Angiotensin Converting Enzyme Inhibitors
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Angiotensin Converting Enzyme Inhibitors (ACE-I) are a class of drugs that inhibit the angiotensin converting enzyme and are often used as first-line treatment for congestive heart failure and hypertension. They work by inhibiting angiotensin converting enzyme, reducing stimulation of AT1 receptors and increasing bradykinin levels, leading to vasodilation. Common side effects include hypotension, dry cough, and hyperkalemia. ACE-I have various clinical uses including treatment of hypertension, heart failure, and diabetic nephropathy.
Angiotensin Converting Enzyme Inhibitors
- 1. Angiotensin Converting Enzyme Inhibitors (ACE-I)
- 2. Definition 1-Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) are a homogenous group of drugs that inhibit ACE enzyme. 2-Often used as first-line agents for CHF and hypertension 3-First found in snake venom.
- 4. Mechanism of action 1-Inhibition of angiotensin converting enzyme, Thus reduce the stimulation of AT1 receptor, And also cause elevation of Bradykinin level 2-lead to Reduction in arteriolar constriction, reduce aldosterone secretion and enhance kinin-induced peripheral vasodilatation
- 5. Pharmacological actions 1-Arterial and venous dilatation. 2- Depress sympathetic activity (no reflex tachycardia). 3-Dcrease blood volume ( natriuretic and diuretic effects). 4- Inhibit cardiac and vascular hypertrophy. 5-No significant increase in cardiac output.
- 6. Clinical uses 1-Treatment of hypertension. 2-Treatment of heart failure. 3-Secondry prevention after myocardial infarction. 4-Diabetic nephropathy in insulin-dependent diabetes mellitus.
- 7. Side effect 1- Hypotension: First dose,NA depleted patient 2- Dry cough: increase Bradykinin 3- Hyperkalamia: decrease aldosterone 4- Protinurea . 5 - Hypersensitivity :(Angioedema) 6- Teratogenic effects . 7- Neutropenia,rash : not related to ACE inhibition
- 8. Drug interactions: 1- NSAID : Decrease the vasodilator effect. 2- Potassium-sparing diuretics, potassium supplement : Exacerbate the hyperkalamia. 3- Digoxin and lithium : ACE-I increase their plasma level. 4- diuretics : Increase sensitivity to the vasodilator effect of ACE-I
- 9. Contraindications 1-Low blood pressure. 2-History of allergy 3-Bilateral renal artery stenosis. 4-Pregnancy. 5-Hyperkalemia. 6-Renal insufficiency. 7-Severe stenosis of aortic or mitral valve. 8-Serum creatinine above 3mg/dl
- 10. Examples: Cibacen benzapril Tritace ramipril Coversyl perindopril Zestril lisinopril Monopril fosinopril Ezapril enalapril (without diuretic) Capoten captopril Brand Name Generic Name