Premium Essay


In: Social Issues

Submitted By bepanda2013
Words 2113
Pages 9
Drug notes

Cough ↑ bradykinin Hydrolysis Inactive metabolites

Siobhan Boyle
BSc (MedSci), MBChB, Foundation Doctor

Gerry McKay
BSc (Hons), FRCP, Consultant Physician

X Blocked
Ramiprilat ACE

Miles Fisher
MD, FRCP, Consultant Physician

Ramipril Liver

X Blocked
Angiotensin Renin Angiotensin I

↓ vasoconstriction

Glasgow Royal Infirmary, Glasgow, UK

Angiotensin II

Correspondence to: Professor Miles Fisher, Wards 3, 4 & 5, Glasgow Royal Infirmary, Glasgow G4 0SF, UK; email:

↓ salt + water retention ↓ blood pressure Kidneys
NOTES. Following oral ingestion and absorption of ramipril, it is hydrolysed in the liver to its active form ramiprilat that acts on the renin angiotensin aldosterone system (RAS). It competitively binds to angiotensin converting enzyme (ACE) to prevent the cleaving of angiotensin II from angiotensin I, directly inhibiting the actions of angiotensin II, a potent vasoconstrictor, thus exerting its haemodynamic effects. It also results in the accumulation of bradykinin a potent vasodilator, which is usually broken down by ACE, resulting in cough as a side effect for some patients.

Figure 1. Pharmacological action of ramipril

Introduction Angiotensin converting enzyme (ACE) inhibitors are used for the treatment of cardiovascular disease in people with diabetes. Ramipril is a second-generation ACE inhibitor, and is prescribed in patients with diabetes for several clinical indications including the management of hypertension, following myocardial infarction (MI), in chronic heart failure, in diabetic nephropathy and in patients with increased cardiovascular risk, where it has been shown to reduce the risk of death and cardiovascular events. Pharmacology Figure 1 outlines the pharmacological action of ramipril, a monoethyl ester prodrug. Following oral ingestion and…...

Similar Documents

Free Essay


...Phenobarbital | phenytoin sodium capsule | Dilantin | potassium chloride ER tablet | K-Dur 20MEQ | potassium chloride ER tablet | Klor-Con 10mEQ | potassium chloride ER tablet | Klor-Con M20 | pramipexole dihydrochloride tablets | Mirapex tablets | pravastatin | Pravachol | pravastatin tablet | Pravachol | prazosin capsule | prazosin capsule | prednisone | Deltasone | prednisone tablet | Prednisone tablet | prochlorperazine | Compazine | prochlorperazine tablet | Prochlorperazine tablet | propafenone hydrochloride | Rythmol | propranolol | Inderal | propranolol tablet | Inderal | propylthiouracil tablet | Propylthiouracil tablet | quetiapine fumarate | Seroquel | quinapril HCI | Accupril | ramipril | Altace | ramipril capsule | Altace | ranitidine | Zantac | risperidone | Risperdal | ropinirole hydrochloride | Requip tablets | rosuvastatin calcium | Crestor | sertraline HCI | Zoloft | simvastatin | Zocor | simvastatin tablets | Zocor | sitagliptin phosphate | Januvia | sotalol | Betapace | sotalol hcl | Betapace AF 120mg | sotalol hcl | Betapace AF 160mg | sotalol hcl | Betapace AF 80mg | spironolactone | Aldactone | sprintec tablet | Ortho-Cyclen | sucralfate | Carafate | sulfamethoxazole/trimethoprim DS tablet | Bactrim DS | sulfamethoxazole/trimethoprim DS tablet | Septra DS | sulfasalazine | Azulfidine | sulfasalazine, USP | Azulfidine EN-Tabs | sulindac | Clinoril | sumatriptan succinate |......

Words: 1073 - Pages: 5

Premium Essay

Cold Rolled Steel quality of products produced. In PharmEvo production is divided into 2 buildings: 1. Production (MB or Main Building) 2. Production (CB or Ceph. Building) 1. Production (Main Building): All the production carried out in this building except cephalosporin or WFI. Some of examples of the products which are manufacturing in this building are as follows:  ANEX (Naproxen Sodium) 275mg & 550mg tablet.  Bonedol (Alfacalcidol) 0.25, 0.5 & 1ug tablet.  BonGard (Alendronate Sodium) 10mg & 70mg tablet.  ORSLIM (Orlistat) 120mg capsule.  NISE (Nimisulide) 100mg tablet.  X-PLENDED (Rosuvastatin) 5, 10 & 20mg tablet.  Lowplet (Clopidogrel) 75mg tablet.  Lowplet Plus (Clopidogrel & Aspirin).  LIMITROL (Simvastatin) 10 & 20mg.  Ramipace (Ramipril) 1.25, 2.5, 5 & 10mg. 9 PREPARED BY MOOSA KAZIM 16-08-2012 2. Production (Ceph. Building): Only sensitive products i.e. cephalosporin and WFI which need extra care or sterile environment during their production are produced or manufacture in this building. Some of examples of the products which are manufacturing in this building are as follows:  EVOROX (Cefuroxime) 250mg tablets.  EVOROX (Cefuroxime) 125mg/5ml.  EVOROX (Cefuroxime) 250 & 750mg injection.  EvoTaxime (Cefotaxime) 250mg, 500mg & 1gm IM/IV Injections.  EVOFIX (Cefixime) 400mg Capsule.  EVOFIX (Cefixime) 100mg/5ml Suspension. GENERAL PRODUCTION PATTERN BEING FOLLOWED IN PRODUCTION IS AS FOLLOWS: WIP Mixing & Granulation Compression Or......

Words: 1689 - Pages: 7

Premium Essay

Heart Attack

...also stabilize the heart's electrical activity. Examples include metoprolol, propranolol, timolol, and atenolol. • ACE (Angiotensin-converting enzyme) inhibitors These drugs help ease the workload on the heart by opening up blood vessels and lowering blood pressure. Experts say ACE inhibitors also protect the heart from further damage. Patient will have a blood test to make sure their kidneys are working properly before starting on this type of medication. Then, about ten days after starting treatment, the patient will undergo further tests to make sure his/her kidneys are still working fine. Over a period of about 3 weeks the patient's dose is gradually increased. Examples of ACE inhibitors include lisinopril, perindopril and ramipril. • Statins Statins make the liver produce less cholesterol, consequently lowering blood cholesterol levels. Patients with high cholesterol levels have a higher risk of developing fatty deposits in their blood vessels, especially their arteries. Statins include atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin. • Surgery after a heart attack If the patient's heart has been severely damaged he/she may need to be operated on. The most common surgeries performed on heart attack patients are: o Angioplasty This can be performed either after the heart attack, or in some specialist units during the attack. Angioplasty opens up the coronary artery. A small wire goes up the artery from the......

Words: 4341 - Pages: 18

Premium Essay

Stroke Case Study

... She lives on Christian Island and needs to take a ferry to get to the nearest hospital. She has a history of atrial fibrillation and TIA’s, and the patient also smokes 2 packs of cigarettes a day. She’s on ASA, digoxin, ramipril, metoprolol. She has an allergy to penicillin and bee stings. The patient shows a-fib on the monitor and vital signs and GCS are normal. Pupils are PEARL at 3mm. Patient name: Myrtle Bellamee Birthday: 1938/01/10 Health card number: 1284569735 VR Treatment with the Ontario Stroke Strategy The Ontario Stroke System (OSS) is a comprehensive and integrated approach that aims to decrease the incidence of a stroke and improve patient care and outcomes for those who’ve experienced a stroke. The treatment plan that Mrs Myrtle Bellamee would have been on before this incident would be a very common strategy due to her history of cerebrovascular accident (CVA) or a stroke, atrial fibrillation and her previous transient ischemic attack (TIA). She would have been on a low dose antiplatelet drug, which she currently is; she is taking acetylsalicylic acid (ASA). She would also be place on blood pressure medications to control her hearts pressure; like the similar drug she is taking, metoprolol and ramipril. To control her irregular heart of atrial fibrillation she would be prescribed digoxin which she was also on. The doctor could also have prescribed her some cholesterol lowering medication depending on her diet and weight...

Words: 1513 - Pages: 7

Premium Essay

Complex Needs

...Investigations were ordered by the nursing and medical team. Eddie had a chest x-ray, which confirmed pulmonary oedema and an echocardiogram to confirm LVF. The nurse inserted a cannula to take blood for testing of the urea and electrolyte levels, cardiac enzymes, liver function, creatinine, full blood count, thyroid function, lipid profile and glucose levels. Arterial blood gases were taken, a urinary catheter was inserted to monitor his fluid balance and perform urinalysis to rule out infection (Johnson & Rawlings-Anderson, 2007; NICE, 2010). Pharmacologically, Eddie was being treated for COPD with salbutamol 100mcg as required to assist with bronchodilation and tiotropium bromide 18mcg once daily. His heart failure and MI was treated with ramipril 2.5mg twice daily, which is an angiotensin-converting enzyme (ACE) inhibitor to reduce blood pressure. He also took furosemide 20mg daily, a diuretic to remove the build up of fluid in the lungs, bisoprolol 1.25mg daily, a beta blocker to reduce the heart rate, simvastatin 20mg daily to reduce cholesterol, aspirin and clopidogrel 75mg daily, both are anti-platelets to prevent the blood from clotting (BNF, 2013; Johnson & Rawlings-Anderson, 2007; NICE, 2010 [CG 101, 108]). Eddie was given another 20mg of furosemide in an attempt to clear the fluid from his lungs, he was also given a salbutamol nebuliser of 2.5mg to ensure bronchodilation and the nurse helped him into an upright position supported with pillows (Peate & Dutton,......

Words: 3716 - Pages: 15

Premium Essay


...parameters (help); Check date values in: |date= (help) 8.Jump up ^ Johnson, David (2011-05-02). "Chapter 4: CKD Screening and Management: Overview". In Daugirdas, John. Handbook of Chronic Kidney Disease Management. Lippincott Williams and Wilkins. pp. 32–43. ISBN 1-58255-893-0. 9.Jump up ^ Chauhan V, Vaid M (November 2009). "Dyslipidemia in chronic kidney disease: managing a high-risk combination". Postgrad Med 121 (6): 54–61. doi:10.3810/pgm.2009.11.2077. PMID 19940417. Cite uses deprecated parameters (help) 10.Jump up ^ Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G (October 1998). "Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy". Lancet 352 (9136): 1252–6. doi:10.1016/S0140-6736(98)04433-X. PMID 9788454. Cite uses deprecated parameters (help) 11.Jump up ^ Ruggenenti P, Perna A, Gherardi G et al. (July 1999). "Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria". Lancet 354 (9176): 359–64. doi:10.1016/S0140-6736(98)10363-X. PMID 10437863. Cite uses deprecated parameters (help) 12.Jump up ^ Lewis EJ, Hunsicker LG, Clarke WR et al. (2001). "Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes". N Engl J Med 345 (12): 851–60. doi:10.1056/NEJMoa011303. PMID......

Words: 5130 - Pages: 21

Free Essay

Top 200 Drugs for 2009 with Classification.Docx

...antagonist | prostate enlargement | not controlled | PO | quetiapine | Seroquel | antipsychotic | schizophrenia/bipolar | not controlled | PO | clonidine | catapress, catapress TTS | alpha receptor agonist | hypertension | not controlled | PO, topical patch | mometasone nasal spray | Nasonex | corticosteriod | allergic rhinitis/nasal polyps | not controlled | inhalation | fenofibrate | Tricor | cholesterol lowering | hypertriglyceridemia | not controlled | PO | insulin glargine | Lantus | insulin | diabetes | not controlled | SQ | sildenafil | Viagra | phosphodiesterase inhibitor | erectile dysfunction | not controlled | PO | olanzeprine | Zyprexa | antipsychotic | schizophrenia/bipolar/agitation | not controlled | PO, IM | ramipril | Altace | ACE inhibitor | hypertension/CHF/post-M.I. | not controlled | PO | promethazine | Phenergan | Anti_nausea/antiemetic | nausea/vometting/allergy/motion sickness | not controlled | PO, IM, IV, suppository | carvedilol | Coreg, Coreg CR | beta receptor blocker (B1+B2) | hypertension/CHF/post-M.I. | not controlled | PO | isosorbide mononitrate | IMdur, Ismo, Monoket | nitrate vasodilator | angina prophylaxis | not controlled | PO | clindamycin | Cleocin | antimicrobial | infection | not controlled | PO, IM, IV, topical | pravastatin | Pravachol | HMG-CoA reductase inhibitor | hpyercholerolemia/hypertriglyceridemia | not controlled | PO | amphetamine+dextroamphetamine | Adderall, Adderal XR | stimulants | ADHD |......

Words: 2310 - Pages: 10

Free Essay


...Contains Nonbinding Recommendations Guidance on Ramipril This guidance represents the Food and Drug Administration's (FDA's) current thinking on this topic. It does not create or confer any rights for or on any person and does not operate to bind FDA or the public. You can use an alternative approach if the approach satisfies the requirements of the applicable statutes and regulations. If you want to discuss an alternative approach, contact the Office of Generic Drugs. Active ingredient: Form/Route: Recommended studies: 1. Ramipril Capsule/ Oral 2 studies Type of study: Fasting Design: Single-dose, two-treatment, two-period crossover in-vivo Strength: 10 mg Subjects: Normal healthy males and females, general population Additional Comments: Female subjects enrolled in the BE studies should not be pregnant, and if applicable, should practice abstention or contraception during the study. ______________________________________________________________________________ 2. Type of study: Fed Design: Single-dose, two-treatment, two-period crossover in-vivo Strength: 10 mg Subjects: Normal healthy males and females, general population Additional comments: Please see comment above. ______________________________________________________________________________ Analytes to measure (in appropriate biological fluid): Ramipril and the metabolite, ramiprilat in plasma. Bioequivalence based on (90% CI): Ramipril. If ramipril can be reliably measured, a confidence interval approach for...

Words: 315 - Pages: 2

Premium Essay

Heart Failure

... DRUGS Sign (2007) state that there are 3 main goals of pharmacological management in heart failure, these being relieving symptoms, avoiding hospital admissions and to increase life expectancy. John was taking Candesartain 16 mg daily. This is a Angiostensin receptor blocker (ARB’s). This drug is one of two ARB’s licensed for use in heart failure in the UK. Candesartain is a neurohormonal antagonist and acts in the same way as an ACE inhibitor; by inhabiting angiotensin I Convertina to angiotensin II. When discussing his medication, I asked John about his Candesartan as I was wondering why he was taking this and not an ACE inhibitor. John confirmed what I was thinking, he confirmed that he was originally commenced on Ramipril, but before he could reach the maximum dose it was charged to ________ as he could not tolerate the cough, one of the drugs side effects. ARB’s are normally well tolerated and side effects are rare, but John’s Hypertension will be closely monitored along with his renal function as these can be effected. DIURETICS Diuretics are needed in most patients with symptomatic heart failure, and are considered essential for relief of odema and breathlessness. They work by increased urine production in the kidney by removing water and sodium from around the body. John is taking Bumetonide 2.5 mg daily at the moment, hoop diuretics like this are _______ commonly used as they are more powerful than Thiaziden diuretics. John’s odema is...

Words: 2206 - Pages: 9

Free Essay

Hypertension Raas Tcm

...water reuptake in the body and therefore decrease fluids in the blood stream and thus lowering blood pressure. Medicines Due to the importance of the renin-angiotensin-aldosterone system in regulating blood pressure, many medical drugs and research have been developed to interrupt different steps in this system to lower blood pressure. These drugs are the main ways to control hypertension, heart failure, kidney failure, and harmful effects of diabetes. Angiotensin-converting-enzyme inhibitor (ACE inhibitor) is a pharmaceutical drug used primarily for the treatment of hypertension, congestive heart failure, or renal complications due to diabetes. Common prescribe ACE inhibitors include perindopril, captopril, enalapril, Lisinopril, and ramipril. This group of drugs causes dilatation of blood vessels, which results in lower blood pressure. Additionally, ACE inhibitors stops the formation of angiotensin II by inhibiting the angiotensin-converting enzyme, thereby, decreasing the tension in the blood vessels and lowering the blood volume, thus lowering blood pressure. Despite the effects of ACE inhibitors, often times, these drugs are coupled with other drugs such as beta blockers and calcium channel blockers in combating hypertension and congestive heart failure. Angiotensin receptor blockers (ARBs) or angiotensin II receptor antagonists is a pharmaceutical drug similar in the function of ACE inhibitors in treating hypertension, congestive heart failure, or renal......

Words: 952 - Pages: 4

Free Essay


...effect the outcome such as age, sex, social class. 7. Aside from the experimental intervention, were the groups treated equally? Tip: for example, were they reviewed at the same time intervals. B. What are the results? 8. How large was the treatment effect? 9. How precise was the estimate of the treatment effect? Tip: look for the confidence limits. C. Will the results help locally? 10. Can the results be applied to the local population? Tip: consider whether the patients covered by the trial are likely to be very different from your population. 11. Were all clinically important outcomes considered? 12. Are the benefits worth the harms and costs? © Critical Appraisal Skills Programme (HOPE) study,4 which investigates the effects of ramipril on cardiovascular events in high-risk patients. A brief critical appraisal of the methods of the HOPE paper (addressed by questions 1–7) is included to demonstrate how critical appraisal tools can be used. How should these questions be used? Questions one and two are screening questions, and any research paper should give the reader the answers to these two questions on the first page, ideally in the abstract. If it is not possible to answer ‘yes’ to both these 3 What is critical appraisal questions, we would normally not continue to read the paper as it is unlikely to be helpful. All questions in sections A and C should be answered with either ‘yes’, ‘no’ or ‘can’t tell’, which should be justified with evidence from the......

Words: 4659 - Pages: 19

Premium Essay

Wthics with Hyperstation

...the assessment, by doing this the nurse will be able to establish the priorities for the care to the individual. Taking the patients history is arguable one of the most important aspects of assessment, it is important that the nurse gains the history from the patient using a systematic, sensitive and professional manner (Nursing standards 2007). In a holistic nursing assessment, it is critical that the appropriate information is collected; a broad range of information is gathered to be able to plan a suitable care plan for individuals. On arrival to the unit the patient appeared calm and appeared to understand what the procedure was that was going to be performed in the unit. The patient suffered from hypertension for this she was taking Ramipril. This controlled her hypertension however; her blood pressure would be closely monitored throughout her time within the unit. During the pre-assessment I was keen to make sure that she fully understood the procedure, and the possible complications and risks involved in this procedure. As midazolam would be used during the procedure it was essential that there was a responsible adult to collect her from the unit and that there was someone to stay for 24 hours with her post sedation this is routine for every patient. Also following sedation there are a number of daily tasks that as with all patients having this procedure should not be performed such as operate machinery and drive. It is imperative that I and the nursing staff feel......

Words: 2335 - Pages: 10

Premium Essay

B Blocker

...symptoms of insulin-induced hypoglycemia • Heart block may occur with nondihydropyridine CCB’s Beta Blockers • Drug interactions (cont’d) – Effect on other drugs • Sympathomimetics cause unopposed alphaadrenoreceptor-mediated vasoconstriction • Beta-blockers increase angina-inducing potential of cocaine Beta Blockers • Monitoring parameters – Blood pressure – Heart rate – Side effects hard disk\course\728-721\htn.ppt 17 ACE Inhibitors • JNC VI recommends considering use in the following indications unless contraindicated – Type 1 Diabetes with proteinuria – CHF – MI with systolic dysfunction/LVH ACE Inhibitors • Examples – – – – – – Benazepril Captopril Enalapril Fosinopril Lisinopril Moexipril – – – – Quinapril Ramipril Trandolapril Combinations • With diuretics • With CCBAs ACE Inhibitors • Dosing of ACE Inhibitors – Please see Appendix III (table 7 and 8 from JNC VI) hard disk\course\728-721\htn.ppt 18 ACE Inhibitors • Possible side effects of ACE Inhibitors – Cough, hyperkalemia, hypotension, metallic or loss of taste, rash, acute renal failure in patients with renal artery stenosis, rarely: neutropenia and angioedema ACE Inhibitors • Special Considerations and Precautions – Bilateral artery stenosis/renal vascular disease – Pregnancy – May reduce GFR in the presence of renal impairment ACE Inhibitors • Drug Interactions – Increase efficacy of ACE Inhibitors • Chlorpromazine, clozapine – Decrease efficacy of ACE Inhibitors......

Words: 3107 - Pages: 13

Premium Essay

Endocrine System

...anxiety. She was also negative for restless leg syndrome and respiratory disturbances. After hiring a full time secretary at work to ease work-related stress, she was advised to use the extra time to exercise and spend time on her favorite hobby. She was also advised to decrease caffeine intake, avoid going to bed so late, and rather than working, do some light reading when unable to sleep. (6) In another case, a 39 year old man was referred to an endocrine clinic with a 2-year history of hypertension and episodic flushing. He has a long history of loud snoring and excessive daytime sleepiness. He denied use of recreational drugs, anabolic steroids, or antipsychotics with no family history of endocrine disorders. He however was taking Ramipril daily, and atenolol and intramuscular testosterone every 4 weeks. A physical examination showed that he was obese with a high blood pressure of 168/105 mmHg. He also had elevated urinary noradrenaline levels. 6 months of overnight continuous positive airway pressure therapy, his urinary noradrenaline levels were back to normal, BP was better controlled and there was no more episodic flushing. (4) Two common sleep disorders are sleep apnea and insomnia. It is usually diagnosed based on medical/family history, a physical exam, and sleep study results. Medical history include knowledge of how much sleep the individual is getting each night and how alert and rested they feel in the morning. It also includes how often and how loudly......

Words: 1055 - Pages: 5

Free Essay


...Paxil Pedvax HIB Pentasa Pepcid Pepcid RPD Permax Persantine Phazyme Phoslo Pindolol (Novapharm) Pitocin Plaquenil Plavix Plendil Pletal Polibar Liquid-may contain gluten Pneumovax 23 Ponstel Potassium Chloride (Andrx) Pravachol Prazosin (Mylan) Prednisone (Mutual, Roxane, West-Ward) Premarin Prempro Prevacid (all forms) Prilosec-all forms Prinivil Prinzide Pristiq-contains wheat derivative Pro-Banthine Procanbid Proctocort Promethazine (Breckenridge, Watson) Propecia Propulcid Proscar Protonix Provera Provigil-The company states that the outer coating could come from a wheat source or a non-wheat source so caution is advised when taking the product Prozac Prozac Weekly Purinethol Questran/Questran Lite Quinaglute Quinapril (Greenstone) Ramipril (Lupin)-all strengths are GF Ranitidine (Geneva,Novapharm) Ready-Cat-2 Vanilla Smoothie-may contain gluten Ready-Cat-2-Smoothie-all other flavors are GF Recombivax Regitin Reglan Regranex Gel Relpax Remeron Renagel Requip Restoril Retrovir Revatio Rifaxamin Rilutek Risperdal Ritalin (all strengths) Ritalin LA Ritalin SR Rolaids Rowasa Saluron Salutensin Sandimmune Sandoglobulin Sandostatin Sansert Selegiline (Novapharm) Selzentry Ser-Ap-Es Serentil Seroquel Sertraline (Greenstone) Serzone Silvadene Simulect Simvastatin (Ranbaxy, Teva) Sinemet Sinemet CR Skelaxin Slow-Mag Sonata Sorbitrate Spironolactone (Greenstone) Spironolactone.Hydrochlorothiazide (Greenstone) Strattera (all strengths) Sular Sulfasalzine (Greenstone)......

Words: 2427 - Pages: 10