ACE inhibitors/angiotensin

Many different drug classes have shown to cause hypotension and orthostatic reactions and drugs for cardiovascular conditions, psychoactive medicines and polypharmacy, can all have this side effect (Box 5.15). Among the most frequently used drugs in the elderly are diuretics, ACE-inhibitors, angiotensin II antagonists, calcium channel blockers and antidepressants. 

Drugs that may affect epierenone include ACE inhibitors, angiotensin II antagonists, CYP3A4 inhibitors, NSAIDs, and St. John s wort. Drugs that may be affected by epierenone include lithium. 

The six main drug classes used, worldwide, for blood pressure lowering treatment are diuretics, jS-blockers, calcium channel blockers (CCB), ACE inhibitors, angiotensin II (All) receptor blockers and a-adrenergic blockers. In some parts of the world, reserpine and methyldopa are also frequently used. 

Paradoxically, these agents—not positive inotropic drugs—are the first-line therapies for chronic heart failure. The drugs most commonly used are diuretics, ACE inhibitors, angiotensin receptor antagonists, aldosterone antagonists, and blockers (Table 13-1). In acute failure,... 

ANTI HYPERTENSIVE VASODILATORS, ACE INHIBITORS, ANGIOTENSIN II RECEPTOR BLOCKERS, AND CALCIUM CHANNEL BLOCKERS ... 

ACE inhibitor angiotensin-converting enzyme inhibitor used for hypertension and congestive heart failure. 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS NS AIDs 1. t risk of renal impairment with NSAIDs and ACE inhibitors 2. t risk of hyperkalaemia with ketorolac 1. Additive effect 2. Ketorolac causes hyperkalaemia, and ACE inhibitors can 1 renal function 1. Monitor renal function and BP closely. Benefits often outweigh risks for short-term NSAID use 2. Ketorolac is only licensed for short-term control of perioperative pain. Monitor serum potassium daily... 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS CICLOSPORIN t risk of hyperkalaemia and renal failure Cidosporin causes a dose-dependent T in serum creatinine, urea and potassium, especially in renal dysfunction Monitor renal function and serum potassium weekly until stable, then at least every 3-6 months... 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS ANTICOAGULANTS -PARENTERAL T risk of hyperkalaemia with heparins Heparin inhibits aldosterone secretion, causing hyperkalaemia Monitor potassium levels closely... 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS ASPIRIN t risk of renal impairment. 1 efficacy of captopril and enalapril with high-dose (>100mg/day) aspirin Aspirin and NSAIDs can cause elevation of BP. Prostaglandin inhibition leads to sodium and water retention and poor renal function in those with impaired renal blood flow Monitor renal function every 3-6 months watch for poor response to ACE inhibitors when >100mg/day aspirin is given... 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS, CENTRALLY ACTING ANTIHYPERTENSIVES, VASODILATOR ANTIHYPERTENSIVES BETA-BLOCKERS t hypotensive effect Additive hypotensive effect may be used therapeutically Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (light-headedness, dizziness on standing, etc.)... 

ACE INHIBITORS EPOETIN 1 haematopoietic effects of epoetin. 1 efficacy of ACE inhibitors Angiotensin II is believed to be responsible for sustaining secretion of eiythropoietin and for stimulating the bone marrow to produce erythrocytes. Epoetin has direct contractile effects on vessels (causing t BP) Watch for poor response to eiythropoietin and to ACE inhibitors. These effects may be delayed so monitor for the duration of co-administration... 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS POTASSIUM t risk of hyperkalaemia Retention of potassium by ACE inhibitors and additional intake of potassium Monitor serum potassium daily... 

PROGESTOGENS 1. ANALGESICS -NSAIDs 2. ANTI HYPERTENSIVES AND HEART FAILURE DRUGS - ACE inhibitors, angiotensin II receptor antagonists 3. DIURETICS — potassium-sparing t risk of hyperkalaemia Drospirenone (component of the Yasmin brand of combined contraceptive pill) is a progestogen derived from spironolactone that can cause potassium retention Monitor serum potassium weekly until stable and then every 6 months... 

Other vasodilators are suited preferentially to hypertension (ACE inhibitors, angiotensin AT, receptor antagonists and r./.-adrenoceptor blockers) or to angina (nitrates),... 

ACE-inhibitors/angiotensin-receptor antagonists Calcineurin inhibitors... 

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