Angiotensin Converting Enzyme Inhibitors (ACE-I)
Definition <ul><li>1-Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) are a homogenous group of drugs...
 
Mechanism of action <ul><li>1-Inhibition of angiotensin converting enzyme,  </li></ul><ul><li>Thus reduce the stimulation ...
Pharmacological actions <ul><li>1-Arterial and venous dilatation.  </li></ul><ul><li>2- Depress sympathetic activity (no r...
Clinical uses <ul><li>1-Treatment of hypertension. </li></ul><ul><li>2-Treatment of heart failure. </li></ul><ul><li>3-Sec...
Side effect <ul><li>1- Hypotension:   First dose,NA depleted patient  </li></ul><ul><li>2- Dry cough:   increase Bradykini...
Drug interactions: <ul><li>1-  NSAID :  Decrease the vasodilator effect. </li></ul><ul><li>2- Potassium-sparing diuretics,...
Contraindications <ul><li>1-Low blood pressure. </li></ul><ul><li>2-History of allergy </li></ul><ul><li>3-Bilateral renal...
Examples: Cibacen benzapril Tritace ramipril Coversyl perindopril Zestril lisinopril Monopril fosinopril Ezapril enalapril...
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Angiotensin Converting Enzyme Inhibitors

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Angiotensin Converting Enzyme Inhibitors

  1. 1. Angiotensin Converting Enzyme Inhibitors (ACE-I)
  2. 2. Definition <ul><li>1-Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) are a homogenous group of drugs that inhibit ACE enzyme. </li></ul><ul><li>2-Often used as first-line agents for CHF and hypertension </li></ul><ul><li>3-First found in snake venom. </li></ul>
  3. 4. Mechanism of action <ul><li>1-Inhibition of angiotensin converting enzyme, </li></ul><ul><li>Thus reduce the stimulation of AT1 receptor, And also cause elevation of Bradykinin level </li></ul><ul><li>2-lead to Reduction in arteriolar constriction, reduce aldosterone secretion and enhance kinin-induced peripheral vasodilatation </li></ul>
  4. 5. Pharmacological actions <ul><li>1-Arterial and venous dilatation. </li></ul><ul><li>2- Depress sympathetic activity (no reflex tachycardia). </li></ul><ul><li>3-Dcrease blood volume ( natriuretic and diuretic effects). </li></ul><ul><li>4- Inhibit cardiac and vascular hypertrophy. </li></ul><ul><li>5-No significant increase in cardiac output. </li></ul>
  5. 6. Clinical uses <ul><li>1-Treatment of hypertension. </li></ul><ul><li>2-Treatment of heart failure. </li></ul><ul><li>3-Secondry prevention after myocardial infarction. </li></ul><ul><li>4-Diabetic nephropathy in insulin-dependent diabetes mellitus. </li></ul>
  6. 7. Side effect <ul><li>1- Hypotension: First dose,NA depleted patient </li></ul><ul><li>2- Dry cough: increase Bradykinin </li></ul><ul><li>3- Hyperkalamia: decrease aldosterone </li></ul><ul><li>4- Protinurea . </li></ul><ul><li>5 - Hypersensitivity :(Angioedema) </li></ul><ul><li>6- Teratogenic effects . </li></ul><ul><li>7- Neutropenia,rash : not related to ACE inhibition </li></ul>
  7. 8. Drug interactions: <ul><li>1- NSAID : Decrease the vasodilator effect. </li></ul><ul><li>2- Potassium-sparing diuretics, potassium supplement : Exacerbate the hyperkalamia. </li></ul><ul><li>3- Digoxin and lithium : ACE-I increase their plasma level. </li></ul><ul><li>4- diuretics : Increase sensitivity to the vasodilator effect of ACE-I </li></ul>
  8. 9. Contraindications <ul><li>1-Low blood pressure. </li></ul><ul><li>2-History of allergy </li></ul><ul><li>3-Bilateral renal artery stenosis. </li></ul><ul><li>4-Pregnancy. </li></ul><ul><li>5-Hyperkalemia. </li></ul><ul><li>6-Renal insufficiency. </li></ul><ul><li>7-Severe stenosis of aortic or mitral valve. </li></ul><ul><li>8-Serum creatinine above 3mg/dl </li></ul>
  9. 10. Examples: Cibacen benzapril Tritace ramipril Coversyl perindopril Zestril lisinopril Monopril fosinopril Ezapril enalapril (without diuretic) Capoten captopril Brand Name Generic Name
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