Angiotensin-converting enzyme (ACE) inhibitors: Nursing Pharmacology

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Notes

Notes

ACE INHIBITORS
DRUG TABLE
-pril: e.g., benazepril (Lotensin); lisinopril (Prinivil); captopril (Capoten); ramipril (Altace); enalapril (Vasotec); 
enalaprilat (Vasotec IV)
CLASS
ACE inhibitors
MECHANISM OF ACTION
Block angiotensin-converting enzyme (ACE), preventing it from converting angiotensin I to its active form angiotensin II; decrease aldosterone secretion
INDICATIONS
  • Hypertension
  • Heart failure
  • Post-myocardial infarction
ROUTE(S) OF ADMINISTRATION
  • PO
  • IV (enalaprilat)
SIDE EFFECTS
  • Headache
  • Dizziness
  • Fatigue
  • Constant, dry, irritating cough
  • Angioedema
  • Hypotension
  • Tachycardia
  • Hyperkalemia
CONTRAINDICATIONS AND CAUTIONS
  • Concurrent use of potassium-sparing diuretics
  • Hyperkalemia
  • Boxed warning: pregnancy
NURSING CONSIDERATIONS
Assessment and monitoring
  • Vital signs, ECG, CBC, urinalysis, sodium, potassium, creatinine, and BUN, negative pregnancy test
  • For heart failure: weight, edema, lung sounds, dyspnea
  • Monitor for side effects; have 1:1000 epinephrine available for angioedema

Client education
  • Purpose of medication
  • Side effects
    • Change position slowly to avoid orthostatic hypotension
    • Avoid potassium supplements, salt substitutes, NSAIDs
    • Cough
    • Angioedema
  • Do not stop abruptly 
  • Lifestyle modifications
  • Blood pressure self-monitoring

Transcript

Angiotensin converting enzyme inhibitors, or ACE inhibitors for short, are a group of medications that help decrease blood pressure and are typically used to treat hypertension or heart failure, but they can be also administered to clients who have recently had a myocardial infarction.

Now, ACE inhibitors usually end in “-pril”, and include enalapril, lisinopril, ramipril, benazepril, and captopril.

Most of these medications are taken orally, but there’s one ACE inhibitor called enalaprilat that can be administered intravenously for hypertension or severe heart failure when oral treatment isn’t practical. However, it’s not recommended for acute heart failure or myocardial infarction.

Alright, ACE inhibitors work by inhibiting the action of an enzyme called angiotensin-converting enzyme, or ACE for short, preventing it from converting angiotensin I into its active form angiotensin II. Angiotensin II causes blood vessels to constrict, which increases the blood pressure.

In addition, it stimulates the adrenal glands to release aldosterone, which increases reabsorption of sodium and water in the kidneys. This results in increased blood volume, which also contributes to increased blood pressure.

So once ACE inhibitors are administered, there’s less angiotensin II in the bloodstream, which decreases vasoconstriction, as well as decreased aldosterone release by the adrenals, leading to natriuresis, or excretion of sodium along with water by the kidneys. In this way, ACE inhibitors effectively lower the blood pressure.

Summary

ACE inhibitors are drugs that lower blood pressure by dilating blood vessels. They work by preventing the conversion of angiotensin I to angiotensin II. Angiotensin II normally constricts blood vessels and raises blood pressure. So, preventing its formation is one of the ways to keep the blood pressure from rising. Some commonly used ACE inhibitors include lisinopril (Prinivil, Zestril), captopril (Capoten), and enalapril (Vasotec).

Sources

  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  6. "Enalaprilat" undefined (2021)
  7. "Anaphylactoid and Possibly Related Reactions" undefined (2020)
  8. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2019)
  9. "Lewis's Medical-Surgical Nursing" Mosby (2019)
  10. "Simple Reason for Hypoglycemia: ACE Inhibitor-induced Severe Recurrent Hypoglycemia in a Nondiabetic Patient" Cureus (2019)
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