Class: Ace Inhibitors

Medications (Generic)

Lisinopril

Captoril

Ace inhibitors all end in

-pril

Brand Name

zestril

prinivil

capoten

What enzyme do -pril drugs inhibit, and where is it located

ACE (angiotensin converting enzyme)

in the blood vessel of the lungs

How do ACE inhibitors affect the conversion of Angiotensin I

they block the conversion of Angiotensin I to Angiotensin II (a potent vasoconstrictor)

what happens to blood vessels when Angiotensin II production is blocked by an ACE inhibitor?

blood vessels dilate which decreases systemic vascular resistance and lowers blood pressure

How do ACE inhibitors affect aldosterone and electrolyte levels in the kidneys

they decrease aldosterone secretion which leads to sodium and water excretion and potassium retention (hyperkalemia risk)

Therapeutic Use

hypertension

heart failure

post-myocardial infarction

diabetic nephropathy

what common side effects of ace inhibitors causes patients to stop taking the drug and why does it happen

a dry persistent cough

it is caused by the buildup of bradykinin in the lungs

if a patient cannot tolerate the dry cough caused by an ace inhibitor what drug class is typically prescribed instead

ARB (angiotensin 2 receptor blocker) because they do not cause bradykinin buildup

what is the most severe, life-threatening allergic reaction associated with ace inhibitors and what are the signs

angioedema

rapid swelling of the lips tongue throat or face

needs airway management and epinephrine

which high alert electrolyte imbalance are patients taking ace inhibitors at risk for

hyperkalemia

what blood pressure complication is especially common after taking the very first dose of an ace inhibitor

first dose orthostatic hypotension

what lab values must be monitored to evaluate for renal impairment secondary to ace inhibitor therapy

BUN and serum creatinine

what specific ace inhibitor prototype carries a rare risk of neutropenia and leukopenia

captopril

Medication Administration: Lisinopril

long acting, dose once daily, taken with or without food

Medication Administration: Captopril

short acting, dosed 2 to 3 times daily, must be taken on an empty stomach

what is the black box warning for ACE inhibitors regarding pregnant patients

causes major fetal toxicity, renal damage, and or fetal death

can a patient who previously experienced angioedema from lisinopril be prescribed enalapril

no, a history of angioedema from any ace inhibitor is an absolute contraindication for the entire class

why are ace inhibitors contraindicated in patients with bilateral renal artery stenosis

blocking angiotensin2 causes renal efferent arteriole dilation, which can precipitate severe acute renal failure in these patients

why should ace inhibitors be used with extreme caution in patients who already have elevated potassium or severe kidney disease

ace inhibitors cause potassium retention which drastically increases the risk of severe life threatening hyperkalemia

why is hypovolemia/dehydration a major precaution before starting an ace inhibitor

volume depleted patients are at an extremely high risk for severe sudden first dose hypotension

Nurse Intervention: Vital Sign

check blood pressure before administering

hold medication if systolic is less than 90

Nursing Intervention: Serum Potassium

3.5-5 mEq/L

monitor regularly for hyperkalemia

Nursing Interventions: Renal Function

Track BUN and creatinine baseline and periodic levels

Nursing Interventions: CBC

monitor WBC count is patient is on captopril

Nursing Interventions: Airway Safety

immediately stop meds and prepare epinephrine if angioedema occurs

Client Education: Postural Safety

change positions slowly to prevent dizziness

Client Education: Dietary Restrictions

avoid salt substitutes containing potassium and potassium supplements

Client Education: Report Red Flag Immediately

if your tongue or lips swell, difficulty to breath, and persistent fever/sore throat

Client Education: Cough management

report persistent dry cough

What happens if a patient takes an ACE inhibitor together with potassium supplements or spironolactone?

It dramatically increases the risk of severe hyperkalemia causes fatal cardiac dysrhythmias

How do regular NSAIDs (e.g., ibuprofen, naproxen) interact with ACE inhibitors?

NSAIDs decrease the blood pressure-lowering effectiveness of ACE inhibitors and increase the risk of renal impairment.

What is the risk when combining an ACE inhibitor with diuretics or other antihypertensives?

Additive hypotension

How do ACE inhibitors affect blood levels of Lithium?

ace inhibitors decrease renal clearance of lithium causing increased lithium levels and severe toxicity.

What common dietary item must patients taking ACE inhibitors avoid to prevent electrolyte spikes

Salt substitutes

Medication Effectiveness

Good blood pressure

reduction of signs of heart failure

preservation of kidney function in diabetic patients