- Body system
- Cardiovascular
- Name stem
- -pril
- Drug cards
- 1 in this guide
Drugs in this class
Other examples: Enalapril, Captopril, Ramipril, Benazepril, Quinapril.
How ACE inhibitors work
Block the angiotensin-converting enzyme, so less angiotensin II is formed (vasodilation, less aldosterone) and bradykinin builds up (the cause of the cough and part of the angioedema risk).
Uses
- Hypertension
- Heart failure
- After a myocardial infarction
- Diabetic kidney disease
Adverse effects
- Dry, nonproductive cough
- First-dose hypotension
- Hyperkalemia
- Rise in creatinine
- Angioedema
Nursing considerations
- Monitor blood pressure, potassium, BUN and creatinine.
- Angioedema is an airway emergency: stop the drug and assess the airway.
- Contraindicated in pregnancy and with a history of angioedema.
Patient teaching
- Avoid potassium supplements and salt substitutes unless prescribed.
- Report a cough that does not go away, or any swelling of the face, lips or tongue.
ACE inhibitors NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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A patient taking lisinopril reports swelling of the lips and tongue. What is the priority action?
Show answer
Answer B: Assess the airway and notify the provider immediately Angioedema can obstruct the airway. It is an emergency: stop the drug, assess and protect the airway, and get help.
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Which lab value should the nurse monitor most closely in a patient on an ACE inhibitor?
Show answer
Answer A: Potassium Less aldosterone means the kidney keeps potassium, so hyperkalemia is a key risk.
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A patient on enalapril has a persistent dry cough. Which drug is the prescriber most likely to switch to?
Show answer
Answer B: Losartan ARBs such as losartan do not cause bradykinin buildup, so they rarely cause cough. Switching to another ACE inhibitor would not help.
Frequently asked questions
What are ACE inhibitors?
ACE inhibitors (the -pril drugs) lower blood pressure and protect the heart and kidneys. Watch for a dry cough, high potassium and the rare but dangerous angioedema.
How do ACE inhibitors work?
Block the angiotensin-converting enzyme, so less angiotensin II is formed (vasodilation, less aldosterone) and bradykinin builds up (the cause of the cough and part of the angioedema risk).
What are examples of ACE inhibitors?
Lisinopril, Enalapril, Captopril, Ramipril, Benazepril and Quinapril.
What are the nursing considerations for ACE inhibitors?
Monitor blood pressure, potassium, BUN and creatinine. Angioedema is an airway emergency: stop the drug and assess the airway.