enalapril (Vasotec)

Question 1

Therapeutic goal of enalapril (Vasotec)

Answer 1

-reduces blood pressure in HYERtensive patients
-hemodynamic improvement in patients with heart
failure

Question 2

HIGH RISK PATIENTS for enalapril (Vasotec)

Answer 2

-ACE inhibitors are CONTRAINDICATED during 2nd +
3rd trimesters of pregnancy
- CONTRAINDICATED in patients with bilateral renal
artery stenosis +
-history of HYPERsensitivity reactions to ACE inhibitors

Question 3

use caution with enalapril (Vasotec) in patients with:

Answer 3

• salt + volume depletion
• renal impairment
• collagen vascular disease
• pts taking potassium supplements, salt substitutes, potassium sparing diuretics, aliskiren & lithium.

Question 4

enalapril (Vasotec) route

Answer 4

ORAL

Question 5

enalapril (Vasotec) dosage + administration

Answer 5

-begin with LOWEST dose possible then increase to
achieve effect
-admin with food
-monitor blood pressure CLOSELY for 2 weeks for
FIRST 3 months of therapy

Question 6

evaluate therapeutic effects of enalapril (Vasotec) by:

Answer 6

• HYPERtension: monitor for reduced blood pressure

- heart failure: monitor for lessening S/S (dyspnea, cyanosis, JVD, edema)

Question 7

minimizing adverse effects of enalapril (Vasotec)

Answer 7

-FIRST DOSE HYPOtension - SEVERE HYPOtension CAN OCCUR WITH FIRST DOSE
-withdrawal diuretics 1 week before initiating ACE
inhibitors
-use low initial dose
-monitor blood pressure for 2 hours following first dose
-instruct patients to lie down if HYPOtension develops
**MAY REQUIRE IV of NS to restore pressure

Question 8

drug-drug interactions

Answer 8

• DIURETICS: may intensify first-dose HYPOtension
• ANTIHYPERTENSIVE Agents
• Drugs that elevate potassium levels
• Lithium levels can be increased by ACE inhibitors
• NSAIDS may interfere with the antihypertensive effects of ACE inhibitors

Question 9

enalapril (Vasotec) & COUGHING

Answer 9

• warn patients about the possibility of persistent, dry, irritating, non-productive cough
• instruct PT to contact the provider if cough is bothersome.

Question 10

enalapril (Vasotec) & HYPERkalemia

Answer 10

• may increase potassium levels
• instruct pts to AVOID POTASSIUM supplements
• avoid potassium sparing diuretics

Question 11

enalapril (Vasotec) & FETAL INJURY

Answer 11

ACE inhibitors taken during the 2ND & 3RD TRIMESTERS of pregnancy can result in MAJOR birth defects + major fetal injury

Question 12

enalapril (Vasotec) & ANGIOEDEMA

Answer 12

-rare + potentially fatal reaction
-S/S: giant wheels + edema of the tongue, glottis &
pharynx
^^^treat with epinephrine + WITHDRAWAL enalapril (Vasotec)