ACEi

Question 1

Side effects

Answer 1

• Persistent dry cough
• Hyperkalaemia
• Anaphylactoid reactions

Question 2

New onset cough

Answer 2

Indicates bradykinin build-up.
Switch to ARB

Question 3

Anaphylactoid reactions

Answer 3

e.g. angiodema

Question 4

Hyperkalaemia

Answer 4

Increased risk in those with:
- renal impairment
- diabetes
Concomitant use with the following increases the risk of hyperkalaemia:
- Aliskeren
- ARB
- K+ sparing diuretics/aldosterone antagonists

Question 5

Hepatic effects

Answer 5

Jaundice
Marked elevations of hepatic enzymes (3x ULN)
STOP - risk of hepatic failure/necrosis.

Question 6

Renal effects

Answer 6

Renoprotective in renal disease e.g. CKD.
Nephrotoxic in acute kidney injury (DAMN)
If initiated, monitor renal function regularly.
Concomitant use with NSAIDs = increased risk of renal damage.

Question 7

DAMN

Answer 7

Diuretics
Ace inhibitors/ARBs
Metformin
NSAIDs

Question 8

Cautions

Answer 8

• HF
• Receiving multiple/high dose diuretics.
• Concomitant ARB or Aliskeren.
• Hypovolaemia
• Hyponatraemia (Na = <130 mmol/L)
• Unstable HF
• High dose vasodilator therapy
• Known renovascular disease

Question 9

Concomitant use of drugs affects the renin-angiotensin system

Answer 9

Concomitant therapy with two drugs affecting the renin-angiotensin system (e.g. ACEi or ARB) not recommended.
Increased risk of :
- Hyperkalaemia
- Hypotension
- Renal impairment.
Patients with diabetic nephropathy are particularly susceptible.

Question 10

Drug interactions - hyperkalaemia

Answer 10

• Aliskeren
• ARB
• K+ sparing diuretics/aldosterone antagonists

Question 11

Drug interactions - nephrotoxicity/reduced eGFR

Answer 11

• NSAIDs (afferent arteriole constriction)

Question 12

Drug interactions - hypotension

Answer 12

Diuretics (volume depletion = low BP)

Question 13

Other side effects

Answer 13

• Oral ulcer
• Taste disturbance
• Hypoglycaemia

Question 14

Pregnancy

Answer 14

AVOID