Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which side effect of starting an angiotensin-converting enzyme (ACE) inhibitor is the least concerning?

1. Dry hacking cough

2. Swelling of face and tongue

3. Potassium rise to 5.8 mg/dL

4. Serum creatinine rise from 1.2 mg/dL to 1.6 mg/dL

The correct answer is: Dry hacking cough

Starting an angiotensin-converting enzyme (ACE) inhibitor can indeed lead to a range of side effects, and understanding their implications is crucial for safety and management in patients, particularly those with diabetes or hypertension. The presence of a dry hacking cough is a well-known side effect associated with ACE inhibitors. While it can be annoying for patients and might lead to discontinuation of the medication, it is typically not considered serious. The cough is thought to occur due to the accumulation of bradykinin, a peptide that ACE inhibitors prevent from being broken down. Though this side effect can lead to discomfort, it generally does not pose a direct threat to the patient's health. In contrast, the other options present more concerning risks. Swelling of the face and tongue can indicate an acute allergic reaction known as angioedema, which may necessitate immediate medical attention. A potassium rise to 5.8 mg/dL can indicate hyperkalemia, a potentially dangerous condition that may lead to cardiac issues. Lastly, a rise in serum creatinine from 1.2 mg/dL to 1.6 mg/dL suggests a decline in kidney function, which is another critical concern. This context helps to illustrate why the dry hacking cough, despite