A LITTLE LIGHTBULB MOMENT
Cardiovascular and renal pharmacology
ACE inhibitors: block angiotensin II formation
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The sneezing cap makes the hose relax
The idea behind the cue
ACE inhibitors prevent conversion of angiotensin I to angiotensin II. That lowers vasoconstriction and aldosterone signaling, so blood pressure falls and afterload decreases. A classic class effect is cough from increased bradykinin.
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Short & simple
The sneezing cap makes the hose relax
Acronym
AAAC — Awkward Avocados Adopt Cupcakes.
Story
A cat sits on a garden hose. When the cat is removed, the hose uncurls and water flows easier. The gardener keeps sneezing from the misty spray, hinting at bradykinin buildup.
Connect the pieces
- A (Awkward) → ACE: ACE is inhibited, so angiotensin I cannot be converted into angiotensin II.
- A (Avocados) → Ang I: Angiotensin I is the substrate that would normally be turned into angiotensin II.
- A (Adopt) → Ang II: Angiotensin II falls, so vasoconstriction and aldosterone signaling drop.
- C (Cupcakes) → Cough: ACE inhibitors can cause cough because bradykinin is increased.
- Awkward · ACE: ACE is inhibited, so angiotensin I cannot be converted into angiotensin II.
- Avocados · Ang I: Angiotensin I is the substrate that would normally be turned into angiotensin II.
- Adopt · Ang II: Angiotensin II falls, so vasoconstriction and aldosterone signaling drop.
- Cupcakes · Cough: ACE inhibitors can cause cough because bradykinin is increased.
Know the limits
Does not apply to ARBs or direct renin inhibitors, which act at different points in the RAAS pathway.
Further reading · OpenStax Pharmacology for Nurses · foundational mechanisms ↗Check your understanding
Which mechanism best describes an ACE inhibitor?
A. Blocks aldosterone receptors in the collecting duct
B. Inhibits sodium-potassium-chloride transport in the thick ascending limb
C. Directly activates beta-1 receptors in the heart
D. Blocks angiotensin I to angiotensin II conversion
Reveal explanation
Blocks angiotensin I to angiotensin II conversion
ACE inhibitors prevent formation of angiotensin II from angiotensin I. The other choices describe an aldosterone antagonist, a loop diuretic, and a beta agonist.