May 15, '12 by NRSKarenRN
from my own backyard
"agioedema from ace inhibitors = unrecognized epidemic". karen
posted: tue, may. 1, 2012, 6:31 am
ace inhibitor blood-pressure drugs can have a severe side effects ...
...i've seen a number of deaths because you just can't get the tube in," said james r. roberts, director of emergency medicine at mercy philadelphia hospital and mercy fitzgerald hospital, which see more than a case a week. roberts recently published a letter in the american journal of cardiology to call attention to what he considers an "unrecognized epidemic."
he would like the u.s. food and drug administration to add its most stringent alert, a "black-box warning," to prescribing information to prod doctors to warn about angioedema. although studies show that fewer than 1 percent of patients will develop it - even fewer will have breathing problems - that's still a vast group, given that tens of millions of americans now take the drugs for hypertension, heart disease, heart failure, stroke, diabetes, and kidney disease.
...the swelling is believed to be caused by too much bradykinin, which makes blood vessels widen until they leak, letting fluid seep into tissues.
unlike an allergic swelling reaction, ace inhibitor angioedema cannot be reversed with antihistamines or other drugs that quiet the immune system. the labeling says epinephrine may be given (it constricts blood vessels), but this stops only added swelling. fluid already in the tissues takes time to be reabsorbed.
roberts and others have tried fresh plasma, which effectively dilutes patients' blood. but plasma takes 30 minutes to thaw - too long in a crisis.
fortunately, most angioedema sufferers endure nothing worse than a day in a hospital - and looking like a horror-movie extra....
.... it is also clear that african americans are more susceptible, with angioedema rates of up to 5 percent in studies.
roberts and his colleagues reviewed angioedema treated in the emergency departments at mercy catholic and mercy fitzgerald, which serves 82,000 patients a year, most of them african americans, many with hypertension and diabetes.
of 91 cases related to ace inhibitors, 35 percent needed intensive care and 4 percent required an airway tube. one patient died.
"the incidence and potential for [complications] is not appreciated by the public, or by many physicians," roberts wrote in the american journal of cardiology.
Last edit by NRSKarenRN on May 15, '12