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Furosemide
3%
9/310
Metoprolol
1%
4/310
Amiodarone
4%
11/310
Digoxin
7%
22/310
Lisinopril
84%
261/310
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ACE inhibitors such as lisinopril have the well-known side effects of cough, decreased GFR, angioedema, and hyperkalemia. Decreased GFR results in an increase in serum creatinine. ACE inhibitors work by stopping production of angiotensin-converting-enzyme (ACE) in the renin-aldosterone-angiotensin pathway; this ultimately produces vasodilation and a reduction in blood pressure. ACE inhibitors are a mainstay of treatment for hypertension and heart failure, being recommended for all patients with reduced left ventricular ejection fraction. Parish et al. discuss known side effects of ACE inhibitors, including those listed above. The one most commonly noted is cough. Additionally they note that with awareness of dietary potassium intake and avoidance of potassium-sparing diuretics, hyperkalemia poses less although not negligible risk. Phillips et al. performed a metanalysis of randomized controlled trials of ACE inhibitors used along with angiotensin II receptor blockers (ARB) in heart failure with symptomatic left ventricular dysfunction. They found that the combination was significantly associated with medication side effects, including hypotension and worsening renal function, and led to more discontinuation of therapy compared to ACE inhibitor alone. Illustration A shows typical ACE inhibitor-induced angioedema. Illustration B shows the pathways affected by ACE inhibitors and ARBs. Incorrect Answers: Answers 1-4: The side effect profiles of these medications are not consistent with those described in the question stem.
3.6
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