A 55-year-old man started on enalapril for hypertension develops a persistent dry cough within two weeks. The mediator most responsible for this adverse effect also explains the risk of which other complication of ACE inhibitors?

• A Angioedema ✓
• B Hyperkalemia
• C Acute tubular necrosis
• D Gynecomastia

Explanation

ACE inhibitors prevent degradation of bradykinin and substance P. Bradykinin accumulation in the respiratory tract causes the dry cough through sensory C-fiber stimulation, and the same kinin excess in the oropharyngeal tissues underlies angioedema, a rarer but potentially fatal reaction. Hyperkalemia results instead from reduced aldosterone secretion, and functional renal insufficiency from efferent arteriolar dilation. Both cough and angioedema are far less frequent with ARBs, which do not affect kinin metabolism.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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