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리μλ Έν릴μ **μμ§μ€ν μ μ ν ν¨μ(ACE) μ΅μ μ **λ‘, μμνμμλ μ£Όλ‘ **μΈνμ± μ¬λΆμ (CHF)** λ° **μ μ κ³ νμ** κ΄λ¦¬λ₯Ό μν νκ΄ νμ₯μ λ‘ μ¬μ©λ©λλ€. μ£Όμ μμ νΉμ§: * **μ§μ νμ±**: μλ λΌν릴과 λ¬λ¦¬ 리μλ Έν릴μ μ ꡬμ½λ¬Ό(prodrug)μ΄ μλλ©° νμ±νλκΈ° μν΄ κ°μ μ체μ νμ νμλ‘ νμ§ μμ΅λλ€. μ΄λ μ¬κ°ν κ° κΈ°λ₯ μ₯μ κ° λλ°λ νμμκ² μ 리ν μ μμ΅λλ€. * **1μΌ 1ν ν¬μ¬**: λ€λ₯Έ μΌλΆ ACE μ΅μ μ μ λΉν΄ μμ© μκ°μ΄ κΈΈμ΄ λ§μ νμμκ² νΈλ¦¬ν 1μΌ 1ν ν¬μ¬κ° κ°λ₯ν©λλ€. * **μ μ₯ 보νΈ**: λ§μ± μ μ₯ μ§ν(CKD) λλ λ¨λ°±μμ€μ± μ λ³μ¦ νμμμ λ¨λ°±λ¨λ₯Ό μ€μ΄κ³ μ μ₯ κΈ°λ₯μ 보쑴νλ λ° μμ£Ό μ¬μ©λ©λλ€. * **νμνμ μ΄μ **: μ΄ λ§μ΄ μ ν, ννκ΄ μ ν λ° νλͺ¨μΈνκ΄ μκΈ°μμ κ°μμν€λ λμμ μ¬λ°μΆλκ³Ό μ΄λ λ΄μ±μ μ¦κ°μν΅λλ€. > **μμ ν**: μμνμμλ μλ λΌν릴과 λ² λμ νλ¦΄μ΄ λ μΌλ°μ μΌλ‘ μ¬μ©λκ³ κ΄λ²μνκ² μ°κ΅¬λμμ§λ§, 리μλ Έν릴μ νΉν 1μΌ 1ν ν¬μ¬λ₯Ό μ νΈν λ μ€ν κ°λ₯νκ³ μ’ μ’ λ μ λ ΄ν λμμ΄ λ μ μμ΅λλ€.
μμ© κΈ°μ : Lisinopril exerts its effects by interfering with the **Renin-Angiotensin-Aldosterone System (RAAS)**. * **Mechanism**: It competitively binds to and inhibits **angiotensin-converting enzyme (ACE)**. * **Pathway**: **Angiotensin I** β (blocked by ACE inhibition) β Decreased **Angiotensin II**. * **Physiological Effects**: 1. **Vasodilation**: Reduction in Angiotensin II (a potent vasoconstrictor) leads to decreased systemic vascular resistance (afterload) and venous tone (preload). 2. **Decreased Aldosterone**: Lower Angiotensin II levels reduce the secretion of **aldosterone** from the adrenal cortex β decreased sodium and water retention. 3. **Bradykinin Preservation**: ACE is also responsible for the breakdown of bradykinin. Inhibition leads to increased bradykinin levels, contributing to vasodilation (but also potentially causing a mild cough). * **Net Result**: Decreased blood pressure, reduced cardiac workload, and decreased proteinuria due to efferent arteriolar vasodilation in the glomerulus.
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- Adjunctive treatment of heart failure Β· 0.25-0.5 mg/kg Β· PO Β· q24h
- Adjunctive treatment of heart failure Β· 0.5 mg/kg Β· PO Β· q12-24h
- Adjunctive treatment of heart failure Β· 0.5 mg/kg Β· PO Β· q24h
- Adjunctive treatment of heart failure Β· 0.25-0.5 mg/kg Β· PO Β· q24h Β· Highest recommended doses should be used unless not tolerated by patient.
μ©λμ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μ°Έκ³ μλ£μ λλ€. νμ μ΅μ λΌλ²¨κ³Ό κ°λ³ νμμ λν΄ νμΈνμμμ€.
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- Known hypersensitivity to ACE inhibitors
- Pregnancy (especially 2nd and 3rd trimesters)
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- Anorexia
- Vomiting
- Diarrhea
- Lethargy or weakness
- Hypotension
- Renal dysfunction (azotemia)
- Hyperkalemia
- Cough (rare in animals compared to humans)
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- Antidiabetic Agents (insulin, oral agents) Β· Possible increased risk for hypoglycemia; enhanced monitoring recommended.
- Diuretics (e.g., furosemide, hydrochlorothiazide) Β· Potential for increased hypotensive effects; reducing furosemide doses (by 25-50%) is often recommended when initiating ACE inhibitors in CHF.
- Potassium-Sparing Diuretics (e.g., spironolactone, triamterene) Β· Increased risk of hyperkalemia; enhanced monitoring of serum potassium recommended.
- Other Hypotensive Agents Β· Potential for additive hypotensive effects.
- Lithium Β· Increased serum lithium levels possible; increased monitoring required.
- NSAIDs Β· May reduce the anti-hypertensive or positive hemodynamic effects of lisinopril; may increase the risk of acute renal failure.
- Potassium Supplements Β· Increased risk for hyperkalemia.
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- Clinical signs of CHF (respiratory rate/effort, exercise tolerance)
- Blood pressure (especially upon initiation or dose changes)
- Serum electrolytes (specifically potassium)
- Renal panel (BUN, Creatinine)
- Urine protein
- Periodic CBC with differential
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The primary concern with overdosage is **hypotension**. * **Toxicity Thresholds**: In dogs, the lowest dosage documented to cause hypotension is 27 mg/kg. Dosages below 20 mg/kg generally cause only mild signs (vomiting, lethargy). In cats, hypotension was noted at 4.9 mg/kg in a single case. In birds, mild somnolence occurred at 41 mg/kg. * **Clinical Signs**: Hypotension, lethargy, vomiting, and tachycardia. * **Treatment**: Recent overdoses should be managed using gut-emptying protocols when warranted. Supportive treatment with **volume expansion using normal saline** is recommended to correct blood pressure. Due to the drug's long duration of action, prolonged monitoring and treatment may be required.
VetSheet μ½λ¬Ό λ νΌλ°μ€λ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μμ¬κ²°μ 보쑰 λꡬμ΄λ©°, μ λ¬Έμ νλ¨μ΄λ μ μ‘°μ¬μ μ΅μ λΌλ²¨μ λμ νμ§ μμ΅λλ€.