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ACE inhibitors

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VOL: 101, ISSUE: 46, PAGE NO: 29

 

GENERIC AND PROPRIETARY NAMES

Angiotensin-converting enzyme (ACE) inhibitors include:

- Captopril: Capoten.

- Cilazapril: Vascace.

- Enalapril: Innovace. 

- Fosinopril: Staril.

- Imidapril: Tanatril.

- Lisinopril: Carace, Zestril.

- Moexipril: Perdix.

- Perindopril: Coversyl.

- Quinapril: Accupro.

- Ramipril: Tritace.

- Trandolapril: Gopten, Odrik.

There are also many combined products that include ACE inhibitors.

ACTION

- Inhibits the conversion of angiotensin I to angiotensin P, which is a vasoconstrictor, therefore relaxing blood vessels and reducing blood pressure.

CLASSIFICATION

- Drugs affecting the renin-angiotensin system.

INDICATIONS

- Heart failure.

- Hypertension.

- Diabetic nephropathy.

- Prophylaxis of cardiovascular events.

CONTRAINDICATIONS

- Hypersensitivity.

- Renovascular disease.

- Pregnancy.

 CAUTIONS

- Patients on diuretics.

- Peripheral vascular disease.

- Renal impairment.

- Aortic stenosis.

- Angio-oedema.

- Breastfeeding.

SIDE-EFFECTS

- Profound hypotension.

- Renal impairment.

- Persistent dry cough.

- Angio-oedema.

- Rash.

- Pancreatitis.

- Upper respiratory tract symptoms.

- Gastrointestinal effects.

- Altered liver function, jaundice and hepatitis.

- Blood disorders. 

- Headache.

- Dizziness.

INTERACTIONS

- Potassium-sparing diuretics may lead to hyperkalaemia.

- Other diuretics may lead to hypotension.

- Alcohol.

- Alpha-blockers.

- Beta-blockers.

- Calcium-channel blockers.

 - Corticosteroids.

- NSAIDs.

- Potassium-containing drugs.

ADMINISTRATION

- Oral.

NURSING CONSIDERATIONS

- Hypertension should be managed according to appropriate guidelines.

- Treatment with an ACE inhibitor can be started in the community in the majority of people with heart failure.

- In patients taking diuretics, close supervision is needed when commencing treatment.

- The initial dose of ACE has a risk of first-dose hypotension, therefore patients should be advised to sit or lie down for 2-4 hours after this.

- Evaluate therapeutic response.

PATIENT TEACHING

- Advise patients to avoid driving and other hazardous work until they are confident that they have no dizziness or fainting from possible hypotensive side-effects.

- Avoid excess intake of alcohol since this can enhance hypotensive effect.

- This medication should not be stopped without medical consultation.

- Advise patients to rise slowly in order to avoid postural hypotension.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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