Ramipril

Question 1

Drug class?

Answer 1

ACE-inhibitor

Question 2

Mechanism?

Answer 2

Inhibits conversion of angiotensin I to angiotensin II.

Increased bradykinin = peripheral vasodilatation

Question 3

Indications?

Answer 3

Heart failure, hypertension, diabetic nephropathy, prophylaxis of cardiovascular events.

Question 4

Contra-indications?

Answer 4

Bilateral renal artery stenosis, hypersensitivity to ACE inhibitors (angioedema), hepatic impairment, renal impairment, pregnancy, breastfeeding.

Question 5

Side-effects?

Answer 5

Hyperkalaemia, impaired renal function, profound hypotension, persistent dry cough.
Angioedema, rash, pancreatitis, URT symptoms such as sinusitis, rhinitis and sore throat.
GI effects include nausea, vomiting, dyspepsia, diarrhoea, constipation, abdominal pain.
Hypoglycaemia, thrombocytopenia, leucopenia, neutropenia, haemolytic anaemia.
Headache, dizziness, fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia, arthralgia, raised ESR, eosinophilia, leucocytosis, photosensitivity.

Question 6

Interactions?

Answer 6

Potassium supplements/sparing diuretics - risk of hyperkalaemia.
Loop diuretics - profound first-dose hypertension.
NSAIDs - concomitant treatment with NSAIDs increases risk of renal damage.