ACE INHIBITORS | MEDICINES | MECHANISM OF ACTION, PHARMACOLOGICAL CLASSIFICATION, USES, SIDE EFFECTS
Channel: PHARMAROCKS THE WAY OF SUCCESS
Date: 21/11/2020

ACE INHIBITORS 

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS are the class of medication which help by relax our veins and arteries to lower our blood pressure.
ACE inhibitors prevent an enzyme in our body from producing angiotensin II, 
Angiotensin II narrows our blood vessels. 
This narrowing can cause high blood pressure & force our heart to work harder

ACE INHIBITORS LIST (RX ONLY)
Enalapril 
Ramipril 
Quinapril 
Perindopril 
Lisinopril 
Benazepril 
Imidapril
Trandolapril 
Cilazapril
Alacepril
Captopril
Zefnopril
Fosinopril

ACE INHIBITORS MECHANISM
ACE inhibitors produce vasodilation by inhibiting the formation of angiotensin II. 
This vasoconstrictor is formed by the proteolytic action of renin (released by the kidneys) acting on circulating angiotensinogen to form angiotensin I. 
Angiotensin I is then converted to angiotensin II by angiotensin converting enzyme.

This group of drugs inhibits the enzyme kininase II or ACE. 
So, these drugs decrease the activity of RAAS (Renin–angiotensin–aldosterone system) and also potentiate the vasodilatory action of bradykinin. 
Because these are preventing the conversion of angiotensin I to angiotensin II

HOW ANGIOTENSIN II INCREASE BP?
Angiotensin II, binds to many receptors in the body to affect several systems. 
It can increase blood pressure by constricting or by narrowing the blood vessels of our body. 
It can also trigger thirst or the desire for salt. 
Angiotensin is responsible for the release of the pituitary gland's anti-diuretic hormone

PHARMACOLOGICAL CLASSIFICATION 
Sulfhydryl-containing agents
Alacepril
Captopril
Zefnopril
These agents appear to show antioxidative properties but may be involved in adverse events such as skin eruptions.

Dicarboxylate-containing agents
Enalapril 
Ramipril 
Quinapril 
Perindopril 
Lisinopril 
Benazepril 
Imidapril
Trandolapril 
Cilazapril

Phosphonate-containing agents
Fosinopril (Fositen/Monopril) 
It is the only member of this group

Naturally occurring
A comprehensive resource on anti-hypertensive peptides is available in form of a database. 
It contains around 1700 unique antihypertensive peptides
Arfalasin (HOE 409) is angiotensin antagonist.

ACE INHIBITORS DOSES

ACE INHIBITORS USES & INDICATIONS
ACEI are used for the treatment of 
Hypertension (High blood pressure)
CHF (Congestive heart failure)
Evolving MI (Myocardial infarction)
Diabetic nephropathy
Diabetic retinopathy
Non-diabetic renal disease
Scleroderma crisis.

ACE INHIBITORS CONTRAINDICATIONS
Pregnancy
Teratogenic in second half of pregnancy
Breastfeeding 
Previous angioedema associated with ACE inhibitor therapy.
Bilateral renal artery stenosis.
Hypersensitivity to ACE inhibitors.
When serum creatinine is more than 3.5 mg/dl ACEI do not recommended

ACE INHIBITORS SIDE EFFECTS
Most frequent adverse effect associated with these agents is dry cough
Increased potassium levels in the blood (hyperkalemia)
Fatigue.
Angioedema 
Dizziness
Headaches.
Loss of taste.

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