ACE inhibitors on the NCLEX
ACE inhibitor class for NCLEX: -pril ending, the cough, angioedema risk, hyperkalemia, and pregnancy contraindication.
ACE inhibitors end in -pril. They block angiotensin-converting enzyme, reducing angiotensin II and aldosterone. The NCLEX tests the cough, the angioedema risk, hyperkalemia, and the absolute pregnancy contraindication.
Common drugs
Lisinopril, enalapril, captopril, ramipril, benazepril.
Action and use
Block ACE → less angiotensin II → vasodilation + less aldosterone → less Na/water retention. Used for HTN, HF, post-MI, diabetic nephropathy (kidney protective).
Major side effects
Dry cough (10-20%, may require switch to ARB). Angioedema (rare, life-threatening, discontinue immediately). Hyperkalemia (monitor K+). First-dose hypotension (especially in volume-depleted patients).
Absolute contraindications
Pregnancy, teratogenic, fetal renal damage. History of angioedema with prior ACE inhibitor. Bilateral renal artery stenosis.
Teaching
Cough usually appears within first weeks. Report swelling of face/lips/tongue immediately. Avoid potassium supplements and salt substitutes (contain KCl).
Frequently asked
Switch to ARB for the cough?
Yes, ARBs (-sartan) don't cause the cough. Same hyperkalemia and pregnancy risks.
Can ACE inhibitors cause kidney damage?
Can worsen function in renal artery stenosis. Otherwise kidney-protective in diabetics. Monitor BUN/creatinine.
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