ACE Inhibitors | ARBs

Angiotensin converting enzyme inhibitors (ACE inhibitors)

The mechanism of action is to block the ACE enzyme and thereby inhibit the formation of the Angiotensin 2, which is responsible for the above action.
Examples:

  • Benazepril
  • Captopril
  • Enalapril
  • Fosinopril

  • Lisinopril

  • Moexipril

  • Perindopril

  • Quinapril

  • Ramipril

  • Trandopril

Uses:

  • For high blood pressure (Hypertension)
  • Heart failure
    • ACE inhibitors are critical in the treatment of heart failure. They decrease the vasoconstriction, prevent the water absorption, and inhibit the aldosterone secretion, which decrease the workload of heart.
  • Heart attack
    • When given shortly after a heart attack, some ACE inhibitors can prevent some of the damage to the heart and improve the survival rate of heart attack patients.
  • Diabetes
    • Some ACE inhibitors have been found to slow the process that leads to kidney damage in many type 2 diabetics.
  • Heart disease prevention


Side effects:

  • Cough
    • If this symptom persists or is severe, contact your doctor. Ask your doctor what type of cough medicine you may use to control the cough.
  • Red, itchy skin rash
  • Dizziness, lightheadedness, or faintness upon rising
  • Salty or metallic taste or a decreased ability to taste
  • Sore throat, fever, mouth sores, unusual bruising, fast or irregular heartbeat, chest pain, swelling of feet, ankles, lower legs
  • Swelling of your neck, face, and tongue
  • High potassium levels (can be major concern for diabetics, renal impairment, and patient on potassium spring diuretics)
    • This is a potentially life-threatening complication. Therefore, people on ACE inhibitors should regularly have blood tests to measure potassium levels. Signs of too much potassium in the body include
      • Confusion
      • Irregular heartbeat
      • Nervousness
      • numbness or tingling in hands, feet or lips
      • shortness of breath or difficulty breathing
      • Weakness or heaviness in legs


Contact your doctor right away, if you have any of these symptoms.

  • Severe vomiting or diarrhea
  • Angioedema
  • Orthostatic hypotension


Angiotensin 2 receptors blockers

Mechanism of action:
Angiotensin II receptor blockers inhibit a substance that causes blood vessels to narrow (constrict). As a result, blood vessels relax and widen (dilate), making it easier for blood to flow through the vessels, which reduces blood pressure. These medicines also increase the release of water and salt (sodium) to the urine, which in turn lowers blood pressure as well.
Preventing the blood vessels from constricting helps improve blood flow, which reduces the backup of blood in the heart and lungs. It also decreases the pressure that the left ventricle of the heart must pump against.
Angiotensin II receptor blockers also act directly on the hormones that regulate sodium and water balance.
Examples:
  • Candesartan
  • Eposartan
  • Irbesartan
  • Isosartan
  • olmesartan
  • Telmisartan
  • Valsartan


Uses:

  • Coronary heart disease
  • Heart failure
  • Diabetes Mellitus 2
  • An Angiotensin II receptor blocker may be used instead of an Angiotensin-converting enzyme (ACE) inhibitor if you are not able to tolerate certain side effects of an ACE inhibitor. ACE inhibitors can cause an annoying cough. This cough may be hard for some people to live with. Therefore, doctors may prescribe an ARB instead, because ARBs are less likely to cause a cough.


Side effects:

  • Low blood pressure
  • Lightheadedness and dizziness
  • Make kidney function worse and raise potassium levels
  • ARBs may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, potassium supplements, certain diuretics, and lithium.

Nursing consideration: (for both Angiotensin converting enzyme inhibitors (ACE inhibitors) and Angiotensin 2 receptors blockers)

  • Assess blood pressure and WBC before giving the first dose and monitor blood pressure for 2 hrs after the first dose and regular thereafter
  • Administer PO 1 hour before meals
  • Report change in WBC, hyperkalemia, BUN, or creatinine
  • Do not administer to clients with renal stenosis