Ace Inhibitors Nursing Considerations

Angiotensin-Converting Enzyme (ACE) Inhibitors are a class of medications commonly prescribed for hypertension, heart failure, and other cardiovascular conditions. These medications work by blocking the conversion of angiotensin I to angiotensin II, resulting in vasodilation and decreased blood pressure.

Generic names: Benazepril, Captopril, Enalapril, Fosinopril, Lisinopril, Quinapril, Ramipril, Perindopril

Brand names: Lotensin, Capoten, Vasotec, Monopril, Prinivil/Zestril, Accupril, Altace, Aceon

Pharmacologic class: Angiotensin-Converting Enzyme Inhibitors

Therapeutic class: Antihypertensive, Cardiovascular agent

Mechanism of action: ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion. This leads to vasodilation, decreased blood pressure, and reduced cardiac workload.

Indications for use: Hypertension, heart failure, left ventricular dysfunction, diabetic nephropathy, post-myocardial infarction, coronary artery disease, and prevention of cardiovascular events in high-risk patients.

Precautions and contraindications:

  • History of angioedema
  • Pregnancy (especially 2nd and 3rd trimesters)
  • Bilateral renal artery stenosis
  • Hyperkalemia
  • Known allergy to ACE inhibitors

Drug Interactions

  • NSAIDs may decrease antihypertensive effect
  • Potassium supplements or potassium-sparing diuretics increase risk of hyperkalemia
  • Lithium levels may increase
  • Antacids may decrease absorption
  • Insulin sensitivity may increase

Adverse Effects

  • Dry, persistent cough
  • Hyperkalemia
  • Hypotension, especially first-dose
  • Acute kidney injury
  • Angioedema
  • Taste alterations
  • Fatigue and dizziness
  • Headache
  • Rash
  • Elevated serum creatinine

Administration Considerations

Available preparations: Oral tablets, oral capsules, oral solution

Typical dosing: Varies by specific medication and indication. Usually started at lowest effective dose and titrated upward as needed.

Administration timing:

  • Onset: 1-2 hours
  • Peak effect: 4-6 hours
  • Duration: 24 hours for most ACE inhibitors

Nursing Considerations for ACE Inhibitors

Related Nursing Diagnoses

Nursing Assessment

  1. Obtain baseline vital signs, especially blood pressure. Monitor for orthostatic hypotension.
  2. Assess cardiovascular status, including heart rate, rhythm, and presence of edema.
  3. Review laboratory values:
  • Serum potassium
  • BUN and creatinine
  • Complete blood count
  • Liver function tests
  1. Assess for the presence of dry cough, which is a common side effect.
  2. Screen for pregnancy status as ACE inhibitors are contraindicated in pregnancy.

Nursing Interventions

  1. Monitor blood pressure frequently, especially after initial dose or dose increases.
  2. Administer first dose at bedtime to minimize orthostatic hypotension risk.
  3. Monitor for signs of angioedema (swelling of face, tongue, or throat).
  4. Assess kidney function regularly through laboratory values.
  5. Monitor potassium levels closely, especially if patient is on potassium supplements or potassium-sparing diuretics.

Patient Teaching Associated with ACE Inhibitors

  1. Instruct patients to rise slowly from lying or sitting positions to prevent orthostatic hypotension.
  2. Teach patients to monitor blood pressure at home and maintain a log.
  3. Educate about the importance of consistent medication timing and not skipping doses.
  4. Advise patients to report persistent dry cough, as this is a common side effect that may require medication change.
  5. Instruct patients to avoid over-the-counter NSAIDs without consulting healthcare provider.
  6. Emphasize the importance of regular laboratory monitoring.
  7. Teach women of childbearing age about pregnancy risks and the need for effective contraception.
  8. Advise patients to maintain adequate hydration and avoid excessive alcohol use.
  9. Instruct patients to report signs of angioedema immediately.

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.

References and Sources

  1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71(19):e127-e248. doi:10.1016/j.jacc.2017.11.006
  2. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2017;70(6):776-803.
  3. Sweitzer NK. What Is an Angiotensin Converting Enzyme Inhibitor? Circulation. 2003;108(3):e16-e18.
  4. Koshy S, Bakris GL. Therapeutic approaches to achieve desired blood pressure goals: focus on calcium channel blockers and angiotensin converting enzyme inhibitors. Cardiovasc Drugs Ther. 2000;14(3):295-301.
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Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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