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Angiotensin-converting
enzyme inhibitors (ACE inhibitors): are indicated for heart failure, diabetes, recurrent
stroke prevention, postmyocardial infarction, people at high risk for coronary
disease,and chronic kidney disease. benazepril
(Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril),
lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril),
ramipril (Altace), and trandolapril (Mavik). KNOW: ACE inhibitors have been shown to decrease morbidity and mortality in patients with heart failure and are first line treatment for heart failure. Additionally, ACE inhibitors are indicated for diabetics type 1 with nephropathy, patients with proteinuria greater than 1 gram per 24 hours, and patients with renal insufficiency. These drugs should be used cautiously in patients with a creatinine greater than or equal to 3 mg/dl and/or patients with renovascular disease. KNOW:
ACE inhibitors are contraindicated in pregnancy.
ACE
inhibitors are associated with a cough in some patients that resolves when the
drug is discontinued. Hyperkalemia
can occur in patients taking an ACE inhibitor especially if the patient is also
taking a potassium-sparing diuretic or a potent NSAID.
Angioedema, neutropenia, and rashes are rare side effects of ACE
inhibitors. Patients with a history
of angioedema should avoid ACE inhibitors. -ACE
inhibitors should be used with caution in patients with renovascular disease
such as bilateral renal artery stenosis, and in patients with one kidney and
unilateral renal artery stenosis since they may produce or worsen renal
insufficiency. -Captopril
has the shortest half-life of the ACE inhibitors. -Enalapril
has an IV form called enalaprilat which is the only ACE inhibitor that can be
given IV. Angiotensin
II receptor blockers (ARB): candesartan (Atacand),
losartan (Cozaar), irbesartan (Avapro), and
valsartan (Diovan). These drugs are alternative agents to treat heart
failure in patients who develop a cough while taking ACE inhibitors.
Other indications for ARB are diabetes and chronic kidney disease.
KNOW: angiotensin II receptor blockers are contraindicated in pregnancy. In general, angiotension II receptor blockers have the same contraindication and precautions as ACE inhibitors.
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