Ace inhibitors are those drugs that inhibit an enzyme Angiotensin converting enzyme. The major function of this enzyme is to convert angiotensin 1 to angiotensin 2. The converted angiotensin 2 helps increase the blood pressure by several mechanisms. Some of these are: secretion of aldosterone which acts on the DCT in the kidney to increase the absorption of sodium and water, also the secretion of ADH which by its name the Anti Diuretic Hormone, decreases the excretion of water from the kidney leads to an increase in the circulating volume and increases blood pressure. By inhibiting the action of ACE, ramipril inhibits formation of angiotensin 2 thus its subsequent actions are also inhibited and blood pressure is maintained (Lippincott, 2005).Ramiprial has an active form known as ramiprilat. Administered orally, the absorption of ramipril is usually 50-6-% and when administered with food the absorption of this drug decreases but not significanty. The drug reaches its peak plasma concentration in about half an hour after administration and the rate of decrease in plasma concentration is as quick. The drug acts by binding of its C domain with the enzyme at its active site thus inhibiting the binding of angiotensin 1 and its conversion to angiotensin 2. The drug has a half life of 20 hours and subsequent doses usually lead to a steady plasma concentration rather than a single dose whose effect is not that steady. Almost 90% percent of the excretion of this drug is through feces whereas the remaining 10% is excreted through urine. The activity i. inhibition of enzyme activity depends on the doses administered (Trevor, 2008).A patient such as Jack can be at a huge risk of developing a thrombosis in any of the vital vessels. Since he is suffering already from heart failure, the slow progression of blood i. stasis can lead to thrombus formation in the vessels and may lead to the blockade of one of the vital vessels such as coronary or cerebral vessels. The prescription of warfarin as a prophylactic medicine would help a smooth flow of blood through these channels. Warfarin acts by inhibiting the formation of prothrombin which is the initial step in the formation of a thrombus and blocking of blood vessels. With no formation of prothrombin, the risk of developing an ischemic disease due to thrombus or even ischemic heart failure such as MI would be decreased (Trevor,
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