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INTRODUCTION

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enalapril, enalaprilat (e-nal-a-pril, e-nal-a-pril-at)

Vasotec, Vasotec IV

Classification

Therapeutic: antihypertensives

Pharmacologic: angiotensin-converting enzyme (ACE) inhibitors

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Indications
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Alone or with other agents in the management of hypertension. Management of symptomatic heart failure. Slowed progression of asymptomatic left ventricular dysfunction to overt heart failure. Unlabeled Use: Treatment of proteinuria in steroid-resistant nephrotic syndrome patients.

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Action
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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 ↑ plasma renin levels and ↓ aldosterone levels. Net result is systemic vasodilation. Therapeutic Effects: Lowering of blood pressure in patients with hypertension. Increased survival and reduction of symptoms in patients with symptomatic heart failure. ↓ development of overt heart failure.

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Adverse Reactions/Side Effects
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CNS: dizziness, fatigue, headache, vertigo, weakness. Resp: cough. CV: hypotension, chest pain. GI: abdominal pain, diarrhea, nausea, vomiting. GU: proteinuria, impaired renal function. Derm: rashes. F and E: hyperkalemia. Resp: dyspnea. Misc: ANGIOEDEMA.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician immediately of these signs.

  • Assess blood pressure periodically and compare to normal values (See Appendix F) to help determine antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

  • Assess signs and symptoms of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) to help document whether drug therapy is effective in reducing these symptoms.

  • Monitor symptoms of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Notify physician because severe cases can lead to life-threatening arrhythmias and paralysis.

  • Assess dizziness and vertigo that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Implement aerobic exercise and cardiac-conditioning programs to augment drug therapy and maintain or improve cardiovascular pump function in patients with heart failure and other cardiac conditions.

  • Avoid physical therapy interventions that cause systemic vasodilation (large whirlpool, Hubbard tank). Additive effects of this drug and the intervention may cause a dangerous fall in blood pressure.

  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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Patient/Client-Related Instruction
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  • Remind patients to take medication as directed to control hypertension and other cardiac conditions even if they are asymptomatic.

  • Instruct patients with heart failure to weigh themselves every day, and call their physician if they gain 3 lb or more in 1 day or more than 5 lb in 1 ...

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