Paper I
Question
Enalapril
Answer
Enalapril is an ACE inhibitor (a prodrug, converted to its active metabolite enalaprilat in the liver).
MOA: enalapril → blocks angiotensin-converting enzyme → ↓angiotensin II formation → reduced vasoconstriction and aldosterone secretion → ↓peripheral resistance and ↓sodium/water retention; also reduces bradykinin breakdown.
Uses: hypertension, heart failure (mortality benefit), diabetic nephropathy (renoprotective), post-myocardial infarction.
Adverse effects: dry cough (bradykinin accumulation), hyperkalemia, first-dose hypotension, angioedema, teratogenicity (contraindicated in pregnancy), acute renal failure in bilateral renal artery stenosis.

