Practice Question
A patient with HFrEF (heart failure with reduced ejection fraction) is transitioning from an ACE inhibitor (ACEI) to sacubitril/valsartan (ARNI). What is the safest transition strategy?
Answer Choices:
Correct Answer:
Discontinue the ACEi and wait at least 36 hours before starting sacubitril/valsartan.
Rationale:
🌟 The 36-hour washout period is essential because both ACE inhibitors and sacubitril/valsartan increase bradykinin, creating a dangerous risk of life-threatening angioedema.
🌟 The neprilysin inhibitor component (sacubitril) already raises bradykinin levels, and adding ACE inhibition on top of that amplifies airway-compromising swelling.
🌟 The 36-hour delay ensures that the ACE inhibitor’s effect on bradykinin metabolism fades, reducing the possibility of overlapping mechanisms.
🌟 This rule is explicitly stated in heart failure guidelines, making it the only safe and evidence-based transition strategy.
❌ Incorrect Options
🌟 Stop ACEI tonight and start ARNI tomorrow morning – Does not guarantee a full 36 hours and still risks angioedema.
🌟 Taper ACEI over one week, start ARNI next day – Tapering is unnecessary; still does not allow 36-hour washout.
🌟 Start ARNI today and taper ACEI – Causes dangerous drug overlap, the worst possible strategy.
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This question is from Pharmacology Exam 2 2025 which contains 51 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: General Exams
- Domain: 🚑Pharmacology
- Answer Choices: 4