دانلود کتاب یادداشت های پس پزشکی 2023

Angiotensin-converting enzyme (ACE) inhibitors are now the established first-line treatment in younger patients with hypertension and are also extensively used to treat heart failure. They are known to be less effective in treating hypertensive Afro-Caribbean patients. ACE inhibitors are also used to treat diabetic nephropathy and have a role in the secondary prevention of ischaemic heart disease. Mechanism of action:
• inhibit the conversion angiotensin I to angiotensin II
• ACE inhibitors are activated by phase 1 metabolism in the liver

Side-effects:
• cough
o occurs in around 15% of patients and may occur up to a year after starting treatment
o thought to be due to increased bradykinin levels
• angioedema: may occur up to a year after starting treatment
• hyperkalaemia
• first-dose hypotension: more common in patients taking diuretics

Cautions and contraindications
• pregnancy and breastfeeding – avoid
• renovascular disease – may result in renal impairment
• aortic stenosis – may result in hypotension
• hereditary of idiopathic angioedema
• specialist advice should be sought before starting ACE inhibitors in patients with a potassium >= 5.0 mmol/L