Pharmacology II: Angiotensin-Converting Enzyme Inhibitors

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Questions and Answers

What is the primary mechanism of action of ACE inhibitors in reducing blood pressure?

ACE inhibitors work by preventing the conversion of angiotensin I to angiotensin II, reducing peripheral vascular resistance and promoting the excretion of sodium and water.

Which ACE inhibitor is available for intravenous administration?

Enalaprilat

What is the effect of ACE inhibitors on the excretion of aldosterone?

ACE inhibitors reduce the secretion of aldosterone, promoting the excretion of sodium and water.

What is the effect of ACE inhibitors on peripheral vascular resistance?

ACE inhibitors decrease peripheral vascular resistance by dilating arterioles. Signup and view all the answers

What type of effects do ACE inhibitors enhance when used with diuretics and other antihypertensives?

Hypotensive effects Signup and view all the answers

What is the clinical indication for using ACE inhibitors in combination with thiazide diuretics?

Hypertension, especially when beta-adrenergic blockers or diuretics are ineffective. Signup and view all the answers

What may occur when ACE inhibitors are used with potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes?

Hyperkalemia Signup and view all the answers

Which ACE inhibitors are indicated for use in heart failure?

Captopril, enalapril, fosinopril, lisinopril, quinapril, ramipril, and trandolapril. Signup and view all the answers

Why should patients taking ACE inhibitors avoid taking NSAIDs?

NSAIDs can decrease the antihypertensive effects of ACE inhibitors and alter renal function Signup and view all the answers

How are ACE inhibitors metabolized and excreted?

ACE inhibitors are metabolized somewhat in the liver and excreted by the kidneys, with ramipril also being excreted in feces. Signup and view all the answers

What is the role of angiotensin II in regulating blood pressure?

Angiotensin II is a potent vasoconstrictor that increases peripheral resistance and promotes sodium and water retention. Signup and view all the answers

What can impair the absorption of fosinopril?

Antacids Signup and view all the answers

What is a common adverse reaction to ACE inhibitors?

Dry, non-productive, persistent cough Signup and view all the answers

Why should ACE inhibitors be avoided during the second or third trimester of pregnancy?

They can cause problems with fetal circulation Signup and view all the answers

What should be monitored regularly when a patient is taking ACE inhibitors?

Blood pressure, pulse rate, and rhythm, weight, fluid and electrolyte status, and laboratory results Signup and view all the answers

Why is it important to assess the patient's underlying condition before and during ACE inhibitor therapy?

To monitor for adverse reactions and adjust treatment as needed Signup and view all the answers

What is the primary goal of planning outcome goals for a patient taking antihypertensive medication?

To maintain blood pressure within acceptable limits, minimize risk for injury, and ensure the patient understands drug therapy. Signup and view all the answers

Why is it important to administer antihypertensive medication before meals as indicated?

To enhance absorption and efficacy of the drug. Signup and view all the answers

What is the purpose of helping the patient to get up slowly and avoiding sudden movements?

To prevent or minimize orthostatic hypotension. Signup and view all the answers

What is a key nursing diagnosis for a patient taking antihypertensive medication?

Risk for injury related to orthostatic hypotension and presence of hypertension. Signup and view all the answers

Why is it essential to maintain the patient's non-pharmacologic therapies?

To support the overall management of hypertension. Signup and view all the answers

What is an evaluation criterion for a patient taking antihypertensive medication?

The patient sustains no trauma from orthostatic hypotension and demonstrates an understanding of drug therapy. Signup and view all the answers

Study Notes

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors reduce blood pressure by interrupting the renin-angiotensin-aldosterone system (RAAS).
Commonly prescribed ACE inhibitors include: • benazepril • captopril • enalapril • enalaprilat • fosinopril sodium • lisinopril • moexipril

Pharmacokinetics

ACE inhibitors are absorbed from the GI tract, distributed to most body tissues, metabolized somewhat in the liver, and excreted by the kidneys.
Ramipril is also excreted in feces.
Enalaprilat is the only IV ACE inhibitor available.

Pharmacodynamics

ACE inhibitors work by preventing the conversion of angiotensin I to angiotensin II.
Angiotensin II is a potent vasoconstrictor that increases peripheral resistance and promotes sodium and water retention.
As angiotensin II is reduced, arterioles dilate, reducing peripheral vascular resistance.
By reducing aldosterone secretion, ACE inhibitors promote the excretion of sodium and water, reducing the amount of blood the heart has to pump.

Pharmacotherapeutics

ACE inhibitors may be used alone or in combination with other agents, such as a thiazide diuretic, to treat hypertension.
They are commonly used when beta-adrenergic blockers or diuretics are ineffective.
ACE inhibitors are also indicated for use in heart failure, particularly in left ventricular systolic failure or dysfunction without symptoms.

Drug Interactions

ACE inhibitors can enhance the hypotensive effects of diuretics and other antihypertensives.
They can also increase serum lithium levels, possibly resulting in lithium toxicity.
ACE inhibitors may interact with potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes, leading to hyperkalemia.
ACE inhibitors may interact with NSAIDs, decreasing their antihypertensive effects and altering renal function.
Food decreases the absorption of ACE inhibitors.

Adverse Reactions

ACE inhibitors can cause: • headache • fatigue • dry, non-productive, persistent cough • angioedema • GI reactions • increased serum potassium concentrations • tickling in the throat • transient elevations of BUN and serum creatinine levels

Assessment

Obtain a baseline blood pressure and pulse rate and rhythm, and recheck regularly.
Monitor the patient for adverse reactions and drug interactions.
Monitor the patient's weight and fluid and electrolyte status.
Assess the patient's underlying condition before therapy and regularly thereafter.

Nursing Diagnoses

Risk for injury related to orthostatic hypotension
Risk for injury related to presence of hypertension
Deficient knowledge related to drug therapy

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Description

This quiz covers Angiotensin-Converting Enzyme (ACE) inhibitors, a type of medication that reduces blood pressure by interrupting the renin-angiotensin activating system (RAAS). It includes commonly prescribed ACE inhibitors and their pharmacokinetics.