Tritace Case Study

1.0 Introduction

Tritace is an Angiotensin-Converting-Enzyme (ACE) Inhibitor. It is used to treat hypertension, heart failure, stroke, myocardial infarction and diabetes. Its generic name is Ramipril. Other brand names include Altace, Cardace, Ramiril and Ramacor. Some examples of other ACE Inhibitors are Enalapril, Quinapril, Captopril and Lisinopril. The oral bioavailability of Tritace is 55%. The absorption is not significantly affected by food and the duration of action is 24 hours (Drugs.com, 2013).

2.0 Physiology of Renin-Angiotensin-Aldosterone System (RAAS)

Baroreceptors located in the aortic arch and carotid sinuses detect changes in blood pressure. When a drop in blood pressure is detected, the medulla oblongata in the brain stimulates the juxtaglomerular kidney cells to secrete renin. Renin converts angiotensinogen to angiotensin I. Angiotensin-Converting-Enzyme which is found in pulmonary blood vessels, acts on angiotensin I to convert it to angiotensin II. Angiotensin II activates angiotensin receptors AT1 and AT2. The result of the activation of AT1 is vasoconstriction and secretion of aldosterone (Brenner et al, 2003). Aldosterone secretion results in fluid retention

In plasma and tissue, ACE catalyses the conversion of angiotensin I to the angiotensin II (active vasoconstrictor), as well as the breakdown of the bradykinin (vasodilator). Therefore ramiprilat reduces angiotensin II formations and inhibits bradykinin breakdown. This results in vasodilation. Since angiotensin II also stimulates the release of aldosterone, ramiprilat causes a reduction in aldosterone secretion. The reduction in aldosterone secretion causes an increase in urinary output. The consequences of all this are decreased arterial and venous pressure. This results in decreased cardiac preload and afterload and this in turn reduces the workload on the