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Angiotensin Converting Enzyme Inhibitors " ACE Inhibitors"

ACE: Mechanism of Action

Inhibit ACE (responsible for converting angiotensin I to angiotensin II) blocking the potent vasoconstriction and aldosterone secretion effects of angiotensin II

ACE: Therapeutic Effects

Less aldosterone = less water and Na+ retention = decreased blood volume (the resulting diuresis decreases preload and workload of the heart)
Prevents breakdown of vasodilating substance Bradykinin
Results: decreased afterload (resistance) and vasodilation = decreased BP

ACE: DOC/First Line Drugs for...

Often used as first line drugs for HF and HTN
DOC in HTN w/ HF
DOC for diabetics

ACE: Indications

HF, HTN, renal protective effects in diabetic pts, slows progression of L ventricular hypertrophy after an MI

ACE: Adverse Effects

Dry, nonproductive cough (reverses if therapy stopped)
Angioedema, 1st dose hypotensive effect, mood changes, impaired taste, possible hyperkalemia, renal failure, sexual dysfunction

ACE: Drug Interactions

K+ sparing diuretics - additive K+ retention, risk of toxicity

ACE: Nursing Implications

Monitor renal FX and K+ levels, jaundice

ACE: Teaching

Take before meals, no antacids, salt substitutes, no K+ supplements, notify MD of cough

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