ACE inhibitors

Question 1

Commonly used drugs

Answer 1

Ramipril
Lisinopril
Perindopril
Enalapril
Captopril

Question 2

What are they used for?

Answer 2

HTN

Heart failure

Question 3

How do they work?

Answer 3

Competitively inhibit angiotensin converting enzyme (ACE) - reducing generation of angiotensin-II and aldosterone

This reduces sodium and water retention = reduced blood volume

Also cause arterial and venous dilation

No reflex tachycardia

Question 4

Indications

Answer 4

HTN - less effective in African origin (use Ca channel blockers or thiazide-like diuretics instead)

Heart failure

Early renal failure with proteinuria

Secondary prevention after MI

Question 5

Contraindications

Answer 5

Thiazide-like diuretics & potassium-sparing diuretics- hyperkalaemia

Don’t prescribe ACEi + Thiazide diuretic + NSAID

Question 6

Side effects

Answer 6

Persistent dry cough

Postural hypotension

Renal impairment

Disturbance of taste, N+V, dyspepsia, bowel disturbance

Rashes

Angioedema