ACE Inhibitors

Question 1

Supplements to stop taking before starting an ACE-I?

Answer 1

Potassium supplements. Because ADR of ACE-Is = hyperkalaemia

Would also need to stop a potassium sparing diuretic

Question 2

ACE inhibitor MOA?

Answer 2

Stops ACE from converting angiotensin I into angiotensin II. Also prevents the breakdown of bradykinin

Question 3

What effects does angiotensin II have on the body?

Answer 3

Stimulates vasoconstriction and binds to the adrenal gland to secrete aldosterone. Aldosterone stimulates the reabsorption of sodium and water to increase blood volume

Question 4

Important ACE inhibitor ADRs?

Answer 4

Orthostatic hypotension (take dose at night to avoid this), first dose hypotension, cough, hyperkalaemia, angioedema

Question 5

Less important side effects or ACE-I?

Answer 5

Headache, hyperkalaemia, fatigue, nausea

Question 6

Starting dose of perindopril?

Answer 6

5mg once daily

Question 7

Maximum dose of perindopril?

Answer 7

10mg once daily

Question 8

Reasons for dose reductions of ACE-Is?

Answer 8

Heart failure, elderly, renal impairment

Question 9

Starting dose of ramipril

Answer 9

2.5mg once daily, increase to 5mg after 2-3 weeks if necessary

Question 10

Maximum dose of ramipril?

Answer 10

10mg daily

Question 11

Monitoring required prior to starting and 1-2 weeks after?

Answer 11

Test renal function and electrolyte levels