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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