 Welcome to Nursing School Explained and this video on ACE inhibitors. ACE inhibitors are a medication that we commonly encounter in the clinical setting. And to really know how ACE inhibitors work, we have to take a look back at the physiology and how our body usually responds to a decrease in blood pressure. So this is under normal circumstances our bodies are designed with the renin angiotensin and aldosterone system to respond to a low blood pressure and our bodies combine angiotensinogen with renin to convert it to angiotensin 1. Then ACE comes in angiotensin converting enzyme and it converts angiotensin 1 to angiotensin 2 and angiotensin 2 then works to release aldosterone. It enhances sodium and water retention. It increases sympathetic nervous system activity as well as vasoconstricts. So with all these four targets here we're able to increase our blood pressure and that is under normal circumstances. Now if we have patients who already have high blood pressure, we kind of want to inhibit this whole cascade of events. So when we talk about ACE inhibitors, angiotensin converting enzyme inhibitors, we take the ACE part out of the equation. So when we inhibit ACE from working to convert angiotensin 1 into angiotensin 2, we prevent this whole cascade of events from happening, therefore we don't elevate the blood pressure because in patients with high blood pressure, we don't want this to happen because their blood pressure is already high or elevated. And if you want to review how this works in detail, please see my video about mechanisms of blood pressure control where I explain this in more detail. As always for medications in the same class, it's always best to memorize the class itself rather than the individual medications. And ACE inhibitors always end in PRIL, P-R-I-L. Very commonly used medications are Lysinopril as well as Captopril. You probably come across those in the clinical setting. So keep in mind ACE inhibitors, as long as they're in the same class and they end in PRIL, they will all have the same mechanism of action as well as side effects, contraindications and nursing considerations. So now for ACE inhibitors, the mechanism of action, they inhibit the renin, angiotensin and aldosterone system, but they also inhibit bradykinene, which then helps us to increase the prostaglandin synthesis, which also helps to decrease blood pressure. So indications, we use it for the treatment of hypertension. And it's very commonly used, as well it is the first line treatment of hypertension in patients with diabetes because it is renal protective. And it's also the first line of treatment for patients with heart failure. This tends to come up in exams quite a bit, so just remember, angiotensin converting enzyme inhibitors, first line of treatment in heart failure. Now side effects can be commonly a dry cough, which really occurs quite a bit and depending on how bothersome it is to the patient, they may continue on the medication or they may need to be switched to another one. It can also cause a rash, dizziness, hyperkalemia, which we always need to be careful with, especially with our diabetic patients. And then it can also lead to hypotension. So now if we completely inhibit this cascade, then the blood pressure might just be too low. Severe side effects include angioedema and laryngeal edema. So this can be life-threatening because they both would cause an airway obstruction, so then the patient certainly needs to be switched to a different medication by their provider. Contraindication, pregnancy and lactation because ACE inhibitors can actually cause fetal death. So if a pregnant patient or if a young female is on an ACE inhibitor and plans to become pregnant, we certainly want to advocate for them to use good birth control measures or if we don't know that they're pregnant as soon as they find out, the patient needs to be taken off this medication and converted to something that is safe for pregnancy. As for nursing considerations, we want to always check blood pressure and heart rate before we administer this medication. And also for the patients at home, they should keep a log of their blood pressure so we can monitor how they're responding to the medication. If the patient has heart failure, we want to do the common things such as measure or monitor their daily weights as well as their intakes and output. And then monitor them for signs and symptoms of fluid volume excess such as crackles in the lungs, peripheral edema, maybe some ascites if they get really severe. As for lab considerations, because they work on the RAS, which involves the kidney a lot with sodium and water retention as well as the renin release, we want to make sure that we check their kidney function to make sure that the kidney is functioning properly to actually be able to be receptive to this medication. Also we want to check their potassium and sodium levels because we know it can cause hyperkalemia, which can be especially dangerous in patients with diabetes if they tend towards the later stages of renal disease. And in diabetics, we also want to check the urine for protein as well as check their blood glucose levels because ACE inhibitors can cause hypoglycemia, especially if early in the treatment if the patient is just being started. And we also want to teach our patients to avoid salt substitutes because mainly or most of the time they contain potassium rather than sodium because in general, patients with hypertension are recommended to stay on a low sodium diet. So many times they switch over to a salt substitute, which instead of sodium contains potassium, but if they're on this ACE inhibitor, it can cause hyperkalemia. So we don't want them to get additional potassium in their diet to prevent dangerous levels of potassium. And then also it can cause some orthostatic hypotension. So we want to use the common measures for that, making sure the patient gets up nice and slowly from a line to a sitting position. Make sure they get their bearings for a few minutes before standing up. Again, wait a few minutes and then start to walk because they might feel dizzy and they're prone to falls. So thank you very much for watching this video on ACE inhibitors. Please also watch the other medication videos that are here in my pharmacology playlist. Give me a thumbs up if you enjoyed the video. Also watch on Instagram. I have videos and study tips there as well and I'll see you soon right here on Nursing School Explained. Thanks for watching.