ENALAPRIL MALEATE 1. Name & class of drug – generic and trade name.

GENERIC NAME: Enalapril maleate, Enalaprilat BRAND NAME: Vasotec, Vasotec I.V. CLASSIFICATION: CV agent, Angiotensin-converting enzyme (ACE) inhibitor, antyhypertensive 2. Dose range and routes for adult & geriatric client. PREPARATIONS: PO/IV – (2.5, 5, 10, 20) mg tablets, 1.25 mg/ml injection, 1 mg/ml syspension DOSING: Hypertension – PO – 5 mg/d, may increase to 10 – 40 mg/d in 1 – 2 divided doses IV – 1.25 q6h, may give up to 5 mg q6h in hypertensive emergencies CHF – PO – 2.5 mg 1 – 2 times/d, may increase up to 5 – 20 mg/d in 1 – 2 divided doses 3. Purpose prescribed. Underline reason your client is prescribed drug. THERAPEUTIC EFFECTS: antihypertensive effect related to suppression of the renin-angiotensinaldosterone system causes vasodilation and, therefore, lower blood pressure. Improvement in cardiac output results in increased exercise tolerance USES: management of mild to moderate hypertension as monotherapy or with a diuretic. Malignant, refractory, accelerated, and renovascular hypertension (except in bilateral renal artery stenosis or renal artery stenosis in a solitary kidney). CHF 4. Major side effects & drug interactions. DRUG INTERACTIONS: Indomethacin and other NSAIDs may decrease antyhypertensice activity, K+ supplements, K+ sparring diuretics may cause hyperkalemia, may increase lithium levels and toxicity SIDE EFFECTS: headache, dizziness, fatigue, nervousness, paresthesias, asthenia, insomnia, hypotension including postural hypotension, rash

5. Nursing Implications & teaching. IMPLICATIONS: • Monitor for therapeutic effectiveness. Peak effects after the first IV dose may not occur for up to 4 h, peak effects of subsequent doses may exceed those of the first • Maintain bedrest and monitor BP for the first 3h after the initial IV dose, watch for first-dose phenomenon, which can occur within 1 – 3 h of first IV dose. • Monitor BP for several days of therapy. • Report transient hypotension with lightheadedness • Monitor serum K+ and be alert to symptoms of hyperkalemia. TEACHING: • Full antihypertensive effect may not be experienced until several weeks after enalapril therapy starts • When drug is d/c due to severe hypotension, the hypotensive effect may persist a week or longer after termination because of long duration of drug action • Do not follow a low sodium diet without approval of Dr • Avoid use of salt supplement • Notify Dr of persistent nonproductive cough, especially at night, accompanied by nasal congestion • Report to Dr promptly if swelling of face, eyelids, tongue, lips or extremities occurs • Do not drive or engage in other dangerous activities until effects of enalapril is known