ACE Inhibitors: Blood Pressure, Aldosterone, and Precautions

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Questions and Answers

How do ACE inhibitors affect blood pressure and aldosterone levels?

  • They increase blood pressure and aldosterone secretion.
  • They decrease blood pressure but increase aldosterone secretion.
  • They increase blood pressure but decrease aldosterone secretion.
  • They decrease blood pressure and aldosterone secretion. (correct)

For older adults receiving antihypertensive therapy, what specific precaution should be observed regarding blood pressure measurement?

  • BP should be taken immediately before any antihypertensive is administered, particularly in an institutional setting. (correct)
  • BP should be taken three hours after the administration of antihypertensives to assess peak effects.
  • BP should be measured only after the older adult has been lying down for at least 30 minutes.
  • BP is not a crucial measurement in older adults; focus should be solely on reported symptoms.

What advice should be given to pregnant patients, or those who may become pregnant, regarding ACE inhibitors?

  • ACE inhibitors can be used if the benefits clearly outweigh the risk to the fetus.
  • ACE inhibitors are safe during the first trimester but should be discontinued in the second and third trimesters.
  • ACE inhibitors, ARBs, and renin inhibitors are contraindicated due to the potential for serious adverse effects on the fetus. (correct)
  • ACE inhibitors can be used as long as the patient carefully monitors their blood pressure.

A patient with hypertension and a history of allergic reactions, including angioedema, requires pharmacological intervention. What is the most appropriate course of action?

<p>ACE inhibitors are contraindicated; select an alternative antihypertensive medication from a different drug class. (C)</p>
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A patient taking captopril is also prescribed allopurinol. What potential interaction should the healthcare provider be aware of?

<p>Increased risk of hypersensitivity reactions (B)</p>
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How do ACE inhibitors work to lower blood pressure?

<p>By preventing the conversion of angiotensin I to angiotensin II. (C)</p>
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Why is it important to avoid cutting, crushing, or chewing sustained-release antihypertensives?

<p>To maintain the intended sustained-release effect and avoid the potential for excessive dosing. (B)</p>
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What is the rationale for using ACE inhibitors in the treatment of diabetic nephropathy?

<p>To slow the damage to the renal artery that occurs in diabetes by decreasing stimulation of angiotensin receptors. (B)</p>
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When initiating ACE inhibitor therapy, which laboratory value is essential to monitor for potential indications of kidney impairment?

<p>Serum creatinine (B)</p>
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A patient with hypertension is started on an ACE inhibitor. Which of the following findings would warrant immediate discontinuation of the drug?

<p>Development of angioedema. (C)</p>
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In stepped care management of hypertension, what is the initial recommended intervention?

<p>Lifestyle modifications (D)</p>
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Captopril and moexipril share a unique administration consideration that differentiates them from most other ACE inhibitors. What is the key difference?

<p>Their absorption may be altered when ingested with food, necessitating administration at least one hour before meals. (A)</p>
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According to the hypertension treatment algorithm for patients with chronic kidney disease (CKD), what is the first action that should be taken?

<p>Determine the BP goal. (B)</p>
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What specific monitoring is crucial when diuretics are used as part of drug therapy for children with hypertension?

<p>Monitoring of blood glucose and electrolyte levels. (A)</p>
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A patient taking an ACE inhibitor develops a persistent, dry cough. What is the likely mechanism behind this side effect?

<p>Increased bradykinin levels due to inhibition of ACE that degrades bradykinin (B)</p>
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Enalapril offers a unique route of administration compared to other ACE inhibitors. Which route is specific to enalaprilat?

<p>Parenteral (B)</p>
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What would be the priority assessment for a patient prescribed an ACE inhibitor who presents with dizziness, syncope, and headache?

<p>Cardiovascular function (B)</p>
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What additional medication taken with ACE inhibitors requires carefully monitoring the patient?

<p>All of the above (D)</p>
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What conditions require caution for patients with impaired renal function taking ACE inhibitors?

<p>Acute heart failure exacerbation, salt/volume depletion (C)</p>
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Flashcards

How do ACE inhibitors work?

ACE inhibitors block the action of ACE, preventing the conversion of angiotensin I to angiotensin II, which leads to vasodilation and decreased BP.

RAAS drug combo not recommended

ACE inhibitors, ARBs, and renin inhibitors.

Common ACE inhibitor adverse effects

Hypotension, reflex tachycardia, cough, and hyperkalemia.

ACE inhibitors and pregnancy

ACE inhibitors are contraindicated in pregnancy due to the potential for serious adverse effects on the fetus.

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Captopril indications

Treat hypertension, heart failure, diabetic nephropathy, and left ventricular dysfunction after MI (myocardial infarction)

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Step 1 Hypertension Management

Weight reduction, smoking cessation, moderation of alcohol intake, reduction of salt in diet, and increase in aerobic physical activity.

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ACE inhibitor actions

ACE inhibitors act in the lungs to prevent ACE from converting angiotensin I to angiotensin II. This action leads to a decrease in BP and aldosterone secretion with a resultant increase in serum potassium and a loss of serum sodium and fluid.

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ACE inhibitors and CKD

Treatment of hypertension in persons with chronic kidney disease (CKD).

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ACE inhibitor cautions

Caution should be used in patients with impaired renal function, with acute heart failure exacerbation, and with salt/volume depletion.

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ACE inhibitor contraindications

ACE inhibitors are contraindicated in people with a history of allergic reaction (including angioedema) to ACE inhibitors and to prevent hypersensitivity reactions.

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ACE inhibitor and lithium interaction

Lithium toxicity increases with coadministration of ACE inhibitors.

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ACE inhibitor administration with food

Absorption of captopril and moexipril may be altered when ingested with food, so they should be taken at least 1 hour before food.

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ACE with Older Adults

Elderly patients need caution with ACE to avoid excessive lowering of BP.

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