Candidates were expected to discuss administration, bioavailability, metabolism, excretion
and half life of captopril. Candidates were then asked to compare it to the longer acting ACE
inhibitors and discuss their advantages and/or disadvantages in ICU patients.
The Viva then explored the candidate’s knowledge of dosing intervals, plasma concentration
times curves and effect time curves in relation to ACE inhibitors. Candidates were expected
to know why these curves differed, (avid enzyme binding), and thus why the dosing intervals
for ACE inhibitors are so long in relation to their half lives. The concepts of Emax, EC50 and
Therapeutic index were required.
Candidates were then asked to discuss the mechanism of action of ACE inhibitors and their
cardiovascular, endocrine, renal and CNS effects. Drug interactions and adverse effects were
Syllabus, General Pharmacology I and II, ACE inhibitors, C2b2f.
References : Katzung B.G.'s 'Basic and Clinical Pharmacology'
Brunton L.L. Goodman and Gilman’s 'The pharmacological basis of