(ACE Inhibitors) Anti-hypertensive agent

ACE Inhibitors

Anti-hypertensive agent

·    Inhibit RAAS (Renin-Angiotensin Aldosterone-system)

·    Manages blood pressure primarlly on the kidneys

·    Activates bradykinin

·    Commonly taken orally

·    Blocks conversion of Angiotensin I to angiotensin II

·    Allows retention of potassium since RAAS is blocked which causes production of Aldosterone

·    Allows excretion of sodium and water in the body

Actions

·    Lower blood pressure

·    Promotes vasodilation because Angiotensin II is blocked.

·    Angiotensin II is a major vasoconstrictor that causes elevated BP.

·    Reduces afterload on the left ventricle of the heart

·    force that the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation

·    treats systolic dysfunction

·    increase stroke volume in each contraction of the heart.

·    Decrease preload

·    Preload is the amount of a ventricle has stretched at the end of its filling phase on every contraction.

·    Treatment of post-myocardial infraction

·    Promotes healing and cardiac hypertrophy. 

Side effects

ANGIOEDEMA

·    When bradykinin is high, it promotes vasodilation and Increased in vascular permeability leading to leakage of fluid or lymph to surrounding tissues

COUGH

·    Elevated bradykinin causes stimulation of cough Reflex resulting in Dry Cough

ELEVATED POTASSIUM

·    Inhibits reduce aldosterone levels that causes decreased potassium excretion.

DIZZINESS

·    Vasodilation due to inhibited Angiotensin II Conversion causes Low blood pressure resulting to Light-headedness or Dizziness.

ORTHOSTATIC HYPOTENSION

·    Vasodilation causes low blood pressure.

·    When a person stand up, gravity causes blood to pool in the lower extremities, reducing the amount of blood returned to the heart. Blood vessels may not constrict adequately to counteract this pooling effect.

Adverse effects

·    Reflex tachycardia

·    Chest pain

·    Angina

·    Heart failure and Cardiac Arrhythmias

·    Gastrointestinal (GI) Irritation, ulcers, constipation

·    Liver injury

·    Renal insufficiency, renal failure, and proteinuria

·    Rash, Alopecia and Dermatitis

·    Photosensitivity

 Contraindicated with

·    Known allergy to ACE inhibitors and its chemical

·    components

·    History of Angioedema

·    Pregnant Women

·    Bilateral Renal Artery Stenosis

·    Hyperkalaemia

·    Severe Kidney Disease

·    Sever Liver Disease

·    ACE Inhibitors induced cough

·    Aortic Stenosis

·    Hypertrophic Cardiomyopathy

Pharmacokinetics

Route	Onset	Peak
Orally taken	15 minutes	30-90 minutes

·    All of the ACE inhibitors are administered orally. Enalapril also has the advantage of parenteral use (enalaprilat) f oral use is not feasible or rapid onset is desirable.

·    These drugs are well absorbed, widely distributed. metabolized in the liver, and excreted in the urine and feces.

·    They have been detected in breast milk, cross the placenta, and have been associated with serious fetal abnormalities so they should not be used during pregnancy.

 Drug-Drug interaction

·    The risk of hypersensitivity reactions increases if these drugs are taken with allopurinol. There is a risk of decreased antihypertensive effects if token with nonsteroidal anti-inflammatory drugs: patients should be monitored.

·    The combination of drugs used to alter the RAAS IS not recommended due to potentially serious adverse effects and should not be combined with other ACE inhibitors, ARBS, or a renin inhibitor.

 Drug-Food interaction

·    Absorption of oral ACE inhibitors decreases if they are taken with food. They should be taken on an empty stomach 1 hour before or 2 hours after meals.

 Nursing Considerations

Perform a thorough assessment of the ff:

·    Medical History

·    Allergies to Food and Drugs

·    Kidney Dysfunction

·    Pregnancy

Assess the Following

·    Vital Signs

·    Fluid Status

·    Electrolyte levels such as Sodium and Potassium

Watch Out for Signs of Hypotension

·    Ash patient if he/she is toking other cardiac medicines libe diuretics and etc.

Assess kidney function

Blood sugar nitrogen	5 – 20
creatinine	0.6 – 1.2

 

Monitor potassium levels

Serum potassium

3.5 - 5

·    Patients with EKG, Hyperkalaemia is often seen as tall peaked T-waves.

 

Monitor urine output

Per hour	0.5-1.5ml/kg/hour
Per day	800 – 2000 ml

Check out for Angioedema

·    Press the patients skin and assess for presence of deep swelling beneath the shin's surface.

Educate Patients to Check their BP and HR

·    Provide health teaching of the importance of obtaining their own Blood pressure and Heart Rate even at home.

Educate Patients to Avold Foods with:

·    Salt Substitutes

·    High potassium foods like Beans, Bananas , Avocado and Potatoes.

For ACE Inhibitor induced cough:

Tell the patient who can't tolerate cough caused by ACE Inhibitors to immediately notify their physicians.