Switching from ACEI to ARNI – Cardiology MCQ – Answer

While switching over from an ACE inhibitor to ARNI, ARNI can be started — hours after ACEI: Correct answer: c) 36 hours Combination of ACEI (angiotensin converting enzyme inhibitor) and neprilysin inhibitor can lead to higher rates of angioedema as both can lead to accumulation of bradykinin [1]. Bradykinin is inactivated by angiotensin converting enzyme and neprilysin. Another drug omapatrilat which is an inhibitor of neprilysin, aminopeptidase P and ACE was tried for hypertension and heart failure. All the three enzymes are involved in inactivation of bradykinin [2]. The development of the drug was discontinued because of higher incidence of angioedema. Back to question Reference Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017 Aug 8;136(6):e137-e161. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 Sep 11;371(11):993-1004.
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs