HESI Med-Surg LPN Ace Inhibitors
Angiotensin-Converting Enzyme Inhibitors
Angiotensin-converting enzymes (ACE) inhibitors are a large group of
... [Show More] medications that are used in heart failure patients and patients that have hypertension. ACE inhibitors interfere with the renin angiotensin-aldosterone system (RAAS), which leads to a decrease in blood pressure. They are used in the treatment of hypertension, heart failure, have shown to prevent heart remolding post myocardial infarction, as well as delaying the onset of nephropathy in diabetic patients at risk.
Key Facts:
1. “-pril” suffix. (Pearls) ACE inhibitors can be identified by having the “-pril” suffix at the end of the generic name of a medication. ACE inhibitors are also prescribed to reduce mortality following an MI and improve hemodynamics in heart failure. Ex. Lisinopril (Prinivil) is generally used in the first line of defense in decreasing BP. Captopril (Capoten) also used for slowing progression of diabetic nephropathy.
Mechanism of Action:
2. Block renin angiotensin-aldosterone system. (Blocking RAAS-berries with wrench, angel-tennis, and Aldo-stereo) ACE inhibitors prevent the conservation of angiotensin 1 and 2. Angiotensin 2 is a powerful vasoconstrictor and its inhibition prevents direct vasoconstriction, which decreases peripheral vascular resistance and BP and prevents the release of aldosterone, which decreases sodium retention.
Indications:
3. Hypertension. (Hiker-BP) ACE inhibitors are one of the safest medications to manage. Typically a first-choice medication, ACE inhibitors help relax and dilate the blood vessels. However, ACE inhibitors may be avoided in African Americans due to the population being at high risk for developing angioedema.
4. Heat failure. (Dead heart) By blocking angiotensin 2 the body does not retain as much water as when angiotensin 2 is activated. Decreases in fluid volume in combination with decreased vascular resistance work synergistically to decrease the workload on the heart.
Side Effects:
5. Dry non-productive cough. (Dry coughing-coffee) ACE inhibitors sometimes cause a side effect which produces a dry non-productive cough related to bradykinin release. These patients should notify their physician immediately if this side effect occurs.
6. Hypotension. (Hippo-BP) The first dose can have the most impact on an individual’s BP. It’s important to always check the BP before administering and monitor BP for 2 hours with the first dose of administration. Follow provider recommendations, commonly hold medication if systolic BP is 90-100.
7. Dizziness. (Dizzy-eyes) Because of the dilated blood vessels, orthostatic hypotensive can occur. This can make the patient feel dizzy or lightheaded, especially when changing positions quickly.
8. Possible Hyperkalemia. (Hiker-banana) Aldosterone assists in the reabsorption of sodium and water in the kidneys, exchanging out potassium. Due to suppressed production of aldosterone from the renin pathway, there is a decrease in sodium and water reabsorption, and an increase in potassium retention. This can lead to hyperkalemia in patients. It’s important to remember not to give ACE inhibitors with potassium-sparring diuretic and to monitor electrolyte levels in patients.
9. Angioedema. (Angel-edamame) Angioedema is rare and is characterized by rapid swelling of the tongue, glottis, and pharynx with giant wheals. Angioedema from ACE inhibitors typically occurs in African American population. Angioedema occurs though the same process as dry cough. The increase in bradykinin causes the increase in vascular permeability resulting in edema. It’s also important to note that NSAIDS may reduce the effectiveness of ACE inhibitors, as well as, increase the potential of angioedema to occur.
Nursing Considerations:
10. Slowly change positions: (Slow-tortoise getting up from Delta-chair) Orthostatic hypotension can occur in patients that take BP medications. It’s important to educate patents to change positions slowly to prevent a drop in BP and feeling dizzy.
11. Do not stop abruptly. (Can’t stop cold-turkey) Educate the patient to not miss a dose. Sudden drop in the blood level of the medication can result in a surge of angiotensin 2 and aldosterone, which can increase the BP causing a hypertensive emergency. [Show Less]