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Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
NICE heart failure guidelines (2004) give advice about ACE inhibitor usage. It is important to start at a low dose (though high dose may be necessary in some cases) and titrate up slowly – doubling the dose no sooner than 2 weeks after starting. The dose should be titrated to the maximum tolerated or target dose, for example, 10mg ramipril. The electrolytes and renal function should be checked with initiation of the medication and with every increase in dose.
Hypertension and pre-eclampsia
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
The angiotensin-converting enzyme (ACE) inhibitors (e.g. ramipril, enalapril) should not be used in pregnancy because they are teratogenic, increasing the risk of cardiovascular and neurological malformations, when used in the first trimester. Use later in pregnancy may cause oligohydramnios, renal failure and hypotension in the fetus. Their use has been associated with decreased skull ossification, hypocalvaria and renal tubular dysgenesis, and there is also a risk of intrauterine death. Any woman on maintenance antihypertensive therapy with an ACE inhibitor should discontinue this prior to pregnancy (and if necessary switch to an alternative suitable for pregnancy such as amlodipine).
Cardiovascular Drugs
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: Ramipril is contraindicated during the 2nd and 3rd Trimesters because the pregnancy experience in humans showed a profound potentiality of teratogenicity and severe fetal toxicity associated with its use during this period.
Discovering hidden patterns among medicines prescribed to patients using Association Rule Mining Technique
Published in International Journal of Healthcare Management, 2023
Using the Apriori approach, we discovered association rules among prescribed medicines. This widely used data mining tool identifies patterns in items or events [35]. We conducted the study to identify any hidden relationships between medications prescribed to patients hospitalized to a multispecialty hospital. Our study reported a high proportion of medicine combinations prescribed to patients by the physicians and dispensed by the pharmacists as a part of the treatment plan, as indicated in the recent study by Xi et al. [36]. Our study reported a high proportion of medicine combinations due to multi-morbidities among patients admitted to the hospital. One of the retrieved rules infers that physicians prescribe 53.25% of times the medicines Ramipril 5MG and Leuprolide 22.5 MG INJ together. The medicine Ramipril 5MG is used to treat high blood pressure, heart failure, and diabetic renal disease, and Leuprolide 22.5 MG INJ is used to treat endometriosis and uterine fibroids. This indicates multi-morbidities among patients admitted to the hospital. The result aligns with the study by Held et al. [32] where they suggested that associations among medicines may occur as patients with multiple diseases (multi-morbidity) are prescribed with medicines from single disease clinical guidelines resulting in complex multiple medicine regimes. For example, if patients with heart disease suffer from diabetes and hypertension, then the demand for diabetes and hypertension medicines may depend on the demand for cardiovascular medicines.
Angiotensin converting enzyme inhibitor potentiates the hypoglycaemic effect of NG-nitro-L-arginine methyl ester (L-NAME) in rats
Published in Archives of Physiology and Biochemistry, 2022
Esther Oluwasola Aluko, Victor Udo Nna, Adesoji Adedipe Fasanmade
The present study observed a significant increase in blood pressure in L-NAME treated rats at the eighth week and at the end of the study, consistent with documented data (Nyadjeu et al.2013, Salami et al.2017). The effect of L-NAME on blood pressure increases with time, as this study observed that the blood pressure recorded at the end of the study was significantly higher than that recorded at the eighth week. L-NAME has been reported to have dose and time dependent effect on blood pressure (Arnal et al. 1992, Rodriguez-Gomez et al. 2003). Ramipril effectively restored the blood pressure of the hypertensive group towards normal, despite being co-administered with L-NAME. ACE inhibitor has been demonstrated to assuage L-NAME hypertension (Linz et al. 1995, Herman and Bhimji 2017). ACE catalyses the conversion of angiotensin I to angiotensin II and has also been reported to cause the deactivation of kallikrein–kinin system which is known to stimulate the production of NO (Mombouli and Vanhoutte 1995), and prostaglandin release (Mombouli et al. 1992). Thus, ACE inhibitor augments NO production besides it inhibitory effect on angiotensin II production, and these consequently decrease blood pressure.
The D allele of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is associated with worse functional outcome of ischaemic stroke
Published in International Journal of Neuroscience, 2018
Rusdy Ghazali Malueka, Ery Kus Dwianingsih, Sri Sutarni, Rheza Gandi Bawono, Halwan Fuad Bayuangga, Abdul Gofir, Ismail Setyopranoto
The above explanation is supported indirectly by studies showing that patients taking ACEI or ARB prior to the occurrence of ischaemic stroke had milder strokes and smaller magnetic resonance imaging lesion volume than patients who did not take ACEI before stroke [8]. A study by Bosch et al. [9] showed that the use of ramipril before stroke decreased the incidence of cognitive impairment, motor weakness, speech impairment and swallowing disorders compared to placebo. Their study also showed that fewer patients in the ramipril group had a fatal stroke compared to the placebo group [9]. Another study of stroke patients in Malaysia showed that the use of ACEI prior to stroke was associated with better functional outcomes defined as BI ≥ 75 at hospital discharge [22]. A study by Fuentes et al. [23] suggested that pre-stroke treatment with ARB is associated with reduced stroke severity and with better outcomes compared with other antihypertensive drugs. All these results indicated that ACE and angiotensin II play an important role in determining the stroke severity and outcome.