Paper I — 2014 September (Supplementary) (2010 Scheme) — Q5

Paper I

2014 September (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Ramipril

Q53 marksShort Notes★✓

Answer

Ramipril is an ACE inhibitor.

Mechanism of action

• Inhibits angiotensin-converting enzyme, blocking conversion of angiotensin I to angiotensin II
• Reduces vasoconstriction (↓afterload) and aldosterone secretion (↓preload/Na⁺-water retention)
• Also prevents breakdown of bradykinin (a vasodilator), contributing to both its efficacy and its characteristic dry cough side effect

Uses

• Hypertension
• Congestive cardiac failure (improves survival)
• Post-myocardial infarction (reduces remodelling, improves survival)
• Diabetic nephropathy (renoprotective — reduces proteinuria)

Adverse effects

• Dry, persistent cough (bradykinin-mediated)
• Hyperkalaemia
• First-dose hypotension
• Angioedema (rare but serious)
• Acute renal failure in bilateral renal artery stenosis
• Teratogenic — contraindicated in pregnancy

Related Concepts

1. 1Antihypertensives

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