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NURS 133 Enalapril and Lisinopril

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jasmine's version from 2016-06-03 01:58

Section 1

Question Answer
Enalapril (Vasotec) ACE inhibitor; Pregnancy Category D; Alone or with other agents in the management of hypertension; Management of HF; Reduction of risk of death or development of HG following MI; Slowed progression of left ventricular dysfunction into overt heart failure
Enalapril actions ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II; ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins; ACE inhibitors also increase plasma renin levels and decrease aldosterone levels; Net result is systemic vasodilation
Enalapril therapeutic uses Lowering of BP in hypertensive patients; Improved symptoms in patients with HF (selected agents only); Decreased development of overt heart failure; Improved survival and decrease development of overt HF after MI (selected agents only)
Elimination/Excretion of Enalapril Converted by the liver to enalaprilat, the active metabolite; Primarily eliminated by the kidneys
Adverse/Side Effects of Enalapril Cough; Hypotension; Taste disturbances; Agranulocytosis; Angioedema
Contraindications of Enalapril Hypersensitivity; History of angioedema with previous use of ACE inhibitors (also in absence of previous use of ACE inhibitors for benazepril); Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr less than 60 mL/min); OB: Can cause injury or death of fetus if pregnancy occurs-discontinue immediately; Lactation: Certain ACE inhibitors appear in breast milk-discontinue drug or use formula
Use Enalapril cautiously in Renal impairment, hepatic impairment, hypovolemia, hyponatremia, concurrent diuretic therapy; Black patients with hypertension (monotherapy less effective-may require additional therapy-increase risk of angioedema); Surgery/anesthesia (hypotension may be exaggerated); Pedi: May be used in children of all ages; Geri: Initial dose decrease recommended for most agents due to age related decrease in renal function; Exercise extreme caution in family with history of angioedema
Drug/Food interactions of Enalapril Excessive hypotension may occur with concurrent use of diuretics and other anti-hypertensives; Increase risk of hyperkalemia with current use of potassium supplements, potassium diuretics, or potassium-containing salt substitutes; Increase risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor antagonists or aliskiren-avoid concurrent use with aliskiren in patients with diabetes or CCr less than 60 mL/min; NSAIDs and selective COX-2 inhibitors may blunt the anti-hypertensive effect and increase the risk of renal dysfunction; Increase risk of angioedema with temsirolimus or everolimus
Medication administration of Enalapril PO; IV
Nursing interventions of Enalapril Hypertension: monitor BP and pulse frequently during initial dose adjustment and periodically during therapy; Monitor frequency of prescription refills to determine adherence; Assess patient for signs of angioedema (dyspnea, facial swelling); HF: monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention); Lab test considerations: Monitor BUN, creatinine, and electrolyte levels periodically; Serum potassium, BUN and creatinine may be increased, whereas may be decreased; If increase BUN or serum creatinine concentrations occur, dose reduction or withdrawal may be required; Monitor CBC periodically during therapy; Assess urine protein prior to and periodically during therapy for up to 1 year in patients with renal impairment
Implementation of Enalapril Correct volume deletion, if possible, before initiation of therapy; PO: Precipitous drop in BP during first 1-3 hour after first dose may require volume expansion with normal saline, yet is not normally considered an indication for stopping therapy; Discontinuing diuretic therapy or cautiously increasing salt intake 2-3 before initiation may decrease risk of hypotension; Monitor closely for at least 1 hour after BP has stabilized; Resume diuretics if BP is not controlled; Administer 1 hour before or 2 hours after meals; May be crushed if patient has difficulty swallowing; Tablets may have a sulfurous odor; An oral solution may be prepared by crushing a 25 mg tablet and dissolving it in 25-100 mL of water-shake for at least 5 minutes and administer within 30 minutes
Client education of Enalapril Instruct patient to take medication as directed at the same time each day, even if feeling well; Caution patient to avoid salt substitutes or foods containing high levels of potassium or sodium unless directed by health care professional; Caution patient to change positions slowly to minimize hypotension; Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension; Instruct patient to notify health care professional of any new medications, especially cough, cold, or allergy remedies; Caution patient to avoid driving and other activities requiring alertness until response to medication is known; Advise patient that medication may cause impairment of taste that generally resolves within 8-12 weeks, even with continued therapy; Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occur; or if taste impairment or skin rash persists; Also, notify health care professional if nausea, vomiting, or diarrhea occurs and continues; Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected; If pregnancy is detected, discontinue medication as soon as possible; Emphasize the importance of follow up examinations to monitor progress; Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management); *Medication controls yet does not cure hypertension; Instruct patient and family on correct technique for monitoring BP; Advise to check BP at least weekly and to report significant changes to health care professional
Evaluation/Desired outcomes of Enalapril Decrease in BP without appearance of excessive side effects; Decrease in signs and symptoms of HF (some drugs may also improve survival); Decrease in development of overt HF; Reduction of risk of death or development of HF following MI
Potential nursing diagnoses of Enalapril Decreased cardiac output (indications, side effects); Noncompliance (patient/family teaching)
memorize

Section 2

Question Answer
Lisinopril (Prinivil) ACE inhibitor; Pregnancy Category D; Alone or with other agents in the management of hypertension; Management of HF; Reduction of risk of death or development of HG following MI
Lisinopril actions ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II; ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins; ACE inhibitors also increase plasma renin levels and decrease aldosterone levels; Net result is systemic vasodilation
Lisinopril therapeutic uses Lowering of BP in hypertensive patients; Improved symptoms in patients with HF (selected agents only); Improved survival and decrease development of overt HF after MI (selected agents only)
Elimination/Excretion of Lisinopril 100 percent eliminated by the kidneys
Adverse/Side Effects of Lisinopril Cough; Hypotension; Taste disturbances; Agranulocytosis; Angioedema
Contraindications of Lisinopril Hypersensitivity; History of angioedema with previous use of ACE inhibitors (also in absence of previous use of ACE inhibitors for benazepril); Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr less than 60 mL/min); OB: Can cause injury or death of fetus if pregnancy occurs-discontinue immediately; Lactation: Certain ACE inhibitors appear in breast milk-discontinue drug or use formula
Use Lisinopril cautiously in Renal impairment, hepatic impairment, hypovolemia, hyponatremia, concurrent diuretic therapy; Black patients with hypertension (monotherapy less effective-may require additional therapy-increase risk of angioedema); Surgery/anesthesia (hypotension may be exaggerated); Pedi: May be used in children greater than or equal to 6 years of age; Geri: Initial dose decrease recommended for most agents due to age related decrease in renal function; Exercise extreme caution in family with history of angioedema
Drug/Food interactions of Lisinopril Excessive hypotension may occur with concurrent use of diuretics and other anti-hypertensives; Increase risk of hyperkalemia with current use of potassium supplements, potassium diuretics, or potassium-containing salt substitutes; Increase risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor antagonists or aliskiren-avoid concurrent use with aliskiren in patients with diabetes or CCr less than 60 mL/min; NSAIDs and selective COX-2 inhibitors may blunt the anti-hypertensive effect and increase the risk of renal dysfunction; Increase risk of angioedema with temsirolimus or everolimus
Medication administration of Lisinopril PO
Nursing interventions of Lisinopril Hypertension: monitor BP and pulse frequently during initial dose adjustment and periodically during therapy; Monitor frequency of prescription refills to determine adherence; Assess patient for signs of angioedema (dyspnea, facial swelling); HF: monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention); Lab test considerations: Monitor BUN, creatinine, and electrolyte levels periodically; Serum potassium, BUN and creatinine may be increased, whereas may be decreased; If increase BUN or serum creatinine concentrations occur, dose reduction or withdrawal may be required; Monitor CBC periodically during therapy; Assess urine protein prior to and periodically during therapy for up to 1 year in patients with renal impairment
Implementation of Lisinopril Correct volume deletion, if possible, before initiation of therapy; PO: Precipitous drop in BP during first 1-3 hour after first dose may require volume expansion with normal saline, yet is not normally considered an indication for stopping therapy; Discontinuing diuretic therapy or cautiously increasing salt intake 2-3 before initiation may decrease risk of hypotension; Monitor closely for at least 1 hour after BP has stabilized; Resume diuretics if BP is not controlled; Administer 1 hour before or 2 hours after meals; May be crushed if patient has difficulty swallowing; Tablets may have a sulfurous odor; An oral solution may be prepared by crushing a 25 mg tablet and dissolving it in 25-100 mL of water-shake for at least 5 minutes and administer within 30 minutes
Client education of Lisinopril Instruct patient to take medication as directed at the same time each day, even if feeling well; Caution patient to avoid salt substitutes or foods containing high levels of potassium or sodium unless directed by health care professional; Caution patient to change positions slowly to minimize hypotension; Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension; Instruct patient to notify health care professional of any new medications, especially cough, cold, or allergy remedies; Caution patient to avoid driving and other activities requiring alertness until response to medication is known; Advise patient that medication may cause impairment of taste that generally resolves within 8-12 weeks, even with continued therapy; Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occur; or if taste impairment or skin rash persists; Also, notify health care professional if nausea, vomiting, or diarrhea occurs and continues; Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected; If pregnancy is detected, discontinue medication as soon as possible; Emphasize the importance of follow up examinations to monitor progress; Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management); *Medication controls yet does not cure hypertension; Instruct patient and family on correct technique for monitoring BP; Advise to check BP at least weekly and to report significant changes to health care professional
Evaluation/Desired outcomes of Lisinopril Decrease in BP without appearance of excessive side effects; Decrease in signs and symptoms of HF (some drugs may also improve survival); Reduction of risk of death or development of HF following MI
Potential nursing diagnoses of Lisinopril Decreased cardiac output (indications, side effects); Noncompliance (patient/family teaching)
memorize