Chapter 16: Drug Therapy for Hypertension
ANS: 3 1 kg=2.2 lb. 66/2.2 = 30 kg. 30 kg 200 mcg = 6000 mcg (1000 mcg = 1 mg); 6000/1000 = 6 mg. 1 capsule = 2 mg. 6 mg/2 = 3 capsules.
A child who weighs 68 lb and has very high blood pressure as a result of an adrenal gland tumor is prescribed a STAT dose of oral prazosin (Minipress) at 200 mcg/kg. You have on hand prazosin 2 mg/capsule. How many capsules will you administer to this child?
ANS: B Because of the patient's question, it is essential to contact the prescriber to clarify the order. Both nifedipine and nicardipine are calcium channel blockers but may not be substituted for each other. Nifedipine XL is an extended release form of the drug that only needs to be taken once a day.
A hospitalized patient prescribed nifedipine XL (Procardia) 60 mg once a day informs you that at home he was taking nicardipine (Cardene) 20 mg three times a day and thinks this is the wrong drug. What is your best action? a. Give the dose as ordered after informing the patient that this is a new medication the prescriber wants him or her to take. b. Hold the drug and contact the prescriber to clarify the order because of the patient's concern before administering the dose. c. Contact the pharmacy to ask what the prescriber ordered and if there was a mistake when the prescription was filled. d. Administer the dose because nifedipine and nicardipine are from the same class of drugs and may be substituted for each other.
ANS: D Atenolol is a beta blocker that blocks the action of epinephrine on the heart. This results in a decreased heart rate and force of contraction, which leads to decreased blood pressure. As a result the heart does not work as hard and requires less oxygen.
A patient asks you how atenolol (Tenormin) will help reduce hypertension. What is your best response? a. "It will help your body rid itself of excess fluids and decrease the work your heart must do to pump blood." b. "It will help decrease built-up water and salt in your blood and tissues." c. "It will block vasoconstriction as well as salt and water retention." d. "It will decrease your heart rate and how hard your heart pumps."
ANS: B Labetalol is a beta blocker which decreases heart rate, force of heart contraction, and blood pressure. Its actions can affect the results of the test, causing inaccurate results.
A patient has a dose of labetalol (Normodyne) ordered twice a day and is due to have an exercise stress test this morning. What is your best action at this time? a. Give the dose as ordered. b. Hold the dose and notify the prescriber. c. Give half the dose now and half after the procedure. d. Ask the patient about chest pain, dizziness, and light-headedness.
ANS: B Salt substitutes are mostly composed of potassium. Losartan is an angiotensin receptor blocker, and this class of drugs causes the kidneys to retain potassium. Taking in more potassium along with this drug could lead to high blood potassium levels (hyperkalemia), which has severe effects on heart contractility.
A patient has been prescribed losartan (Cozaar). Which substance, drug, or activity do you teach the patient to avoid? a. Oral contraceptives b. Salt substitutes c. Caffeine d. Running
ANS: C ACE inhibitors should not be prescribed for women who are pregnant. They can cause low blood pressure, severe kidney failure, increased potassium, and even death in a newborn when used after the first trimester of pregnancy.
A 33-year-old female patient is currently taking captopril (Capoten) and metoprolol (Lopressor) to control her blood pressure. She tells you that she plans to become pregnant. What should you teach the patient about the use of this drug during pregnancy? a. ACE inhibitors affect women differently than men. b. ACE inhibitors have fewer side effects than other hypertension drugs. c. ACE inhibitors should not be prescribed for women who are pregnant. d. ACE inhibitors are only safe for use during the third trimester of pregnancy.
ANS: B It is important to address the reason that the patient has stopped taking the drug at this time. Fairly common side effects of beta blockers include decreased sexual ability, dizziness, drowsiness, trouble sleeping, tiredness, and weakness. All of the other actions are important and appropriate, but do not focus on the patient's concerns with regard to why he stopped taking the drug.
A 38-year-old patient has been prescribed nadolol (Corgard) 80 mg daily for hypertension. The patient tells you that he has stopped taking the drug. What is your best first action at this time? a. Instruct the patient to begin taking the drug immediately. b. Ask the patient if he is experiencing side effects of the drug. c. Document this finding in detail. d. Immediately notify the prescriber.
ANS: C A side effect of both thiazide and loop diuretics is loss of potassium resulting in hypokalemia (low blood potassium). Signs of hypokalemia include cramps, sudden decrease in urination, and irregular heartbeats.
A patient prescribed a thiazide diuretic for hypertension reports having cramps and feeling like the heart is skipping beats. What side effect of this drug do you suspect? a. Muscle breakdown b. Orthostatic hypotension c. Hypokalemia d. Dysrhythmia
ANS: A Normal blood levels of sodium range between 135 and 145 mEq/L. The value listed here, 124 mEq/L, is low (hyponatremia) and can weaken the skeletal muscles, increasing the risk for falls. Most likely, the diuretic therapy caused the kidneys to excrete too much sodium.
A patient taking a thiazide diuretic has the following blood laboratory values for kidney function. Which value will you report to the prescriber immediately? a. Sodium 124 mEq/L b. Potassium 3.6 mEq/L c. Creatinine 0.9 mg/dL d. Blood urea nitrogen 16 mg/dL
ANS: C Chest pain is never considered normal. Chest pain should be reported to the prescriber any time a patient experiences it because this is one symptom of many serious cardiac problems such as angina or heart attack.
A patient taking metoprolol (Lopressor) for hypertension reports all of the following side effects. For which side effect will you notify the prescriber a. Increased urination during the daytime b. Heart rate of 68 per minute c. Chest pain during exercise d. Decreased sexual ability
ANS: D Development of a dry, persistent cough is a side effect of angiotensin-converting enzyme inhibitor drugs such as enalapril. The cough indicates that the patient is having a reaction to the drug. The drug needs to be discontinued and the patient should be started on another drug to control hypertension.
A patient who has been prescribed enalapril (Vasotec) has developed a persistent nonproductive cough. What is your best action? a. Ask the prescriber to order something for the patient's cough. b. Suggest that the family bring the patient some cough drops. c. Offer the patient sips of water and ice chips. d. Hold the dose and notify the prescriber.
ANS: D About 15% of patients taking an angiotensin-converting enzyme (ACE) inhibitor develop allergies to the drug with the first symptom angioedema (swelling) of the face, lips, tongue, and neck. The swelling can become severe enough to block the patient's airway. Although this reaction is not usually as immediately life threatening as anaphylaxis, another dose of the drug would worsen the problem.
A patient who has been taking lisinopril (Zestril) develops swollen lips and reports that the tongue feels thick. What is your best action? a. Document the report and reassure the patient that this is a common drug side effect. b. Check the patient's pulse for rhythm and take the patient's blood pressure. c. Ask the patient whether this has ever happened before. d. Hold the lisinopril dose and notify the prescriber.
ANS: A An adverse effect of calcium channel blocker drugs is Stevens-Johnson syndrome (erythema multiforme), a skin disorder from an allergic reaction. It causes damage to blood vessels of the skin. Symptoms include many different types of skin lesions, itching, fever, joint aching, and generally feeling ill.
A patient who is taking nicardipine (Cardene) develops skin lesions, itching, fever, and achy joints. What is your best first action? a. Hold the drug and notify the prescriber. b. Document the finding as expected with this drug. c. Administer a dose of oral diphenhydramine (Benadryl). d. Apply a thin coat of hydrocortisone ointment to the lesions.
ANS: 5 1 kg = 2.2 lb. 220 lb/2.2 = 100 kg. 100 kg 0.25 mg = 25 mg 100 mg/20 mL = 5 mg/1 mL 25/5 = 5 mL
A patient who weighs 220 lb is to receive labetalol 0.25 mg/kg intravenously. The solution of labetalol on hand is 100 mg/20 mL. How many milliliters of labetalol will you prepare for a correct dose?
ANS: C Carvedilol is an alpha-beta blocker drug. These drugs can cause elevated blood glucose levels, so you should teach a patient with diabetes to monitor blood glucose levels regularly.
A patient with hypertension and type 2 diabetes mellitus is taking carvedilol (Coreg). What special precaution should you teach the patient to take when taking this drug? a. Check blood pressure in both arms. b. Keep a strict record of intake and output. c. Check blood sugar levels regularly. d. Avoid sugar-containing drinks.
ANS: D Orthostatic hypotension is a common side effect of the first dose of an alpha blocker drug. You should give the first dose at bedtime and caution the patient not to get up without assistance.
A patient with hypertension is prescribed terazosin (Hytrin). When should you administer the first dose of this drug to the patient? a. In the morning to avoid waking the patient at night b. With meals to avoid GI problems c. With a full glass of water d. At bedtime
ANS: B There are five classifications of hypertension (see Table 16-1 in the text). This patient's blood pressure is consistently within the range for prehypertension.
A patient's blood pressure is consistently around 138/88 mm Hg. What does this reading represent? a. Normal blood pressure b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension
ANS: 0.5 100 mg/1 tablet : 50 mg/X tablet = tablet (0.5 tablet).
An adult patient is prescribed metoprolol (Lopressor) 50 mg orally twice a day. Metoprolol is available in 100 mg tablets. How many tablets will you give for each dose?
ANS: B Breast enlargement (gynecomastia) is a common side effect of verapamil in men. The cause of the enlargement is not completely known, but it does not represent cancer or any health problem. Unless the patient is very distressed by the presence of the breast enlargement, it is not necessary to stop the drug.
An older adult man who takes verapamil (Calan) reports that his breasts have enlarged. What is your best action? a. Ask the patient whether he has had any difficulty getting or maintaining an erection. b. Document the response and reassure the patient that this is a common side effect. c. Instruct the patient to use an elastic wrap to bind his breasts during the day. d. Hold the drug dose and notify the prescriber.
ANS: C Older adults are at greater risk for postural (orthostatic) hypotension when taking ACE inhibitors because of the cardiovascular changes associated with aging. Quickly changing from lying or sitting position to standing can lower blood pressure so rapidly that the patient can get dizzy or faint, leading to a fall.
An older patient has been prescribed an angiotensin-converting enzyme (ACE) inhibitor. Which precaution is most important for you to teach the patient about this drug? a. "Avoid caffeinated drinks that may increase your blood pressure." b. "Take this drug at night so that you won't be aware of nausea." c. "Change positions slowly when rising up from a sitting position." d. "Weigh yourself daily upon first arising in the morning."
ANS: D Labetalol is a beta blocking agent. Although it relaxes blood vessel smooth muscle to lower blood pressure, it causes constriction of smooth muscles in the airways and can worsen asthma. It should be given to anyone with respiratory problems, especially severe asthma.
For which patient is labetalol (Normodyne) contraindicated as an antihypertensive drug? a. 48-year-old woman who is going through menopause b. 72-year-old man who has an enlarged prostate gland c. 80-year-old woman with severe glaucoma d. 60-year-old man with severe asthma
ANS: C Alpha blockers block receptors in arteries and smooth muscle. This relaxes the blood vessels and leads to an increase in blood flow and a lower blood pressure.
How do alpha blockers work to lower blood pressure? a. Preventing clots from forming b. Promoting water and potassium loss c. Relaxing blood vessel muscles d. Reversing atherosclerosis
ANS: C ACE inhibitors block production of substances that constrict (narrow) blood vessels. They also help decrease the buildup of water and salt in the blood and body tissues. The exact way that these drugs work is not known but they block an enzyme in the body that is necessary for production of angiotensin II (a substance that causes blood vessels to tighten or constrict). The result is that blood vessels relax and blood pressure is decreased.
How do angiotensin-converting enzyme (ACE) inhibitors lower blood pressure? a. Preventing clots from forming b. Promoting water and potassium retention c. Relaxing blood vessel muscles d. Reversing atherosclerosis
ANS: A Calcium channel blockers block calcium from entering the muscle cells of the heart and arteries. Blocking calcium causes a decrease in the contraction of the heart and also dilates (widens) the arteries. Widening the arteries causes a decrease in blood pressure and reduces the workload of the heart.
How do calcium channel blockers help to lower blood pressure? a. Relaxing arteries and slowing heart contractions b. Increasing constriction of muscles in veins c. Inducing weight loss and reducing obesity d. Increasing water and sodium loss
ANS: B Diuretics are drugs that decrease blood pressure by eliminating excess water and salt from the body.
How do most diuretics lower blood pressure? a. Preventing clots from forming b. Promoting water and sodium loss c. Constricting blood vessel muscles d. Reversing atherosclerosis
ANS: D Constricted blood vessels increase peripheral resistance and raise blood pressure. Calcium channel blockers work in several ways to lower blood pressure. The main way is by preventing calcium from entering smooth muscle cells in blood vessels, especially small arteries. With less calcium entering these smooth muscle cells, they are more relaxed, dilating (widening) the blood vessels.
How does the drug diltiazem (Cardizem) lower blood pressure? a. Prevents angiotensin from binding to its receptors. b. Blocks nerve stimulation of blood vessels. c. Increases water and sodium loss. d. Widens small arteries.
ANS: D The most common side effects of alpha blockers are dizziness, drowsiness, fatigue, headache, nervousness, irritability, stuffy or runny nose, nausea, pain in the arms and legs, hypotension, and weakness.
What are the most common side effects of alpha blockers? a. Shakiness and tremors b. Leg and ankle swelling c. Constipation and nausea d. Dizziness and drowsiness
ANS: A High blood pressure causes arterial walls to thicken and harden. With atherosclerosis plaques are formed inside the walls of arteries. As arterial walls harden and thicken, the arteries become narrow resulting in increased blood pressure over time.
What condition is a major cause of long-term high blood pressure? a. Atherosclerosis b. Bleeding disorders c. Chronic liver disease d. Diabetes insipidus
ANS: A Angioedema is a diffuse swelling of the eyes, lips, and tongue. It may occur with allergic reactions to ACE inhibitors and may be life threatening. Swelling of the trachea (windpipe/airway) can interfere with breathing, a life-threatening event. Angioedema can occur months or even years after ACE inhibitor therapy is started.
What is a possible life-threatening adverse effect that can occur when a person is taking an ACE inhibitor? a. Angioedema b. Rebound hypertension c. Loss of taste sensation d. Rapid development of glaucoma
ANS: C Although there are many factors that contribute to the development of primary hypertension (e.g., obesity, smoking, stress, unhealthy diet), it has no single cause. (Many people with hypertension risk factors do not always develop hypertension.) On the other hand, secondary hypertension results from either another health problem or from the drug treatment of another health problem.
What is the difference between primary hypertension and secondary hypertension? a. Secondary hypertension is not as severe as primary hypertension. b. Primary hypertension usually occurs at an earlier age than secondary hypertension. c. Secondary hypertension is caused by another health problem, whereas primary hypertension does not have a known cause. d. Primary hypertension can be treated with antihypertensive drugs, whereas secondary hypertension does not respond to drug therapy.
ANS: B The most common side effects of calcium channel blockers are constipation, nausea, headache, flushing, rash, edema (legs, ankles), hypotension, drowsiness, and dizziness.
What side effect is common to calcium channel blockers? a. Diarrhea b. Leg and ankle swelling c. Worsening of glaucoma d. Dry, hacking cough
ANS: B Teach patients to avoid salt substitutes. Salt substitutes contain potassium, and a side effect of ACE inhibitors is increased blood potassium level (hyperkalemia). Salt substitutes and ACE inhibitors together can significantly increase potassium levels.
What substance should patients taking ACE inhibitors avoid? a. Alcoholic beverages b. Salt substitutes c. Citrus fruits d. Aspirin
ANS: A Patients with hypertension should not take over-the-counter drugs (such as drugs for appetite control, asthma, colds, and hay fever) without asking their prescriber. These drugs can cause worsening of high blood pressure because they all constrict blood vessels.
What types of over-the-counter drugs can worsen high blood pressure? a. Drugs for asthma b. Laxatives c. Cortisone creams d. Aspirin
ANS: A Drugs that lower blood pressure can make a normal pressure too low and can make a low blood pressure worse. Checking the patient's blood pressure before giving a drug ensures that the patient is not hypotensive at the time he or she receives the drug. Some drugs can change the body's electrolyte concentration so much that an irregular heart rate can occur; however, all antihypertensive drugs can lower blood pressure.
Which action or precaution is most important for before giving any type of drug for hypertension? a. Check the patient's blood pressure. b. Ensure that the patient is in a sitting position. c. Check the patient's pulse for regularity. d. Have the patient drink a full glass of water.
ANS: B Many drugs are not considered safe for use during pregnancy or breastfeeding. Methyldopa, a centrally acting adrenergic drug, has been used safely during both pregnancy and breastfeeding to treat hypertension. Hydralazine (Apresoline), a direct vasodilator, has also been used safely during both pregnancy and breastfeeding. However, small amounts of hydralazine pass into breast milk, putting infants at minimal risk for side effects.
Which antihypertensive drug would you teach a patient is considered safe for use during pregnancy or breastfeeding? a. Clonidine (Catapres) b. Methyldopa (Aldomet) c. Labetalol (Normodyne) d. Carvedilol (Coreg)
ANS: D Direct vasodilators and centrally acting drugs have a higher incidence of side effects.
Which class of antihypertensive drugs has a higher incidence of side effects? a. Angiotensin-converting enzyme (ACE) inhibitors b. Calcium channel blockers c. Alpha-beta blockers d. Direct vasodilators
ANS: C Adverse effects of ARBs are rare but include kidney failure and life-threatening angioedema.
Which condition can be a severe adverse reaction to angiotensin II receptor blockers? a. Asthma b. Heart failure c. Kidney failure d. Seizure activity
ANS: A Signs of beta blocker overdose include very slow heart rate, chest pain, severe dizziness or fainting, fast or irregular heart rate, difficulty breathing, bluish-colored fingernails and palms, and seizures. Report these signs and symptoms to the prescriber at once.
Which condition is a possible severe adverse effect of beta blockers? a. Difficulty breathing b. Blood clots c. Kidney failure d. Worsening glaucoma
ANS: A, B, D, E Secondary hypertension is the result of other health problems or drugs. Table 16-2 in the text lists the health problems and drugs that can cause secondary hypertension.
Which conditions or drugs can cause secondary hypertension? (select all that apply) a. Adrenal gland tumors b. Estrogen in birth control pills c. Leukemia d. Cortisol e. Kidney infection
ANS: B The most common physiologic change that increases blood pressure is narrowing or constricting of the small arteries. Drugs that cause blood vessels to relax or dilate are most effective at lowering blood pressure.
Which drug action is most likely to lower blood pressure? a. Increasing the effectiveness of heart pumping b. Relaxing (dilating) blood vessel smooth muscle c. Increasing the concentration of urine d. Retaining the body's concentration of potassium
ANS: A Minoxidil is a direct vasodilator that acts on peripheral arteries, causing them to dilate (widen) and leading to decreased blood pressure. Propranolol is a beta blocker, captopril is an angiotensin-converting enzyme inhibitor, and diltiazem is a calcium channel blocker.
Which drug acts directly on the peripheral arteries, causing them to dilate and leading to decreased blood pressure? a. Minoxidil (Loniten) b. Propranolol (Inderal) c. Captopril (Capoten) d. Diltiazem (Cardizem)
ANS: D Beta blockers block the effects of epinephrine (adrenaline) on the heart. They decrease the heart rate and force of heart contractions, which leads to decreased blood pressure. As a result the heart does not work as hard and requires less oxygen. The generic names of beta blockers end with "-olol" (e.g., metoprolol, atenolol, propranolol).
Which drug for high blood pressure is a beta blocker? a. Verapamil b. Telmisartan c. Captopril d. Propranolol
ANS: D ARBs block the effects of angiotensin II (vasoconstriction, sodium, and water retention) by directly blocking the binding of angiotensin II to angiotensin II type 1 receptors. The generic names for ARBs end in "-sartan" (e.g., valsartan, losartan, candesartan).
Which drug is an angiotensin II receptor blocker (ARB)? a. Lisinopril b. Bumetanide c. Ramipril d. Losartan
ANS: D Beta blocker therapy increases the number of beta-adrenergic receptors in the heart and blood vessels. If these drugs are suddenly stopped, there are more beta receptors present and the patient's own adrenaline (epinephrine and norepinephrine) can bind to these receptors and cause dangerously high blood pressure.
Which precaution is most important for you to teach a patient who has been prescribed a beta blocker drug for hypertension? a. "Avoid alcoholic beverages while taking this drug." b. "Weigh yourself daily at the same time every morning." c. "Wear gloves and other warm clothing during cold weather." d. "Do not suddenly stop taking this drug without notifying your prescriber."
ANS: D The more common side effects of ACE inhibitors include hypotension; protein in the urine; taste disturbances; increased blood potassium level (hyperkalemia); headache; and persistent, dry cough. If one ACE inhibitor causes a cough, it is likely that others will also, and the patient will need to be prescribed another type of antihypertensive drug.
Which side effect of ACE inhibitors is very common? a. Hypertension b. Difficulty sleeping c. Constipation d. Dry, hacking cough
ANS: A Teach patients to avoid salt substitutes. Salt substitutes contain potassium, and a side effect of ACE inhibitors is increased blood potassium level (hyperkalemia).
Which statement by a patient prescribed enalapril (Vasotec) indicates the need for additional teaching? a. "I will use a salt substitute instead of table salt when I eat." b. "I will avoid alcohol while I am taking this medication." c. "I will wear long sleeves, a hat, and sunscreen when I go outdoors." d. "I will call my prescriber immediately if I notice any swelling in my face."
ANS: A, B, C, E Systolic blood pressure is the pressure of blood against the artery walls when the heart contracts. Diastolic blood pressure represents pressure against artery walls when the heart relaxes. The cause of primary hypertension is unknown while secondary hypertension is caused by another health problem or drug.
Which statements are true about blood pressure? (select all that apply) a. Blood pressure decreases when a person is resting. b. Blood pressure increases when a person is active. c. Low blood pressure is called hypotension. d. Systolic blood pressure is the pressure against artery walls when the heart relaxes. e. As people get older they are more likely to develop high blood pressure. f. Primary hypertension is caused by another health problem or prescribed drug.
ANS: C Primary hypertension is defined as hypertension for which there is no known cause but is associated with risk factors; 85% to 90% of cases of hypertension are of this type.
Which term means high blood pressure from no known cause? a. Orthostatic hypertension b. Orthostatic hypotension c. Primary hypertension d. Secondary hypertension
ANS: D This patient's blood pressure is quite low. If the patient is receiving this drug because he or she has hypertension, another dose of the drug right now could make the patient's blood pressure dangerously low. Sometimes a patient may be prescribed an antihypertensive drug for another reason. You must check with the prescriber before administering this antihypertensive drug dose.
You are checking a patient's blood pressure before administering an antihypertensive. The reading of 88/52 mm Hg. What is your best action? a. Give the patient a cup of coffee and retake the blood pressure in 30 minutes. b. Document the finding as the only action and administer the drug as usual. c. Raise the side rails and apply oxygen by mask or nasal cannula. d. Hold the dose and notify the prescriber.
ANS: A Antihypertensive drugs do not cure high blood pressure, they only control it. The patient must continue to take the drug to keep blood pressure at target levels unless the factors that are increasing the blood pressure are changed or eliminated. For example, sometimes blood pressure becomes normal again when the person is no longer overweight. In addition, if another drug is causing the hypertension, like corticosteroids, and the patient no longer needs to take that drug, blood pressure can become normal again.
You are teaching a patient about antihypertensive therapy. Which statement by the patient indicates the need for more teaching? a. "Now that my blood pressure is normal, I won't need to take my medication anymore." b. "When I take my blood pressure at home, I always try to take it at just about the same time every day." c. "I check the labels on cans and other food packages to be sure they do not have too much sodium." d. "I hope that by continuing to lose weight, I might not have to take medications to manage my high blood pressure."
ANS: C The nature of the clonidine patch delivers a low dose of the drug continually from the patch for 7 days. After 7 days, minimal drug is left in the patch and the patient will no longer receive a therapeutic dose. To ensure a continual therapeutic dose, the patch is removed after 7 days and a fresh one applied.
You are teaching a patient how to administer clonidine (Catapres) using the transdermal patch system. How often do you teach the patient to change the patch? a. Daily b. Every 3 days c. Every 7 days d. Every 14 days
ANS: D Sildenafil is a drug for erectile dysfunction and works by dilating blood vessels. When taken with an alpha blocker, sildenafil can cause a very rapid drop in blood pressure to the extent that the patient may fall or pass out.
You are teaching a patient who has just been prescribed prazosin (Minipress) for hypertension. You immediately notify the prescriber and question the order upon discovering that the patient is also taking which drug? a. Aspirin b. Atenolol (Tenormin) c. Chlorothiazide (Diuril) d. Sildenafil (Viagra)
ANS: A Sometimes hypertension is not well controlled using only one antihypertensive agent. Often two drugs from different classes are prescribed for better control. Enalapril is an angiotensin-converting enzyme inhibitor and furosemide is a "loop" diuretic. They have different mechanisms of action to lower blood pressure and can be taken together.
You are to give the first dose of enalapril (Vasotec) to a patient whose medication reconciliation indicates he also takes furosemide (Lasix) for hypertension. What action should you take? a. Administer both drugs as prescribed. b. Be sure to separate administering the two drugs by at least 6 hours. c. Notify the prescriber that this patient already takes a drug for hypertension. d. Suggest to the patient that he take the enalapril in the morning and the furosemide at bedtime.
ANS: A After taking the first dose of an antihypertensive drug, a patient may develop dizziness, light-headedness, or orthostatic hypotension. The patient should be given the call light and instructed to call for help getting up out of bed. The patient should also be instructed to change positions slowly.
You give the first dose of an antihypertensive drug to a hospitalized patient. Which instruction should you give to the patient next? a. "Stay in bed and call for help if you need to get up for any reason." b. "Urinate in a container so that we can keep track of your urine output." c. "If you develop a headache, we can give you some acetaminophen (Tylenol)." d. "You may get up but only if you need to use the bathroom."
