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condition
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Angioedema is a condition that can occur as a side effect of taking ACE inhibitors.
condition
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Hypertension is a condition that can be managed with medications such as ACE inhibitors.
concept
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The renal overview covers how the kidneys regulate blood pressure and fluid balance, which are directly impacted by the action of ACE inhibitors.
condition
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Diabetic nephropathy is a complication of diabetes that can lead to kidney damage, requiring management to prevent further deterioration of kidney function.

ACE Inhibitors

pharmacology cardiac renal hypertension
ACE inhibitors are medications that block the conversion of angiotensin I to angiotensin II, leading to vasodilation, reduced blood volume, and lower blood pressure. Commonly used for hypertension, heart failure, and diabetic nephropathy, they also reduce post-MI mortality. Side effects include dry cough, hyperkalemia, and angioedema. They are contraindicated in pregnancy and patients with renal artery stenosis.
Context: Renal Overview

In the renal context, ACE inhibitors play a key role in controlling intraglomerular pressure. By blocking angiotensin II formation, they reduce efferent arteriole constriction and help preserve filtration surface integrity. However, in patients with existing renal artery stenosis, ACE inhibitors can further reduce GFR — requiring cautious monitoring of serum creatinine and potassium levels.

Mechanism of Action

Angiotensin-Converting Enzyme (ACE) inhibitors block the enzyme responsible for converting angiotensin I to angiotensin II, a powerful vasoconstrictor. By reducing angiotensin II levels, these drugs promote vasodilation, decrease sodium and water retention, and lower systemic vascular resistance. This action also decreases aldosterone secretion, which in turn reduces blood volume and preload.

Common Medications

  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Lisinopril (Prinivil, Zestril)
  • Ramipril (Altace)

Clinical Indications

  • Hypertension (first-line therapy for many patients)
  • Heart failure management (reduces afterload and improves survival)
  • Post-myocardial infarction (prevents ventricular remodeling)
  • Diabetic nephropathy (slows progression of kidney damage)

Adverse Effects

  • Dry cough – due to increased bradykinin levels.
  • Hyperkalemia – reduced aldosterone increases potassium retention.
  • Hypotension – especially after the first dose; monitor blood pressure closely.
  • Angioedema – rare but potentially life-threatening; more common in Black patients.
  • Renal impairment – avoid in bilateral renal artery stenosis.

Contraindications

  • Pregnancy (teratogenic, especially in 2nd and 3rd trimesters)
  • History of angioedema related to prior ACE inhibitor use
  • Severe renal impairment or bilateral renal artery stenosis

Nursing Considerations

  • Monitor blood pressure and renal function (BUN, creatinine) regularly.
  • Assess potassium levels to detect early hyperkalemia.
  • Instruct patient to avoid salt substitutes containing potassium.
  • Advise taking medication at the same time daily, with or without food.
  • Teach to report persistent cough or facial swelling immediately.
  • Warn about potential first-dose hypotension — especially when combined with diuretics.

Key NCLEX Concept Integration

  • ACE inhibitors belong to the pharmacology and cardiac content areas but are also integral to renal pathophysiology through the RAAS mechanism.
  • They connect to hyperkalemia (adverse effect), RAAS pathway (mechanism), and heart failure (therapeutic context).
  • Patients in heart failure or hypertension scenarios are common NCLEX case subjects for ACE inhibitor application and patient safety teaching.
Context from Referenced By
Renal Overview

In the renal context, ACE inhibitors play a key role in controlling intraglomerular pressure. By blocking angiotensin II formation, they reduce efferent arteriole constriction and help preserve filtration surface integrity. However, in patients with existing renal artery stenosis, ACE inhibitors can further reduce GFR — requiring cautious monitoring of serum creatinine and potassium levels.

Hypertension Overview

From a hypertension standpoint, ACE inhibitors lower systemic vascular resistance by preventing angiotensin II–mediated vasoconstriction. They are often prescribed early in therapy, particularly for younger, non-Black patients or those with comorbid heart failure or diabetes. Emphasize patient adherence, monitoring of orthostatic changes, and the importance of avoiding potassium-rich salt substitutes.

Diabetic Nephropathy

In diabetic nephropathy, ACE inhibitors are essential in slowing disease progression. They reduce glomerular capillary hypertension and proteinuria by relaxing efferent arterioles. Regular monitoring of kidney function and microalbumin levels is essential. Educate patients about consistent medication use and reporting signs of dizziness, weakness, or swelling.

Context from Related Topics
Pop Quiz
Topic: ace_inhibitors
Level:
True or False:

ACE inhibitors are contraindicated in patients with bilateral renal artery stenosis.

Topic: ace_inhibitors
Level:
True or False:

ACE inhibitors are contraindicated in patients with bilateral renal artery stenosis.

Topic: ace_inhibitors
Level:
True or False:

ACE inhibitors are contraindicated in patients with bilateral renal artery stenosis.

Next Topic
contraindicated_in
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Pregnancy
ACE inhibitors are contraindicated during pregnancy due to the risk of fetal toxicity and adverse effects on fetal development.
inhibits
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Raas Pathway
The RAAS pathway is a hormone system that regulates blood pressure and fluid balance. ACE inhibitors block the conversion of angiotensin I to angiotensin II, a key step in the RAAS pathway, leading to vasodilation and reduced blood pressure.
contraindicated_in
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Pregnancy Contraindications
ACE inhibitors are contraindicated during pregnancy due to the risk of fetal harm, including renal damage and developmental issues.
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Heart Failure
ACE inhibitors are commonly used to treat heart failure due to their ability to decrease the workload on the heart by reducing blood pressure and volume.
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Hyperkalemia
ACE inhibitors can increase potassium levels in the blood, which may lead to hyperkalemia.
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Angioedema
Angioedema is a known side effect of ACE inhibitors, which can occur as a result of their pharmacological action.