Matters of the Heart – ACE Inhibitors
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Alrighty guys, now we are going to tackle ACE Inhibitors. I don’t know why, but I always think of that ACE hardware commercial jingle with I hear ACE Inhibitors, do you know the one I mean? “Ace is the place with the helpful hardware folks”.
Hopefully, that little Jingle can hope you guys remember some of the information in this post. Let’s get to it!
What are ACE Inhibitors?
ACE Inhibitors are Angiotensin-Converting Enzyme Inhibitors, a classification of medications that are primarily used to treat hypertension, though they also can be used in the treatment of heart failure.
How do ACE Inhibitors work?
ACE Inhibitors work by disrupting the formation of the hormone Angiotensin II, which acts as a vasoconstrictor. ACE Inhibitors also blockers the hormone Aldosterone from being released as freely into the bloodstream. Aldosterone encourages water and sodium absorption, which increases fluid in the vascular network, and can lead to increased blood pressure. If you need a quick review of these hormonal processes, click here, to be lead to the awesome review on the Khan Academy website.
ACE inhibitors don’t impact the actual heart rate and cardiac output as significantly as cardiovascular medications. However, this doesn’t mean that it doesn’t impact the heart rate at all.
Remember my rule with cardiac medications, if a medication that has the potential of impacting the cardiovascular system, especially when combined with other medications, you should always have a recent HR and BP within 30 minutes PRIOR to administering this medication.
My rule about having a HR and blood pressure is a personal practice and is flexible according to patient care setting and condition. Use your nursing judgment and follow facility guidelines. If a patient is admitted for a non-cardiac or issue and has been taking a medication regularly, prior to admission, some may feel comfortable not taking HR and BP as often.
Uses and Indications
ACE Inhibitor uses and indications are fairly easy to remember because they are almost exclusively primarily used to prevent and/or treat the following:
- Heart Failure
Secondary Uses and Indications:
List of Common ACE Inhibitors
- Benazepril (Lotensin)
- Enalapril (Vasotec)
- Lisinopril (Prinivil, Zestril)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
By far, the most common ACE Inhibitors I see in my practice are Lisinopril, Ramipril, and Captopril. If I’m honest, I’ve never seen any of the other ACE Inhibitors listed above, in my personal practice.
Administration of ACE Inhibitors
Once again, this part is kind of easy, since the most common Ace Inhibitors are all only given orally (PO). So, refer to my nursing tidbits for any other nuances and information regarding the administration of this class of medications.
Of course, always follow the 6 rights of medication administration. Yes, there are 6 of them now…
Sidenote: I kind of feel old because when I was in nursing school there were still only 5 rights of medication administration that were popular. The first time I heard a nursing student say something about 6 rights I was like…..
Contraindications, Precautions, and Considerations
- Hacky cough, often dry. Some patients may have frothy or very slightly pink-tinged sputum, especially in longer-term therapy.
- Nausea and Vomiting (This is the case from pretty much any oral medications).
- Pregnancy: Many ACE Inhibitors care class C and D pregnancy warnings.
- Concurrent therapy with potassium-sparing diuretics or take salt-supplements with potassium, due to the risk of hyperkalemia. For a review of normal lab values, check out the book, Lab Values for Nurses By NRSNG, which the BOSSRN helped develop the content for.
- Monitoring Electrolytes, BP, and HR regularly at the commencement of therapy.
- Particular watch for hypotension and significant changes to serum potassium levels.
- Patient’s who are taking an ACE inhibitor in combination with the other antihypertensive agents, such as diuretics, should be monitored closely for hypotension.
- Some research suggests that African Americans and older adults don’t respond as effectively as other groups who may take ACE inhibitors for Hypertension.
Assessment: When starting a new therapy, you want to be sure to obtain a good baseline physical assessment and vital signs.
- Assess Urine output and quality
- Assess extremities and peripheral vascular system for edema
- Auscultate lung fields for crackles and for Shortness of Breath
- Always assess for allergic reactions when a patient takes a medication for the first time.
Sources and References
- Merck’s Manual – Professional, Online
- Tarascon Pharmacopoeia
- Mosby’s 2019 Nursing Drug Reference
- Cardiovascular Care Made Incredibly Visual, 3rd Edition
Written by: Patrick McMurray of PatMacRN is a full-time critical and intermediate care nurse at Level I academic trauma center. In his spare time, Patrick enjoys reading, traveling, and improving his French language skills.
- Check out our other Matters of the Heart post in our series!
- Normal Sinus Rhythm
- Cardiac Arrest
- Heart Attack
- Premature Atrial Contractions (PACs)
- Junctional Rhythms
- Supraventricular Tachycardia (SVT)
- Atrial Fibrillation & Atrial Flutter
- Premature Ventricular Contractions (PVCs)
- Ventricular Tachycardia (Vtach)
- Ventricular Fibrillation (Vfib)
- Torsades de Pointes (TdP)
- Beta Blockers
- Calcium Channel Blockers
- ACE Inhibitors
- Angiotensin II Receptor Blockers (ARBs)
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolisms (PE)
- Peripheral Vascular Disease (PVD)