Generic NameEnalaprill

Trade NameVasotec

ClassificationACE Inhibitors

Dose: 5 mgDosage range: 5mg q day, increased as required by response. 10-40mg q day in 1-2 divided doses.

RoutePO

Time/frequencyQ AM

Peak4-6 hr

Onset1 hr

Duration24 hours

For IV meds, compatibility with IV drips and /or solutionsN/A

Mechanism of action and indications(Why med ordered)Angiotensin-converting enzyme (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 reduce aldosterone levels. Net result is systemic vasodilation. Indicated for the treatment of hypertention.

My patient is receiving this med for Hypertension.

Nursing Implications (what to focus on) Contraindications/warnings/interactionspt’s w/ Hypersensitivity and history of angioedema with previous use of ACE inhibitors. Use cautiously in pt’s w/ Renal impairment, hypovolemia, hyponatremia, concurrent diuretic therapy (initial dosage reduction recommended). Use extreme caution in pt’s w/ a family history of angioedema.

Common side effectsdizziness, cough,hypotension, n/v/d, rashes, hyperkalemia, and angioedema

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Additive hypotension with other antihypertensive agents (Coreg for ex.)

Lab value alterations caused by medicineMonitor BUN, creatinine, and electrolyte levels periodically. Serum potassium may be increased and BUN and creatinine transiently increased, whereas sodium levels may be decreased. If elevated BUN or serum creatinine concentrations occur, dosage reduction or withdrawal may be required. Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause slight decrease in hemoglobin and hematocrit and agranulocytosis. May cause elevated AST, ALT, alkaline phosphatase, and serum bilirubin.

Be sure to teach the patient the following about this medicationInstruct patient to take exactly as directed at the same time each day, even if feeling well. Missed doses should be taken as soon as possible but not if almost time for next dose. Do not double doses. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional. Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. Caution patient to change positions slowly to minimize hypotension, particularly after initial dose. Advise patient to consult health care professional before taking any OTC medications, especially cold remedies. May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known. 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; or if difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues. 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).

Nursing Process- Assessment(Pre-administration assessment)Take blood pressure

AssessmentWhy would you hold or not give this med?If bp is too low (systolic less than 100) contact physician. These should not be stopped abruptly

EvaluationCheck after givingDecrease in blood pressure without appearance of side effects and improvement in survival and reduction of symptoms in heart failure