Cough and Hyperkalemia are the side effects of?

NIMHANS Nursing Officer - 2021

Pharmacology

Easy

Appeared in: NIMHANS Nursing Officer - 2021

Explanation

ACE inhibitors block the enzyme that breaks down bradykinin, leading to its accumulation in the lungs, which causes a characteristic dry, persistent cough.
These drugs also inhibit the production of angiotensin II, which in turn reduces aldosterone secretion.
Reduced aldosterone causes the kidneys to excrete sodium and water but retain potassium, leading to an increased risk of hyperkalemia (high potassium levels).

Option B: Calcium channel blockers work by relaxing blood vessels. Their main side effects include peripheral edema (swelling in the ankles), headache, flushing, and constipation.
Option C: Potassium channel blockers, such as amiodarone, are primarily used as antiarrhythmics. Their side effect profile is complex and includes potential thyroid, lung, and liver toxicity, but not typically the combination of cough and hyperkalemia.
Option D: Protease inhibitors are antiretroviral drugs used to treat HIV. Their side effects are mainly metabolic, including hyperglycemia, hyperlipidemia (high cholesterol and triglycerides), and lipodystrophy (abnormal fat distribution).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacology: Side Effects of Cardiovascular Drugs as background academic context rather than a clinical decision trigger.
Nurses must monitor serum potassium and creatinine levels at baseline and within 1-2 weeks of starting an ACE inhibitor or changing the dose, as hyperkalemia can cause life-threatening cardiac arrhythmias.
Patient education is critical. The nurse should inform the patient about the possibility of a dry cough and instruct them to report it if it becomes bothersome, as the medication may need to be changed.
What if the patient cannot tolerate the cough? If a patient develops an intolerable dry cough from an ACE inhibitor, the provider will likely switch them to an Angiotensin II Receptor Blocker (ARB). ARBs work further down the RAAS pathway and do not affect bradykinin levels, thus avoiding this side effect while providing similar cardiovascular benefits.

How to Approach the Question

First, identify the key terms in the question stem: the two specific side effects are 'Cough' and 'Hyperkalemia'.
Next, review the options provided, which are different classes of medications.
Systematically recall or deduce the primary side effect profile for each drug class.
Recognize that a dry, persistent cough is a hallmark, and somewhat unique, side effect of ACE inhibitors due to bradykinin accumulation.
Connect the drug's mechanism (inhibition of the renin-angiotensin-aldosterone system) to the electrolyte imbalance. Reduced aldosterone leads to potassium retention, hence hyperkalemia.
Confirm that this specific combination of side effects points directly to ACE inhibitors over the other classes.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 38-40, 70-72

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 33-35