Page 34 - RxExam's Naplex Theory Review Part-1

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M/A: Ace Inhibitors (Angiotensin Converting Enzymes) inhibit the enzymatic conversion of Angiotensin I to
Angiotensin II. Angiotensin II is a powerful vasoconstrictor. It also stimulates aldosterone secretion.
Aldosterone leads to sodium and water retentions, which result in an increase in cardiac workload. Ace
Inhibitors, by producing vasodilation and inhibiting aldosterone secretion, help controlling hypertension.

Dose Special Notes

Enalapril 10-40 mg per 1). Enalapril (Vasotec) is indicated for the treatment of hypertension,
(Tablet) day given in a heart failure and asymptomatic left ventricular dysfunction.
(Injection - single dose or
Enalaprilat) two divided 2). Only Enalapril, Lisinopril and Benazepril are useful for treating
doses. hypertension in pediatric patients.

3). Excessive hypotension may be reported when an ACE inhibitor is
given with a diuretic. It is recommended to withdraw diuretic therapy 2
to 3 days before initiating therapy with ace inhibitors. Patients should
also increase the salt intake to minimize the hypotension.

4). A reversible renal failure has been reported when ACE inhibitors are
used in sodium and volume depleted patients.

Lisinopril 20-40 mg PO 1). Lisinopril (Prinivil) is indicated for the treatment of hypertension,
(Tablet) QD. heart failure and acute myocardial infarction.

2). Except Captopril and Lisinopril, all ace inhibitors are prodrugs and
need to be converted to their active metabolites before they produce
any pharmacological effects.

Quinapril 20-80 mg per 1). Quinapril (Accupril) is indicated for the treatment of hypertension,
(Tablet) day given as a heart failure and angioedema in Black patients.
single dose or in
two equally 2). Pharmacokinetic data indicate that quinapril elimination is dependent
divided doses. on level of renal function. In patients with heart failure and renal
impairment, quinapril dose should be reduced.

Captopril 25-50 mg PO 1). Captopril (Capoten) is indicated for the treatment of hypertension,
(Tablet) B.I.D. or T.I.D. heart failure, left ventricular dysfunction after myocardial infarction and
Should be taken diabetic nephropathy.
one hour before
meals. 2). Neutropenia (< 1000/mm³) with myeloid hypoplasia has resulted
from use of captopril. About half of the neutropenic patients developed
systemic or oral cavity infections or other features of the syndrome of
agranulocytosis.
Since discontinuation of captopril and other drugs has generally led
to prompt return of the white count to normal, upon confirmation of
neutropenia (neutrophil count < 1000/mm³) the physician should
withdraw captopril and closely follow the patient's course.

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