
LISINOPRIL

(-pril)

Question 2

What is the mode of action of ACEi?

Answer 2

Inhibit the action of angiotensin converting enzyme which converts angiotensin I into angiotensin II causing:
• Vasoconstriction
• NaCl and H2O retention
• Increase BP

Question 3

What are the positive effects of ACEi (4)?

Answer 3

• Reduce BP
• Reduce afterload + preload
• Reduce proteinuria
• Prevent aberrant remodelling after MI

Question 4

Side effects of ACEi

Answer 4

• COUGH (main side effect)
• Orthostatic hypotension
• Hyperkalaemia
• Reduce perfusion pressure in glomerulus= renal impairment
• Angioedema

Question 5

Drug-drug interactions of ACEi (3)

Answer 5

• NSAIDs-> precipitate acute renal failure
• Potassium supplements – hyperkaliaemia
• Potassium sparing diuretics-> hyperkalaemia

Question 6

Contraindications of ACEi (4)

Answer 6

• Renal artery stenosis-> may precipitate renal failure or infarction
• Impaired renal function
• Worsens hyperkalaemia
• Teratogenic

Question 7

Examples of ARB (angiotensin 2 antagonist) (4)

Answer 7

LOSARTAN
VALSARTAN
CANDESARTAN
IRBESARTAN

-sartan

Question 8

Mode of action of ARB

Answer 8

Block the action of angiotensin II at the angiotensin AT1 receptor 
•	Reduce BP 
•	Reduce afterload 
•	Reduce proteinuria 
•	Prevent aberrant remodelling after MI

Question 9

Side effects of ARB

Answer 9

Fewer than ACEi- NO COUGH
• Orthostatic hypotension
• Hyperkalaemia
• Reduce perfusion pressure in glomerulus= renal impairment

Question 10

Examples of CCB (calcium channel blockers)

Class IV anti-arrhythmics (centrally acting and peripherally acting)

Answer 10

Centrally acting (non-dydropyridine)
•	VERAPAMIL 
•	DILTIAZEM 
Peripherally acting (dydropyridine)
•	AMLODIPINE 
•	FELODIPINE 
•	NIFEDAPINE

Question 11

Mode of action of CCB

Answer 11

Block L-type Ca2+ channel in myocytes of vasculature (peripherally acting) and heart (centrally acting)

• Depress phase 4 depolarisation in SA and AV nodes = ↓ HR
• Shorten phase 2 plateau phase = ↓contractility

Centrally acting-> decrease HR + vasodilatation
Peripherally acting-> decrease TPR and afterload

Question 12

Side effects of CCB

Answer 12

• Flushing
• Headache
• Peripheral oedema (unresponsive to diuretics)
• Palpitations
• Indigestion and reflux oesophagitis
• Bradycardia & Constipation for centrally acting (rate limiting)
• Heart block – non dihydropyridine with Beta blocker
• Postural hypotension

Question 13

Drug-drug interactions CCB

Answer 13

VERAPAMIL/DILTIAZEM
Used for
- AV nodal re-entrant tachycardia
- Rate control for A Fib and A flutter

Question 14

Contraindications CCB

Answer 14

• Acute MI
• Heart failure
• Bradycardia (rate limiting centrally acting CBBs)
• NEVER USE NIFEDAPINE IMMEDIATE RELEASE
• Unstable angina (dihydropyridines)