Enzyme (ACE) Inhibi 1. Overview of ACE inhibitors ‘A. Description B, Action G. Indications D. Overview of nursing manage- ‘management for ACE ment inhibitors I. ACE inhibitors I. Common ACE inhibitors A. General information Bibliography B. Pharmacodynamics /action Study questions G. Pharmacotherapeutics /indica- I. Overview of ACE inhibitors ‘A. Description: ACE inhibitors help control blood pressure by preventing the conversion of angiotensin I to angiotensin II. B. Action 1. ACEs convert angiotensin I to angiotensin II, a potent vasoconstrictor. ‘This stimulates aldosterone release, which promotes sodium and water retention. 2. Increased blood pressure results from vasoconstriction, sodium, and water retention. This renin-angiotensin-aldosterone system is essential in the maintenance of blood pressure. C. Indications: Treatment of hypertension and heart failure. D. Overview of nursing management 1. Because this drug affects cardiac output, closely monitor the CV effects. i 2. Ensure that the client understands the medication regimen. * ACE inhibitors A. General Information: ‘These drugs are among the many types of agents used to treat high blood pressure. B. Pharmacodynamics/action 1. ACE inhibitors block conversion of angiotensin I to angiotensin II. 2. This reduces peripheral vascular resistance, prevents vasoconstriction, and lowers blood pressure. ~ 99 Scanned with CamScanner100 Axgiotensin-Converting Enzyme (ACE) Inbibitors 3. ACE inhibitors increase renal blood flow, which promotes sodium ay, water excretion and reduces potassium excretion. ‘4. Vasodilation results from bradykinin release; ACE inhibitors stop the py lease of bradykinin. C. Pharmacotherapeutics /indications 1. Treatment of mild to moderate hypertension, heart failure, left ventriqy lar failure, diabetic nephropathy. 2. ACE inhibitors are often used after other antihypertensive therapig, (diuretics, B blockers) have failed to control blood pressure. D. Pharmacokinetics 1. Onset is usually within 1 hour. 2, Peak action occurs within 4 to 8 hours, depending on the drug. 3. Duration depends on the drug. 4. Drug is excreted in the urine, E. Contraindications/cautions 1, Contraindicated for pregnant and breast-feeding women; previous his tory of angioedema and hypersensitivity reactions to prior ACE inhibitoy treatment. 2. Used with caution in clients with renal insufficiency. F. Drug interactions 1. Drug-drug interactions. a. Allopurinol, digoxin, lithium, phenothiazine, probenecid: in creased action of ACE inhibitors. >. Antacids: decreased therapeutic effects of ACE inhibitors. . Nonsteroidal anti-inflammatory drugs (NSAIDs; especially in; domethacin) and rifampin: antagonize ACE inhibitor effects d. Potassium supplements: increased risk of hyperkalemia. 2, - Drug-food interactions: Taking these agents with food decreases ther) peutic effects. 3. Drug-laboratory test interferences: increased blood utea nitrogen (BUN), creatinine, hyperkalemia, blood dyscrasia (neutropenia, agrant: locytosis). G. Side/adverse effects 1. CV: hypotension, nm 2. Derm: rash If the client develops angioedema, bronchospasm, ané dyspnea, immediate treatment with epinephrine and antihistamine is needed. ACE inhibitor treatment will be discontinued if a hype sensitivity reaction occurs. 3. Gl: nausea, vomiting, diarthea, constipation, altered taste (dysgeusish anorexia, abdominal pain. 4, Hem: neutropenia and agranulocytosis. 5. Renal: nephrotic syndrome, hyperkalemia. 6. Other: dry cough. HL. Nursing management for ACE inhibitors 1. Assessment, a, Assess CV, renal, fluid, and electrolyte status. b. ‘Assess all baseline data: ECG, blood pressure, heart rate, respi tory rate, body weight, skin color and temperature, renal and @! ‘output, nutritional status, serum chemistries. Scanned with CamScanner2. 3. PPPS pe Angiotensin-Converting Enzyme (ACE) Inbibitors 104 ¢. Evaluate liver function. d, Review all aspects of medical regimen to determine the possibili- ties of contraindications and drug interactions. Planning and implementation. a. _ Instruct client on how to monitor blood pressure. b. Monitor urinary protein; if proteinuria is present the drug may need to be discontinued. ¢. Provide client teaching covering: (1). Identification and prevention of situations in which blood pressure may drop. (2) Recognition and prevention of infection. (3) Need for salt intake (severely limiting salt intake may result in hypotension), (4) Avoidance of raking double doses if a medication is missed. (5) Avoidance of excessive amounts of tea, coffee, and colas. (6) Need to consult the physician if any over-the-counter med- ications (especially cold and cough remedies) are needed. (7) Importance of maintaining drug therapy even when blood pressure is controlled, Evaluation: The outcome of drug therapy with ACE inhibitors may be ‘evaluated as successful as follows: fl a. The client experiences a reduction in blood pressure. b. The client complies with client drug therapy. I. Common ACE inhibitors Captopril (Capoten): pregnancy category C. Benazepril (Lotens pregnancy category C. Fosinopril (Monopril): pregnancy category D. Quinapril (Accupril): pregnancy category D. Lisinopril (Prin ): pregnancy category C. Ramipril (Altace): pregnancy category C. Enalapril (Vasotec): pregnancy category C. a. Contraindications/cautions. (1), . Contraindicated in any prior history of angioedema bron- chospasm and dyspnea to previous ACE inhibitor therapy. (2) Neutropenia. b. Drug interactions. > i Allopurinol: increased risk of hypersensitivity reactions to enalapril. Additional antihypertensives, diuretics: increased risk for hy- potensior Digoxin, lithium: increased risk of toxicity. NSAIDs, rifampin: decreased therapeutic effects of enalapril, Potassium supplements: hyperkalemia (if there is no diuretic in the regimen). ¢. Nursing management. (1). Instruct the client to avoid of salt substitutes, which are high in potassium. (2) Note that dosage of enalapril may be adjusted if the client is also receiving diuretic therapy. (3) Be aware that surgery or anesthesia could cause hypoten- sion, which resolves with volume expansion. Scanned with CamScanner