Antihypertensives: Antiotensin Converting Enzyme (ACE) Inhibitors

1. quinapril

2. trandolapril

3. benzapril

4. enalapril (IV enalaprilat)

5. moexipril

6. drugs: 9 available agents with different pharmacokinetic profiles

6.1. prodrugs that are converted by liver to active forms

6.2. eliminated by kidnes

7. AE: rash 10%; cough 10-20% block breakdown of bradykinins which produces cough; hyperkalemia (rare); acute renal failure and elevated serum creatinine; hypotention; angioedema (MC in AA pts); dysgeusia

8. drug interactions: NSAIDS (decreased effects); DIG and lithium levels can be increased

9. CI: pregnancy (2nd and 3rd trimester); antioedema; hyperkalemia;

9.1. bilateral renal artery stenosis: stenosis of blood coming into kidney; if you give these pts ACEI or ARB you see drop in GFR, increase in BUN and creatinine and increase BP

10. END IN -PRIL

11. catopriol (short half life)

12. lisinopril

13. fosinopril

14. ramipril

15. MOA: inhibits ACE which blocks concersion to ANG II

15.1. reduces preload and afterload in HTN

15.2. decreases left ventricular remodeling caused by chronic HTN and MI

15.3. vasodilates the efferent arterioles and reduce GFR

16. indications: HTN; all pts post MI and heart failure; diabetic and non-diabetic proteinuria: reduce progression to clinical nephropathy; patients with HTN and kidney issues

17. First line HTN drugs

17.1. RAAS

17.1.1. renin from JGA in afferent arterioles is released->renin actos on antiotensinogen->ang I which is converted to ANG II by Ace

17.1.2. ANGII actions: potent vasoconstrictor (afterload); stimulates release of aldosterone from adrenal cortex-> Na and water retention->preload; constricts effecrent and afferent arterioles-more efferent vasoconstriction; myocardium effects