this is a presentation about ace inhibitor, Introduction,therapeutic use ,mechanism of action ,Adverse effect,Drug Drug interaction,case study

1. ACE INHIBITOR
Angiotensin Converting Enzyme Inhibitor

2. Introduction
Anti hypertensive drug
Captropil:first orally-active ACE inhibitor, in
1975
Some ACE inhibitors available in
Bangladesh:
 Captopril (Cardopril®- Beximco
pharmaceutical Ltd.)
Enalapril Maleate (Anapril®- Eskayef
pharmaceutical Ltd.)
Lisinopril (Neopril®- Beximco
pharmaceutical Ltd.)
Classification
Sulfhydryl-
containing
ACE
inhibitor.
Ex: Captopril
Phosphorus-
containing
ACE inhibitor.
Ex: Fosinolpril
Dicarboxylic-
containing
ACE
inhibitors.
Ex: Enalapril

3. Therapeutic
Uses
Hypertension
Heart Failure
Diabetic nephropathy
Albuminuria

4. Liver Kidney
Angiotensinogen
Angiotensin I
Angiotensin II
Aldosterone
Increased
sympathetic
drive
Normal artery Vasoconstriction
ACE
Renin
Bradykinin
Inactive metabolites
Mechanism of Action

5. Adverse Effects
Hypotension
HyperkalemiaAngioedema
Dry CoughRenal
Insufficiency

6. Drug Drug Interaction
Antacid decreases
the bioavailability
of ACE Inhibitors
Rifampicin
decreases plasma
ACE
concentration
Potassium
supplement can to
be taken with
ACE Inhibitor

7. Case Study
◦ L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension,migraine
headaches.The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild
polyuria and polydipsia.Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid
addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.
◦ Hypertension was diagnosed 5 years ago.L.N. was initially treated with lisinopril, starting at 10 mg daily
and increasing to 20 mg daily, yet her BP control has fluctuated.One year ago, microalbuminuria was
detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample.
L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals
an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.(Benjamin, 2004)

8. Problems:
Diabetes type 2
Hypertension
Migraine headaches
Micro albuminuria
(diabetic nephropathy)
Current Medications:
Sulfonyluria
Metformin
Lisopril 20mg daily
Treatment Strategy
Hypertension
(BP 154/86mmHg)
Lifestyle management
Increase dose of
ACE inhibitor
Add third agent
Add second agent
Micro albuminuria
Migraine Headache Beta Blockers
Combination of
ARBs and ACE
Inhibitors

9. References:
Benjamin, E. M. (2004). Case Study: Treating Hypertension in Patients With Diabetes. Clinical Diabetes, 22(3), 137–138.
https://doi.org/10.2337/diaclin.22.3.137
CV Pharmacology | Angiotensin Converting Enzyme (ACE) Inhibitors. (n.d.).
Durante, A., Peretto, G., Laricchia, A., Ancona, F., Spartera, M., Mangieri, A., & Cianflone, D. (2012). Role of the Renin-Angiotensin-
Aldosterone System in the Pathogenesis of Atherosclerosis. Current Pharmaceutical Design, 18(7), 981–1004.
https://doi.org/10.2174/138161212799436467
Peng, H., Carretero, O. A., Vuljaj, N., Liao, T. D., Motivala, A., Peterson, E. L., & Rhaleb, N. E. (2005). Angiotensin-converting
enzyme inhibitors: A new mechanism of action.
Circulation, 112(16), 2436–2445. https://doi.org/10.1161/CIRCULATIONAHA.104.528695
Shionoiri, H. (1993). Pharmacokinetic Drug Interactions with ACE Inhibitors. In Clinical Pharmacokinetics (Vol. 25, Issue
1, pp. 20–58). Springer. https://doi.org/10.2165/00003088-199325010-00003
Thomas, G., & Tomlinson, B. (2008). Prevention of Macrovascular Disease in Type 2 Diabetic Patients: Blockade of the Renin-Angiotensin-
Aldosterone System. Current Diabetes Reviews, 4(1), 63–78. https://doi.org/10.2174/157339908783502334

11. Thank you