Details About Generic Salt ::  Enalapr2

Main Medicine Class:: Antihypertensive,ACE inhibitor   

(EH-NAL-uh-prill-at)
Vasotec IV
Class: Antihypertensive/ACE inhibitor

 

Drugs Class ::

 Action Competitively inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Clinical consequences include decrease in sodium and fluid retention, decrease in blood pressure and increase in diuresis.

Indications for Drugs ::

 Indications Treatment of hypertension when oral therapy is not practical. Unlabeled use(s): Hypertensive emergencies.

Drug Dose ::

 Route/Dosage

IN ADULT PATIENTS NOT TAKING DIURETICS: IV 1.25 mg over 5 min q 6 hr. IN ADULT PATIENTS TAKING DIURETICS: IV 0.625 mg over 5 min. If inadequate response after 1 hr, may repeat 0.625 mg. Give additional doses of 1.25 mg q 6 hr.

Contraindication ::

 Contraindications Standard considerations.

Drug Precautions ::

 Precautions

Pregnancy: Category D (second, third trimester); Category C (first trimester). Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Angioedema: May occur. Use extreme caution in patients with hereditary angioedema. Cough: Chronic severe cough may occur during treatment. Hypotension/first-dose effect: Significant decreases in blood pressure may occur following first dose, especially in severely salt- or volume-depleted patients or those with heart failure; monitor closely for at least 2 hr after initial dose and during first 2 wk of therapy. Minimize risk by discontinuing diuretics, decreasing dose or increasing salt intake approximately 1 wk prior to initiating enalaprilat. Neutropenia and agranulocytosis: Have occurred; risk appears greater with renal dysfunction, heart failure or immunosuppression; monitor WBC counts periodically. Proteinuria: May occur, especially in patients with prior renal disease or those receiving high doses. Renal impairment: Reduce dose and give less frequently. In renal insufficiency, stable elevations in BUN and serum creatinine may occur due to inadequate renal perfusion; monitor renal function during first few weeks of therapy and adjust dosage.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Chest pain; myocardial infarction; hypotension; angina; orthostatic hypotension; tachycardia. CNS: Headache; vertigo; dizziness; fatigue; asthenia; syncope. DERM: Rash; photosensitivity. GI: Nausea; abdominal pain; vomiting; diarrhea. GU: Urinary tract infection. HEMA: Decreased hemoglobin and hematocrit; neutropenia; agranulocytosis; thrombocytopenia; pancytopenia; eosinophilia. META: Hyperkalemia. RESP: Bronchitis; cough; dyspnea. OTHER: Fever; myalgia; arthralgia; arthritis; vasculitis.

Drug Mode of Action ::  

 Action Competitively inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Clinical consequences include decrease in sodium and fluid retention, decrease in blood pressure and increase in diuresis.

Drug Interactions ::

 Interactions

Allopurinol: Greater risk of hypersensitivity possible with coadministration. Antacids: Enalaprilat bio-availability may be decreased. Separate administration times by 1 to 2 hr. Capsaicin: Cough may be exacerbated. Digoxin: Increased digoxin levels. Indomethacin: Hypotensive effects may be reduced, especially in low-renin or volume-dependent hypertensive patients. Lithium: Increased lithium levels and symptoms of lithium toxicity may occur. Phenothiazines: May increase pharmacological effect of phenothiazines. Potassium preparations, potassium-sparing diuretics: May increase serum potassium levels. Rifampin: Pharmacologic effects of enalapril may be decreased.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Obtain baseline vital signs, LFT results, serum bilirubin, uric acid, electrolytes, CBC, creatinine and BUN, and monitor these values throughout therapy.
  • Monitor vital signs closely after initial dose, at least 2 hr and during first 2 wk of therapy. Peak effect with initial dose may be 4 hr after injection.
  • Notify physician of any adverse reaction, including angioedema, chest pain, hypotension, tachycardia, dyspnea, bronchitis, vertigo, nausea or vomiting.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension

Drug Storage/Management ::

 Administration/Storage

  • Dilute with 0.9% normal saline in D5W or 5% Dextrose in Lactated Ringer’s.
  • Give as slow IV infusion over 5 min.
  • Store at room temperature and discard after 24 hr.

Drug Notes ::

 Patient/Family Education

  • Advise patient to notify nurse of any vertigo, chest pain, techycardia, dyspnea, persistent cough, nausea or vomiting.
  • Caution patient not to discontinue drug suddenly.

Disclaimer ::

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