ACE inhibitors: adverse effects and teaching
8 questions on this concept, from 4 angles.
The idea in full
An angiotensin-converting enzyme inhibitor lowers blood pressure and unloads a failing heart by blocking the formation of angiotensin II, and the same mechanism, together with the bradykinin it lets accumulate, produces a predictable set of effects the nurse anticipates and teaches before the first tablet is taken — a dry persistent cough that is a nuisance rather than a danger and is managed by reporting it and switching class rather than by stopping the drug unannounced; a fall in pressure on the first dose and on standing that is sharpest in the patient who is volume-depleted or already taking a diuretic, so the first dose is given with the patient's volume status and other pressure-lowering drugs in view and the patient taught to rise slowly; a rise in potassium and a rise in creatinine that are expected in small measure, watched by drawing both before the drug starts and again early in treatment, and kept in check by leaving potassium supplements, potassium-containing salt substitutes, potassium-sparing diuretics and non-steroidal anti-inflammatories out unless they are deliberately prescribed alongside; and angioedema of the lips, tongue, face or airway, which is rare, can arrive at any point in treatment, and is an emergency that ends the drug and its whole class permanently — while the drug is never given in pregnancy because it harms the fetus, so a patient who could become pregnant is taught to use contraception and to report a pregnancy at once.
Beliefs this concept corrects
- 1A dry cough that starts on this drug is a cold or a chest infection until proven otherwise
- 2The cough means the patient is allergic to the drug, so the whole class and its cousins must be avoided
- 3A patient who cannot bear the cough should just stop the tablet and mention it at the next visit
- 4Swelling of the lips is a food or latex allergy, because the patient has taken this drug for months without trouble
- 5Angioedema only happens with the first few doses
- 6Dizziness on standing after the first dose is dehydration, so the patient needs to drink more
- 7A salt substitute is the healthy choice for a patient told to cut down on salt
- 8A potassium-rich diet is good for the heart, so the more the better while on this drug
- 9Any rise in creatinine after starting means the drug is damaging the kidneys and must be stopped
- 10An over-the-counter anti-inflammatory for a sore joint has nothing to do with the blood-pressure tablet
- 11A blood-pressure tablet is safe in pregnancy because blood pressure matters most in pregnancy
- 12The first dose is the same as any other dose
Your record
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