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