ACE INHIBITORS

Ajouté : 2026-06-06

[00:00:01]so i like to record these for youtube but because then you've got a playlist to study from so the ace inhibitor will always end in prill so there are lots and lots of different ace inhibitors in fact i think if you pull up your blueprint um i think that so enala pro is not the only one that you're going to need to know yeah captopril is the other one so it's in yellow prill and captopril but you know what you see one you see them all okay the ace inhibitors have all sorts of things that are so in common with the next ace inhibitor right and so you're learning these because they are ace inhibitors now there are all sorts of things about um ace inhibitors ace inhibitors a lot of times um a lot of times providers will use like diuretics first um for blood pressure but if they're going to use an actual antihypertensive that's just focused on um the anti-anti-hypertensive part um often the first line anti-hypertensive after those um diuretics are the ace inhibitors okay so we're going to talk about these all right and so this is the random angiotensin system and you said hey the last one was a black picture of the red and angiotensin system this one's a little different well they're both saying the same thing okay so the body does homeostasis pretty well right and the renin-angiotensin system is part of or the raas um it is part of our ability to um it's part of our ability to compensate right and it's part of our homeostasis so in this run and angiotensin system we have the body responds to this drop in blood pressure okay and drop in fluid volume and what happens when we have this drop in fluid volume drop in blood pressure is our body our liver goes all right let's send out some angiotensinogen okay our kidney says i notice a drop in blood pressure i notice a drop in fluid volume um i'm going to release renin and so that's actually what this is right here um i'm going to pull this up a little bit so you can see it nope i guess not so right here that's actually what this is is renin there's a really clear picture of the renin angiotensin aldosterone system in the nati so you can always pull that up but this is released from the kidney that renin causes a transition from angiotensinogen to angiotensin one and then the lungs actually notice it too so they release something called um this ace so it the lungs release this angiotensin converting enzyme okay and that converts this from angiotensin one angiotensin ii but what happens with the ace inhibitors is that it blocks this part of the pathway right here where that ace angiotensin converting enzyme is working it blocks that ace enzyme okay it blocks that and so angiotensin one does not get converted to angiotensin ii what results is then because that does not happen then the blood vessels can go big again meaning they can go back to their vasodilated state they're not vasoconstricted which means the pressure goes down okay so this one over here pressure was up because this ras system was working right we've gone in we've blocked this ace the raz system is no longer working right so we're blocking that out no more of that vasoconstriction and we're letting it all relax and get bigger and the blood pressure part of it can go down okay um if you don't believe me go and spray a hose with your thumb over the end that's kind of like this right here spraying your hose with a thumb over the end creates high pressure removing your thumb out of the way of that hose creates a little bit lesser pressure right so that brings down the blood pressure right away but it also it also acts on the adrenal gland um because it also because it has blocked this ace right here the body is also not going to release aldosterone okay so you will get a little bit of diuresis okay a little bit most of the action of this med is going to be right up here um in allowing the vessels to be vasodilated but down here you're also going to block that release of aldosterone which is going to mean they're going to pee a little right okay so what does that all mean when it comes to the medications i'm just going to actually go backward um and get rid of this for a second okay i'm gonna pause that so sorry ace inhibitors can be used um in the relief of hypertension in the release leaf of hypertension with heart failure so that we're not getting so much systemic vascular resistance on that heart um that's also something that ati has remediation for if you didn't get that when you were um in patho um diabetic nephropathy um sometimes it can be used with but not very often um but it is often used for the hypertension in diabetes okay and i'm gonna keep it as simple as that okay again this one you can have the side effects of severe hypotension um severe hypotension why well because you're giving it for hypertension and you're trying to bring down the blood pressure it might get overdone okay um a person can get a dry non-productive cough due to a rise in bradycainin and it has to do with the fact that we are blocking that ace production from the lungs okay if somebody has um a cough from this if the cough so if somebody has a cough from this if it's problematic so if it's disruptive to the client they should be ch switched to an arb um or medications that end in certain arbs are very similar to aces but um they have a less likelihood of of causing that cough now it doesn't mean they have zero likelihood but they do have less of a likelihood okay so i'm gonna sit that right here and that's how those two relate to one another okay now the person should change positions slowly why because we could cause severe hypotension um and so changing position slowly is really important because if they change positions quickly what they can do is they can because we've caused that increasing of the um lumen of the blood vessel um what we've done is we've created a pool kind of throughout the body right and when that person stands up all that water goes to the pools down via gravity right so it goes to the lowest pools and the brain is not the lowest pool so if they're severely hypotensive and they're they stand up real quickly and their fluid all goes down to the bottom pools they're not perfusing their brain they could fall and hit their head right so um another thing that's really common with this medication and i'm gonna actually i think i'd put this completely in orange here angioedema is a huge side effect and i'm probably going to leave it really nice and big here um angioedema i want to bring back a picture of angioedema for you because i think it's really important for you to see it angioedema and i want to bring it in an adult um here is a very common one i'm going to copy the image and bring it over and then i'm going to bring over another one okay so these are both examples of angioedema okay angioedema just means localized swelling okay angioedema can be very very dangerous if people are experiencing this localized swelling from this medication i do recommend the er so here we go here's the first gentleman and this is um his angioedema that he's experienced and his is in his lips now that's really really dangerous right because the lips are kind of close to the rest of the airway um the tongue is very very dangerous because it's in the airway right it's it could at any point that angioedema could spread a little bit and cause problems with the airway i'm not kidding so you want to be very careful um when people have angioedema now if somebody gets an angioedema from an ace inhibitor they will never take another ace inhibitor again so if you see a provider order an ace inhibitor for somebody who has a history of angioedema you need to hold that medication contact that provider and uh bring it up with them you know i noticed that they've got a history of angioedema i'm not sure what it's from or maybe you know it was from another ace inhibitor um and and tell them you know i'm just concerned and maybe they'll order something else sometimes they'll order an arb but sometimes they'll go with something different altogether arbs can cause this okay uh but uh not as likely so these right here are potentially very dangerous things which would cause the person never ever ever ever to be on it again so those are really the most important things about ace inhibitors that i want you to take away so that's really what i want you to walk away with with ace inhibitors okay um and for this part right here i'm going to move this right here this right here and i'm just gonna add another one work on the razz system okay by blocking the ace so the angiotensin-converting enzyme that came out of the lungs it blocks that and by doing that um and causes um basically vasodilation [Music] um i'm gonna say more of a vasodilation state um and a little bit of diuresis okay so that's really what i want you to walk away from with this okay