Lippincotts Drugs to Know for the NCLEX

Angiotensin-converting enzyme inhibitors
benazepril hydrochloride
captopril
enalapril maleate
fosinopril sodium
lisinopril
quinapril hydrochloride
ramipril
trandolapril
INDICATIONS
Hypertension, heart failure, left ventricular dysfunction, MI (ramipril, lisinopril), and diabetic
nephropathy (captopril)
ACTION
ACE inhibitors prevent conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.
Besides decreasing vasoconstriction and thus reducing peripheral arterial resistance, inhibiting
angiotensin II decreases adrenocortical secretion of aldosterone. This reduces sodium and water
retention and extracellular fluid volume.
ACE inhibition also causes increased levels of bradykinin, which results in vasodilation. This
decreases heart rate and systemic vascular resistance.
ADVERSE REACTIONS
The most common adverse effects of therapeutic doses are angioedema of the face and limbs, dry
cough, dysgeusia, fatigue, headache, hyper-kalemia, hypotension, proteinuria, rash, and tachycardia.
Severe hypotension may occur at toxic drug levels.
CONTRAINDICATIONS AND CAUTIONS
Contraindicated in patients hypersensitive to these drugs.
Use cautiously in patients with impaired renal function or serious autoimmune disease and in those
taking other drugs known to decrease WBC count or immune response.
Women of childbearing potential taking ACE inhibitors should report pregnancy immediately to
prescriber. High risks of fetal morbidity and mortality are linked to ACE inhibitors, especially in the
second and third trimesters. Some ACE inhibitors appear in breast milk. To avoid adverse effects in
infants, instruct patient to stop breast-feeding during therapy. In children, safety and effectiveness
haven’t been established; give drug only if potential benefits outweigh risks. Elderly patients may
need lower doses because of impaired drug clearance.