Answer and Explanation 21

21.  The correct answer is D.  This is a notorious side effect of ACE inhibitors and should be classified as a class effect.  Switching a patient to a different ACE inhibitor will not fix this.  It is because of the elevated levels of the bradykinnin produced.  Diovan is an angiotensin receptor blocker and would produce  a similar effect but not raise bradykinnin levels.  Metoprolol may induce bronchospasm but should not be ruled out.  It the patient is not wheezing, it would be prudent to start removing the ACE inhibitor.