ACE inhibitors-ATI pharm

Question 1

Guidelines for pharmacological management of hypertension

Answer 1

The Eighth Report of the Joint National Committee on Prevention,Detection,Evaluation, and Tx of High BP released in 2013 by US dept of Health and Human Services

Question 2

What does ACE stand for

Answer 2

Angiotensin-converting enzyme inhibitors

Question 4

Angiotensin-converting enzyme inhibitors:

Answer 4

Select prototype :Captopril

• enalapril
• enalaprilat
• fosinopril
• lisinopril
• ramipril
• moexipril
• benazepril

Question 5

Therapeutic uses

Answer 5

1-hypertension
2-heart failure
3-myocardial infarction(decrease mortality/risk of heart failure/left ventricular dysfunction
4-diabetic/nondiabetic nephropathy
5-pts at high risk for cardio event,ramipril is used to prevent MI,stroke,or death

Question 6

Complications

Answer 6

1-first-dose orthostatic hypotension
2-cough
3-hyperkalemia
4-rash & dysgeusia(altered taste)
5-angioedema
6-neutropenia

Question 7

First-dose orthostatic hypotension

Answer 7

1-if pt is already taking a diuretic,stop med temporarily for 2-3 days prior to start of an ACE inhibitor

• taking another type of antihypertensive med increases hypotension effects of ACE inhibitor
• start tx with low dose
• monitor BP for 2 hr after initiation of tx
• instruct clients to change positions slowly & to lie down if feeling dizzy,lightheaded or faint

Question 8

Cough

Answer 8

1-related to inhibition of kinase II(alternative name for ACE), which results in increase in bradykinin
2-inform pts of the possibility of experiencing a dry cough & to notify provider. Discontinue medication

Question 9

Hyperkalemia

Answer 9

1-monitor potassium levels to maintain a level within the expected reference range of 3.5 to 5 mEq/L
2-advise pts to avoid the use of salt substitutes containing potassium
3-monitor for manifestations of hyperkalemia,such as numbness/tingling/paresthesia in hands & feet

Question 10

Rash & dysgeusia

Answer 10

-primarily w/ captopril
1-pts should inform the provider if these effects occur
2-adverse effects will stop w/ discontinuation of the med

Question 11

Angioedema

Answer 11

-swelling of tongue & oral pharynx
1-treat severe effects w/ subcutaneous injection of epinephrine
2-discontinue med

Question 12

Neutropenia

Answer 12

-rare but serious complication of captopril
1-monitor WBC counts every 2 wks for 3 months, then periodically
2-condition is reversible when detected early
3-inform pts to notify provider at first indications of infection(fever,sore throat) & discontinue med

Question 13

Contraindications/Precautions

Answer 13

Pregnancy Risk Cat D during 2-3 trimester,related to fetal injury
-Contraindicated in pts who have:
1-history of allergy/angioedema to ACE inhibitors
2-in bilateral renal artery stenosis
3-in pts who have a single kidney
-Use cautiously in pts who:
1-have kidney impairment
2-collagen vascular disease
Because they are at greater risk for developing neutropenia;closely monitor pts for manifestations of infection

Question 14

Interactions

Answer 14

1-Diuretics=can contribute to first-dose hypotension;advise pts to temporarily stop taking diuretics 2-3 days before start of therapy w/ an ACE inhibitor
2-Antihypertensive meds=can have an additive hypotensive effect;advise pts that dosage of med might need to be adjusted if ACE inhibitors are added to tax regimen
3-Potassium supplements /potassium-sparing diuretics=increase risk of hyperkalemia;pts should only take K supplements if prescribed, avoid salt subs with potassium
4-ACE inhibitors=can increase levels of lithium;monitor lithium levels to avoid toxicity
5-NSAIDs=can decrease the antihypertensive effect of ACE inhibitors;avoid concurrent use

Question 15

Nursing Administration

Answer 15

1-administer orally except enalaprilat(IV use)
2-advise pts med is prescribed as a single formulation or in combo w/ hydrochlorothiazide(thiazide diuretic)
3-advise pts BP is monitored after 1st dose for at least 2 hr to detect hypotension
4-instruct pts to take captopril & moexipril at least 1 hr before meals,others can be taken w/ or without food
5-advise pts to notify provider if cough,rash,dysgeusia or indications of infections occur
6-advise pt to rise slowly from sitting
7-advise pt to avoid activities that require alertness until effects are known
8-advise pts to report if pregnancy is suspected

Question 16

Expected Pharmacological Action

Answer 16

-reduce production of angiotensin II by blocking the conversion of angiotensin I to angiotensin II & increasing levels of bradykinin leading to
1-vasodilation(mostly arteriole)
2-excretion of sodium/water, retention of potassium by actions in kidneys
3-reduction in pathological changes in blood vessels & heart that result from presence of angiotensin II & aldosterone