Ans. is 'd' i.e., Fosinopril Drugs acting on RASACE inhibitorsRenin inhibitorsAngiotensin antagonists (Angiotensin receptor blockers or ARBs)o Captoprilo Enalaprilo Aliskireno Losartano Lisinoprilo Benazeprilo Remikireno Candesartano Ramiprilo Fosinoprilo Enakireno Irbesartano Trandoloprilo Imidapril o Valsartano Perindopril o Telmisartano All ACE inhibitors are prodrugs except captopri! and Lisinopril.Important points about ACE inhibitorso ACE inhibitors inhibit the enzyme kininase II or ACE.o Angiotensin converting enzyme is also involved in the metabolism of Bradykinin -Bradykinin level is increased, which is responsible for dry cough and angioedema produced by ACE inhibitors,o ACE inhibitors also potentiate the hypotensive action of exogenously administered bradykinin.o ACE inhibitors decreases BP by decreasing total peripheral resistance (A-II is a potent vasoconstrictor) - Both systolic and diastolic BP fall,o There is no effect on cardiac output.o Cardiovascular reflexes are not interfered with and there is little dilatation of capacitance vessels - Postural hypotension is not problem (But because of faster action of captopril an initial sharp fall in BP first dose hypotension may occur).o Reflex sympathetic stimulation does not occur despite vasodilatation - Can be used safely in patients with ischaemic heart disease. (Note - ACE inhibitors are the only vasodilators which do not reflexly activate sympathetic system).o All ACE inhibitor are prodrugs except captopril and lisinopril.o Captopril is shortest and fastest acting A CE inhibitor:o Captopril has maximum bioavailibily among ACE inhibitors,o Lisinopril is slowest acting.o Presence of food in stomach reduces the bioavailibility of captopril and Imidapril (not other ACE inhibitors).o Fosinopril is unique in being a phosphinate compound that is glucuronide conjugated and eliminated both by liver and kidney (only kidney is the mode of excretion for all other ACE inhibitors after metabolism in the liver).o ACE inhibitors are teratogenic - Contraindicated in pregnancy.o Acute renal failure is precipitated by ACE inhibitors in patients with bilateral renal artery stenosis - Contraindicated in these patients.