6481749
Description
Flashcards by Andrew Street, updated more than 1 year ago
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Created by Andrew Street
over 7 years ago
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| Question | Answer |
| Give eg's of & indications for ACEi's. | eg's: ramipril, lisinopril, perindopril Indications: • HT - 1st or 2nd line Rx • CHF - 1st line Rx • Ischaemic HF • Diabetic nephropathy • CKD with proteinuria |
| MOA of ACEi's. | ACE inhibitors block the action of the ACE, to prevent the conversion of angiotensin I to angiotensin II. Angiotensin II is a vasoconstrictor & stimulates aldosterone secretion. Blocking its action reduces peripheral vascular resistance (afterload), which lowers BP. It particularly dilates the efferent glomerular arteriole, which reduces intraglomerular pressure & slows the progression of CKD. Reducing the aldosterone level promotes sodium & water excretion. This can help to reduce venous return (preload), which has a beneficial effect in heart failure. |
| SE's of ACEi's. | • Hypotension • Dry cough • Hyperkalaemia • Renal failure - this is particularly relevant in patients with renal artery stenosis, who rely on constriction of the efferent glomerular arteriole to maintain glomerular filtration • Angioedema & other anaphylactoid reactions |
| CI's, cautions, & important interactions of ACEi's. | CI's: • Renal artery stenosis • AKI Cautions: • Pregnancy • Breastfeeding • CKD - lower dose & carefully monitor Important interactions: Due to the risk of hyperkalaemia, avoid prescribing ACE inhibitors with other potassium-elevating drugs, including potassium supplements (oral or IV) & potassium-sparing diuretics except under specialist advice for advanced HF. In combination with other diuretics they may be associated with profound first-dose hypotension. The combination of an NSAID & an ACE inhibitor ^the risk of renal failure. |
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