Hesi Guide - Pharmacology

6) ACE inhibitors-(-pril ending, such as lisinopril) o Blocks conversion of angiotensin 1 to angiotensin 2 and as a result, aldosterone is not released. § Lower aldosterone means more sodium will be excreted and potassium will be retained § There is no vasoconstriction from angiotensin 2 either. o First line drug for pts with (compensated) heart failure – ACE inhibitors prevent remodeling of the heart (the enlarged heart with decreased contractility). Breaks the RAA system. o If you use an ACE inhibitor with a potassium-sparing diuretic, this increases risk for hyperkalemia (aldosterone is blocked) o S/E: Bradykinin may accumulate in the lung, creating a dry, nagging cough – pt may need to be changed to another ACE inhibitor. Life-threatening adverse reaction of angioedema (watch for swelling to the tongue or the face). • If they develop angioedema, they should not be placed on another ACE inhibitor, but can be put on an AngiotensinReceptor Blocker (ARB). • Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II from binding to its receptors. o ARBs are more expensive, not considered to be a first-line drug o ACE inhibitors do not affect heart rate – decreases water retention and vasodilates, but does not affect heart rate