CC Jan 2016 Angiotensin-Converting Enzyme (ACE) Inhibitor Cough

echoecho's version from 2016-03-27 22:50


Question Answer
What type of cough is a known side effect of ACE inhibitors?dry, chronic cough
The incidence has been estimated to be between 5-35% of patients prescribed this class of medication, but a more recent review of randomized, controlled trials put the incidence closer to ____%3
The cough is considered to be a ____ effect of ACEI. The cough is _____ (not vs. is not) dose-dependent. The cough may occur days, weeks or even months after _____ of therapy?1) class 2) is not 3) initiation
Cough seems to be more common in what 4 patient types?1) those treated for heart failure 2) in women 3) in the elderly 4) in nonsmokers
There appears to be an ethnic and racial difference in the incidence. Give an example?East Asians are at highest risk and AA are at lower risk
What is the etiology of ACEI associated cough?unknown
What is the proposed etiology of ACEI associated cough?1)the accumulation of bradykinin (due to the inhibition of ACE) 2) activation of the arachidonic acid pathyway by ACE inhibition
What tratment has been anecdotally reported to improve ACEI associated cough, but their use has not been evaluated in large-scale studies?NSAIDs
If NSAIDS are given with ACEI, what is there an increased risk of?1) acute kidney injury 2) hyperkalemia
Is there evidence of a genetic basis for predisposition to ACEI cough?yes
The majority of patients with ACEI associated cough who are placed on what class of drugs do not subsequently develop a cough/ARB (angiotensin-receptor blockers)
*** In 2006, the American College of Chest Physicians (ACCP) made what 3 recommendations concerning ACEI associated cough?1) Patients with a chronic cough (i.e. cough lasting > 3 months) currently taking an ACEI should stop the ACEI regardless of the length of time they have been on the medication. If the cough resolves in 1-4 weeks, the chronic cough is likely due to the ACE inhibitor. In a small percentage of patients, the cough may take up to 3 months to resolve 2) the only effective treatment for ACEI cough is discontinuation of the ACEI. There is no compelling evidence to support the use of any medicaitons to alleviate ACE inhibitor associated cough 3) for patients with ACE inhibitor-assocaited cough who have a compelling indication for blockage of reanl angiotensin system (i.e.. heart failure) an ARB should should be prescribed
*** SUMMARY = The incidence of ACEI cough is _________ %?3
*** SUMMARY = Cough is more common in what 2 patient groups? Which ethnic group is at lower risk?1) East Asians and women 2) AA
*** SUMMARY = The only effective treatment for ACEI cough is what?discontinuation of the medication