ACE Inhibitors & ARBs (Angiotension II Receptor Blockers)

1. All ACE inhibitors end with the suffix:

Ace

Ing

Pril

Lol

The ACE inhibitors are the "prils"!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

The ACE inhibitors are the "prils"!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

2. Which of the following drugs is an ACE inhibitor?

Losartan

Metoprolol

Lanoxin

Captopril

ACE inhibitors are the "prils"!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ACE inhibitors are the "prils"!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

3. True or False: ACE inhibitors and ARBs reduce the workload of the heart.

True

False

ACE inhibitors are often prescribed to reduce the workload of the heart.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ACE inhibitors are often prescribed to reduce the workload of the heart.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

4. Which of the following is the most important assessment after administering a newly prescribed ACE inhibitor/ARB?

Temperature

Respiratory rate

Cardiac rhythm

Blood pressure

ACE inhibitors/ARBs can cause hypotension. They will not affect respiratory rate or cardiac rhythm. They can reduce white blood cell count, putting the patient at higher risk of infections - but this would not be as immediately important as the blood pressure.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ACE inhibitors/ARBs can cause hypotension. They will not affect respiratory rate or cardiac rhythm. They can reduce white blood cell count, putting the patient at higher risk of infections - but this would not be as immediately important as the blood pressure.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

5. Which of the following side effects is common with ACE inhibitors and ARBs?

Persistent, dry cough

Nasal congestion

Increased fluid in lungs

Drowsiness

ACE inhibitors (like enalapril, lisinopril) commonly cause a dry, persistent cough in some patients due to increased bradykinin levels, which can irritate the airways. This side effect is well-documented and is a frequent reason for switching patients to ARBs (angiotensin receptor blockers), which do not elevate bradykinin and thus usually do not cause cough. Both ACE inhibitors and ARBs are beneficial in treating heart failure and help reduce pulmonary congestion, not worsen it. They also do not cause nasal congestion or sedation.

Explanation

ACE inhibitors (like enalapril, lisinopril) commonly cause a dry, persistent cough in some patients due to increased bradykinin levels, which can irritate the airways. This side effect is well-documented and is a frequent reason for switching patients to ARBs (angiotensin receptor blockers), which do not elevate bradykinin and thus usually do not cause cough. Both ACE inhibitors and ARBs are beneficial in treating heart failure and help reduce pulmonary congestion, not worsen it. They also do not cause nasal congestion or sedation.

6. ACE inhibitors/ARBs are most commonly prescribed for patients with:

Angina

Arrhythmia

Hypotension

Heart failure

Patients with heart failure are likely to be put on an ACE inhibitor/ARB. ACE inhibitors/ARBs can CAUSE hypotension. They have no effect on cardiac arrhythmias, and do not directly affect angina.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

Patients with heart failure are likely to be put on an ACE inhibitor/ARB. ACE inhibitors/ARBs can CAUSE hypotension. They have no effect on cardiac arrhythmias, and do not directly affect angina.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

7. The nurse should teach the patient on ACE inhibitors/ARBs to:

Take the medication at alternating times of the day

Rise slowly from a sitting to standing position

Monitor their weight monthly

Avoid leafy green vegetables

ACE inhibitors/ARBs can cause orthostatic hypotension - so patients will need to rise slowly from a sitting position, to avoid falls. ACE inhibitors/ARBs should be taken at the same time of the day everyday - weight should be monitored weekly or biweekly, and leafy green vegetables are contraindicated for meds like Coumadin, since they contain Vitamin K.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ACE inhibitors/ARBs can cause orthostatic hypotension - so patients will need to rise slowly from a sitting position, to avoid falls. ACE inhibitors/ARBs should be taken at the same time of the day everyday - weight should be monitored weekly or biweekly, and leafy green vegetables are contraindicated for meds like Coumadin, since they contain Vitamin K.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

8. Which lab value should you play close attention to when a patient is on an ACE inhibitor/ARB?

Potassium; ACE inhibitors/ARBs can cause hypokalemia

BUN; ACE inhibitors/ARBs can cause renal failure

Sodium; ACE inhibitors/ARBs can cause hyponatremia

Potassium; ACE inhibitors/ARBs can cause hyperkalemia

ACE inhibitors/ARBs often result in hyperkalemia. They have no effect on sodium, and may cause a transient increase in BUN/Creatinine - but do not cause renal failure.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ACE inhibitors/ARBs often result in hyperkalemia. They have no effect on sodium, and may cause a transient increase in BUN/Creatinine - but do not cause renal failure.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

9. All ARBs (Angiotensin II receptor Blockers) end with this suffix:

Tan

Pril

Lol

Ace

ARBs are the "tans"!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ARBs are the "tans"!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

10. ACE inhibitors and ARBs:

Reduce afterload

Increase preload

Decrease renal blood flow

Increase afterload

ACE inhibitors/ARBs reduce afterload. Afterload is the pressure the heart has to push AGAINST when it pumps blood out to the body - afterload is higher in high blood pressure, atherosclerosis (clogged blood vessels), and vasoconstriction. Afterload is lower in low blood pressure and vasodilation. Preload is the VOLUME, coming from the body, that enters the heart. Preload is high in fluid volume overload, and low in fluid volume deficit. Most cardiac meds work by either: lowering preload (diuretics) or lowering afterload (vasodilators). ACE inhibitors/ARBs also increase renal blood flow - they shunt more fluid to the kidneys, which reduces the amount of volume going to the heart from the body (reduced preload). Cardiac meds will NEVER increase preload or afterload! That wouldn't be good for the heart!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ACE inhibitors/ARBs reduce afterload. Afterload is the pressure the heart has to push AGAINST when it pumps blood out to the body - afterload is higher in high blood pressure, atherosclerosis (clogged blood vessels), and vasoconstriction. Afterload is lower in low blood pressure and vasodilation. Preload is the VOLUME, coming from the body, that enters the heart. Preload is high in fluid volume overload, and low in fluid volume deficit. Most cardiac meds work by either: lowering preload (diuretics) or lowering afterload (vasodilators). ACE inhibitors/ARBs also increase renal blood flow - they shunt more fluid to the kidneys, which reduces the amount of volume going to the heart from the body (reduced preload). Cardiac meds will NEVER increase preload or afterload! That wouldn't be good for the heart!

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

11. True or False: ACE Inhibitors/ARBs are given to improve cardiac output.

True

False

True! Decreased cardiac output is NEVER a good thing.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

True! Decreased cardiac output is NEVER a good thing.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

12. Which of the following medications should not be taken with an ACE inhibitor or ARB?

Protonix

Aldactone

Furosemide

Aspirin

Because ACE inhibitors/ARBs can cause hyperkalemia, potassium-sparing diuretics may make this even worse. Furosemide is not a potassium-sparing diuretic. Protonix has no association with ACE inhibitors/ARBs. Many patients who need ACE inhibitors/ARBs are already on baby aspirin.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

Because ACE inhibitors/ARBs can cause hyperkalemia, potassium-sparing diuretics may make this even worse. Furosemide is not a potassium-sparing diuretic. Protonix has no association with ACE inhibitors/ARBs. Many patients who need ACE inhibitors/ARBs are already on baby aspirin.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

13. Which of the following lab values may result when taking an ACE inhibitor/ARB?

Decreased chloride level

Increased magnesium level

Decreased WBC count

Decreased potassium level

ACE Inhibitors/ARBs can cause low white blood cell count, increased potassium level, but have little to no effect on chloride or magnesium.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

ACE Inhibitors/ARBs can cause low white blood cell count, increased potassium level, but have little to no effect on chloride or magnesium.

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

14. Match the generic and trade names of these ARBs (Angiotension II Receptor Blockers).

Candesartan

Losartan

Telmisartan

Irbesartan

Nesiritide

Valsartan

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Submit

15. Match the generic and trade names of these ACE inhibitors.

Enalapril

Captopril

Moexipril

Quinapril

Trandolapril

Lisinopril

Fosinopril

Perindopril

Ramipril

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Explanation

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th ed., San Francisco: Pearson. p.980-981.

Submit

ACE Inhibitors & Arbs (Angiotension II Receptor Blockers)