enalapril

Question 1

class

Answer 1

ACEI

Question 2

indications

Answer 2

hypertension
HF
post MI
diabetic neuropathy

Question 3

risk with enalapril

Answer 3

rsisk of hyperkalaemia

should not be used with potassium
supplements or potassium sparing diuretics
(caution/monitoring)

Question 4

first dose caution with enelapril

Answer 4

first dose hypotension

especially already and taking diuretics

Question 5

monitoring for ACEI

Answer 5

• renal fxn (U&Es) & electrolytes before starting ACEI
• within 7-10 days of dose changes
• inc frequency of montoring in high risk patients or those with s/e

Question 6

ACEI and renal fxn

Answer 6

expect to see small decline in eGFR

not huge dip

if big drop = c/i

Question 7

ACEI and pregnancy

Answer 7

ACEI avoided in pregnancy (hypertension U55 Rx ACEI, caution)

can affect fetal and neonatal blood pressure control and renal function

skull defects and oligohydramnios reported

Question 8

Sx of angiodema

Answer 8

itchy, raised rash/hives

swelling of lips/tongue

swellnig around eyes

abdominal pain

SOB

dizziness

Question 9

when does angiodema with ACEI most commonly occur

Answer 9

Most commonly occurs in the 1st year of
treatment

but can occur at any time

Question 10

re-star ACEI in patient who had angiodema?

Answer 10

NO not with ACEI class

high risk of recurrence

Question 11

How does angiodema occur with ACEI?

Answer 11

• angiodema from ACEI due to excessive accumulation of bradykinin
• due to genetic variations in bardykinin metabolism
• alternative metabolism pathways for bradykinin become essential when Tx with ACEI
• people with lower activity of these alternative pathways are at inc risk of bradykinin accumulation and angiodema

Question 12

when to avoid enalapril

Answer 12

renal artery stenosis
- ACEI can reduce GFR
- can casue renal failure

-> suspected renovascular disease, PVD, severe artherosclerosis

Question 13

drugs that can inc risk of renal damage with ACEI

Answer 13

NSAIDs

Question 14

s/e of enelapril

Answer 14

• first dose hypotension
• renal impairment
• persistent dry cough
• angiodema (can be delayed onset)
• hyperkalaemia

Question 15

ACE1 & ARB effect on kidney normally

Answer 15

angiotension vasoconstricts efferent arteriols

inc glomerular capillary pressure leads to inc permeability and inc proteinuria

Question 16

ACE1/ARB renoprotective properties

Answer 16

ACE/ARB cause vasodilation of efferent arteriole by reduction of angiotension II (antagomisn at receptor)

benefits = dec intraglomerular pressure, reduction in proteinuria

Question 17

factors affecting afferent blood flow

Answer 17

• NSAIDs (afferent vasoconstrictors)
• dec intravascular vomume -> dehydration, diuretic overuse, vomiting, diarrhoea, CHF
• sepsis
• renal artery stenosis