Lecture on ACE Inhibitors

Introduction

• Presenter: Sarah Thread Sterner
• Focus: ACE Inhibitors
• Additional Resource: Free quiz to test knowledge on the medication.

Overview of ACE Inhibitors

• Mnemonic: NURSE
  • Name of the drug
  • How it works
  • Uses
  • Nurse responsibilities
  • Side effects
  • Patient education

Name

• A stands for Angiotensin Converting Enzyme
• Inhibit this enzyme to affect blood pressure regulation
  • Used in Renin-Angiotensin-Aldosterone System (RAAS)
  • Goal: Manage low blood pressure by increasing blood pressure through vasoconstriction and aldosterone release
• Pril: Common suffix of ACE inhibitors
  • Examples: Captopril, Lisinopril, Ramipril

Mechanism of Action

• RAAS System
  • Low blood pressure triggers kidneys to release renin
  • Renin converts angiotensinogen (from liver) to angiotensin I
  • Angiotensin-Converting Enzyme (ACE) converts angiotensin I to angiotensin II
  • Angiotensin II effects:
    • Major vasoconstrictor
    • Increases systemic vascular resistance and blood pressure
    • Triggers aldosterone for sodium and water retention
• ACE Inhibitors
  • Prevent conversion of angiotensin I to II
  • Lower blood pressure, cause vasodilation
  • Inhibit breakdown of bradykinin, causing vasodilation and dry cough
  • Side effect: Persistent dry cough due to bradykinin

Effects on Kidneys

• Potassium Levels
  • Normally, aldosterone excretes potassium
  • ACE inhibitors prevent this, leading to potential hyperkalemia
• Diuretic Effect
  • Increase excretion of sodium and water
  • Beneficial for fluid overload in heart failure

Uses of ACE Inhibitors

• Treat hypertension (lower blood pressure)
• Heart failure (systolic dysfunction)
  • Decrease afterload, making it easier for heart to pump
  • Decrease preload
• Post-myocardial infarction
  • Limit damage effects on the heart

Nursing Responsibilities

• Monitor blood pressure and pulse
  • Risk of hypotension, especially with diuretics or other blood pressure meds
• Monitor potassium levels (risk of hyperkalemia)
  • Normal range: 3.5 - 5
• Monitor renal function (BUN, creatinine)
  • Normal BUN: 5 - 20, Creatinine: 0.6 - 1.2
• Watch for signs of angioedema (swelling of deep dermis)
  • More common in African American patients
  • Can affect airway and be life-threatening
• Differentiate between drug-induced cough and heart failure symptoms
  • Check lung sounds, exertional breathing difficulties

Side Effects

• Persistent dry cough (harmless, but annoying)
• Dizziness (advise changing positions slowly)
• Hypotension (monitor blood pressure)
• Hyperkalemia (advise on potassium intake)
• Angioedema (emergency if it occurs)

Patient Education

• Regularly check blood pressure and pulse
• Avoid potassium-rich foods and salt substitutes
  • Risk of hyperkalemia, especially with potassium-sparing diuretics
• Report persistent cough to physician
  • Do not stop medication abruptly (risk of rebound hypertension)
• Recognize signs of angioedema
• Missed dose protocol:
  • Take missed dose same day if remembered, otherwise skip
  • Never double doses

Conclusion

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