USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

What side effect is commonly associated with ACE inhibitors?

1. Hyperkalemia

2. Severe hypotension

3. Weight gain

4. Constipation

The correct answer is: Hyperkalemia

ACE inhibitors are commonly associated with hyperkalemia, which is an elevated level of potassium in the blood. This occurs because ACE inhibitors decrease the production of angiotensin II, a hormone that plays a significant role in regulating potassium levels. By inhibiting the renin-angiotensin-aldosterone system, these medications reduce aldosterone secretion, leading to decreased potassium excretion in the kidneys. As a result, potassium levels can rise, particularly in patients with renal impairment or those taking potassium supplements or potassium-sparing diuretics. Other potential side effects of ACE inhibitors, while clinically significant, are not as commonly encountered as hyperkalemia. Severe hypotension can occur, especially after the first dose, but it is less frequent in patients who are not volume-depleted. Weight gain and constipation are not typical side effects associated with ACE inhibitors.