So now, let’s look at ACE Inhibitors in a little more detail.
You see how they fit into our flow chart.
They prevent the conversion of angiotensin I to angiotensin II because you have less of the ACE.
That’s what that job is. They end in pril.
So, look at the names up there: benazepril, captopril, enalapril, lisonopril. They all end in pril.
Now, we talked about that earlier, but P-R-I-L is the ending for most ACE inhibitors, and that’s what you gonna see in the generic name.
Now, we put in ace of hearts on there. Yeah, well played. Don’t you think?
We put an ace of heart on there to help you have a visual to remind you, ACE inhibitors impact your blood pressure,
which is obviously very closely connected to your heart.
Now, why do we use ACE inhibitors?
Well, we obviously used them to treat hypertension, but there’s some other things that we used,
but first of all, just remind yourself, an ACE inhibitor treats hypertension because by having less ACE available,
I’m gonna have less angiotensin II available. Right.
So when I have less angiotensin II available, I have less volume expansion and less vasoconstriction.
Now, what else do you think we can use that for?
Well, left ventricle systolic with or without failure.
So, if I’m having some issues with my left ventricle, ACE inhibitors are really good.
Because remember that left ventricle is the ones having to push blood out to the rest of the body.
By having less angiotensin II available because of the ACE inhibitor, it’s gonna be an easier workload for that left side of my heart.
Now, we also know that after someone has an MI, a myocardial infarction or a heart attack,
if we give them ACE inhibitors, many studies have shown that this reduces our chance of mortality and that means death.
That’s a good thing. Kind of an overall healthcare goal for us,
that we help patients reduce the risk of mortality, so they can live their best life.
We also use ACE inhibitors with diabetic patients because it can help with a diabetic and nondiabetic nephropathy.
So, that is definitely a bonus and we’re gonna help with diabetic retinopathy.
So, researchers supported the use of ACE inhibitors for high blood pressure,
left ventricular problems, after a heart attack, nephropathy, and diabetic retinopathy, problems with your eyes.
Also, the side effects for ACE inhibitors, spell out A-C-E.
So, I'd like you to write those three capital letters on your notes. Capital A, Capital C, Capital E.
Now, there are lots and lots of side effects for ACE inhibitors.
So, I want you to remember these three and look at that, they spell ACE.
A is for angioedema, remember that one. C is for cough, and E is for elevated potassium.
So, when I’m thinking about the side effects for ACE inhibitors, I know their mechanism of action.
They suppressed, they inhibit ACE, so it end up with less vaso, angiotensin II and I know that their side effects fall into A-C-E.
Angioedema, which is a swelling of the mucous membranes, cough, and elevated potassium.
So, with angioedema, obviously, we want to educate the patients, “Hey, if you notice any swelling of your mucous membranes,
you have any trouble swallowing or trouble breathing, please contact us immediately, okay?
Don’t take your dose and contact your health care provider immediately.”
If they develop a cough, a lot of times, patients don’t put together a cough with a blood pressure medication.
So, make sure they’re aware, “Hey, if you notice you have a cough that persists for a while,
give us a call, because we want you to contact your health care provider
because that’s the side effect of your medication that some people experience.”
We used to think it was no big deal, but now we’ve realized you kind of end up scarring the lungs.
So, we rather put you on another medication, so we don’t get those lungs involved in any way.
The last one, E for elevated potassium.
Now, this becomes an issue if you are on any other medication that also elevates your potassium., okay.
So, you wanna be really careful with that.
If I know you already have elevated potassium, because maybe another disease process that you have,
or I wanna be very careful with other medications that also elevate your potassium.
See, you don’t really wanna put a patient on two medications that have the same side effect.
Especially, a side effect like elevated potassium.
So, there’s also a thing with blood pressure medication since certain medications are worst than others,
but you see there’s a red box that just appeared on your screen. It’s called the first-dose effect.
So, whenever you see a test question that talks about someone who’s just starting an ACE inhibitor
or just beginning a treatment, with some other of the medications we'll talk about.
When first dose-effect and a blood pressure medication, it’s gonna be a -- a precipitous drop in blood pressure.
So, just with the first dose, they end up with this really big drop in blood pressure.
So, you want the patients to be very careful because they’re an extreme risk for falls.
An ACE inhibitors are not appropriate in pregnancy. Okay, so that red box is important.
Do what you need to do or what your system is for making that really stand out for you
because those are two really important side effects.
One with the first dose and the other, a patient population that should not receive this medication.
And if you look at our -- watch our video about the eight important questions to look at on pharmacology.
You know, we’re always asking, who should take this medication? Who should not take this medication?
So, that’s one of our eight important questions. So, that’s really important that you know that.
Okay. Now, I love what the Lecturio artists have done here. I like to think of side effects in head to toe.
That’s how my brain works and look what they’ve done, using more pharmacology things. I think this is really cool.
Now, you already know for ACE inhibitors that you’re looking for angioedema, cough, and elevated potassium, right?
So, they’ve got it down, there's increased potassium. That’s great. Because you can see a different way to word it.
So, those three are like, whoa, you really need to remember those.
But I wanna teach you a strategy, for when you’re looking at the side effects of a certain group of medications that you can use.
Any type of blood pressure medication is likely gonna make your patient feel kinda tired.
Or usually at risk for orthostatic hypotension.
Now, certain blood pressure medications, anti-hypertensives are worse than orthostatic hypotension than others
like, vasodilators and ACE inhibitors are bad at that. But I just want you to know, like wow,
those are kind of common concepts and things, that patients gonna be tired,
their blood pressure might be too low, orthostatic hypotension might be a problem.
So, those are common side effects. That’s really zero in on what’s different for ACE inhibitors.
Well, we already know angioedema, cough, and elevated potassium.
So, what else is on this slide that's new to you?
Well, down on the lower column, well, it is important, it doesn’t have to take up the top real estate in your brain.
So, we’ve looked at headache and fatigue, angioedema, look they’ve got a cough there,
and I love it that they’ve used tablets to represent lungs, they've got a heart in the middle,
and now you're moving down to the bottom of the slide, you see that it says transient which means it comes and goes.
Elevations in the BUN and creatinine, and the protein and the urine.
Okay, BUN and creatinine are lab tests that we do, we draw a lab blood and we register those values for BUN and creatinine.
If they’re elevated, they tell us the kidneys are having a problems.
Protein in the urine also tells us your kidney is having a problem,
because protein is supposed to stay in your bloodstream, not be peed out in your urine.
So, people on ACE inhibitors may have this come and go elevation of their BUN and creatinine
and possibly protein in their urine, which we call, proteinuria.
Well, I think that it’s important to know about ACE inhibitors, it's not the most important.
Angioedema, cough, and elevated potassium are top priorities, but don’t forget about that orthostatic hypotension.
ACE inhibitors, in addition, really do have some pretty significant orthostatic hypotension, particularly with the first dose effect.
Okay. Now, here’s what I want you to do, I call this study-as-you-go.
So, without looking at your notes, see how many of the side effects we’ve talked about for ACE inhibitors you can recreate,
and if you’re really up to the challenge, do it head to toe.