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20 Cards in this Set
- Front
- Back
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ACEIs - MOA
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Inhibit conversion of Angiotensin I-->II, reducing
1. vasoconstriction 2. Sodium retention 3. aldosterone release 4. GF effect on heart muscle 5. SNS activation Also reduces bradykinin breakdown, a potent vasodilator, which also mediates anaphylaxis and ACEI induced angioedema |
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ACEIs - indications
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1. HTN
2. MI 3. Angina 4. HF & LV dysfunction 5. Prevention of progression of renal disease with proteinuria >1g d 6. TYPE ONE DIABETES nephropathy 7. Prevention of CVD in patients greater than 55 with DM, stroke, or PVD |
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ACEIs - Contraindications and cautions
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1. Pregnancy - CI
3. Hyperkalaemia- RI, Drugs increasing potassium concentration 4. First dose hypotension - with diuretics, hypovolaemia 5. Renal hypoperfusion with renal artery stenosis, increased risk in PVD and atherosclerosis 6. Aortic stenosis - may casue hypovolaemia but may benefit 2. Angioedema, Hx of - AVOID 7. ESRF - myelosuppressive, may require increased dose of epoetin |
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ACEIs
- preg - BF |
Cat D
Major congenital malformations in first trimester; third semester: fetal renal dysfunction, oligohydramnos, fetal death No A/Es with captopril and enalapril. Others have insufficient evidence. |
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ACEIs
- Adverse Effects |
Common
- dizziness, headache (L12) - cough - hyperkalaemia Infrequent - angioedema (early or delayed) - elevated LFTs - pharyngitis but not rhinitis, muscle aches, and also strange dreams Rare - hepatitis, blood dyscrasias, psoriasis |
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ACEIs
- Counselling points |
L11
L16 Not L12 according to AMH APF indicates L12 for initiation of treatment |
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ACEIs
- what monitoring required - Do what when starting an ACEI? |
Before starting:
- CrCl, U+E, Review after 1-2 weeks STOP diuretics for 24hrs STOP K supplements and K sparing diuretics START low |
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ACEIs
- Drugs in class (8) - How many doses per day? |
Daily dosing except captopril
CERT-Q-FLP Captopril (Acenorm, Capoten) Enalapril (Renitec) Ramipril (Prilace, Tritace) Fosinopril (Monopril, Monoplus) Quinalapril (Accuretic) Trandolapril (Odrik, Gopten) Lisinopril (Zestril , Lisodur) Perindopril (Coversyl) |
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ACEIs
- DIs |
potassium retention
Antihypertensice Hypoperfusion NSAIDs do all the above Increase Li retention AND THAT IS IT! for all ACEIs |
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Captopril
- dose form, brands - dose |
12.5mg.90, 25mg.90, 50mg.90 tab (ACENORM, CAPOTEN)
5mg/ml.95mL oral liquid (Capoten, PBS-R) 6.25mg-50mg bd (start low for the elderly, RI, HF) 6.25mg-150mg bd for HF 6.25mg-50mg tds for MI 25mg tds for diabetes nephropathy |
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Captopril liquid administration advice
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You can mix it with any cold drink but drink it immediately
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Enalapril
- dose form, brands (remember combos) - dose |
- 2.5, 5, 10, 20mg.30 tabs (Renitec, Auspril, Alphapril, AMPRACE)
- 20mg/6mg with HCTZ (Renitec Plus 20/6) - 10mg/10mg, 20mg/10mg with lecarnidipine (Zan-Extra) 2.5mg-40mg d (start low for HF, RI, elderly, and use 40mg only for HTN not HF) |
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Fosinopril
- dose form, brands - dose |
10mg, 20mg.30 tab (Monace, Monopril)
10mg/12.5, 20mg/12.5 with HCTZ (Monoplus, Hyforil) 5-40mg d (start low for HF, elderly, RI) Max 10mg d if taking a diuretic or if there is RI |
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Lisinopril
- dose form, brands - dose |
5, 10, 20mg.30 tab (Lisodur, FIBSOL, ZESTRIL, PRINIVIL, LIPRACE, Lisinobell)
2.5-40mg d (start low prn, max 20mg in HF, max 5mg in RI or if taking a diuretic) |
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Perindopril
- dose form, brands - dose |
- 2.5, 5, 10mg, 2.5/0.625, 5/1.25mg with indapamide (Coversyl) ** ARGININE
- 2, 4, 8, 4/1.25 (Perindo, Perindopril, Perindo Combi) Max 5mg d in HF, Max 10mg in HTN |
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Qunialapril
- dose forms, brands - dose |
- 5mg, 10mg, 20mg tabs (Accupril, ACQUIN, Filpril)
- 10/12.5mg, 20mg/12.5 (Accuretic) 2.5-40mg d (Start low prn, max 20mg for HF, max 5mg for RI) |
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Ramipril
- dose forms, brands (remember combos) - dose |
- 1.25, 2.5mg, 5mg TABS (Tritace, Prilace, Ramace, )
- 10mg.30 TABLETS (Tritace) - 10mg.30 caps (The rest) - 1.25mg, 2.5mg, 5mg caps (Tryzan) - Tritace titration pack - 2.5/2.5, 5/5 CR TABS with felodipine (Triasyn) 1.25mg-10mg d (Max 1.25mg in RI, with diuretic, elderly) Also used for proteinuria up to 5mg d. |
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Trandolapril
- dose forms, brands - dose |
- 0.5, 1, 2, 4mg CAPS (Gopten, Dolapril, Odrik, Tranalpha)
0.5-4mg d (0.5 is max for RI, diuretics, the elderly, HI) |
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Which ACEI used for proteinuria?
Which for reduction of CV risk? Which for LV dysfunction? Which for diabetic nephropathy? |
Ramipril
Perindopril Enalapril Captopril |
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Which ACEs have a daily dose of
(a) up to 40mg d, with 20mg d for HF (b) of the above, which doesn't have a minimum dose of 2.5 (c) which ACEIs have a maximum daily dose of 10mg, and of these which has a 5mg max for HF? (d) which leaves which ACEIs with unusual dosing? |
(a) FLEQ: Qunialapril, Enalapril, Fosinopril, Lisinopril
(b) Fosinopril - comes in 10,20mg tabs, while the rest are 5,10,20mg (c) perindopril, ramipril - max 5mg for perindopril in HF (d) captopril and trandolapril |
