A Patient, who is on anti-hypertensive drug, develops dry cough. Which of the following drug might be responsible for the condition:
Ref: KDT, 6th ed. pg. 484* Angiotensin converting enzyme normally helps in conversion of angiotensin I to angiotensin II, which acts as a vasoconstrictor in case of hypovolemia.* In addition to that, ACE also helps in breakdown of bradykinin.* When ACE inhibitors (captopril) are given, it inhibits ACE and in addition inhibits breakdown of bradykinin also, which leads to accumulation of bradykinin level in body.* This increased level of bradykinin presents with Dry cough, rashes, urticaria and angioedema.Other side effects of ACE inhibitorsContraindications of ACE (-)Safe alternative of ACE (-)HypotensionHyperkalemiaFetal growth retardationPregnancyBilateral Renal artery stenosisHyperkalemiaAngiotensin receptor blocker is a safe alternative in case of cough, angioedema.* Why ACEI is contraindicated in bilateral renal stenosis# Patients with B/L renal artery stenosis or patients with single kidney having renal artery stenosis will develop renal failure if treated with ACEI.# In stenosis there is reduced GFR, and body manage the adequate GFR by angiotensin II mediated efferent arteriole constriction to maintain the renal perfusion. In such patients, Inhibition of ACE can induce acute renal insufficiency.
Diuretics
ACE inhibitors
Calcium channel blockers
Beta blockers
C.V.S