ACE Inhibitors – NCLEX Review (Nursing)

00:00 <b>Now, ACE inhibitors. Think back to that RAAS.</b> <b>Hey, if we've got less ACE available, that's cool</b> <b>because we're not gonna have as much angiotensin I converted</b> <b> to angiotensin II.</b> <b>The potent vasoconstrictor and volume expander. So that's </b> <b>how ACE inhibitors work.</b> <b>You see, their names in here, PRIL, PRIL, PRIL, PRIL, </b> <b>there's a key on how to remember.</b> <b>Now, we've put a picture of an ace of hearts on there. </b> <b>You're welcome.</b> <b>Just to help you remember A for ACE and the heart that we </b> <b>use these for antihypertensive medications.</b> <b>Predominantly, that's one of the main sources we use them </b> <b>for.</b> <b>It's for hypertension.</b> <b>We can also use them with some fancier stuff like left </b> <b>ventricular systolic</b> <b>with or without symptoms of failure.</b> <b>We use it after an acute MI. Helps with mortality which </b> <b>we're all after reducing.</b> <b>We also use this in diabetic and nondiabetic nephropathy and</b> <b> diabetic retinopathy.</b> <b>Whoa, that's a way long list. What are the top 2 I'd </b> <b>remember?</b> <b>Hypertension and after an MI.</b> <b>Now, I can talk to you into 2 of them, those would be the </b> <b>top 2 I would choose to remember.</b> <b>That's not an exact complete list but those 2 are gonna be </b> <b>the most common</b> <b>so those are the ones I would make sure I knew.</b> <b>Now, like this because ACE inhibitors have like a lot of </b> <b>side effects</b> <b>but these are the ones I want you to remember.</b> <b>A is for angioedema. The angioedema means that your mucous </b> <b>membranes</b> <b>are all swollen and you're not going to be able to breathe.</b> <b>So A for angioedema is a bad deal. Cough is for C and </b> <b>elevated potassium is E.</b> <b>The 3 side effects I wanna make sure you know for ACE </b> <b>inhibitors.</b> <b>A is for angioedema, C is for cough, and E is for elevated </b> <b>potassium.</b> <b>Now, there's also a first dose effect and we don't want you </b> <b>to use these meds in pregnancy </b> <b>because of their teratogenicity. ACE inhibitors are </b> <b>negatron. No go, don't use them in </b> <b>pregnant patients because of their teratogenicity. </b> <b>First dose effect means that they're gonna have a -- like a </b> <b>precipitous drop in blood pressure.</b> <b>So whenever you see a test question that talks about the </b> <b>initial dose or the first dose,</b> <b>particularly if you know it's a blood pressure medication, </b> <b>that's what you're worried about.</b> <b>It's that really big drop in blood pressure.</b> <b>So first dose effect, I know. Remember, repetition is your </b> <b>friend.</b> <b>So first dose effect is a big drop in blood pressure.</b> <b>We don't give these to pregnant women and the 3 main side </b> <b>effects, spell out ACE.</b> <b>Angioedema, cough, and elevated potassium.</b> <b>Why do we care about elevated potassium?</b> <b>Because I don't wanna give a patient an ACE inhibitor who's </b> <b>also on another medication</b> <b>that elevates potassium like a potassium-sparing diuretic.</b> <b>So keep in mind, if a med already has one side effect,</b> <b>I don't wanna give them another medication that also has </b> <b>that side effect.</b> <b>Alright, there's a key slide for ACE inhibitors.</b> <b>Make sure you come back and review that later on.</b> <b>Now, think about the side effects. Hey, I told you there's a</b> <b> lot of them, right?</b> <b>I gave you the most important ones.</b> <b>You can kinda keep an eye on those but you also gonna watch </b> <b>about the kidneys</b> <b>but if I'm gonna go for 3, A-C-E is what I'm going to </b> <b>remember.</b> <b>Now here's your chance.</b> <b>Supercharge your memory, study as you go without looking at </b> <b>your notes.</b> <b>See if you can answer the order. What is the order of the </b> <b>RAAS?</b> <b>Let's take a look at this NCLEX exam-level question. </b> <b>Remember this one?</b> <b>The nurse assesses a client who is taking spironolactone </b> <b>which is a potassium-sparing diuretic.</b> <b>They're taking it daily and the health care provider has </b> <b>just ordered captopril.</b> <b>Which of the following is the most important action for the </b> <b>nurse to take?</b> <b>Okay, now recall what you answered on his question. Which </b> <b>one did you pick?</b> <b>Well, when you look at these 4 options, now that we've gone </b> <b>over ACE inhibitors,</b> <b>we know that this patient is on spironolactone</b> <b>which I told you was a potassium-sparing diuretic</b> <b>just because I knew you were just getting into this.</b> <b>So spironolactone is a potassium-sparing diuretic and </b> <b>they've now ordered captopril</b> <b>which is an ACE inhibitor.</b> <b>So now when I'm looking at the options, what's the most </b> <b>important action for me to take?</b> <b>It's always the one that keeps the patient the safest so do </b> <b>I need to assess the heart rate?</b> <b>No, that's not a problem with spironolactone or really with </b> <b>the ACE inhibitor.</b> <b>That would be more of a beta blockers so I could get rid of </b> <b>that one.</b> <b>Should I educate them to take the first dose at bedtime? </b> <b>That's kinda odd.</b> <b>I'll leave that in. Should I assess the patient for any </b> <b>history of GI bleeding?</b> <b>Yeah, no combination to captopril or spironolactone.</b> <b>Should I auscultate the patient's lung sounds?</b> <b>Based on the topic of this question, I wanna keep this </b> <b>patient the safest</b> <b>so I'm picking between lung sounds and take the first dose </b> <b>at bedtime.</b> <b>Oh, first dose, risk of big drop in blood pressure that's </b> <b>why that's the correct answer</b> <b>because pretty much if someone's gonna have a big drop in </b> <b>blood pressure,</b> <b>we would like them to already be horizontal on a soft and </b> <b>cushy surface rather than falling.</b> <b>So that's why we encourage them to take the first dose at </b> <b>bedtime.</b>