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The Angiotensin converting enzyme (ACE) inhibitors are a class of medication used to treat and manage hypertension, a significant risk factor for coronary disease, heart failure, stroke, along with a number of other cardiovascular conditions including congestive heart failure with reduced ejection fraction (CHFrEF), chronic kidney disease (CKD), Coronary artery disease (CAD) and myocardial infarction (MI). Most cases are primary and not attributable to any specific etiology. ACE is an enzyme involved in the renin-angiotensin-aldosterone system (RAAS). ACE inhibitors are competitive inhibitors of ACE, which block the conversion of Angiotensin I to Angiotensin II. Captopril was the first ACE inhibitor approved for clinical use in 1981. This activity reviews the indications, contraindications, mechanism of action, administration, dosing, adverse events, monitoring, and clinical toxicology of the ACE inhibitors. The CME program aims to provide evidence-based medicine to improve patient care and outcomes. It focuses on strategies to minimize adverse reactions while maximizing the effectiveness of ACE inhibitors. This training will equip healthcare professionals with the knowledge to deliver safe, effective, and individualized care during the administration of ACE inhibitors. Objectives: Identify the mechanism of action of ACE inhibitors. Evaluate the adverse drug reactions of ACE inhibitors. Determine the classic indications for initiating ACE inhibitor therapy. Implement an interprofessional team approach that utilizes evidence-based medicine and a patient-centered approach to enhance patient outcomes. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose/Toxicity When used at therapeutic doses, the risk of toxicity is rare. Toxicity is more likely when the drug is used in combination with other antihypertensive drugs or at supratherapeutic doses. Captopril is the only ACE inhibitor to penetrate the blood-brain barrier and potentially cause confusion and lethargy.[59] Combining ACE inhibitors with other antihypertensive drugs can increase adverse effects like hyperkalemia, hypotension, and renal failure. Precaution is required when the patient is given an ACE inhibitor and already receives a potassium-sparing diuretic, NSAIDs, cyclosporine, and anticoagulants. Management of Overdose/Toxicity For the majority of patients, the effects of poisoning are mild, and close observation is required. Hospital admission is indicated when symptoms and signs are more severe. Derranged hemodynamic parameters may require supportive therapy with intravenous fluids and inotropic and vasopressor support.[59] ACE inhibitor overdose can cause hypotension, which can be treated with the use of naloxone, with the presumed mechanism of returning the effect of enkephalinase, which leads to increased degradation of endogenous opioids, which were inhibited by ACE inhibitors. Although very few case reports have been published in the literature suggesting the stated treatment.[60] Severe refractory shock caused by concomitant ACE inhibitor and other antihypertensives toxicity can be treated with Angiotensin II.[61]

Clinicians widely use ACE inhibitors in medicine to treat hypertension, heart failure, and patients with chronic kidney disease. While effective, healthcare workers (nurse practitioners, physicians, and pharmacists) who prescribe these agents should be aware of their adverse drug reactions and contraindications. Patients must also be regularly monitored for their renal function and electrolyte concentrations. Healthcare providers should be aware that these agents can produce a chronic dry cough. The clinician should try another class of antihypertensive medication if the patient experiences a dry cough.[24][62][63][64] Even though ACE inhibitors are among the oldest drug classes available, there is a threat that familiarity can lead to carelessness. That is why, like any other drug, these agents require the oversight and coordination of an interprofessional team. Pharmacists need to verify that dosing is appropriate and check for potential drug interactions.[65] Nurses should take blood pressure at every visit and chart it accurately, so the clinician can determine if dosing or other changes are required. Nurses can monitor for potential signs of pregnancy and promptly inform the clinician if the patient is pregnant, as ACE inhibitors are absolutely contraindicated in pregnancy.[66] The clinician must remain informed of these findings from the other interprofessional healthcare team members to take corrective action if necessary. All team members must keep meticulous records of their observations and interventions in the patient's medical record. In summary, the interprofessional team approach between clinicians, nurses, and pharmacists using evidence-based medicine and patient-centered care correlates with reduced morbidity and mortality in patients receiving ACE inhibitor therapy.[67]