February 8, 2023

ACE Inhibitors (angiotensin-converting enzyme inhibitors) pharmacology nursing review of the mechanism of action, side effects, nursing considerations etc.

Hey everyone it’s sarah thread sterner sorry and calm and today we’re going to go over ace inhibitors and after you done went to this youtube video don’t forget to access the free quiz that will test you on this medication so let’s get started what are ace inhibitors well to help us learn this medication we’re going to use the mnemonic nurse which is going to tell

Us the name of the drug and that tells us how this drug works on the body what it’s used for what is it treat our responsibilities as the nurse side effects we can expect from this medication and education pieces we need to provide for our patient so first let’s talk about the name the letters a stands for angiotensin converting enzyme so what these drugs do is they

Inhibit this enzyme from really doing its job so ace plays a huge role in our wrath system the renin-angiotensin-aldosterone system and what this system does is the whole goal of it is to manage our blood pressure especially when our blood pressure is low so when the blood pressure is low this system kicks in what it wants to do is it wants to get angiotensin ii

In the body working because angiotensin ii as we learn from our short series is a major vaso constrictor of our vessels so that’s going to increase our blood pressure plus it triggers the release of aldosterone which is going to help put more sodium and water into our circulation which is going to help increase our blood volume and this patient can get their blood

Pressure back up so that is what a steps but if we want to throw an ace inhibitor it’s going to cause the opposite effect it’s going to lower the blood pressure now one thing you want to remember to help make things easier on you while you’re studying is to remember that ace inhibitors in with pril p r i l so when you’re looking at your patients medication list

Trying to figure out which one’s an ace inhibitor or you’re taking an exam look for prio and some examples of an ace inhibitor is like captopril lisinopril ramipril or bins aprill so what ace inhibitors do is they inhibit this wrath system and again that stands for renin-angiotensin-aldosterone system and if you can understand how this system works it’s a breeze

Learning ace inhibitors because ace inhibitors do the opposite and what this system is really supposed to do so let’s quickly talk about this system so a patient’s blood pressure drops it’s really low and the kidneys sense this and they’re like hey we got to do something about this low blood pressure we’re not gonna get enough blood supply and we’re gonna die so what

They do is they release renin into the circulation and when renton is present in the circulation this causes angiotensinogen which is a protein created and produced in the liver to create angiotensin 1 now remember the goal of this whole system is to get angiotensin 2 on board because it’s a major vaso constrictor so in order to do that we have to have a spread the

Angiotensin converting enzyme so whenever that is present it’s going to convert this angiotensin 1 into angiotensin 2 when we have angiotensin 2 present in the body we’re gonna get major vasoconstriction of vessels increasing systemic vascular resistance increasing blood pressure and it’s gonna trigger the release of aldosterone which is going to help increase our

Blood volume now if we throw an ace inhibitor on what’s it gonna do it’s going to prevent this ace from doing its job so we’re not going to get the conversion of angiotensin 1 into angiotensin 2 so we’re going to lower our blood pressure now let’s talk a little bit more about this angiotensin converting enzyme ace in angiotensin 2 to help drive home some points so

You can really understand your role as a nurse and those education pieces there will be really no reason to memorize it because it just makes sense okay so angiotensin converting enzyme when we’re not inhibiting it what it does as we’ve already established is that it converts angiotensin 1 into angiotensin 2 we get major vasoconstriction we increase blood pressure

Systemic vascular resistance now another thing that it does when we’re not inhibiting it is that it activates a substance called bradykinin by breaking it down now let’s talk about brady cotton brady honey is a substance that’s an inflammatory substance that really helps dilate the vessels when we dilate vessels we decrease like systemic vascular resistance hence

The blood pressure so whenever you have the right system kicking in the renin-angiotensin-aldosterone system kicking in it doesn’t need dilation so it’s very important that it inactivates this substance because we don’t need dilation if our blood pressure is low but if we’re throwing on an ace inhibitor we can benefit from this brady cotton’s actions of dilation

So it will inhibit these ace inhibitors will inhibit this inactivation of this brady cotton so we’ll increase the amount of a brady cotton present which is going to dilate vessels and help us decrease our blood pressure even more which is great but one thing i really wants you to remember because of this brady con and it’s an inflammatory substance some patients

Can have a side effect of having a persistent dry cough and literally it drops some patients just crazy because they’re just hacking and coughing all the time and sometimes patients have to be switched to another medication because it’s so bad and i’ve had patients who have had this so this does happen with ace inhibitors so remember brady conan can lead to that

Persistent annoying dry cough now let’s talk a little bit more about this angiotensin 2 well we’ve already established it’s a major vaso constrictor so when we constrict our vessels was i do it increases systemic vascular resistance and our blood pressure now another thing angiotensin 2 does when it’s in the is this going to trigger the release of this aldosterone

And aldosterone influences the kidneys to keep sodium and water and the whole reason for that is it’s gonna really help increase our blood volume which will help increase our pressure even more now while it’s keeping the sodium in the water the kidneys are going to be excreting potassium so if we throw an ace inhibitor on we’re going to prevent remember angiotensin

1 turning into angiotensin 2 so that right here is not going to happen so our ace comes it x’s it out so what’s the effects going to be whenever we give our patient an ace inhibitor well we don’t have the conversion of angiotensin one to angiotensin 2 so our blood pressure and systemic vascular resistance will drop what is going to happen with this sodium and water

Well instead of keeping it like how we did over here we’re going to excrete the sodium in water which is going to provide like a diuretic effect for our patient now this is good for patients for instance who are in fluid overload due to heart failure so here in a moment we’re going to get in what this drug is really useful in potassium over here we were excreting it

Well with ace inhibitors because how it’s working on the kidneys you can actually keep too much potassium so with many patients you have to watch their potassium levels because they’re at risk for hyperkalemia so remember that ace inhibitors hyperkalemia so nursing considerations will have to be looking at those potassium levels and educating our patients on what

Foods to watch out for so that we don’t increase those levels now let’s talk about what ace inhibitors are used for well we’ve established that ace inhibitors help lower the blood pressure because we’re preventing that angiotensin 1 to angiotensin 2 so it’s great for people who have hypertension it will lower their blood pressure another thing it’s used to treat

Is heart failure specifically systolic dysfunction and this is where that left ventricle can’t really empty or pump blood forward out of it through the aorta into the body so instead that blood can back up go into the and lead to heart failure fluid overload so our ace inhibitors what they can do is they can help decrease after load and remember after load and

We’re talking about the left ventricle is where is the pressure that the ventricle must overcome in order to get that semilunar valve open so blood can leave it so if we decrease that resistance that pressure that that ventricle must overcome hence the systemic vascular resistance it’ll make it a lot easier for that ventricle to pump blood forward in addition ace

Inhibitors are gonna help decrease our preload and preload is the amount of that ventricle has stretched at the end of its filling phase with blood so at the end of diastole another thing that ace inhibitors will help treat is a patient who has suffered a myocardial infarction an mi so when their post mi and what ace inhibitors will do because it alters a lot of

This after load and preload it will help limit the effects of damage that can happen to the heart once a patient has had a myocardial infarction now let’s talk about the responsibilities of the nurse okay whenever a patient is on an ace inhibitor what are you gonna do well of course you’re going to monitor their blood pressure and their pulse routinely you want to

Look at that see where they’re running with our blood pressure because with ace inhibitors there’s a risk of hypotension where that systolic is less than 90 and that increases even more of your patients on diuretics where they’re urinating a lot they’re losing other fluid volume and that can decrease pressure or if they’re on other blood pressure medicines because

A lot of cardiac patients are going to be on a variety of medication so you definitely want to watch their blood pressure in addition you want to monitor some things like their potassium level make sure that they’re not experiencing hyperkalemia and we talked about the reason for that a normal potassium is three point five to five so you want them within that rain

And if they if you get an ekg or they’re on bedside monitoring you can look at their ekg and one sign in symptom of hyperkalemia with their ekg is that they have tall peaked t-waves also you want to be looking at their renal function so their bu in and creatinine because remember this drug can alter how our kidneys work we’re messing with the sodium and the water

And the potassium so making sure that they’re within range and normal be you in is about 5 to 20 normal creatinine is 0.6 to 1.2 and of course looking at how they’re urinating what is their urinary output we want it in an adult at least 30 cc’s per hour another thing to remember with ace inhibitors is that you want to watch out for a condition called angioedema this

Is where they’re a swelling of the dermis and the sub-q tissue so we have really deep swelling it’s not superficial swelling like you to care yeah this is deep down in there and that can be life-threatening so how your patient will present with this is that they can get swelling on their face their mouth or extremities and it can affect the airway where they’re

Gonna have difficulty breathing so you want to educate your patient about that what are the signs and symptoms of it it’s rare but it can happen to any patient it’s most common they have found in african american patients and if it happens it’s dangerous and they need medical treatment immediately and lastly with our responsibilities you want to look at how your

Patient is really tolerating this medication because i mentioned that persistent dry cough it will literally drive some people crazy because they’re constantly just hacking and coughing but because this medication is prescribed with people who also have heart failure as a nurse you want to look and make sure is this the persistent dry cough associated with this

Medication or is this heart failure exacerbation where they’re going into fluid overload so you’d want to determine the two and how you would look at that is you would listen the lung sounds what is our lung sunlight are they wet where they you can hear crackles are they having difficulty breathing on exertion just getting up from the chair to the bed they’re really

Winded they can’t breathe and they’re having swelling and they’re shrim adiz where the retaining fluid so make sure you look at that and assess that and just don’t write it off that it’s that dry hacking cough that you get with ace inhibitors because it could be that they are in heart failure exacerbation they’ll talk about the side-effects of ace inhibitors well

This medication can cause that persistent dry hacking cough and that was related to that brady kannan and this is usually harmless so if your patient has that let them know that another thing is that it can cause dizziness because we’re changing dealing with the blood pressure so tell the patient to change positions slowly when they get up because they can become

Dizzy and they might fall it can also cause hypotension because it can lower the blood pressure too much it can increase potassium levels at hyperkalemia and it can cause angioedema that dangerous swelling of the deep tissues and if they experience that they need medical treatment fast now let’s wrap up this lecture and let’s talk about the education pieces for

The patient so since your patient is taking an ace inhibitor which alters blood pressure it’s really important you educate your patient to check their blood pressure and pulse regularly and to record it and to bring those recordings to their follow-up visits so the physician can see if this medication is doing what it’s supposed to do also you want to educate your

Patient to avoid salt substitutes with potassium and consuming foods that are rich in potassium like potatoes bananas pork oranges tomatoes spinach avocados because we could increase the potassium level even more because remember ace inhibitors how they work on the kidneys they will call us the kidneys to keep potassium now this education piece is really important

If the patient is also taking other types of medications that keep potassium like those potassium sparing diuretics like spironolactone so the patients at double risks for high potassium level so really drive that point home to them another thing is if they do have that dry cough and can’t tolerate it some patients can tolerate it and it’s just fine but a lot of

Patients when they do get it they can’t tolerate it they need to speak with their physician about it instead of just stopping taking medication because some patients like it was driving me crazy i just quit taking it you don’t want to quit taking an ace inhibitor because it can lead to a condition called rebound hypertension and this is where the blood pressure is

Rebounding it’s just like super high and it’s really hard to treat and bring it down also teacher patient the signs and symptoms associated with angioedema can really occur at any any time so let them know what may happen and what they should do and miss dose because we don’t want our patient to just abruptly quit taking this we want them to take it whenever they

Need to how it’s scheduled and even if they feel unwell they need to take the medication because of the rebound hypertension so they miss a dose and and they remember that same day that they’re supposed to take it they can go ahead and take the dose but let’s say they didn’t remember until the next day well they would skip that dose that they miss but take that

Scheduled dose that is due that day they would never want to double doses because that could lead to severe hypotension okay so that wraps up this lecture over ace inhibitors thank you so much for watching don’t forget to take the free quiz and to subscribe to our channel for more videos

Transcribed from video
ACE Inhibitors Pharmacology Nursing (Angiotensin Converting Enzyme Inhibitors) By RegisteredNurseRN