DR Medhat MRCP

Angiotensin converting enzyme inhibitors (ACE - - ) :
Mechanism of action : - - conversion of angiotensin I to angiotensin II
Uses :
1) 1 st line of TTT of HTN in young age < 55 years old.
2) 1 st line of TTT of heart failure (before BB).
3) 2ndry prevention of MI.
4) TTT of proteinuria in nephrotic syndrome (e.g diabetic nephropathy).
Side effects :
1) Dry cough :
o In 15% of patients , may occur after up to 1 year after starting TTT.
سؤال o Due to bradykinin levels
2) Angioedema : may occur up to a year after starting TTT.
3) Hyperkalemia.
4) 1 st dose hypotension in patients taking diuretics (> 80 mg furosemide/day).
Cautions & contraindications :
Pregnancy : avoid.
Renovascular disease : significant renal impairment in undiagnosed RAS.
Aortic stenosis : may result in hypotension.
Monitoring :
SUE should be checked before TTT and after dose :
o Accepted in s. creatinine after staring ACE - - is up to 50% of base line
or up to 265 µmol/L (whichever is smaller).
o Accepted in serum K is up to 5.5 mmol/L.
Lipid lowering agents :
VD.
Drugs
Statins (HMG-co A reductase - - ).
Fibrates
Nicotinic acid
Ezetimibe
Anion exchange resin
Side effects
Myositis , deranged LFTs
Myositis , cholestaisis , pruritis
Myositis,flushing,impaired glucose tolerance
Headache
GI side effects.
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