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Pharmacologic Effects of “ACE Inhibitors” In Patients with Congestive


PharmacologicEffects of &quotACE Inhibitors” In Patients with Congestive HeartFailure and Nursing Implications


AngiotensinConverting Enzyme (ACE) inhibitors describe a new class ofanticongestive heart failure, as well as antihypertensive agents withwide acceptability among physicians and patients. Primarily,angiotensin converting enzyme inhibitor blocks the development ofangiotensin II in tissue and blood. The implication of theangiotensin converting enzyme inhibitor in the body of patients isthat it maintains the perfusion of the vital organs. Angiotensinconverting enzyme inhibitor enhances cardiac function through loweredsystematic vascular resistance, as well as lowered blood pressure.Although the drug has a series of side effects to the patients, thewide acceptability is based on the effectiveness of the drug inbringing down the cases of hypertension. Numerous studies have beenperformed on how to improve the drug and achieve high effectivenesswith minimum side effects. The initial ACE inhibitor that has anactive sulfhydryl group is the captopril. Notably, the side effectsof the ACE inhibitor on the patients include taste abnormalities,blood dyscrasias, skin rashes, oral ulcers and pruritus among others.This brief review examines the pharmacodynamics Pharmacodynamicproperties potential effects of these medications (ACE inhibitors) onthe patient. Further, the paper will examine the nursing implicationsthat are related to the administration of ACE inhibitors to patientswith congestive heart failure.

PharmacologicEffects of &quotACE Inhibitors” In Patients with Congestive HeartFailure and Nursing Implications

AngiotensinConverting enzyme inhibitor describes a pharmaceutical drug, which isused (primarily) for hypertension treatment. Hypertension, on theother hand, describes a medical situation where the blood pressure ofa patient becomes elevated to levels that threaten the lives ofpatients. Further, an ACE inhibitor is also used in the treatment ofcongestive heart failure. Both congestive heart failure andhypertension are two diseases that are closely related (Golan, 2011).Congestive heart failure affects patients whose cardiac muscles havestopped functioning&nbspas a result of limited blood flow to themuscles (cardiac). The muscles cease to work resulting to a heartfailure (D`Orléans-Juste, 2001). On the same note, hypertensionresults from the inelasticity of the arterial walls. The arteriesnarrow thus increasing the pressure of the blood that passes throughthe arteries. The ACE inhibitor drugs cause relaxation (dilation) ofthe blood vessels and this leads to lowered blood pressure (Strube,2013). ACE inhibitors impede the enzyme that the convert angiotensinthereby diminishing the blood vessels’ tension, as blood volume.Eventually, blood pressure is maintained at lower and optimal levels.


Thehelpful effects of ACE inhibitors in heart failure, as well ashypertension result from the suppression of the system of plasmarenin-angiotensin aldosterone. Renin describes an enzyme (endogenous)that is produced, by the kidneys (Golan, 2011). Once the endogenousenzyme is released into the circulation, it changes angiotensinogento angiotensin I. Angiotensin I is an inactive decapeptide thusharmless to the body of the patient. However, once angiotensin I isconverted to angiotensin II, the harmful effects are felt, by thepatient. Angiotensin II is a powerful vasoconstrictor, which isaccountable for elevated blood pressure and vasoconstriction. On thesame note, angiotensin II is also stimulated the glands (adrenal),which in turn secrete aldosterone (Strube, 2013). The introduction ofACE inhibitor drugs minimizes the plasma angiotensin II, and thisleads to a subsequent decrease in aldosterone secretion, as well asvasopressor activities. Notably, the decline in the aldosteronesecretion is not substantial and this may result to a slight increasein the concentrations of serum potassium (Golan, 2011). In the sameline of argument, fluid loss and sodium loss may also occur inpatients. The activity of plasma renin increases as a result oftermination negative effects of the angiotensin II on secretion ofrenin.

Theconverting enzyme has another function that involves the degradationof the powerful vasodepressive kinin peptide bradykinin tometabolites that are inactive. In this sense, the inhibition of ACEleads to an increased circulating activity, as well as an increasedsystem of local kallikrein-kinin, which activates the prostaglandinsystem thus contributing to peripheral vasodilation. There is apossibility the above mechanism has certain adverse reactions as theentire process is related to the hypotensive consequence ofinhibitors (ACE) (In Zipes, 2014).

Forpatients with hypertension, ACE inhibitors administration leads to adecline in blood pressure (standing) and supine pressure to a fairlysame extent. However, there is no compensatory escalation of theheart rate (Golan, 2011). The advantage is that, arterial resistance,peripheral, is declined with little or no change in cardiac output.Therefore, there is an elevated flow of blood while the rate ofglomerular filtration remains constant.

Imperatively,the administration of ACE inhibitors does not result to instantresults. In fact, the attainment of optimal blood pressure fall maytake more than one week of therapy depending with the conditions ofthe patient. The subsequent antihypertensive effects are sustainedthroughout the entire long-term therapy (Strube, 2013). Surprisingly,sudden withdrawal of therapy has not been associated with any suddenincrease in the pressure of blood, in patients. The insinuation ofthis position is that the blood pressure of patients remains fairlyconstant for some time long after the medication is ceased (In Zipes,2014).

Itis also worth noting that, low-renin hypertension patients benefitfrom ACE inhibitors as the inhibitors are also effective on patientswith such conditions. Studies and research on the area ofantihypertensive across races have proved that antihypertensivecommand their effects in all races. However, black patients, who arecharacterized with low renin, showed a slight variation from the restof the races. Black patients (hypertensive) recorded the lowestaverage with regards to ACE inhibitor (monotherapy) response (Strube,2013).

Inline with the pharmacodynamics properties of ACE inhibitors, it is ofvital significance to mention the hemodynamics of therapy (ACE) inheart failure patients. The effects are outcomes of bothvasodilatation, as well as arteriolar. In these cases, the venouscapacity is augmented as a consequence of systematic reduction ofvascular resistance. The eventual implication is that the pre andafter loads is minimized (Golan, 2011). Therefore, the consequencesare a decline in the filling pressure of the left ventricle and anupsurge in the cardiac output (2013Nurse`s Drug Handbook, 2013).The heart rate remains fairly constant, although there might be aslight decrease in the rate of the same. Clinically speaking, thesymptoms and signs of heart failure will progress and the capacity toengage in exercise will also elevate with time. Notably, the positiveeffects are realized in the course of a long-term treatment.


Asit was noted before, congestive heart failure describes a serioushealth problem, which involves the hearts inability to pumpsufficient blood to respond to the nutrients and oxygen demands ofthe body. Patients of heart failure are normally incapacitated by thecondition and in most cases bed ridden (Hale &amp Hovey, 2014). Thesignificance of the nurses implication with regard to heart failurepatients is intensified by the seriousness of the ailment to thepatients and significant others. Nurses perform extremely importanttasks to ensure that heart failure patients live lives with minimumpain and suffering (2013Nurse`s Drug Handbook, 2013).Evidently, nurses play a leading role in the care of heart failurepatients and proper medication for the same is central to therestoration of the health of the patients. Nurses poses exceptionalcommunication skills, as well as clinical skills, which come in handywhen dealing with patients (Miller, 2009). Furthermore, nurses workto establish helpful rapport and relationship with the patients thusare able to relate closely and at personal level with the patients.The same is extended to the family and friends of the patient asthey invest their resources and emotions in an attempt to make theirloved ones recover from congestive heart failure (Wilkes, 2013). Itis imperative to note that, nurses are the only caregivers who canmanage to deliver care to patients in numerous contexts and formsthroughout the entire course of the disease.

Withthis respect, nurses are obligated to obtain a comprehensive history,health history, which should include angioedema incidence, latestcardiac events, possible drug interactions, drug history, as well asallergies (Karch, et al, 2013). Notably, ACE inhibitors do not gowell with other drugs. Therefore, in the event that the patient wasunder different medication, the nurse should seek to know the exactmedication, as well as determine the possible interaction with theACE inhibitors. On the same note, patients that are allergic to drugsshould be approached with extreme care to avoid worsening thecondition of the patient. Accidental administration of ACE inhibitorsto allergic patients should be addressed with anti-allergic drugs,and the nurses should seek to establish alternative medication to thepatient.

Further,the nurse should obtain the vital signs and ECG baseline immediatelythe patient is brought to the hospital. The nurse should determinethe patients’ consciousness level, as well as perform aneurological status assessment (Karch, et al, 2013). It is a bit easyto communicate with conscious patients and determine their progress.However, most of the times nurses deal with unconscious patientsthus the nurses are required to employ their knowledge and soundtests to establish the exact condition of the patient (Wilkes, 2013).Therefore, obtaining the vital signs is central to the nursingimplications while dealing with heart failure patients under ACEinhibitors medication.

Laboratoryanalysis reports are extremely vital in making medication and caredecisions. Nurses should seek the consent of the patient to takeurine and blood samples for the purposes of analysis. Primarily, labreports can be used to establish possible side effects of ACEinhibitors on the body functioning of the patients (Hale &amp Hovey,2014). For instance, urine samples can give indications of possiblerenal disease in the patient thus facilitate timely intervention andmeasures.

Furthermore,nurses should seek to establish the conditions that surrounded theonset of the heart failure in patients. Imperatively, patients cansustain injuries during the heart failure by falling on the groundand perhaps breaking a limb. In the case of such injuries, the nurseshould organize for appropriate treatment and course of action.Nurses are also expected to determine the knowledge level of thepatient with regard to drug therapy. The duty of the nurses forpatients under ACE inhibitors is to provide the best possibleeducation and explanation with regard to the effectiveness of themedicine, as well as side effects. Patients should be made aware ofthe drugs that they are using and facilitated to make the best inputand contribution in the entire drug therapy intervention. Finally,nurses take charge of the patients’ nutrition intake to ensure thathis patient gets meals that are balanced in adequate quantities. ACEdrugs are as very strong and they require that patients maintains anadmirable nutritional levels

Itis also a requirement for nurses to prepare a treatment plan for thepatient, as well as establish the goals of the client and theanticipated outcomes. Among the expectations from the patient includea decline in both diastolic and systolic pressure (blood). Theoutcome is expected to be realized after a period of consistent ACEdrug therapy (Karch, et al, 2013). Further, the patient is expectedto retain normal levels of electrolyte during the entire therapy.Notably, a considerable rise or decline of electrolyte level could bea direct indication of renal disease or kidney failure (Hale &ampHovey, 2014). Therefore, any deviation from the normal serumelectrolyte level should be noted and addressed, without delay. Theclient is also expected to demonstrate substantial comprehension ofthe healing process, as well as the working of the drugs. Anypossible side effect should be known by the patient.

Thepaper holds that the nursing implications for patients under ACEmedication should be tailored to cover the entire medical and careneeds of the client. During the implementation of the therapy by thenurses, the nursing process should capture any incidence offirst-dose phenomenon, which is caused by the initial dose of ACEinhibitors (Karch, et al, 2013). Signs of profound hypotension can bedetected during the early stages of the drug therapy intervention. Insuch cases, nurses are obligated to reassure patients that thefeelings are common and that the feelings will disappear in thecourse of the intervention. On the same note, nurses should establishdirect communication channels with the client and encourage thepatients to report the slightest signs of faintness. Notably, asudden drop in the level of blood can result to instantaneous loss ofconsciousness. Nurses should be keen with the resting position ofpatients in bed to ensure that blood supply to the head is enhancedat all times.

Inconclusion, the implication of the angiotensin converting enzymeinhibitor in the body of patients is that it maintains the perfusionof the vital organs. Congestive heart failure affects patients whosecardiac muscles have stopped to operate as a result of limited bloodflow to the muscles. Angiotensin Converting enzyme inhibitordescribes a therapeutic drug, which is used (primarily) forhypertension treatment. The helpful effects of ACE inhibitors inheart failure, as well as hypertension result from the suppression ofthe system of plasma renin-angiotensin aldosterone. Angiotensin II isa powerful vasoconstrictor, which is accountable for elevated bloodpressure and vasoconstriction. The decline in the aldosteronesecretion is not substantial and this may result to a slight increasein the concentrations of serum potassium. Sudden withdrawal oftherapy has not been associated with any sudden increase in thepressure of blood, in patients. Nurses play a foremost role in thecare of heart failure patients and proper medication for the same iscentral to the restoration of the health of the patients. The volumestatus is concerned with the cardiac activity and the cardiac output.Nurses are obligated to obtain a comprehensive history, healthhistory, which should include angioedema incidence, latest cardiacevents, possible drug interactions, drug history, as well asallergies. The nurse should determine the patients’ consciousnesslevel, as well as perform a neurological status assessment.Obtainingthe vital signs is central to the nursing implications while dealingwith heart failure patients under ACE inhibitors medication.Labreports can be used to establish possible side effects of ACEinhibitors on the body functioning of the patients.Nursesare also expected to determine the knowledge level of the patientwith regard to drug therapy. Thepatient is expected to retain normal levels of electrolyte during theentire therapy. The nursing process should capture any incidence offirst-dose phenomenon, which is caused by the initial dose of ACEinhibitors. Nursesshould be keen with the resting position of patients in bed to ensurethat blood supply to the head is enhanced at all times.


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